Patients with Diabetic Nephropathy in Established Renal Failure: Demographics, Survival and Biochemical Variables (Chapter 16)

Diabetic nephropathy is now the most common renal disease leading to renal replacement therapy in developed countries1,2,3,4. Within the UK, the number of DN patients accepted for RRT rose steadily in the 1990s5 especially in the African–Caribbean and South Asian populations3,4,5,6. This may be related to the increased prevalence of Type 2 diabetes in the general population, the ageing population and the liberalisation of attitudes to acceptance for RRT5,7. The overall rise has slowed in the last 4 years8 . DN patients starting RRT are likely to have more co-morbidity than other patients, in particular cardiovascular disease, and consequently worse survival on RRT9,10,11. In recent years there has been some reduction in the high mortality of such patients, so the prevalence of diabetic nephropathy patients on RRT (currently lower than the percentage of incident patients, see Chapter 3) might increase12,13. The National Service Frameworks for Diabetes14 and for Renal Services15 have highlighted the importance of the primary prevention of DN in diabetic patients by early detection and aggressive management of hypertension, glucose control and cardiovascular risk factors and of the timely referral (recommendation >1 yr before RRT) of those with progressive renal disease in order to plan for RRT. 251 There is a key policy drive to reduce health inequalities in England16. In the UK there is evidence that diabetic patients in more socially deprived areas have higher all cause mortality even after adjustment for smoking and blood pressure9 , and lower rates of attendance at GP and hospital clinics17. The UK Renal Registry 2003 Report highlighted the possible role of social deprivation in the context of DN. This chapter examines the characteristics of patients developing established renal failure from DN, their access to modalities of treatment and their survival on RRT relative to other incident patients. It also includes data on quality of care (HbA1c, cholesterol and blood pressure). These analyses were undertaken before individual patient data from the Scottish Registry became available and therefore only includes England and Wales

Matching the termination of radiating non-uniform transmission-lines

In this contribution a concept of matching the termination of radiating non-uniform transmission-lines is proposed. Using Transmission-Line Super Theory, position and frequency dependent line parameters can be obtained. Therefore, a characteristic impedance can be determined which is also position and frequency dependent. For a single wire transmission-line it could be shown that the maximum value of that characteristic impedance is an optimal termination in the sense of minimizing the variation of the current on the line. This indicates that matching is not a local effect at the position of the concentrated load but a cooperative process including the whole non-uniform transmission-line. In addition this choice of termination minimizes the variation of the radiated power over frequency

Incomplete reversibility of estimated glomerular filtration rate decline following tenofovir disoproxil fumarate exposure.

BACKGROUND: Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment, but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline during TDF therapy. METHODS: Cox proportional hazards models assessed factors associated with discontinuing TDF in those with an exposure duration of >6 months. In those who discontinued TDF therapy, linear piecewise regression models estimated glomerular filtration rate (eGFR) slopes before initiation of, during, and after discontinuation of TDF therapy. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multivariable logistic regression. RESULTS: We observed declines in the eGFR during TDF exposure (mean slopes, -15.7 mL/minute/1.73 m(2)/year [95% confidence interval {CI}, -20.5 to -10.9] during the first 3 months and -3.1 mL/minute/1.73 m(2)/year [95% CI, -4.6 to -1.7] thereafter) and evidence of eGFR increases following discontinuation of TDF therapy (mean slopes, 12.5 mL/minute/1.73 m(2)/year [95% CI, 8.9-16.1] during the first 3 months and 0.8 mL/minute/1.73 m(2)/year [95% CI,.1-1.5] thereafter). Following TDF discontinuation, 38.6% of patients with a decline in the eGFR did not experience recovery. A higher eGFR at baseline, a lower eGFR after discontinuation of TDF therapy, and more-prolonged exposure to TDF were associated with an increased risk of incomplete recovery 6 months after discontinuation of TDF therapy. CONCLUSIONS: This study shows that a decline in the eGFR during TDF therapy was not fully reversible in one third of patients and suggests that prolonged TDF exposure at a low eGFR should be avoided

Aberrant network connectivity during error processing in patients with schizophrenia

BACKGROUND: Neuroimaging methods have pointed to deficits in the interaction of large-scale brain networks in patients with schizophrenia. Abnormal connectivity of the right anterior insula (AI), a central hub of the salience network, is frequently reported and may underlie patients’ deficits in adaptive salience processing and cognitive control. While most previous studies used resting state approaches, we examined right AI interactions in a task-based fMRI study. METHODS: Patients with schizophrenia and healthy controls performed an adaptive version of the Eriksen Flanker task that was specifically designed to ensure a comparable number of errors between groups. RESULTS: We included 27 patients with schizophrenia and 27 healthy controls in our study. The between-groups comparison replicated the classic finding of reduced activation in the midcingulate cortex (MCC) in patients with schizophrenia during the commission of errors while controlling for confounding factors, such as task performance and error frequency, which have been neglected in many previous studies. Subsequent psychophysiological interaction analysis revealed aberrant functional connectivity (FC) between the right AI and regions in the inferior frontal gyrus and temporoparietal junction. Additionally, FC between the MCC and the dorsolateral prefrontal cortex was reduced. LIMITATIONS: As we examined a sample of medicated patients, effects of antipsychotic medication may have influenced our results. CONCLUSION: Overall, it appears that schizophrenia is associated with impairment of networks associated with detection of errors, refocusing of attention, superordinate guiding of cognitive control and their respective coordination

Gravitational Lorentz Force and the Description of the Gravitational Interaction

In the context of a gauge theory for the translation group, we have obtained, for a spinless particle, a gravitational analog of the Lorentz force. Then, we have shown that this force equation can be rewritten in terms of magnitudes related to either the teleparallel or the riemannian structures induced in spacetime by the presence of the gravitational field. In the first case, it gives a force equation, with torsion playing the role of force. In the second, it gives the usual geodesic equation of General Relativity. The main conclusion is that scalar matter is able to feel anyone of the above spacetime geometries, the teleparallel and the metric ones. Furthermore, both descriptions are found to be completely equivalent in the sense that they give the same physical trajectory for a spinless particle in a gravitational field.Comment: Equations (44)-(47) correcte

Axial Torsion-Dirac spin Effect in Rotating Frame with Relativistic Factor

In the framework of spacetime with torsion and without curvature, the Dirac particle spin precession in the rotational system is studied. We write out the equivalent tetrad of rotating frame, in the polar coordinate system, through considering the relativistic factor, and the resultant equivalent metric is a flat Minkowski one. The obtained rotation-spin coupling formula can be applied to the high speed rotating case, which is consistent with the expectation.Comment: 6 page

Multi-transmission-line-beam interactive system

We construct here a Lagrangian field formulation for a system consisting of an electron beam interacting with a slow-wave structure modeled by a possibly non-uniform multiple transmission line (MTL). In the case of a single line we recover the linear model of a traveling wave tube (TWT) due to J.R. Pierce. Since a properly chosen MTL can approximate a real waveguide structure with any desired accuracy, the proposed model can be used in particular for design optimization. Furthermore, the Lagrangian formulation provides for: (i) a clear identification of the mathematical source of amplification, (ii) exact expressions for the conserved energy and its flux distributions obtained from the Noether theorem. In the case of uniform MTLs we carry out an exhaustive analysis of eigenmodes and find sharp conditions on the parameters of the system to provide for amplifying regimes

Enhanced brain activity may precede the diagnosis of Alzheimer's disease by 30 years

Presenilin 1 (PSEN1) mutations cause autosomal dominant familial Alzheimer's disease (FAD). PSEN1 mutation carriers undergo the course of cognitive deterioration, which is typical for sporadic Alzheimer's disease but disease onset is earlier and disease progression is faster. Here, we sought to detect signs of FAD in presymptomatic carriers of the PSEN1 mutation (C410Y) by use of a neuropsychological examination, functional MRI during learning and memory tasks and MRI volumetry. We examined five non-demented members of a FAD family and 21 non-related controls. Two of the five family members were carrying the mutation; one was 20 years old and the other 45 years old. The age of clinical manifestation of FAD in the family studied here is ∼48 years. Neuropsychological assessments suggested subtle problems with episodic memory in the 20-year-old mutation carrier. The middle-aged mutation carrier fulfilled criteria for amnestic mild cognitive impairment. The 20-year-old mutation carrier exhibited increased, while the middle-aged mutation carrier exhibited decreased brain activity compared to controls within memory-related neural networks during episodic learning and retrieval, but not during a working-memory task. The increased memory-related brain activity in the young mutation carrier might reflect a compensatory effort to overcome preclinical neural dysfunction caused by first pathological changes. The activity reductions in the middle-aged mutation carrier might reflect gross neural dysfunction in a more advanced stage of neuropathology. These data suggest that functional neuroimaging along with tasks that challenge specifically those brain areas which are initial targets of Alzheimer's disease pathology may reveal activity alterations on a single-subject level decades before the clinical manifestation of Alzheimer's diseas