Short Bowel Patients Treated for Two Years with Glucagon-Like Peptide 2 (GLP-2): Compliance, Safety, and Effects on Quality of Life

Background and aims. Glucagon-like peptide 2 (GLP-2) has been shown to improve intestinal absorption in short bowel syndrome (SBS) patients in a short-term study. This study describes safety, compliance, and changes in quality of life in 11 SBS patients at baseline, week 13, 26, and 52 during two years of subcutaneous GLP-2 treatment, 400 microgram TID, intermitted by an 8-week washout period. Methods. Safety and compliance was evaluated during the admissions. The Sickness Impact Profile (SIP), Short Form 36 (SF 36), and Inflammatory Bowel Disease Questionnaire (IBDQ) evaluated quality of life. Results. The predominant adverse event was transient abdominal discomfort in 5 of 11 patients, but in 2, both suffering from Crohns disease, it progressed to abdominal pain and led to discontinuation of GLP-2 treatment. One had a fibrostenotic lesion electively resected at the jejuno-ascendo-anastomosis. The investigator excluded a patient due to unreliable feedback. Stoma nipple enlargement was seen in all 9 jejunostomy patients. Reported GLP-2 compliance was excellent (>93%). GLP-2 improved the overall quality of life VAS-score (4.1 ± 2.8 cm versus 6.0 ± 2.4 cm, P < .01), the overall SIP score (10.3 ± 8.9% versus 6.2 ± 9.5%, P < .001), the mental component of the SF-36 (45 ± 13% versus 53 ± 11%, P < .05), and the overall IBDQ score (5.1 ± 0.9 versus 5.4 ± 0.9, P < .007) in the 8 patients completing the study. Conclusions. Long-term treatment with GLP-2 is feasible in SBS patients, although caution must be exercised in patients with a history of abdominal pain. Although conclusions cannot be made in a noncontrolled trial, the high reported compliance might reflect a high treatment satisfaction, where the clinical benefits of GLP-2 may outweigh the discomforts of injections

Short Bowel Patients Treated for Two Years with Glucagon-Like Peptide 2: Effects on Intestinal Morphology and Absorption, Renal Function, Bone and Body Composition, and Muscle Function

Background and aims. In a short-term study, Glucagon-like peptide 2 (GLP-2) has been shown to improve intestinal absorption in short bowel syndrome (SBS) patients. This study describes longitudinal changes in relation to GLP-2 treatment for two years. Methods. GLP-2, 400 micrograms, s.c.,TID, were offered, to eleven SBS patients keeping parenteral support constant. 72-hour nutritional balance studies were performed at baseline, weeks 13, 26, 52 during two years intermitted by an 8-week washout period. In addition, mucosal morphometrics, renal function (by creatinine clearance), body composition and bone mineral density (by DEXA), biochemical markers of bone turnover (by s-CTX and osteocalcin, PTH and vitamin D), and muscle function (NMR, lungfunction, exercise test) were measured. Results. GLP-2 compliance was >93%. Three of eleven patients did not complete the study. In the remaining 8 patients, GLP-2 significantly reduced the fecal wet weight from approximately 3.0 to approximately 2.0 kg/day. This was accompanied by a decline in the oral wet weight intake, maintaining intestinal wet weight absorption and urinary weight constant. Renal function improved. No significant changes were demonstrated in energy intake or absorption, and GLP-2 did not significantly affect mucosal morphology, body composition, bone mineral density or muscle function. Conclusions. GLP-2 treatment reduces fecal weight by approximately 1000 g/d and enables SBS patients to maintain their intestinal fluid and electrolyte absorption at lower oral intakes. This was accompanied by a 28% improvement in creatinine clearance

Photonic crystal resonator integrated in a microfluidic system

We report on a novel optofluidic system consisting of a silica-based 1D photonic crystal, integrated planar waveguides and electrically insulated fluidic channels. An array of pillars in a microfluidic channel designed for electrochromatography is used as a resonator for on-column label-free refractive index detection. The resonator was fabricated in a silicon oxynitride platform, to support electroosmotic flow, and operated at 1.55 microns. Different aqueous solutions of ethanol with refractive indices ranging from n = 1.3330 to 1.3616 were pumped into the column/resonator and the transmission spectra were recorded. Linear shifts of the resonant wavelengths yielded a maximum sensitivity of 480 nm/RIU and a minimum difference of 0.007 RIU was measured

Universality in edge-source diffusion dynamics

We show that in edge-source diffusion dynamics the integrated concentration N(t) has a universal dependence with a characteristic time-scale tau=(A/P)^2 pi/(4D), where D is the diffusion constant while A and P are the cross-sectional area and perimeter of the domain, respectively. For the short-time dynamics we find a universal square-root asymptotic dependence N(t)=N0 sqrt(t/tau) while in the long-time dynamics N(t) saturates exponentially at N0. The exponential saturation is a general feature while the associated coefficients are weakly geometry dependent.Comment: 4 pages including 4 figures. Minor changes. Accepted for PR

Plasmonic silicon Schottky photodetectors: the physics behind graphene enhanced internal photoemission

Recent experiments have shown that the plasmonic assisted internal photoemission from a metal to silicon can be significantly enhanced by introducing a monolayer of graphene between the two media. This is despite the limited absorption in a monolayer of undoped graphene ( ∼ π α = 2.3 % ). Here we propose a physical model where surface plasmon polaritons enhance the absorption in a single-layer graphene by enhancing the field along the interface. The relatively long relaxation time in graphene allows for multiple attempts for the carrier to overcome the Schottky barrier and penetrate into the semiconductor. Interface disorder is crucial to overcome the momentum mismatch in the internal photoemission process. Our results show that quantum efficiencies in the range of few tens of percent are obtainable under reasonable experimental assumptions. This insight may pave the way for the implementation of compact, high efficiency silicon based detectors for the telecom range and beyond

Low-loss criterion and effective area considerations for photonic crystal fibers

We study the class of endlessly single-mode all-silica photonic crystal fibers with a triangular air-hole cladding. We consider the sensibility to longitudinal nonuniformities and the consequences and limitations for realizing low-loss large-mode area photonic crystal fibers. We also discuss the dominating scattering mechanism and experimentally we confirm that both macro and micro-bending can be the limiting factor.Comment: Accepted for Journal of Optics A - Pure and Applied Optic

Intershell resistance in multiwall carbon nanotubes: A Coulomb drag study

We calculate the intershell resistance R_{21} in a multiwall carbon nanotube as a function of temperature T and Fermi level (e.g. a gate voltage), varying the chirality of the inner and outer tubes. This is done in a so-called Coulomb drag setup, where a current I_1 in one shell induces a voltage drop V_2 in another shell by the screened Coulomb interaction between the shells neglecting the intershell tunnelling. We provide benchmark results for R_{21}=V_2/I_1 within the Fermi liquid theory using Boltzmann equations. The band structure gives rise to strongly chirality dependent suppression effects for the Coulomb drag between different tubes due to selection rules combined with mismatching of wave vector and crystal angular momentum conservation near the Fermi level. This gives rise to orders of magnitude changes in R_{21} and even the sign of R_{21} can change depending on the chirality of the inner and outer tube and misalignment of inner and outer tube Fermi levels. However for any tube combination, we predict a dip (or peak) in R_{21} as a function of gate voltage, since R_{21} vanishes at the electron-hole symmetry point. As a byproduct, we classified all metallic tubes into either zigzag-like or armchair-like, which have two different non-zero crystal angular momenta m_a, m_b and only zero angular momentum, respectively.Comment: 17 pages, 10 figure