Protein-Energy Wasting and Mortality in Chronic Kidney Disease

Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with an increased death risk from cardiovascular diseases. However, while even minor renal dysfunction is an independent predictor of adverse cardiovascular prognosis, PEW becomes clinically manifest at an advanced stage, early before or during the dialytic stage. Mechanisms causing loss of muscle protein and fat are complex and not always associated with anorexia, but are linked to several abnormalities that stimulate protein degradation and/or decrease protein synthesis. In addition, data from experimental CKD indicate that uremia specifically blunts the regenerative potential in skeletal muscle, by acting on muscle stem cells. In this discussion recent findings regarding the mechanisms responsible for malnutrition and the increase in cardiovascular risk in CKD patients are discussed. During the course of CKD, the loss of kidney excretory and metabolic functions proceed together with the activation of pathways of endothelial damage, inflammation, acidosis, alterations in insulin signaling and anorexia which are likely to orchestrate net protein catabolism and the PEW syndrome

Effect of light-tip distance on the shear bond strengths of resin-modified glass ionomer cured with high-intensity halogen, light-emitting diode, and plasma arc lights

INTRODUCTION: The purpose of this study was to assess the effect of light-tip distance on the shear bond strength and the failure site of brackets cured with 3 light-curing units (high-intensity halogen, light-emitting diode, and plasma arc). METHODS: One hundred thirty-five bovine mandibular permanent incisors were randomly allocated to 9 groups of 15 specimens each. Stainless steel brackets (Victory Series, Unitek/3M, Monrovia, Calif) were bonded with a resin-modified glass-ionomer (Fuji Ortho LC, GC Europe, Leuven, Belgium) to the teeth, and each curing light was tested at 3 distances from the bracket: 0, 3, and 6 mm. After bonding, all samples were stored in distilled water at room temperature for 24 hours and subsequently tested for shear bond strength. RESULTS: When the 3 light-curing units were compared at a light-tip distance of 0mm, they showed no significantly different shear bond strengths. At a light-tip distance of 3 mm, no significant differences were found between the halogen and plasma arc lights, but both lights showed significantly higher shear bond strengths than the light-emitting diode light. At a light-tip distance of 6 mm, no significant differences were found between the halogen and light-emitting diode lights, but both showed significantly lower bond strengths than the plasma arc light. When the effect of the light-tip distance on each light-curing unit was evaluated, the halogen and light-emitting diode lights showed no significant differences among the 3 distances. However, the plasma arc light produced significantly higher shear bond strengths at a greater light-tip distance. No significant differences were found among the adhesive remnant index scores of the various groups, except with the LED light at a distance of 3 mm. CONCLUSIONS: In hard-to-reach areas, the plasma arc curing light is suggested for optimal curing efficiency