[Acute renal failure in patients with liver cirrhosis--what to do? An update]

A lot of patients suffering from liver cirrhosis show a decreased renal perfusion and glomerular filtration rate. An impaired renal function is the result of complex e.g. hemodynamic disturbances, resulting of the chronic liver disease. This explains its disposition to renal dysfunction and the higher incidence of acute renal failure in liver cirrhosis. In the case of renal failure hepatorenal syndrome, apart from prerenal, renal and postrenal causes, should be included in the differential diagnosis especially when signs of portal hypertension are apparent regarding its high mortalityand fatal prognosis requiring an immediate therapeutically approach. Special attention must be due to preventive strategies to avoid renal deterioration. This includes simple steps e.g. a careful election of medication but also an adequate therapy of infection-associated complications in patients with liver cirrhosis.

[Satisfaction survey of the dental treatment project of Hadassah and the "International Fellowship of Christians and Jews" among the family and the professional servant]

Social inequalities in health are a serious public health problem. In Israel dental treatment is not included in the national health insurance. Low socio-economic groups are therefore significantly inferior in oral and dental health. Health for all is one of the WHO aims for the 21st century. This project, which was described in a previous article, intended to upgrade dental health of those belonging to a low socio-economic group and to minimize the inequality in dental health by providing care to children 6-12 years of age free of charge. This survey investigated the satisfaction of the children's family, the social workers and the dental team, involved in this project.

METHODS

The study population included 124 parents of children who were treated. These were chosen by a randomized sample from the entire population that was treated in the project. Interviews were conducted in Hebrew, by one interviewer who read the questions and all possible answers. The other satisfaction's interview was targeted at the professional team including the entire dental team and the welfare department's workers.

RESULTS

55 providers were interviewed and 124 parents. There satisfaction from the project was very high although there were concerns regarding the range of the ages that had been chosen. The satisfaction among the children's family was high but there were significant differences between the clinics in the various cities. The parents from Jerusalem and Bet -She'an were more satisfied than the others (P = 0.011).

DISCUSSION

Overall, the parents, the dental team and the social workers, expressed high levels of satisfaction with the project. The differences between the clinics could be due to the character, the background, the knowledge and the professionalism of the clinic and the dental team on the one hand and, the environment and the culture on the other hand. The project was very successful among all the participants the care givers, social workers and patients. The treatment improved quality of life of the children and brought some hope and light to their lives.

[Drug-related disorders of water and electrolyte metabolism]

Pharmacologic treatment may lead to diverse disturbances of water and electrolyte metabolism as adverse drug events. Diuretics are particularly likely to cause these complications typically including volume depletion, metabolic alkalosis, hyponatremia, and hypokalemia. Salt and water retention with edema formation is most frequently elicited by antihypertensives, steroid hormones, and nonsteroidal anti-inflammatory drugs. Drug-induced disorders of Na+ concentration may usually be attributed to altered antidiuretic hormone (ADH) effects, either as diabetes insipidus or as the syndrome of inappropriate ADH secretion. With hyper- and hypokalemia, redistribution between intra- and extracellular fluid as well as renal excretion play a role. Strategies to prevent these adverse drug reactions include careful consideration of risk factors and clinical and laboratory controls in the course of treatment.

Darbepoetin alfa once every 2 weeks for treatment of anemia in dialysis patients: a combined analysis of eight multicenter trials

AIM

Darbepoetin alfa has a longer half-life than epoetin-(EPO) alfa or beta, allowing administration at less frequent intervals for the treatment of renal anemia. The aim of the present analysis was to evaluate the efficacy and tolerability of an every-2-week (Q2W) schedule of darbepoetin alfa in a large cohort of dialysis patients.

METHODS

Data were combined from eight similarly designed 24-week phase 3b European studies, in which patients receiving EPO alfa or beta once-weekly were converted to Q2W darbepoetin alfa. Darbepoetin alfa dosage was titrated to maintain hemoglobin (Hb) between 10 and 13 g/dl and efficacy was evaluated during a 4-week evaluation period.

RESULTS

In the 1,101 patients assigned to Q2W darbepoetin alfa (i.v., n = 196, s.c., n = 905), mean (SD) Hb levels were 11.53 (0.77) g/dl at baseline and 11.35 (1.04) g/dl at evaluation (mean change in Hb -0.27 g/dl, 95% confidence interval 0.34, -0.20). Hb levels were maintained between 10 and 13 g/dl during evaluation in 85% of patients. Darbepoetin alfa doses were similar at baseline and evaluation, and the i.v. and s.c. routes were associated with similar efficacy and dose requirements. Darbepoetin alfa was well-tolerated.

CONCLUSIONS

Q2W darbepoetin alfa is effective in maintaining Hb levels in dialysis patients switched from weekly rHuEPO, regardless of the route of administration and with no notable increase in the weekly equivalent dose.

Regulation of myofibroblast transdifferentiation by DNA methylation and MeCP2: implications for wound healing and fibrogenesis

Myofibroblasts are critical cellular elements of wound healing generated at sites of injury by transdifferentiation of resident cells. A paradigm for this process is conversion of hepatic stellate cells (HSC) into hepatic myofibroblasts. Treatment of HSC with DNA methylation inhibitor 5-aza-2'-deoxycytidine (5-azadC) blocked transdifferentiation. 5-azadC also prevented loss of IkappaBalpha and PPARgamma expression that occurs during transdifferentiation to allow acquisition of proinflammatory and profibrogenic characteristics. ChIP analysis revealed IkappaBalpha promoter is associated with transcriptionally repressed chromatin that converts to an active state with 5-azadC treatment. The methyl-CpG-binding protein MeCP2 which promotes repressed chromatin structure is selectively detected in myofibroblasts of diseased liver. siRNA knockdown of MeCP2 elevated IkappaBalpha promoter activity, mRNA and protein expression in myofibroblasts. MeCP2 interacts with IkappaBalpha promoter via a methyl-CpG-dependent mechanism and recruitment into a CBF1 corepression complex. We conclude that MeCP2 and DNA methylation exert epigenetic control over hepatic wound healing and fibrogenesis.

Diet, nutrition and the prevention of type 2 diabetes

Objectives:

The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes.

Design:

Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available.

Setting and subjects:

Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women's Health Study; and the study of the US Male Physicians.

Results:

There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake andtransfatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof.

Conclusions:

Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21–23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake.

Pharmacokinetic interaction between ketoconazole and SPP301 in healthy volunteers

BACKGROUND

SPP301 is a potent and highly selective ETA receptor blocker. The primary aim of the present study was to investigate the effect of the potent CYP3A4 inhibitor ketoconazole on the pharmacokinetics of SPP301.

METHODS

In a randomized, open-label 2-period oral crossover study, 12 healthy male subjects received treatments A and B. Treatment A consisted of 200 mg ketoconazole once daily on Days 1 - 4 and concomitantly 5 mg SPP301 on Day 3. Treatment B consisted of 5 mg SPP301 administered alone. Plasma concentrations of SPP301 and its hydroxymethyl metabolite were measured by LC-MS/MS.

RESULTS

Ketoconazole coadministration increased the systemic availability of SPP301 and its hydroxymethyl metabolite 3-fold and prolonged their half-lives by a factor of 2. The ratios of least square means (90% CI) of pharmacokinetic parameters in the presence and absence of ketoconazole for SPP301 and its metabolite were C(max) (maximum plasma concentration) 1.22 (1.13, 1.32) and 1.2 (1.05, 1.37), AUC(0-infinity) (area under the plasma concentration-time curve from time zero to infinity) 3.16 (2.84, 3.51) and 3.14 (2.49, 3.70) and t1/2 (apparent terminal half-life) 2.21 (1.55, 2.87) and 2.00 (1.17, 2.84), i.e. an increase of systemic exposure by a factor of 3.2, with individual exposures increasing up to 5.9-fold. Single oral doses of SPP301 were well tolerated when administered alone or together with multiple doses of ketoconazole.

CONCLUSION

In the presence of potent CYP3A4 inhibitors exposure of SPP301 may be increased up to 6-fold.

Influence of avosentan (SPP301) on the pharmacokinetics of a second generation oral contraceptive containing ethinylestradiol and levonorgestrel in healthy female volunteers

BACKGROUND

Avosentan (SPP301) is a potent and highly selective ETA receptor blocker and is clinically investigated in diabetic nephropathy. This study was designed to evaluate whether avosentan influences the pharmacokinetics of steroid oral contraceptives.

METHODS

During a run-in phase, 16 healthy females received an oral contraceptive containing ethinylestradiol 0.03 mg and levonorgestrel 0.15 mg for the first 21 days of a minimum of one menstrual cycle. In a subsequent double-blind, randomized two menstrual cycle crossover treatment phase, subjects received either avosentan 25 mg or placebo once daily concomitantly with the oral contraceptive. Serum ethinylestradiol and plasma levonorgestrel concentrations were measured on Days 14 and 15 of the two treatment periods for the evaluation of the 24-hour kinetic parameters, and an additional sample was collected on Day 21 to determine their trough concentrations. Serum progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels as well as plasma avosentan and Ro 68-5925 levels were determined on Days 13, 14, 15 and 21 of each cycle of the treatment phase.

RESULTS

Avosentan had a statistically significant lowering effect of 9 - 15% on the ethinylestradiol serum concentration levels. The 90% confidence intervals of the pharmacokinetic parameters did not include 1 or exceeded the 0.8 - 1.25 acceptance range for lack of interaction. The plasma concentration-time curves and pharmacokinetic parameters of levonor-gestrel were not statistically different during concomitant treatment with either avosentan or placebo. Compared to placebo, avosentan lowered the serum concentrations of progesterone statistically significantly by about 8% and increased slightly the LH and FSH serum concentrations. Safety and tolerability patterns were comparable during avosentan and placebo administration.

CONCLUSION

Because of the effect of avosentan on the concentration levels of ethinylestradiol and progesterone, it is possible that the contraceptive efficacy of low-dose combination oral contraceptives may be adversely affected during avosentan treatment.

Pharmacological inhibitors of NF-kappaB accelerate apoptosis in chronic lymphocytic leukaemia cells

Nuclear factor-kappaB (NF-kappaB) is a transcription factor that plays a critical role in the inappropriate survival of various types of malignant cells. Chronic lymphocytic leukaemia (CLL) is the most common B-cell malignancy in the Western world. Although overexpression and regulation of NF-kappaB has been described in CLL, its function remains unclear. Exposure of CLL cells to BAY117082 or Kamebakaurin, potent pharmacological inhibitors of the NF-kappaB pathway, accelerated apoptosis in approximately 70% of cases. Sensitivity to NF-kappaB pathway inhibitors was not related to the prognostic markers VH status, CD38 or Zap70 expression, or to the levels of nuclear NF-kappaB. Normal peripheral B cells were resistant to the apoptosis-inducing effects of these compounds. Cell death induced by the inhibitors was associated with activation of caspase-9 and -3, and loss of mitochondrial membrane polarization, but did not involve changes in the expression of Bcl-2 or Mcl-1. Inhibitors caused an increase in c-jun NH2-terminal kinase activity in CLL, but this did not appear to be important for apoptosis. Microarray analysis identified some potential novel NF-kappaB target genes, including interleukin-16- and the Bcl-2- related survival protein Bcl-w. These results demonstrate that a substantial proportion of CLL are dependent on NF-kappaB for enhanced survival and suggest that inhibition of NF-kappaB may have therapeutic potential.

Left ventricular growth response to exercise and cigarette smoking: data from LARGE Heart

BACKGROUND

Increasing left ventricular mass is a risk factor for cardiovascular morbidity and mortality.

OBJECTIVE

To examine the possible association of smoking with the left ventricular growth response in men.

METHODS

Left ventricular mass was measured in 309 army recruits before and after an identical 12-week physical training programme. Left ventricular mass was determined using cardiovascular magnetic resonance.

RESULTS

Left ventricular mass increased with training (mean (standard deviation (SD)) 3.83 (10.81) g, p<0.001). By univariate analysis, exercise-induced change in left ventricular mass was positively associated with cigarette smoking (mean (SD) 1.69 (11.10) g v 4.76 (10.23) g for non-smokers v ex- and current smokers, respectively; p = 0.026), whereas age, height, diastolic and systolic blood pressure (SBP), alcohol consumption or indices of physical activity were not significantly associated with change in left ventricular mass. Multivariate analysis showed body weight, smoking status and SBP to be independent predictors of left ventricular mass (incremental R(2) = 3.4%, p = 0.004; R(2) = 4.9%, p = 0.024; and R(2) = 1.7%, p = 0.041, respectively).

CONCLUSIONS

Cigarette smoking and SBP are associated with exercise-induced left ventricular growth in young men. The positive association of smoking with changes in left ventricular mass is surprising, given the limited exposure of these subjects to smoking, and although these data do not prove causation, they are of great interest to those trying to uncover the drivers of left ventricular hypertrophy, as well as to those examining the possible ill-effects of smoking in the young.

[End stage renal disease after ingestion of mushrooms]

This case report describes a 56 year old patient with acute renal failure caused by a mushroom poisoning. Unspecific symptoms like a gastroenteritis followed by kidney insuffiency lead to the diagnosis of an orellanus syndrome. The toxin can be proved by thin layer chromatography in renal biopsy. Fast processing of hemoperfusion may avoid lasting kidney damage and dialysis.

Pharmacokinetic interactions of the oral renin inhibitor aliskiren with lovastatin, atenolol, celecoxib and cimetidine

OBJECTIVE

Aliskiren is the first in a new class of orally effective renin inhibitors for the treatment of hypertension. This study investigated the interaction profile of aliskiren, which is of clinical importance because hypertensive patients often require concomitant drug therapy for associated comorbidities.

METHODS

Four separate studies investigated the pharmacokinetic interaction between single oral doses of aliskiren and lovastatin, atenolol, celecoxib or cimetidine, respectively. All studies involved healthy male volunteers aged 18-45 years. In 3 studies, subjects (n = 15 in each study) received single doses of aliskiren 150 mg alone, the test drug alone (lovastatin 40 mg, atenolol 100 mg or celecoxib 200 mg), or both drugs in combination, according to a 3-period crossover design. In the cimetidine study (n = 12), aliskiren 150 mg was administered alone or concomitantly with cimetidine 800 mg according to a two-period crossover design. Plasma concentrations of aliskiren and test drugs were determined by liquid chromatography and mass spectrometry methods. Pharmacokinetic parameters were derived from these data.

RESULTS

Mean AUC and t1/2 for aliskiren were not significantly changed by lovastatin, atenolol or celecoxib (< 10% difference between treatments). Aliskiren mean Cmax was not affected by either lovastatin or atenolol, although a non-significant 36% increase was observed with celecoxib. Modest, non-significant increases in aliskiren systemic availability followed coadministration with cimetidine (aliskiren mean AUC, Cmax and t1/2 increased by 17%, 19% and 15%, respectively). Aliskiren coadministration had no significant effect on the disposition of lovastatin, atenolol or celecoxib.

CONCLUSIONS

Overall, single doses of aliskiren showed no evidence of clinically important pharmacokinetic interactions with lovastatin, atenolol, celecoxib or cimetidine.

Behaviourally specific preferred associations in bottlenose dolphins, Tursiops spp

We investigated association patterns of 52 photographically identified, free-ranging bottlenose dolphins (Tursiops spp. Gervais, 1855) across four behavioural states (rest, travel, social, and foraging/feeding) to investigate how behavioural state influences patterns of association. Group composition and behavioural data were extracted from 2178 encounter surveys collected over 3 years. Analyses revealed three general types of association: (1) affiliates, which consistently demonstrate preferred associations across all behavioural states; (2) acquaintances, which never form preferred associations but still associate in at least one behavioural state; and (3) behavioural associates, which form preferred associations in at least one, but not all behavioural states. The majority of associations in Shark Bay, Australia, are acquaintance type (38.2%), with affiliates (5.7%, principally between adult males) and behavioural associates (28.9%, principally between juveniles) being relatively rarer. Permutation tests identified behaviourally specific preferred associations during all behavioural states. Although behaviourally specific preferred associations appear to exist within the Shark Bay social structure, it seems that the social organization and mating system constrain the social relationships for the majority of males and females in differing ways which prevent them from having behavioural associates, leaving juveniles free to associate based on short-term expediency and behavioural specific needs.

Specialization and development of beach hunting, a rare foraging behavior, by wild bottlenose dolphins (Tursiops sp.)

Foraging behaviors of bottlenose dolphins vary within and among populations, but few studies attempt to address the causes of individual variation in foraging behavior. We examined how ecological, social, and developmental factors relate to the use of a rare foraging tactic by wild bottlenose dolphins (Tursiops sp. Gervais, 1855) in Shark Bay, Western Australia. Beach hunting involves partial and nearly complete stranding on beach shores. Over 10 years of observation, only four adults and their calves were observed beach hunting in more than 1 year. Of two adult beach hunters observed in detail, one was more specialized in beach hunting than the other, indicating substantial flexibility in degree of use. Only calves born to beach hunters developed the tactic, although complete stranding was not observed at least up to 5 years of age. Beach hunters used shallow, inshore habitats significantly more than others and were more likely to hunt during incoming tide. Mitochondrial DNA haplotypes were not consistent with strict matrilineal transmission. Thus, beach hunting likely involves vertical social learning by calves, while individual, horizontal, and (or) oblique learning may occur among individuals who frequent coastal habitats.

Cholesterol lowering effects of nuts compared with a Canola oil enriched cereal of similar fat composition

BACKGROUND AND AIM

Small quantities of nuts protect against subsequent cardiovascular risk. There is speculation that the cholesterol lowering effect associated with nut consumption arises primarily from the fatty acid composition of nuts but may be caused by some other component. To evaluate this possibility we compared the effect of various nuts, against a Canola oil based cereal with a comparable fatty acid profile, on lipids, lipoproteins and fatty acids to determine whether the fatty acid profile of nuts explains their cholesterol lowering effects.

METHODS AND RESULTS

Twenty-eight men and women with mean (s.d.) levels of total and low density lipoprotein cholesterol of 6.0 (1.1) mmol/L, and 4.1 (1.0) mmol/L, respectively and a mean body mass index (BMI) of 26.9 (3.2) kg/m2 took part in a randomised cross over trial. For two periods of six weeks, separated by a four-week washout, participants were asked to consume a low saturated fat diet, which included either 30 g/d nuts (nut diet) or one serving of a cereal containing Canola oil (cereal diet). There were no significant differences in the lipids, lipoproteins, plasma fatty acids or other variables between the two diets at the end of the study. Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were lower on both experimental diets than at baseline, 0.51 mmol/L and 0.40 mmol/L (p<0.001, p<0.01), respectively on the nut diet and 0.42 mmol/L and 0.37 mmol/L (p<0.001, p<0.01), respectively on the cereal diet.

CONCLUSION

A 30 g serving of nuts, or a serving of a Canola oil enriched cereal with a similar fatty acid composition reduced total and LDL cholesterol to a similar extent when consumed as part of a lipid lowering diet. Results suggest that foods with a similar fatty acid composition to nuts can produce comparable decreases in lipoprotein mediated cardiovascular risk.

Multiple-dose pharmacokinetics, pharmacodynamics and tolerability of the oral ET(A) endothelin-receptor antagonist SPP301 in man

BACKGROUND

SPP301 is a competitive antagonist of ET-1 with a high selectivity for the ET(A) receptor. The multiple-dose pharmacokinetics, pharmacodynamics, safety and tolerability of SPP301 were investigated in healthy male subjects.

METHODS

In an ascending-dose, double-blind, placebo-controlled trial doses of 5, 20, 40 and 60 mg SPP301 were given orally on Day 1 and, after a wash-out period of 48 hours, once daily for seven days. At regular intervals, blood pressure and pulse rate, plasma levels of ET-1, and of SPP301 and its hydroxymethyl metabolite as well as urinary excretion of the parent drug and its metabolite were determined.

RESULTS

SPP301 was generally well-tolerated. With the higher doses asymptomatic and transient increases in liver transaminases were observed. No other clinically relevant effects of SPP301 on hematology, biochemistry or urinalysis parameters were observed. Vital signs, ECG parameters and physical examinations showed no time or treatment effect. The pharmacokinetics of SPP301 and its hydroxymethyl metabolite (Ro 68-5925) were linear up to 40 mg SPP301. Steady state was reached after 3-4 days. The apparent terminal half-life of SPP301 and the metabolite was in the range of 7-10 hours after single and repeated doses. At the 60 mg dose level plasma concentrations of SPP301 decreased from the first to the last day of oral treatment. The average decreases in Cmax and AUC were 33% and 37%, respectively. Cmax and AUC of the metabolite amounted to about 4-6% of the values for SPP301 under single and repeated-dose conditions. Urinary excretion of SPP301 and of its metabolite were below 0.1% and 5%, respectively.

CONCLUSION

SPP301 is quite well-tolerated, pharmacokinetics are linear and time-independent up to 40 mg multiple doses. Steady state is reached after 3-4 days. Urinary excretion of the unchanged drug plays a minor role in the elimination process of SPP301. ET-1 plasma concentrations increased about 1.5-fold at 20 mg and all further doses.

Anatomical success rate of macular hole surgery with autologous platelet without internal-limiting membrane peeling

AIM

To describe our experience and success rate of macular hole surgery with pars plana vitrectomy with autologous platelet and without internal limiting membrane peel.

METHODS

Retrospective review of 56 consecutive patients who underwent macular hole surgery.

RESULTS

Anatomical success was achieved in 55 out of 56 patients (98.2%). Functional success was achieved in 37 out of 56 patients (66.1%). A total of 21 patients (37.5%) achieved postoperative visual acuity of 6/12 or better. No intraoperative complications were encountered. Postoperative complications included cataract progression in eight eyes and raised intraocular pressure in 20 eyes.

CONCLUSIONS

Our success rate was comparable to that reported in macular hole surgery incorporating internal limiting membrane (ILM) peel or with autologous platelet without ILM peel.

In vivo mammary tumourigenesis in the Sprague-Dawley rat and microdosimetric correlates

Standard methods for risk assessments resulting from human exposures to mixed radiation fields in Space consisting of different particle types and energies rely upon quality factors. These are generally defined as a function of linear energy transfer (LET) and are assumed to be proportional to the risk. In this approach, it is further assumed that the risks for single exposures from each of the radiation types add linearly. Although risks of cancer from acute exposures to photon radiations have been measured in humans, quality factors for protons and ions of heavier atomic mass are generally inferred from animal and/or cellular data. Because only a small amount of data exists for such particles, this group has been examining tumourigenesis initiated by energetic protons and iron ions. In this study, 741 female Sprague-Dawley rats were irradiated or sham irradiated at approximately 60 days of age with 250 MeV protons, 1 GeV/nucleon iron ions or both protons and iron ions. The results suggest that the risk of mammary tumours in the rats sequentially irradiated with 1 GeV/nucleon 56Fe ions and 250 MeV protons is less than additive. These data in conjunction with earlier results further suggest that risk assessments in terms of only mean LETs of the primary cosmic rays may be insufficient to accurately evaluate the relative risks of each type of particle in a radiation field of mixed radiation qualities.

A review of satisfaction with dental service at a Jerusalem community clinic serving elderly patients

AIM

The audit of dental satisfaction and its association with the reported outcome of a dental health care programme for elderly patients.

DESIGN

A telephone survey of 162 patients in a Jerusalem municipal dental clinic for geriatric patients, who had completed a treatment course in oral rehabilitation.

RESULTS

The average age of the respondents was 73.2 +/- 8.45 years, over 80% of who were very satisfied or satisfied with the treatment given by the dental clinic staff. Only 1.8% were not satisfied (the remaining 17.9% were unable to answer the question). Among those who responded, 91.6% were currently using their full dentures, 80.4% reported an improvement in chewing ability, and 82.3% an improvement in appearance. Respondents who reported daily use of dentures and improved chewing and appearance, also reported higher levels of satisfaction with the clinic.

CONCLUSIONS

These results indicate a potentially important role of satisfaction with dental staff in optimal compliance and success of a geriatric oral health care programme.

Can Satellite Sampling of Offshore Wind Speeds Realistically Represent Wind Speed Distributions? Part II: Quantifying Uncertainties Associated with Distribution Fitting Methods

Remote sensing tools represent an attractive proposition for measuring wind speeds over the oceans because, in principle, they also offer a mechanism for determining the spatial variability of flow. Presented here is the continuation of research focused on the uncertainties and biases currently present in these data and quantification of the number of independent observations (scenes) required to characterize various parameters of the probability distribution of wind speeds. Theoretical and empirical estimates are derived of the critical number of independent observations (wind speeds derived from analysis of remotely sensed scenes) required to obtain probability distribution parameters with an uncertainty of ±10% and a confidence level of 90% under the assumption of independent samples, and it is found that approximately 250 independent observations are required to fit the Weibull distribution parameters. Also presented is an evaluation of Weibull fitting methods and determination of the fitting method based on the first and third moments to exhibit the “best” performance for pure Weibull distributions. Further examined is the ability to generalize parameter uncertainty bounds presented previously by Barthelmie and Pryor for distribution parameter estimates from sparse datasets; these were found to be robust and hence generally applicable to remotely sensed wind speed data series.

Diet, nutrition and the prevention of type 2 diabetes

OBJECTIVES

The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes.

DESIGN

Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available.

SETTING AND SUBJECTS

Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women's Health Study; and the study of the US Male Physicians.

RESULTS

There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake and trans fatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof.

CONCLUSIONS

Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21-23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake.

[A new gel for topical use in treating severe periodontal disease--clinical observations]

Within the framework of the efforts to find non-invasive treatment methods for severe periodontitis, a topical gel was developed by an Israeli research group. The aim of the current study is to present clinical observations and X-ray measurements of alveolar bone changes following an 8 week, self-care periodontal treatment in two groups of patients with severe periodontitis. All 31 patients who participated in the study showed an improvement of the periodontal condition as expressed in all the indexes examined. The observation findings testify to the fact that through self-care using a topical gel, significant results were achieved: decrease in probing depth, decrease in bleeding, significant improvement in teeth mobility and in level of the alveolar bone height and its density. These clinical findings raise interesting research questions and hint at the potential for regeneration of supportive periodontal tissues in cases of severe periodontitis, currently achieved only through surgical means. In order to obtain more accurate data regarding the treatment potential of this gel, it is important to conduct additional controlled clinical trials on different populations and also to try and determine how it works.

Replacing cows' with sheep's dairy fat lowers plasma cholesterol concentration in participants consuming dairy fat-rich diets

OBJECTIVE

To determine the effects on plasma cholesterol concentration of replacing cows' dairy fat with sheep's dairy fat.

DESIGN

Randomised crossover dietary intervention.

SETTING

General community, Dunedin, New Zealand.

SUBJECTS

Volunteer sample of 41 healthy adults with initial plasma cholesterol concentration between 4.8 and 7.8 mmol/l.

INTERVENTIONS

Participants were asked to follow a self-selected low-fat background diet throughout the study to which, during each of the 2, 3-week dairy diets, they were asked to add sheep's or cows' dairy products.

MAIN OUTCOME MEASURES

Energy and nutrient intakes, plasma triacylglycerol fatty acids, and plasma cholesterol.

RESULTS

Energy and nutrient intakes on the sheep-dairy and cow-dairy diets were very similar, with total, saturated, monounsaturated and polyunsaturated fat contributing 34, 18-19, 9, and 3% of total energy intake, respectively. Participants consumed approximately 50 g/day of dairy fat on each diet. Replacing cows' with sheep's dairy fat led to a 0.33 (0.11-0.56, 95% CI) mmol/l decrease (6%) in plasma total cholesterol concentration, from 5.53 (0.90, s.d.) to 5.20 (0.90) mmol/l. Plasma low-density lipoprotein (LDL) cholesterol was 0.18 (0.02-0.33) mmol/l lower on the sheep-dairy diet as was the concentration of plasma high-density lipoprotein (HDL) cholesterol, 0.11 (0.02-0.20) mmol/l. The LDL to HDL cholesterol ratio at the end of the sheep-dairy diet, 2.91 (1.10), was not significantly different (P>0.05) from the cow-dairy diet, 2.73 (0.83).

CONCLUSIONS

Within the context of a diet high in dairy fat (50 g/day), replacing cows' milk fat with sheep's milk fat leads to a small reduction in plasma cholesterol concentration, but no change in the ratio of LDL to HDL cholesterol.

Mechanistic and anti-proliferative studies of two novel, biologically active bis-benzimidazoles

We have previously synthesised a number of novel head-to-head bis-benzimidazole derivatives that are structurally related to the fluorochrome, Hoechst 33258, and which possess strong affinity for A:T sites in the minor groove of duplex DNA. Initial studies revealed these compounds to exhibit potent antiproliferative activity against a range of ovarian cell lines and to inhibit transcription in an in vitro setting. In this study, we have examined their cellular behaviour in detail and have shown that two of these compounds (ABA13 and ABA833) potently inhibit the proliferation of a range of human tumour cell lines, and show some specificity towards breast carcinoma cell lines. In most of the cell lines investigated, ABA833 was the more potent of the two compounds. Flow cytometric analysis revealed that ABA13 and ABA833 (50-500 nM) induced an S phase block and increased the pre-G1 population in MCF-7 and MDA 468 human breast cancer cells. An increase in the pre-G1 population of RKO colon carcinoma cells was seen only at 500 nM with ABA833, reflecting the reduced sensitivity of this cell line to the bis-benzimidazoles in comparison to the breast cancer cell lines. Mechanistic studies revealed that neither ABA13 or ABA833 act as topoisomerase I (topo I) or topoisomerase II (topo II) poisons in plasmid or kinetoplast DNA (kDNA) relaxation assays, but both compounds do inhibit the catalytic activity of these enzymes. Drug uptake studies showed that reduced sensitivity of MCF-7adr and RKO cells compared with MCF-7 to both ABA13 and ABA833 correlated with a markedly reduced intracellular drug accumulation.

Angiotensin-I-converting enzyme insertion/deletion polymorphism and high urinary albumin concentration in French Type 2 diabetes patients

AIMS

Family-based studies suggest a genetic basis for nephropathy in Type 2 diabetes. The angiotensin-I-converting enzyme (ACE) gene is a candidate gene for Type 1 diabetes nephropathy. We assessed the association between high urinary albumin concentration and ACE insertion/deletion (I/D) polymorphism, in French Type 2 diabetes patients.

METHODS

We studied 3139 micro/macroalbuminuric French patients recruited in the DIABHYCAR Study, an ACE inhibition trial in Type 2 diabetes patients with renal and cardiovascular outcomes. The main inclusion criteria were age >/= 50 years, urinary albumin concentration >/= 20 mg/l assessed centrally during two consecutive screening visits, and plasma creatinine concentration </= 150 micro mol/l. These patients were compared with 605 normoalbuminuric (NA; urinary albumin concentration < 10 mg/l at first screening for the DIABHYCAR Study) French patients. ACE I/D genotype was determined by nested polymerase chain reaction.

RESULTS

The ACE I/D polymorphism was in Hardy-Weinberg equilibrium. The distribution of genotypes did not differ significantly between micro/macroalbuminuric and NA patients: 552 and 115 II, 1468 and 282 ID, 1119 and 208 DD (P = 0.67). However, the ACE D allele was more frequent among normotensive micro/macroalbuminuric patients than among NA patients (P = 0.039).

CONCLUSIONS

The ACE I/D polymorphism was not associated with high urinary albumin concentration in French Type 2 diabetes patients.

Experimental studies of occupation times in turbulent flows

The motion of passively convected particles in turbulent flows is studied experimentally in approximately homogeneous and isotropic turbulent flows, generated in water by two moving grids. The simultaneous trajectories of many small passively convected, neutrally buoyant, polystyrene particles are followed in time by a particle tracking technique. We estimate the probability distribution of the occupation times of such particles in spherical volumes with a given radius. A self-consistently moving particle defines the center of the reference sphere, with the occupation time being defined as the difference between entrance and exit times of surrounding particles convected through the sphere by the turbulent motions. Simple, and seemingly universal, scaling laws are obtained for the probability density of the occupation times in terms of the basic properties for the turbulent flow and the geometry. In the present formulation, the results of the analysis are relevant for understanding details in the feeding rate of micro-organisms in turbulent waters, for instance.

[Is there a need for an additional dental school in Israel? 2002 status and future forecasting]

Dental manpower planning is constantly in discussion throughout the world. Current data indicates a transition from oversupply reports 10 to 20 years ago to a present undersupply of dentists with a forecast for further shortage in the near future. The dental profession in Israel has gone through deep and extreme changes since the late 80'. Dentists are now at the "bottom of the barrel" and many abandoned the profession after long and demanding years of education. The future of the academic dental institutions is also unclear. In spite of the current unrealistic present, we are witnessing some processes that might change the status of the dental profession in Israel in the near future. Among these are the changing roll of female dentists in the profession, increasing age of practicing dentists, obligatory state licensing exams, less immigration of dentists and the natural growth of the population. Together with the expected increase of demand for dental care, a decrease in the number of dentists in Israel will result in a balanced dental manpower in 2011. Therefore, the necessity of establishing a third dental school in Israel was brought to discussion. Dental schools are responsible not only for students qualification as caregivers, but also for enrichment of practicing dentists with updated data, and qualifying specialist dentists in the various fields of the profession. At the present, there is no justification for establishing a third dental school in Israel. Nevertheless, it is obligatory to maintain and strengthen the two existing dental schools in spite of the needed high costs. Only in this way the profession will continue to enjoy a nation high quality professional and academic dental manpower. The continuous qualification of specialists will be maintained and an open "path" will be available for future manpower enlargement. Hastiness and rashness, which ended in national shortage of dentists in other countries, should be avoided in Israel.

Relation between body mass index and mortality in an unusually slim cohort

STUDY OBJECTIVE

To investigate the relation between body mass index and mortality in an unusually slim cohort.

DESIGN

Prospective cohort study.

SETTING

United Kingdom.

PARTICIPANTS

About 11,000 non-meat eaters and their meat eating friends and relatives, with a median age of 33 years were recruited between 1980 and 1984. More than 20% of the cohort had a self reported BMI below 20 kg/m(2) at recruitment. There were 195,000 person years of observation after a mean of 18.0 years of follow up.

MAIN RESULTS

The characteristics of participants with a BMI below 18 kg/m(2) were favourable to a lower risk of cardiovascular disease. Nevertheless, these participants had an increased all cause death rate ratio (2.07, 95% CI 1.58 to 2.70) in comparison with participants who had a BMI between 20 and 22 kg/m(2). The death rate ratio for the slimmest category was also significantly increased for circulatory diseases (including ischaemic heart disease and cerebrovascular disease), respiratory diseases, and all other causes combined excluding all malignant neoplasms. This finding was consistent across a range of subgroups.

CONCLUSIONS

Lean men and women (BMI <18 kg/m(2)) experience increased all cause mortality compared with those with a BMI between 20 and 22 kg/m(2). This pattern is not seen for cancer mortality, but is found for cardiovascular and respiratory diseases. It is important that public health messages regarding healthy eating are aimed at maintaining a healthy body weight rather than just "losing weight".

[Oral health in dementia patients]

Dementia shares multiple clinical symptoms characterized by cognitive deficits that interfere with daily activities but differentiated by etiology. Advanced age is a major risk factor for dementia especially in more developed countries where older adults are most evident and growing rapidly. Since the prevalence of edentulism is decreasing, greater efforts will be necessary in the future to maintain oral health in dementia patients. Meeting the oral care needs of these individuals can be very challenging and should include prevention, maintenance of oral function and improved access for emergencies as well as regular dental care. Dental professionals should provide complex treatment utilizing appropriate behavioral and communication techniques. At the national level there is also a need for oral disease prevention programs directed towards staff, family members, and other caregivers of dementia patients.

Plant sterol-enriched spread enhances the cholesterol-lowering potential of a fat-reduced diet

OBJECTIVE

To determine the effect of a plant sterol-enriched spread on plasma cholesterol concentrations when replacing butter or a standard polyunsaturated spread in a diet containing 30% of energy fat.

DESIGN

Parallel butter phase followed by double-blind, randomized, cross-over polyunsaturated spread phases.

SETTING

General community.

SUBJECTS

Volunteer sample of 50 free-living men and women with mean age (s.d.) 46.7 y (10.5), moderately elevated plasma total cholesterol 5.95 mmol/l (0.78), and body mass index 26.0 (3.9) kg/m(2).

INTERVENTION

Participants ate a moderately low-fat diet (30% of energy) for the 11-week intervention. During the first 3 weeks the diet included 20 g per day of butter. Participants were then randomized to replace the butter with 25 g of polyunsaturated spread with or without 2 g of plant sterols for 4 weeks, crossing over in the last 4 weeks to the alternate spread.

MAIN OUTCOME MEASURES

Plasma cholesterol and fatty acids.

RESULTS

Replacing butter with a standard polyunsaturated fat spread reduced mean plasma total cholesterol concentrations by 4.6% (from 6.09 (0.82) to 5.81 (0.77) mmol/l, P<0.01) and low-density lipoprotein cholesterol by 5.5% (from 3.98 (0.76) to 3.76 (0.74) mmol/l, P<0.05). Replacing butter with a polyunsaturated spread containing plant sterols reduced plasma total cholesterol by 8.9% (from 6.09 (0.82) to 5.55 (0.76) mmol/l, P<0.01) and low density lipoprotein cholesterol by 12.3% (from 3.98 (0.76) to 3.49 (0.72) mmol/l, P<0.01). Plasma high density lipoprotein cholesterol concentration was the same on the three diets.

CONCLUSION

In people with moderately raised plasma cholesterol concentrations consuming reduced-fat diets the reduction in plasma total and low-density lipoprotein cholesterol concentrations achieved by replacing butter with a polyunsaturated spread is enhanced by addition of plant sterols.

Predator-prey encounters in turbulent waters

With reference to studies of predator-prey encounters in turbulent waters, we demonstrate the feasibility of an experimental method for investigations of particle fluxes to an absorbing surface in turbulent flows. A laboratory experiment is carried out, where an approximately homogeneous and isotropic turbulent flow is generated by two moving grids. The simultaneous trajectories of many small neutrally buoyant polystyrene particles are followed in time. Selecting one of these to represent a predator, while the others are considered as prey, we obtain estimates for the time variation of the statistical average of the prey flux into a suitably defined "sphere of interception." The variation of this flux with the radius in the sphere of interception, as well as the variation with basic flow parameters is well described by a simple model, in particular for radii smaller than a characteristic length scale for the turbulence. Also the Eulerian counterpart of the problem has been analyzed, and the particle fluxes from the two studies compared.

The comparative anticaries efficacy of a dentifrice containing 0.3% triclosan and 2.0% copolymer in a 0.243% sodium fluoride/silica base and a dentifrice containing 0.243% sodium fluoride/silica base: a two-year coronal caries clinical trial on adults in Israel

The purpose of this two-year clinical study was to provide a comparison of the anticaries efficacy associated with two commercially available, American Dental Association-accepted dentifrices: Colgate Total Toothpaste, which contains 0.3% triclosan and 2% copolymer in a 0.243% sodium fluoride/silica base; and Crest Cavity Fighting Toothpaste with Fluoristat, which contains 0.243% sodium fluoride in a silica base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. The study employed a double-blind parallel-group design, and involved adults living in communities throughout Israel. Qualifying subjects were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. Two calibrated examiners performed all of the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to ensure compliance with the study. Post-baseline examinations were performed after one year of product use, and again after two years of product use. Three-thousand, three-hundred and ninety-two (3,392) subjects completed this two-year study. For these subjects, the mean caries scores (DFS, decayed or filled surfaces) at baseline were 21.96 for the Colgate Total Toothpaste group, and 21.49 for the Crest Cavity Fighting Toothpaste with Fluoristat group. For caries increment after one year, the respective means were 1.37 for the Colgate Total Toothpaste group, and 1.56 for the Crest Cavity Fighting Toothpaste with Fluoristat group. After two years, the mean caries increments were 1.46 for the Colgate Total Toothpaste group, and 1.75 for the Crest Cavity Fighting Toothpaste with Fluoristat group. No statically significant difference was indicated between the treatment groups at baseline. However, for both the one-year and two-year increments, there was a statistically significant difference between treatment groups. Relative to the Crest Cavity Fighting Toothpaste with Fluoristat group, the Colgate Total Toothpaste group presented a 12.2% reduction in caries increment scores at one year, and a 16.6% reduction in caries increment scores at two years. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that Colgate Total Toothpaste provides a superior level of coronal anticaries efficacy compared to Crest Cavity Fighting Toothpaste with Fluoristat.

Chronic diabetic nephropathy: role of inducible nitric oxide synthase

Nitric oxide (NO) is a multifunctional mediator that has been implicated in the short-term hemodynamic alterations that occur in acute streptozocin (STZ)-induced diabetes. We investigated the role of NO produced by inducible nitric oxide synthase (iNOS) in chronic STZ diabetic nephropathy. Diabetes was induced in C57BL/6 and iNOS knockout (KO) mice with two intraperitoneal injections of STZ, 100 mg/kg. Animals were maintained without insulin treatment for 40 weeks. There were no significant differences between the strains in blood urea nitrogen (BUN), serum creatinine or glucose concentration, or urinary protein excretion during the entire observation period. Urinary nitrite + nitrate excretion was significantly lower in iNOS KO mice compared to control animals at all time points; in C57 mice, urinary nitrite declined progressively with more prolonged duration of diabetes. Renal hypertrophy (kidney weight/body weight) was noted in both strains of mice. However, histopathological assessment of renal tissue specimens at 16 and 40 weeks demonstrated increased mesangial hypercellularity and expansion as well as more prominent tubulointerstitial fibrosis in iNOS KO versus C57 mice. These changes were accompanied by increased interstitial deposition of type I collagen at 16 and 40 weeks in iNOS KO mice. Glomerular basement membrane staining for type IV collagen was also increased at 40 weeks in diabetic iNOS KO mice. While iNOS protein was undetectable in any of the kidney specimens obtained from either strain, eNOS was present throughout the course of chronic STZ diabetes. Moreover, eNOS expression was significantly increased by approximately 40% at 16 and 40 weeks of observation in iNOS KO versus C57 mice. There was no difference in renal cortical malondialdehyde content between the strains early or late in the disease course. In time control animals, there was no evidence of renal histopathological damage in iNOS KO or C57 mice after 40 weeks. We conclude that iNOS-derived NO modulates glomerulosclerosis and tubulointerstitial fibrosis in chronic STZ nephropathy. This action is probably a result of the direct actions of NO on the synthesis and degradation of extracellular matrix proteins.