Synergism between the Two Membranes of the Blood-brain Barrier: Glucose and Amino Acid Transport

Brain capillary endothelial cells, which are connected by extensive tight junctions and are polarized into luminal (blood-facing) and abluminal (brain-facing) plasma membrane domains, form the blood-brain barrier (BBB). The polar distribution of transport proteins mediates glucose and amino acid (AA) homeostasis in the brain. The ability to isolate the luminal and abluminal membranes has permitted the study of each side of the BBB separately in vitro and yielded new information on BBB function. The two membranes have different characteristics. Facilitative transporters were found on both membranes in a position to permit the bidirectional transport of glucose, almost all amino acids and taurine. Na+-dependent transporters were only found on abluminal membranes. The Na+-dependent transporters on the abluminal side are capable of removing virtually all amino acids including acidic AA from the extracellular fluid of brain (ECF). The presence of Na+-dependent carriers on the abluminal membrane provides a mechanism by which the concentrations of AA, glucose and taurine in the ECF of brain may be maintained at optimal levels under physiological and pathophysiological circumstances. Facilitative carriers for glutamine (n) and glutamate (xg-) are found only in the luminal membrane of the BBB. This organization allows the net removal of acidic and nitrogen-rich AA from brain, and explains the low rate of glutamate and glutamine penetration into the central nervous system. The presence of a g-glutamyl cycle at the luminal membrane and Na+-dependent AA transporters at the abluminal membrane may serve to modulate movement of AA from blood to brain. The g-glutamyl cycle is expected to generate pyroglutamate within the endothelial cells. Pyroglutamate stimulates Na+-dependent AA transporters at the abluminal membrane thereby reducing net influx of AA the to brain. It is now clear the BBB may actively participate in the regulation of the AA content of the brain as well as contributing to the control of brain osmolarity

Simvastatin is associated with superior lipid and glycaemic control to atorvastatin and reduced levels of incident Type 2 diabetes, in men and women, in the UK Biobank

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of mortality in people with Type 2 diabetes mellitus (T2DM). Statins reduce low‐density lipoproteins and positively affect CVD outcomes. Statin type and dose have differential effects on glycaemia and risk of incident T2DM; however, the impact of gender, and of individual drugs within the statin class, remains unclear. AIM: To compare effects of simvastatin and atorvastatin on lipid and glycaemic control in men and women with and without T2DM, and their association with incident T2DM. METHODS: The effect of simvastatin and atorvastatin on lipid and glycaemic control was assessed in the T2DM DiaStrat cohort. Prescribed medications, gender, age, BMI, diabetes duration, blood lipid profile and HbA1c were extracted from Electronic Care Record, and compared in men and women prescribed simvastatin and atorvastatin. Analyses were replicated in the UKBiobank in those with and without T2DM. The association of simvastatin and atorvastatin with incident T2DM was also investigated in the UKBiobank. Cohorts where matched for age, BMI and diabetes duration in men and women, in the UKBioBank analysis, where possible. RESULTS: Simvastatin was associated with better LDL (1.6 ± 0.6 vs 2.1 ± 0.9 mmol/L, p < .01) and total cholesterol (3.6 ± 0.7 vs 4.2 ± 1.0 mmol/L, p < .05), and glycaemic control (62 ± 17 vs 67 ± 19 mmol/mol, p < .059) than atorvastatin specifically in women in the DiaStrat cohort. In the UKBiobank, both men and women prescribed simvastatin had better LDL (Women: 2.6 ± 0.6 vs 2.6 ± 0.7 mmol/L, p < .05; Men: 2.4 ± 0.6 vs 2.4 ± 0.6, p < .01) and glycaemic control (Women:54 ± 14 vs 56 ± 15mmol/mol, p < .05; Men, 54 ± 14 vs 55 ± 15 mmol/mol, p < .01) than those prescribed atorvastatin. Simvastatin was also associated with reduced risk of incident T2DM in both men and women (p < .0001) in the UKBiobank. CONCLUSIONS: Simvastatin is associated with superior lipid and glycaemic control to atorvastatin in those with and without T2DM, and with fewer incident T2DM cases. Given the importance of lipid and glycaemic control in preventing secondary complications of T2DM, these findings may help inform prescribing practices

The Interplay Between Anxiety and Social Functioning in Williams Syndrome

The developmental disorder Williams syndrome (WS) has been associated with an atypical social profile of hyper-sociability and heightened social sensitivity across the developmental spectrum. In addition, previous research suggests that both children and adults with WS have a predisposition towards anxiety. The current research aimed to explore the profiles of social behaviour and anxiety across a broad age range of individuals with the disorder (n = 59, ages 6–36 years). We used insights from parental reports on two frequently used measures, the Spence Children’s Anxiety Scale (SCAS-P) and the Social Responsiveness Scale (SRS). Severity of anxiety was correlated with a greater degree of social dysfunction as measured by the SRS in this group. We split the group according to high or low anxiety as measured by the SCAS-P and explored the profile of social skills for the two groups. Individuals high and low in anxiety differed in their social abilities. The results emphasise the need to address anxiety issues in this disorder and to consider how components of anxiety might relate to other features of the disorder

Participating in CaMKIN : impact on patients

Introduction: Managing long-term health conditions is a global challenge, which has necessitated developing innovative ways to deliver patient centred care. Social media allow patients to access and share personal experiences and peer support, with potential to feed back into the patient-centred development and improvement of healthcare services. The Cheshire and Merseyside Kidney Information Network (CaMKIN) was established in 2019 as part of the Kidney Information Network (KIN), providing CKD patients 24-hour online access to information and support regarding their condition. Methods A novel digital method (Vasilica et al., 2021) of a dataset retrieved from a CaMKIN patient Facebook micro-community (1,119 posts and 5,266 comments), complemented by a survey (61 CaMKIN members). The digital methods steps involved a framework analysis to create themes and subthemes, directed analysis of data, familiarisation and sense making. Findings Analysis of data identified four major themes and an additional 13 subthemes of impact. Patients used the group to ‘improve understanding of their condition’ (theme 1) through sharing useful information, accessing information from lived experiences and organizing Q&A with health professionals. The micro-community formed a peer support network with both, in person and online peer to peer support. This support extended to ‘encouragement of self-management of health’ (theme 2), including managing diet and fitness. Group members created their own healthy choices weight loss accountability group, adopting a supportive ‘weight watchers’ style. They encouraged each other to take proactive steps in self-managing their health recommending people to contact renal team or ring emergency line where necessary. CaMKIN positively contributed to ‘improved health and wellbeing outcomes’ (theme 3), by providing a safe space to air frustrations, quell anxieties, and support each other’s mental health. This was important during the COVID_19 pandemic. CaMKIN provided patients a ‘safe environment, outside clinical settings’ (theme 4), to share and receive health information related to their kidney disease or treatment. Throughout the pandemic, the group discussed or clarified information (with professionals on the network), reducing demand on the local services through the self-organisation that occurred within the group. Survey results reinforced the Facebook dataset findings; most respondents benefited from access to health care information (86.9 %), which made them feel more informed about their condition (77.1%). Patients received valuable support from peers (75.4%). Almost half of respondents agreed that it reduced isolation and it contributed to management of mental health (48.8%). Conclusion This innovative micro-community helps CKD patients understand their condition better and improve health awareness through information sharing (peer and professionally developed) and peer support that contribute to increased self-management. Demonstrated through self-reported mechanisms, CaMKIN improved mental health and reduced social isolation. During the pandemic it offered patients a safe environment to develop understanding of the volatile situation to manage their health safely. The data provides insight into an untapped opportunity, recommendations include utilising the CAMKIN to further develop service provision and communication between hospitals and patients. Further research is required to roll out and evaluate embedding KIN into local service provision, and developing a patient network at a regional and national level

13.9% efficiency ternary nonfullerene organic solar cells featuring low-structural order

The insufficient phase separation between polymer donors and nonfullerene acceptors (NFAs) featuring low structural order disrupts efficient charge transport and increases charge recombination, consequently limiting the maximum achievable power conversion efficiency (PCE) of organic solar cells (OSCs). Herein, an NFA IT-M has been added as the third component into the PBDB-T:m-INPOIC OSCs and is shown to effectively tune the phase separation between donor and acceptor molecules, although all components in the ternary system exhibit low degrees of structural order. The incorporation of 10 wt % IT-M into a PBDB-T:m-INPOIC binary host blend appreciably increases the length scale of phase separation, creating continuous pathways that increase and balance charge transport. This leads to an enhanced photovoltaic performance from 12.8% in the binary cell to 13.9% for the ternary cell with simultaneously improved open-circuit voltage, short-circuit current, and fill factor. This work highlights the beneficial role of ternary components in controlling the morphology of the active layer for high-performance OSCs

Treatment outcomes of patients with atopic dermatitis (AD) treated with dupilumab through the early access to medicines scheme (EAMS) in the UK

BACKGROUND Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017. OBJECTIVES The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS. METHODS A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI). RESULTS Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16+4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either ‘better’ (19%) or ‘much better’ (65%). CONCLUSIONS Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials

Increase in the flock prevalence of lameness in ewes is associated with a reduction in farmers using evidence-based management of prompt treatment : a longitudinal observational study of 154 English sheep flocks 2013–2015

Since 2006, farmers in England have received new recommendations on best practice to manage lameness in sheep through a range of knowledge exchange activities. The adoption of each recommendation varied, but in 2013 approximately 50% of farmers reported treating all lame sheep within 3 days of onset of lameness (prompt treatment), 41% did not practice routine foot trimming, 50% culled sheep that had been lame and 14% vaccinated against footrot; all recommended best practices. The aim of this study was to investigate the prevalence of lameness in ewes in England from 2013 to 2015 and to identify changes in practice to manage lameness between 2013 and 2015 and the population attributable fraction for these managements. A longitudinal study with a cohort of 154 English sheep farmers was run for three years, farmers completed questionnaires on lameness in their flock for the previous 12 months in 2013, 2014 and 2015. The geometric mean prevalence of lameness in ewes was 4.1% in 2015, significantly higher than 3.3% and 3.2% for the same 128 farmers who provided data in both 2013 and 2014. Between 2013 and 2015 there was a significant reduction in farmers practising prompt treatment (50.6%–28.6%) but an increase in not practising routine foot trimming (40.9%–79.2%), culling sheep that had been lame (49.4%–81.8%), and vaccinating against footrot (14.3%–29.2%). Not practising prompt treatment, ≥5% of sheep feet bleeding during routine foot trimming, vaccinating ewes for 5 years, not treating lame sheep promptly, ≥5% of sheep feet bleeding during routine foot trimming, and mixing of flocks were 34.5%, 25.3%, 2.9% and 2.4%. In 2013, when 50% of farmers used prompt treatment, the PAF for not using prompt treatment was only 13.3%. We conclude that the change in practice by these farmers towards flock-level managements and a reduction in individual prompt treatment of lame sheep negatively impacted the prevalence of lameness in sheep. This change occurred despite the evidence that prompt treatment of lame sheep is highly effective at reducing the prevalence of lameness in sheep flocks and is an example of cognitive dissonance

Using Football Cultures as a Vehicle to Improve Mental Health in Men: The Case of the Redcar and Cleveland Boot Room

This paper sets out to appraise (from the perspective of members) the impact of a localized, football-based mental health intervention. Commissioned in late 2015, the ‘Redcar and Cleveland Boot Room (BR)’ was implemented in response to mass redundancy in the local area, coupled with regional suicide rates in men that exceed the national average. Interactive discussions with BR members revealed that: (a) the language of football and shared identity were important for initiating and sustaining engagement in the BR; (b) peer-support and mentoring combined with member-led activities were active ingredients of the BR and (c) that the BR was an effective vehicle for building mental health resilience. This evaluation adds to the evidence base on the value of football as a context to engage adult males in community-based interventions targeting mental health resilience

Polariton condensation in an organic microcavity utilising a hybrid metal-DBR mirror

We have developed a simplified approach to fabricate high-reflectivity mirrors suitable for applications in a strongly-coupled organic-semiconductor microcavity. Such mirrors are based on a small number of quarter-wave dielectric pairs deposited on top of a thick silver film that combine high reflectivity and broad reflectivity bandwidth. Using this approach, we construct a microcavity containing the molecular dye BODIPY-Br in which the bottom cavity mirror is composed of a silver layer coated by a SiO2 and a Nb2O5 film, and show that this cavity undergoes polariton condensation at a similar threshold to that of a control cavity whose bottom mirror consists of ten quarter-wave dielectric pairs. We observe, however, that the roughness of the hybrid mirror—caused by limited adhesion between the silver and the dielectric pair—apparently prevents complete collapse of the population to the ground polariton state above the condensation threshold