New strategies to improve clinical outcomes for diabetic kidney disease

BACKGROUND: Diabetic kidney disease (DKD), the most common cause of kidney failure and end-stage kidney disease worldwide, will develop in almost half of all people with type 2 diabetes. With the incidence of type 2 diabetes continuing to increase, early detection and management of DKD is of great clinical importance. MAIN BODY: This review provides a comprehensive clinical update for DKD in people with type 2 diabetes, with a special focus on new treatment modalities. The traditional strategies for prevention and treatment of DKD, i.e., glycemic control and blood pressure management, have only modest effects on minimizing glomerular filtration rate decline or progression to end-stage kidney disease. While cardiovascular outcome trials of SGLT-2i show a positive effect of SGLT-2i on several kidney disease-related endpoints, the effect of GLP-1 RA on kidney-disease endpoints other than reduced albuminuria remain to be established. Non-steroidal mineralocorticoid receptor antagonists also evoke cardiovascular and kidney protective effects. CONCLUSION: With these new agents and the promise of additional agents under clinical development, clinicians will be more able to personalize treatment of DKD in patients with type 2 diabetes

The roles of immune cells in bone healing; what we know, do not know and future perspectives

Key events occurring during the bone healing include well-orchestrated and complex interactions between immune cells, multipotential stromal cells (MSCs), osteoblasts and osteoclasts. Through three overlapping phases of this physiological process, innate and adaptive immune cells, cytokines and chemokines have a significant role to play. The aim of the escalating immune response is to achieve an osseous healing in the shortest time and with the least complications facilitating the restoration of function. The uninterrupted progression of these biological events in conjunction with a favourable mechanical environment (stable fracture fixation) remains the hallmark of successful fracture healing. When failure occurs, either the biological environment or the mechanical one could have been disrupted. Not infrequently both may be compromised. Consequently, regenerative treatments involving the use of bone autograft, allograft or synthetic matrices supplemented with MSCs are increasingly used. A better understanding of the bone biology and osteoimmunology can help to improve these evolving cell-therapy based strategies. Herein, an up to date status of the role of immune cells during the different phases of bone healing is presented. Additionally, the known and yet to know events about immune cell interactions with MSCs and osteoblasts and osteoclasts and the therapeutic implications are being discussed

Non-ablative Implantatbettformung und Minimaldurchmesserimplantate : eine alternative Versorgungsstrategie bei mittelgradiger Alveolarkammatrophie?

This thesis presents and discusses two controlled clinical trials which where designed to evaluate efficacy and clinical relevance of diameter reduced oral implants and residual, non-ablative implant sight preparation in the treatment of normally configurated to horizontally resorbed alveolar ridges. During the last 20-25 years hardly any other dental discipline has undergone a development with a comparable scope as oral implantology: Reliability for various implant based treatment concepts has been established through numerous clinical reports and studies, thus, contributing to a considerable rise of acceptance among clinicians and patients as well as to a stunning amplification of their indication for clinical application. Considering the clinical outcome, established implant based prosthetics come nowadays very close to the benchmark “time in situ” of natural teeth. Therefore, the primary objective of these studies was not to improve even further the efficacy level of oral implants or surgical techniques. Rather, to evaluate a therapeutical alternative that provides for equivalent reliability, while reducing treatment risks and being less invasive, time, and cost consumptive. Hence, the trials where designed in accordance to the standards of “testing for therapeutical equivalence” derived from bioequivalence testing well established in pharmacologic research. This testing method was implemented in two controlled clinical trials each set in a parallel group design. To guarantee the independence of the each “monitored unite” per patient only one implant was elected at random. Case figures calculation – to define an adequate trial power – and statistical evaluation of clinical endpoints were based on that election. Results of both trials reveal consistent evidence for therapeutical equivalence of diameter reduced oral implants and residual, non-ablative implant sight preparation in the treatment of normally configurated to horizontally resorbed alveolar ridges compared to the respective therapy of reference; and this while reducing treatment risks and being less invasive, time, and cost consumptive

Ein Wunder seltzame Leichpredigt/|| Gehalten im Bein=||hause/ Vber den kahlen Todten=||kœpffen vnd Todtenbeinen/ Jn grosser || Versamlung allda/|| Durch den Pfarrner zu Aschers=||hausen/ Streckbein genandt.|| Anno Christi, M.D.XCIII.|| ... ||

Vorlageform des Erscheinungsvermerks: Gedruckt zu Freybergk/ bey || Georg Hoffman/|| 1593.|

Non-ablative Implantatbettformung und Minimaldurchmesserimplantate : eine alternative Versorgungsstrategie bei mittelgradiger Alveolarkammatrophie?

This thesis presents and discusses two controlled clinical trials which where designed to evaluate efficacy and clinical relevance of diameter reduced oral implants and residual, non-ablative implant sight preparation in the treatment of normally configurated to horizontally resorbed alveolar ridges. During the last 20-25 years hardly any other dental discipline has undergone a development with a comparable scope as oral implantology: Reliability for various implant based treatment concepts has been established through numerous clinical reports and studies, thus, contributing to a considerable rise of acceptance among clinicians and patients as well as to a stunning amplification of their indication for clinical application. Considering the clinical outcome, established implant based prosthetics come nowadays very close to the benchmark “time in situ” of natural teeth. Therefore, the primary objective of these studies was not to improve even further the efficacy level of oral implants or surgical techniques. Rather, to evaluate a therapeutical alternative that provides for equivalent reliability, while reducing treatment risks and being less invasive, time, and cost consumptive. Hence, the trials where designed in accordance to the standards of “testing for therapeutical equivalence” derived from bioequivalence testing well established in pharmacologic research. This testing method was implemented in two controlled clinical trials each set in a parallel group design. To guarantee the independence of the each “monitored unite” per patient only one implant was elected at random. Case figures calculation – to define an adequate trial power – and statistical evaluation of clinical endpoints were based on that election. Results of both trials reveal consistent evidence for therapeutical equivalence of diameter reduced oral implants and residual, non-ablative implant sight preparation in the treatment of normally configurated to horizontally resorbed alveolar ridges compared to the respective therapy of reference; and this while reducing treatment risks and being less invasive, time, and cost consumptive