Management of diabetes in people with advanced chronic kidney disease.

Diabetes is the commonest cause of end stage kidney disease globally, accounting for almost 40% of new cases requiring renal replacement therapy. Management of diabetes in people with advanced kidney disease on renal replacement therapy is challenging due to some unique aspects of assessment and treatment in this group of patients. Standard glycaemic assessment using glycated haemoglobin may not be valid in such patients due to altered red blood cell turnover or iron/erythropoietin deficiency, leading to changed red blood cell longevity. Therefore, use of continuous glucose monitoring may be beneficial to enable more focussed glycaemic assessment and improved adjustment of therapy. People with advanced kidney disease may be at higher risk of hypoglycaemia due to a number of physiological mechanisms, and in addition, therapeutic options are limited in such patients due to lack of experience or license. Insulin therapy is the basis of treatment of people with diabetes with advanced kidney disease due to many other drugs classes being contraindicated. Targets for glycaemic control should be adjusted according to co-morbidity and frailty, and continuous glucose monitoring should be used in people on dialysis to ensure low risk of hypoglycaemia. Post-transplant diabetes is common amongst people undergoing solid organ transplantation and confers a greater risk of mortality and morbidity in kidney transplant recipients. It should be actively screened for and managed in the post-transplant setting.

Thermally tunable electromagnetic surface waves supported by graphene loaded indium antimonide (InSb) interface.

The thermal agitation plays a vital role in tunability of optoelectronic, structural and chemical characteristics of the temperature sensitive materials. Graphene enables the THz optics, due to its unprecedent controlling characteristics over the traditional materials. The influence of temperature on the monolayer graphene is very negligible due to its low free charge carrier density, to enhance the thermal sensitivity of graphene, the graphene loaded temperature sensitive material interface has been proposed. A theoretical analysis has been carried out on temperature dependent propagation characteristics of electromagnetic surface waves supported by the graphene loaded semi-infinite indium antimonide (InSb). The InSb has been taken as temperature sensitive material. The Drude model has been used for the modeling of InSb in the THz region while the modeling of the graphene has been done by random phase approximation-based Kubo's formulism. To realize the graphene loaded indium antimonide interface, the impedance boundary conditions (IBCs) have been employed. The numerical analysis has been conducted to analyze the influence of temperature on the characteristics of electromagnetic surface waves i.e., dispersion curve, effective mode index (Neff), penetration depth (δ), propagation length (Lp), phase speed (Vp) and field profile, propagating along the graphene loaded InSb. In all the numerical results, the temperature variation has been considered from 200 to 350 K. It has been concluded that the graphene-InSb interface provides more temperature assisted tunability to the interfacial surface modes, commonly known as surface waves, as compared to monolayer graphene. Further, the graphene parameters can play a vital role in the dynamical tuning of electromagnetic surface waves in THz to IR frequency range. The numerically computed results have potential applications in designing of thermo-optical waveguides, temperature assisted communication devices, thermo-optical sensors and near field thermal imaging platforms.

Pattern of third molar impactions in north-eastern peninsular Malaysia: A 10-year retrospective study.

BACKGROUND: Third molar impaction, if left untreated, has the potential to cause several complications. The evaluation of surgical difficulty of impacted third molar extraction aids in better formulation of treatment plan by minimizing surgical complications. OBJECTIVE: This study aimed to determine the prevalence of third molar impaction and related pathologic conditions in a cohort of patients living in North-eastern Peninsular Malaysia. METHODS: In this retrospective study, 490 orthopantomograms (OPGs) of patients who were referred to the Oral and Maxillofacial Surgery department between January 2010 and December 2019 were assessed. Data including age, gender, ethnicity, frequency of third molar impactions, their angulations and levels of eruption, retromolar space, and associated pathologic conditions were collected. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 24.0. The significance level was set to P < 0.05. RESULTS: A total of 490 patients with a mean age of 28.87 years (range: 20-64) demonstrated 1957 impacted third molars (1022 mandibular + 935 maxillary). Impacted third molars were more likely present in females than males (1:2.20) (p < 0.05); and in Malay-ethnic (44.49%) patients followed by Chinese (34.45%) and Indians (21.02%). Mesioangular was the most common angulation of impaction both in the maxilla (24.68%) and mandible (18.34%). The most common pattern of third molar impaction was IIA (61.67%), and the retromolar space was significantly larger in males (13.6 mm; P < 0.05) than females (11.6 mm). The most frequently occurring pathological condition associated with third molars impaction is dental caries in the second or third molar (15.38%). CONCLUSIONS: This study highlights mesioangular impaction with their occlusal plane at the same level as the occlusal plane of the adjacent tooth being the most prevalent pattern of third molar impaction in North-eastern Peninsular Malaysia.

The potential mechanistic insights and future implications for the effect of prebiotics on poultry performance, gut microbiome, and intestinal morphology.

Prebiotics may modify the biological processes in the chickens' gastrointestinal tract to improve poultry performance and health. Prebiotics are natural feed additives that offer many economic advantages by decreasing mortality rates, increasing growth rates, and improving birds' feed efficiency. Prebiotic action potentially affects the degradation of indigestible dietary compounds, the synthesis of nitrogen components and vitamins, and simplifies the removal of undesirable elements in the diet. Prebiotics could also induce desirable gut microbiome modifications and affect host metabolism and immune health. It is worth mentioning that gut bacteria metabolize the prebiotic compounds into organic compounds that the host can subsequently use. It is important to limit the concept of prebiotics to compounds that influence the metabolism of resident microorganisms. Any medicinal component or feed ingredient beneficial to the intestinal microecosystem can be considered a prebiotic. In this review, the impacts of prebiotics on the gut microbiome and physiological structure are discussed, emphasizing the poultry's growth performance. The current review will highlight the knowledge gaps in this area and future research directions.

The Barts Health NHS Trust COVID-19 cohort: characteristics, outcomes and risk scoring of patients in East London.

BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.

Reflectance and transmittance of terahertz waves from graphene embedded into metamaterial structures.

In this work, the theoretical study of the interaction of terahertz (THz) waves with graphene embedded into two different semi-infinite metamaterials was carried out. To model the graphene, the effective surface conductivity approach based on the Kubo formalism was used. In addition, two types of metamaterials, i.e., double-positive (DPS) and double-negative (DNG), were studied in the THz regime. The numerical modeling of metamaterials was performed in the framework of causality-principle-based Kramers-Kronig relations. The reflectance and transmittance from the graphene-embedded metamaterial structures are studied for the following four different configurations: DPS-Graphene-DPS, DPS-Graphene-DNG, DNG-Graphene-DPS, and DNG-Graphene-DNG. The influence of the chemical potential and scattering rate on the reflectance and transmittance for each configuration is analyzed. It is concluded that the DPS-Graphene-DPS and DNG-Graphene-DNG configurations behave as anti-reflectors for the THz waves, while the DPS-Graphene-DNG and DNG-Graphene-DPS configurations are suitable for THz reflector applications. Moreover, a parametric study revealed that the relative permittivity of the partnering metamaterial can be used as an additional degree of freedom to control the reflectance and transmittance of THz waves. In conclusion, the transmissive and reflective characteristics of THz waves can be controlled effectively with the appropriate choice of graphene parameters, as well as the configuration of metamaterial structures. The convergence of the analytical and numerical results is found with the published results under special conditions. The present work may have potential applications in the design of THz wave controllers, reflectors, absorbers, and anti-reflectors.

Retraction notice to "Synergistic effects of thymoquinone and curcumin on immune response and anti-viral activity against avian influenza virus (H9N2) in turkeys" [Poult. Sci. 95 (2016) 1513-1520].

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The authors retract the above paper due to: 1) conflict of interest among the authors; and 2) addition of coauthor Dr. Muhammad Younus without his knowledge or permission. The authors apologize for these two grave mistakes.

Electromagnetic surface waves supported by a resistive metasurface-covered metamaterial structure.

This study examines the analytical and numerical solution of electromagnetic surface waves supported by a resistive metasurface-covered grounded metamaterial structure. To simulate the metamaterial, the Kramers-Kronig relation based on the causality principle is used, while the modeling of the resistive metasurface has been done by implementing the impedance boundary conditions. The analytical expressions for the field phasors of surface waves are developed for the transverse magnetic (TM) polarized mode and transverse electric (TE) polarized mode. The characteristic equations are computed for both modes, and the unknown propagation constant is evaluated numerically in the kernel. After computation, the dispersion curves, electric field profiles, effective mode index ([Formula: see text]), and phase speeds ([Formula: see text]) are presented for both the TM and TE polarized modes. To study the tunability of surface waves, the influence of the thickness of the metamaterial slab ([Formula: see text]), effective permittivity of the metamaterial ([Formula: see text]), thickness of the resistive metasurface ([Formula: see text]), and effective permittivity of the metasurface ([Formula: see text]) on all the numerical results has been studied. However, the geometrical parameters are found to be more sensitive to the effective mode index ([Formula: see text]) and phase speed ([Formula: see text]) of the surface waves. The results are consistent with the published results, which reflects the accuracy of the work. It is concluded that the appropriate choice of parameters can be used to achieve surface waves with the desired characteristics in the GHz range. The present work may have potential applications in surface waveguide design, surface wave speed controllers, surface communication devices, and light trapping configurations.

Current trends of Hepatitis C virus genotypes and associated risk factors in hemophilia patients in Pakistan.

Hemophilia is a rare bleeding disorder that needs plasma or clotting factor concentrate transfusion. Therefore chances of blood-borne pathogens like HCV transmission increase due to high prevalence in healthy donors. This study was aimed to determine the prevalence of HCV genotypes and associated risk factors in hemophilia patients of Khyber Pakhtunkhwa, Pakistan. Blood samples and data were collected from 672 hemophiliacs after proper consent obtained from each patient. Samples were analyzed for anti-HCV, HCV RNA and HCV genotype/s detection. Of the total, 22.32% (150) were anti-HCV positive, of which HCV RNA was detected in 18.45% (124) individuals. HCV genotype 3a was found with significantly higher prevalence (p<0.05) (19.35%) as compared to 2a (16.13%) and 1a (12.90%). HCV-3b and HCV-4 were found each in 3.22% samples. Dual infection of genotypes was found in 22.58% of individuals and 22.58% HCV RNA positive sampels were not typed. A total of 572 (85.12%) subjects had hemophilia A and 100 (14.88%) had hemophilia B. In hemophiliacs A the most dominant genotype was 3a (19.27%) while in hemophilia B, genotype 1a was prevalent (26.67%). Whole blood and plasma transfusion were observed as the main risk factors of HCV. It is concluded that HCV genotype 3a and 2a are prevalent in hemophilia patients of Khyber Pakhtunkhwa Pakistan and the main risk factor observed was an unscreened whole blood transfusion.

Current trends of Hepatitis C virus genotypes and associated risk factors in hemophilia patients in Pakistan

@# Hemophilia is a rare bleeding disorder that needs plasma or clotting factor concentrate transfusion. Therefore chances of blood-borne pathogens like HCV transmission increase due to high prevalence in healthy donors. This study was aimed to determine the prevalence of HCV genotypes and associated risk factors in hemophilia patients of Khyber Pakhtunkhwa, Pakistan. Blood samples and data were collected from 672 hemophiliacs after proper consent obtained from each patient. Samples were analyzed for anti-HCV, HCV RNA and HCV genotype/s detection. Of the total, 22.32% (150) were anti-HCV positive, of which HCV RNA was detected in 18.45% (124) individuals. HCV genotype 3a was found with significantly higher prevalence (p<0.05) (19.35%) as compared to 2a (16.13%) and 1a (12.90%). HCV-3b and HCV-4 were found each in 3.22% samples. Dual infection of genotypes was found in 22.58% of individuals and 22.58% HCV RNA positive sampels were not typed. A total of 572 (85.12%) subjects had hemophilia A and 100 (14.88%) had hemophilia B. In hemophiliacs A the most dominant genotype was 3a (19.27%) while in hemophilia B, genotype 1a was prevalent (26.67%). Whole blood and plasma transfusion were observed as the main risk factors of HCV. It is concluded that HCV genotype 3a and 2a are prevalent in hemophilia patients of Khyber Pakhtunkhwa Pakistan and the main risk factor observed was an unscreened whole blood transfusion.

Hybrid Surface Plasmon Polariton Wave Generation and Modulation by Chiral-Graphene-Metal (CGM) Structure.

Theoretical investigations are carried out to study hybrid SPP wave propagation along the Chiral-Graphene-Metal (CGM) interface. The Kubo formulism is used for the physical modeling of single-layer graphene and the impedance boundary conditions approach is applied at the CGM interface to compute the dispersion relationship for hybrid SPP waves. It is demonstrated that the chirality (ξ) and chemical potential (µc) parameters can be used to modulate the resonance surface plasmon frequencies of the upper and lower propagating modes. Furthermore, the propagation bandgap between the upper and the lower modes can be tuned by changing the chirality parameter. The effect of the chemical potential (µc)and the relaxation time (τ) on the normalized propagation constant, propagation length, and the effective refractive index is studied. The present work may have potential applications in optical and chiral sensing in the terahertz frequency range.

Could metformin be used in patients with diabetes and advanced chronic kidney disease?

Diabetes is an important cause of end stage renal failure worldwide. As renal impairment progresses, managing hyperglycaemia can prove increasingly challenging, as many medications are contra-indicated in moderate to severe renal impairment. Whilst evidence for tight glycaemic control reducing progression to renal failure in patients with established renal disease is limited, poor glycaemic control is not desirable, and is likely to lead to progressive complications. Metformin is a first-line therapy in patients with Type 2 diabetes, as it appears to be effective in reducing diabetes related end points and mortality in overweight patients. Cessation of metformin in patients with progressive renal disease may not only lead to deterioration in glucose control, but also to loss of protection from cardiovascular disease in a cohort of patients at particularly high risk. We advocate the need for further study to determine the role of metformin in patients with severe renal disease (chronic kidney disease stage 4-5), as well as patients on dialysis, or pre-/peri-renal transplantation. We explore possible roles of metformin in these circumstances, and suggest potential key areas for further study.

RETRACTED: Synergistic effects of thymoquinone and curcumin on immune response and anti-viral activity against avian influenza virus (H9N2) in turkeys.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The authors retract the above paper due to: 1) conflict of interest among the authors; and 2) addition of coauthor Dr. Muhammad Younus without his knowledge or permission. The authors apologize for these two grave mistakes.

Estrogen protects the blood-brain barrier from inflammation-induced disruption and increased lymphocyte trafficking.

Sex differences have been widely reported in neuroinflammatory disorders, focusing on the contributory role of estrogen. The microvascular endothelium of the brain is a critical component of the blood-brain barrier (BBB) and it is recognized as a major interface for communication between the periphery and the brain. As such, the cerebral capillary endothelium represents an important target for the peripheral estrogen neuroprotective functions, leading us to hypothesize that estrogen can limit BBB breakdown following the onset of peripheral inflammation. Comparison of male and female murine responses to peripheral LPS challenge revealed a short-term inflammation-induced deficit in BBB integrity in males that was not apparent in young females, but was notable in older, reproductively senescent females. Importantly, ovariectomy and hence estrogen loss recapitulated an aged phenotype in young females, which was reversible upon estradiol replacement. Using a well-established model of human cerebrovascular endothelial cells we investigated the effects of estradiol upon key barrier features, namely paracellular permeability, transendothelial electrical resistance, tight junction integrity and lymphocyte transmigration under basal and inflammatory conditions, modeled by treatment with TNFα and IFNγ. In all cases estradiol prevented inflammation-induced defects in barrier function, action mediated in large part through up-regulation of the central coordinator of tight junction integrity, annexin A1. The key role of this protein was then further confirmed in studies of human or murine annexin A1 genetic ablation models. Together, our data provide novel mechanisms for the protective effects of estrogen, and enhance our understanding of the beneficial role it plays in neurovascular/neuroimmune disease.

PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis.

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

A key role for interferon regulatory factors in mediating early-life metabolic defects in male offspring of maternal protein restricted rats.

An adverse intra-uterine environment, induced by maternal consumption of diets high in saturated fat or low in protein have been implicated as a potential trigger for development of metabolic disease in later life. However, the underlying mechanisms responsible for this programming of obesity have yet to be described. Recent studies have demonstrated that interferon regulatory factors 3 (IRF3) and 4 (IRF4) function to repress adipogenesis. We investigated whether impaired IRF3 and IRF4 function may predispose to development of metabolic disease in a model of programmed obesity. Changes in IRF3 and IRF4 levels, adipogenic gene expression, and adiponectin signalling were measured in white adipose tissue from programmed male offspring of rat dams fed a low-protein diet (MLP), which are predisposed to obesity. 3T3L1 adipocytes were used to determine novel regulatory mechanisms governing IRF expression. IRF3 and IRF4 levels were suppressed in MLP rats, together with raised lipogenic and adipogenic gene expression. Adiponectin and adiponectin receptor 1 and 2 mRNA levels were reduced in MLP rats, along with levels of PPARα and activity of AMP-activated protein kinase (AMPK), 2 downstream targets of adiponectin. Further studies determined that both IRF3 and IRF4 are induced by adiponectin, with adiponectin-AMPK and adiponectin-PPARα signalling regulating IRF3 and IRF4, respectively. We have demonstrated that impaired ability to repress adipogenesis and lipogenesis, through dysregulated adiponectin-PPARα-AMPK-IRF signalling, may play a causal role in predisposing MLP offspring to development of obesity and metabolic disease in later life.

23-year-old female with dyspnea, hematuria, and seizure progressing to respiratory failure.

Takayasu arteritis is a rare chronic inflammatory disease on unknown etiology. We report a 23-year old female who presented with fever, shortness of breath and abdominal pain. Shortly thereafter the patient developed hematuria, hemoptysis and seizure progressing to respiratory failure. She was found to have aortitis and alveolar hemorrhage. We discuss the clinical manifestations and the diagnostic work up of Takayasu arteritis. The patient's response to therapy and a discussion on treatment modalities of the disease are also included in the report.