A combination of nifedipine and octreotide treatment in an hyperinsulinemic hypoglycemic infant.

PublishedResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from Galenos Publishing via the DOI in this record.Hyperinsulinemic hypoglycemia (HH) is the commonest cause of persistent hypoglycemia in the neonatal and infancy periods. Mutations in the ABCC8 and KCNJ11 genes, which encode subunits of the ATP-sensitive potassium channel in the pancreatic beta cell, are identified in approximately 50% of these patients. The first-line drug in the treatment of HH is diazoxide. Octreotide and glucagon can be used in patients who show no response to diazoxide. Nifedipine, a calcium-channel blocker, has been shown to be an effective treatment in a small number of patients with diazoxide-unresponsive HH. We report a HH patient with a homozygous ABCC8 mutation (p.W1339X) who underwent a near-total pancreatectomy at 2 months of age due to a lack of response to diazoxide and octreotide treatment. Severe hypoglycemic attacks continued following surgery, while the patient was being treated with octreotide. These attacks resolved when nifedipine was introduced. Whilst our patient responded well to nifedipine, the dosage could not be increased to 0.75 mg/kg/day due to development of hypotension, a reported side effect of this drug. Currently, our patient, now aged 4 years, is receiving a combination of nifedipine and octreotide treatment. He is under good control and shows no side effects. In conclusion, nifedipine treatment can be started in patients with HH who show a poor response to diazoxide and octreotide treatment.Sian Ellard is employed by the Exeter Clinical Research Facility and is a Wellcome Trust Senior Investigator. The genetic testing was funded by a research grant from the Medical Research Council

Structural, optical and magnetic properties of Cr doped ZnO microrods prepared by spray pyrolysis

A series of Cr-doped ZnO micro-rod arrays were fabricated by a spray pyrolysis method. X-ray diffraction patterns of the samples showed that the undoped and Cr-doped ZnO microrods exhibit hexagonal crystal structure. Surface morphology analysis of the samples has revealed that pure ZnO sample has a hexagonal microrod morphology. From X-ray photoelectron spectroscopy studies, the Cr 2p3/2 binding energy is found to be 577.34 eV indicating that the electron binding energy of the Cr in ZnO is almost the same as the binding energy of Cr3+ states in Cr2O3. The optical band gap Eg decreases slightly from 3.26 to 3.15 eV with the increase of actual Cr content from x = 0.00 to 4.63 at % in ZnO. Photoluminescence studies at 10 K show that the incorporation of chromium leads to a relative increase of deep level band intensity. It was also observed that Cr doped samples clearly showed ferromagnetic behavior; however, 2.49 % Cr doped ZnO showed remnant magnetization higher than that of 1.07 % and 4.63 % Cr doped samples, while 4.63 % Cr doped ZnO samples had a coercive field higher than the other dopings

Temperature dependence of electrical properties in In/Cu2ZnSnTe4/Si/Ag diodes

WOS: 000458625200001Cu2ZnSnTe4 (CZTTe) thin films with In metal contact were deposited by thermal evaporation on monocrystalline n-type Si wafers with Ag ohmic contact to investigate the device characteristics of an In/CZTTe/Si/Ag diode. The variation in electrical characteristics of the diode was analysed by carrying out current-voltage (I-V) measurements in the temperature range of 220-360 K. The forward bias I-V behaviour was modelled according to the thermionic emission (TE) theory to obtain main diode parameters. In addition, the experimental data were detailed by taking into account the presence of an interfacial layer and possible dominant current transport mechanisms were studied under analysis of ideality factor, n. Strong effects of temperature were observed on zero-bias barrier height (Phi(B0)) and n values due to barrier height inhomogeneity at the interface. The anomaly observed in the analysis of TE was modelled by Gaussian distribution (GD) of barrier heights with 0.844 eV mean barrier height and 0.132 V standard deviation. According to the Tung's theoretical approach, a linear correlation between Phi(B0) and n cannot be satisfied, and thus the modified Richardson plot was used to determine Richardson constant (A*). As a result, A* was calculated approximately as 120.6 A cm(-2) K-2 very close to the theoretical value for n-Si. In addition, the effects of series resistance (R-s) by estimating from Cheng's function and density of surface states (N-ss) by taking the bias dependence of effective barrier height, were discussed

Digital Transformation in Higher Education: Maturity and Challenges Post COVID-19

Digital transformation in higher education, especially after COVID-19 is inevitable. This research explores digital transformation maturity and challenges post COVID-19. The significance of the study does not only stem from the critical role of higher education in building the workforce and knowledge economy. This study triangulates the findings of multiple research instruments, including survey, interviews, case study, and direct observation. The research findings show a significant variance between the respondents’ perception of digital transformations maturity levels, and the core requirements of digital transformation maturity. The findings also show the lack of holistic vision, digital transformation competency, and data structure and processing as the leading challenges of digital transformation

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study

Background/Aims: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients. Materials and Methods: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies. Results: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis. Conclusion: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further. © Copyright 2018 by The Turkish Society of Gastroenterology

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

<p>Abstract</p> <p>Background</p> <p>Ectopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis.</p> <p>Methods</p> <p>Gastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.</p> <p>Results</p> <p>EO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued.</p> <p>Conclusions</p> <p>The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.</p

Defect-induced room temperature ferromagnetism in B-doped ZnO

ZnO microrods were grown on glass substrates by the spray pyrolysis method and boron was doped into the ZnO microrods by diffusion. X-ray diffraction results confirmed that the incorporation of B leads to a slight reduction in the deposit texture. Scanning electron microscopy measurements showed that the morphology of the ZnO samples changed from a microrod to nanocrystalline structure with B-doping. Photoluminescence data indicate that B-doping leads to a relative increase of the unstructured green band intensity. Magnetic measurements revealed that B-doped ZnO samples exhibited room temperature ferromagnetism related to defects, in agreement with first principles theoretical calculations

Changes in intraocular pressure in study and fellow eyes in the IVAN trial

PURPOSE: To describe changes in intraocular pressure (IOP) in the 'alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN)' trial (registered as ISRCTN92166560). DESIGN: Randomised controlled clinical trial with factorial design. PARTICIPANTS: Patients (n=610) with treatment naïve neovascular age-related macular degeneration were enrolled and randomly assigned to receive either ranibizumab or bevacizumab and to two regimens, namely monthly (continuous) or as needed (discontinuous) treatment. METHODS: At monthly visits, IOP was measured preinjection in both eyes, and postinjection in the study eye. OUTCOME MEASURES: The effects of 10 prespecified covariates on preinjection IOP, change in IOP (postinjection minus preinjection) and the difference in preinjection IOP between the two eyes were examined. RESULTS: For every month in trial, there was a statistically significant rise in both the preinjection IOP and the change in IOP postinjection during the time in the trial (estimate 0.02 mm Hg, 95% CI 0.01 to 0.03, p<0.001 and 0.03 mm Hg, 95% CI 0.01 to 0.04, p=0.002, respectively). There was also a small but significant increase during the time in trial in the difference in IOP between the two eyes (estimate 0.01 mm Hg, 95% CI 0.005 to 0.02, p<0.001). There were no differences between bevacizumab and ranibizumab for any of the three outcomes (p=0.93, p=0.22 and p=0.87, respectively). CONCLUSIONS: Anti-vascular endothelial growth factor agents induce increases in IOP of small and uncertain clinical significance