A potential link between AQP3 and SLC14A1 gene expression level and clinical parameters of maintenance hemodialysis patients.

BACKGROUND: The transport of water and urea through the erythrocyte membrane is facilitated by aquaporins such as aquaglyceroporin (AQP3), and type B urea transporters (UT-B). As they may play an important role in osmotic balance of maintenance hemodialysis (HD) patients, the aim of the present study was to determine whether any relationship exists between the expression of their genes and the biochemical / clinical parameters in HD patients. METHODS: AQP3 and UT-B (SLC14A1) gene expression was evaluated using RT-qPCR analysis in 76 HD patients and 35 participants with no kidney failure. RESULTS: The HD group demonstrated significantly higher median expression of AQP3 and UT-B (Z = 2.16; P = 0.03 and Z = 8.82; p < 0.0001, respectively) than controls. AQP3 negatively correlated with pre-dialysis urea serum concentration (R = -0.22; P = 0.049) and sodium gradient (R = -0.31; P = 0.04); however, no significant UT-B correlations were observed. Regarding the cause of end-stage kidney disease, AQP3 expression positively correlated with erythropoietin dosages in the chronic glomerulonephritis (GN) subgroup (R = 0.6; P = 0.003), but negatively in the diabetic nephropathy subgroup (R = -0.59; P = 0.004). UT-B positively correlated with inter-dialytic weight gain% in the GN subgroup (R = 0.47; P = 0.03). CONCLUSION: Maintenance hemodialysis seems significantly modify AQP3 and UT-B expression but their link to clinical and biochemical parameters needs further large-scale evaluation.

Vital root submergence of immature permanent incisors after complicated crown-root fracture followed by orthodontic space maintenance: A presentation of two cases.

Complicated crown-root fractures are considered rare occurrences in young permanent dentition; however, they pose a particularly difficult clinical challenge, especially when the traumatized tooth is immature. Two cases of complicated crown-root fractures of immature incisors are presented. In both cases, vital root submergence with no treatment to the exposed pulp was introduced as a stage in a complex treatment plan with the primary goal of preserving the shape of the alveolar ridge in the traumatized area until the root was completely formed or facial growth was finished. No inflammatory symptoms were detected either radiographically or clinically during the 15- and 16-month follow-up periods. In the chosen clinical cases, vital root submergence followed by orthodontic space maintenance can be beneficial to young patients if other treatment options are limited by the depth of the crown-root fracture or if the patient suffers from high dental fear and presents a particularly low level of compliance.

Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients

BACKGROUND: In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients. MATERIAL AND METHODS: The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured. RESULTS: Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p = 0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p = 0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p = 0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p = 0.03), as was the pre-dialysis sodium serum (Z=3.4, p = 0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p < 0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p < 0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient. CONCLUSIONS: Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient

Prenatal and familial factors of caries in first permanent molars in schoolchildren living in urban area of Lódz, Poland.

The objective of the present work is to identify the set of prenatal and familial factors that contribute to dental caries of first permanent molars in preschool and young schoolchildren, which will make it possible to determine a high-risk group that should be considered for special preventive measures. This study contributes to the evidence for the multifactorial nature of dental caries. Material was collected during a 2009-2010 study conducted in randomly selected schools and kindergartens in the city of Lódz (Poland). Only children with first permanent molars present were considered for the analysis, which limited the database to 1131 children. Dental examinations were accompanied by a questionnaire completed by the parents, covering items pertaining to prenatal and familial determinants. The present study shows that there are significant differences in the prevalence of caries in first molars between children of different ages (5-13 lat) and that no such differences exist between boys and girls. The prenatal and familial factors conducive to caries include maternal education level (OR=0.55), mode of delivery (OR=0.63) and birth order (OR=0.63). Mothers' smoking habit is also associated with increased caries prevalence in children. Caries prevention should already begin during the prenatal period primarily in respect of mothers with lower educational attainment who are pregnant with a second or subsequent child.

Caries Experience and Distribution by Tooth Surfaces in Primary Molars in the Pre-school Child Population of Lodz, Poland.

PURPOSE: To evaluate caries experience in primary molars as well as the differences in caries prevalence and caries lesion location on individual tooth surfaces between first and second primary molars in pre-school children. MATERIALS AND METHODS: A cross-sectional study was conducted on 307 children, aged 3 to 5 years, from randomly chosen kindergartens in Lodz, Poland. Caries experience was scored according to WHO recommendations. The caries intensity (dmft, dmfts) for first and second primary molars was calculated. In addition, the percentage of particular surfaces with caries was counted for each molar separately. RESULTS: The mean dmft for primary molars was 1.84 (dmfts=2.47) and dmft>0 was seen in 53.09% of the study subjects. While in the entire examined population dmft and dmfts for first and second molars did not differ significantly, in 5-year-old children, the left mandibular first molar was associated with a higher caries intensity than the left mandibular second molar (dmfts=0.465 vs 0.344, Z=-1.98, p=0.04). However, in 5-year-olds, higher caries occurrence was seen for occlusal surfaces of the tooth 85 than 84 (33.62% vs 20.68%, χ2=4.09, p=0.03). The distal surface was more frequently affected in first molars than in second molars in children aged 4 (85 vs 84, χ2=17.1, p<0.001; 75 vs 74, χ2=11.5, p=0.007, 55 vs 54; χ2=4.6, p=0.03) and 5 years (54 vs 55, χ2=20.09; 64 vs 65, χ2=16.75; 74 vs 75, χ2=21.6; 84 vs 85, χ2=31.07; all comparisons p<0.001). In contrast, the mesial surfaces of mandibular second molars demonstrated more caries than the homologous surfaces of first molars, both in 4-year-olds (85 vs 84, χ2=6.15, p=0.01) and 5-year-olds (75 vs 74, χ2=3.9, p=0.04). CONCLUSION: In 5-year-old children, caries of occlusal and mesial surfaces was more common in primary second molars. However, distal surfaces were affected more in first than second molars.

Sodium gradient, xerostomia, thirst and inter-dialytic excessive weight gain: a possible relationship with hyposalivation in patients on maintenance hemodialysis.

PURPOSE: The aim of the study was to assess whether hyposalivation is linked with increased thirst sensation and weight gain in hemodialysis (HD) patients and whether there is any connection between hyposalivation and sodium balance. METHODS: One hundred and eleven participants (64 males and 47 females) receiving maintenance hemodialysis, mean age 59.1 ± 13.6 years old, were involved in the study. All participants completed a survey evaluating thirst intensity (DTI) and xerostomia inventory (XI). In addition, pre-dialysis sodium concentration and inter-dialytic weight gain (IWG) were assessed. The division into no-hyposalivation and hyposalivation groups was based on an unstimulated whole saliva (UWS) flow rate. RESULTS: Hyposalivation, UWS below 0.1 mL/min, was reported in 28.8% of HD patients. In these participants, IWG was higher than in patients with UWS > 0.1 mL/min (3.65 ± 1.78 vs 3.0 ± 1.4; p = 0.042), as well as the pre-dialysis sodium gradient (3.22 ± 2.1 vs 1.6 ± 2.8; p = 0.031). The mean XI and DTI scores did not differ between study groups. In the hyposalivation group, pre-dialysis sodium serum gradient negatively correlated with saliva outflow (ρ = -0.61, p = 0.019) and positively with IWG (ρ = 0.49, p = 0.022). IWG correlated with XI (ρ = 0.622, p = 0.016) in hyposalivation group and with DTI in no-hyposalivation group (ρ = 0.386, p = 0.033). CONCLUSIONS: Hyposalivation significantly correlates with IWG; however, its influence on thirst and self-reported mouth dryness seems to be weaker than expected. Additionally, hyposalivation was found to be associated with an elevated pre-dialysis sodium gradient.

Does oral health contribute to post-transplant complications in kidney allograft recipients?

OBJECTIVE: The significant number of complications in kidney graft recipients can not be easily explained. The paper assesses whether poor oral health increases the risk of acute rejections and hospitalizations in kidney allograft recipients. MATERIALS AND METHODS: Ninety-one kidney transplant recipients were divided into three sub-groups according to post-transplant time (< 1, 1-5 and > 5 years). Dental examination evaluated oral hygiene index (OHI-S) and Community Periodontal Index of Treatment Needs (CPITN), which were correlated with the occurrence of post-transplant complications. RESULTS: Within the first year after transplantation the indicators of the increased risk of hospitalizations and acute rejection episodes was the OHI-S (hazard ratio 1.02 and 1.11, respectively), also CPITN score correlated with acute rejections (R = 0.82, p < 0.01). CONCLUSION: The neglect in oral health is associated with the increased risk of clinical complications within first year after kidney transplantation.

The dual blockade of the renin-angiotensin system in hemodialysis patients requires decreased dialysate sodium concentration.

PURPOSE: The study evaluated whether the dual blockade of the renin-angiotensin system may influence the sodium balance in hemodialysis. METHODS: The study involved 148 hemodialysis patients (male 85, female 63), mean age 59.6 ± 12.9 years. Participants were randomly selected to receive either angiotensin-converting enzyme inhibitor (ACEI)--subgroup A--or dual blockade ACEI and angiotensin receptor blocker (ARB)--subgroup AA. RESULTS: At baseline, in the A versus AA subgroups, the pre-dialysis sodium concentrations (mmol/l) were 137.7 ± 0.5 versus 137.9 ± 0.8, the sodium gradients 2.6 ± 0.5 versus 2.9 ± 0.4, interdialytic weight gain (IWG) (kg) 3.1 ± 0.2 versus 3.0 ± 0.3, and thirst inventory score (points) 18.1 ± 1.0 versus 19.0 ± 1.7, respectively. After 3 months of therapy, a decrease in sodium concentration to 134.5 ± 0.5 and the increase of its gradient to 5.5 ± 0.5 were noted in the AA subgroup. An elevation of mean interdialytic weight gain to 3.47 ± 0.2 and thirst score to 21.3 ± 2.1 was observed. No significant changes in subgroup A were found. One month of the dialysate sodium concentration being lowered from 140 mmol/l to 138 mmol/l was associated with reduced serum sodium concentration and gradient, decreased IWG and restored moderate thirst score in the AA subgroup (137.5 ± 0.6 and 2.9 ± 0.6, 3.0 ± 0.5 and 19.2 ± 1.3, respectively). CONCLUSIONS: The dual blockade of the renin-angiotensin system affects sodium balance, increasing the sodium gradient, thus elevating thirst sensation and enhancing interdialytic weight gain. In maintenance hemodialysis patients treated with both ACEI and ARB, lowered dialysate sodium levels should be prescribed.