The Effect of Iron and Erythropoietin Treatment on the A1C of Patients With Diabetes and Chronic Kidney Disease

OBJECTIVE - To examine the effect of intravenous iron and erythropoietin-stimulating agents (ESAs) on glycemic control and A1C of patients with diabetes and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS- This was a prospective study of patients with type 2 diabetes and CKD stage IIIB or IV undergoing intravenous iron (group A) and/or ESA (group B). Full blood profiles were determined over the study period. Glycemic control was monitored using A1C, seven-point daily glucose three times weekly, and continuous glucose monitoring (CGM). RESULTS - There were 15 patients in both group A and group B. Mean A1C (95% CI) values fell in both groups (7.40% [6.60-8.19] to 6.96% [6.27-7.25] , P < 0.01, with intravenous iron and 7.31% [6.42-8.54] to 6.63% [6.03-7.36] , P = 0.013, ESA). There was no change in mean blood glucose in group A (9.55 mmol/l [8.20-10.90] vs. 9.71 mmol/l [8.29-11.13] , P = 0.07) and in group B (8.72 mmol/l [7.31-10.12] vs. 8.78 mmol/l [7.47-9.99] , P=0.61) over the study period. Hemoglobin and hematocrit values significantly increased following both treatments. There was no linear relationship found between the change in A1C values and the rise of hemoglobin following either treatment. CONCLUSIONS - Both iron and ESA cause a significant fall in A1C values without a change to glycemic control in patients with diabetes and CKD. At the present time, regular capillary glucose measurements and the concurrent use of CGM remain the best alternative measurements of glycemic control in this patient group

Zytotoxizität natürlicher Killer- (NK-) Zellen im HPV-assoziierten Oropharynxkarzinom (OSCC)

Einleitung: In HPV-assoziierten OSCC konnte in eigenen Vorarbeiten eine dichte NK-Zell Infiltration in Tumor und Stroma gezeigt werden. NK-Zellen werden eingeteilt in regulatorische CD56high+/CD16-/CD3- und zytotoxische CD56low+/CD16+/CD3-Zellen. Aktivierte, zytotoxische NK-Zellen produzieren die Serinprotease Granzym B, die nach Bindung der NK-Zellen an einer Zielzelle Apoptose induziert. NKT-Zellen sind eine Subpopulation der T-Zellen. Sie exprimieren CD56/CD16/CD3 und bilden die Brücke zwischen dem angeborenem und dem erworbenem Immunsystem. Ziel der Arbeit war es den Aktivitätsstatus der zuvor identifizierten CD56+ NK-Zellen bei HPV-assoziierten OSCC festzustellen.Methoden: Serienschnitte von FFPE Gewebeproben von OSCC (n=20) wurden in Immunfluoreszenz-Doppelfärbungen untersucht. Es wurden HPV-assoziierte (n=10) und HPV-negative (n=10) Fälle mit vergleichbaren UICC-Stadien ausgewählt. Folgende Antigen-Kombinationen wurden mit spezifischen Primärantikörpern und entsprechend markierten Sekundärantikörpern nachgewiesen: CD3/GZMB, CD3/CD56, CD56/GZMB, CD16/GZMB und CD16/CD56.Ergebnisse: Neben der erhöhten Anzahl CD56+ Zellen in HPV-assoziierten OSCC wurde bei dieser Tumorgruppe eine höhere Anzahl aktivierter zytotoxischer NK-Zellen (Ø=90%) im Vergleich zu HPV-negativen OSCC (Ø=63%) nachgewiesen. Bemerkenswert ist, dass in HPV-assoziierten Tumoren CD56+/CD16+/CD3+ & GZMB+ NKT-Zellen gefunden wurden, die mit einer regulatorischen als auch zytotoxischen-Funktion assoziiert sind. Schlussfolgerung: Die hohe Anzahl CD56-positiver, aktiver NK-Zellen und die Rekrutierung von NKT-Zellen im Tumorgewebe und Stroma bei HPV-assoziierten OSCC trägt möglicherweise entscheidend zur guten Prognose dieser Patienten bei.Der Erstautor gibt keinen Interessenkonflikt an

Separation of chitosan by degree of acetylation using simple free solution capillary electrophoresis

Chitosan is a biopolymer of increasing significance, as well as a renewable and sustainable material. Its main molecular characteristics are molar mass and degree of acetylation (composition). Precise average degrees of acetylation were measured by quantitative 1H solution-state NMR spectroscopy. While number-average degrees of acetylation had already been determined by 1H NMR spectroscopy, weight-average degrees of acetylation are also determined and may be more relevant for some properties, such as mechanical properties. We report the first separation of chitosan according to its degree of acetylation using free solution capillary electrophoresis. Capillary electrophoresis separates chitosan in the ‘critical conditions’: the molar mass plays little role and the separation is by the degree of acetylation. It characterises the heterogeneity of chitosan samples in terms of composition (dispersity of the distribution of degrees of acetylation). This heterogeneity (broad distribution of degrees of acetylation) cannot be neglected contrary to a common assumption found in the literature. This fast and easy separation will allow establishing a structure–property relationships

Correlation of whole blood hydroxychloroquine concentration with cutaneous lupus erythematosus and factors associated with it: first multicenter, cross-sectional analysis in Malaysia

Hydroxychloroquine (HCQ) is the first-line systemic treatment for cutaneous lupus erythematosus (CLE). Whole blood HCQ concentration (WBHCQ) was found to correlate with CLE severity among Caucasians. However, studies on Asians are scarce. We aim to explore the relationship of WBHCQ with CLE disease activity among multi-racial Malaysians and the factors associated with WBHCQ. A cross-sectional study targeting patients with CLE was conducted from 1 June till 30 November 2019. Disease activity was assessed using Cutaneous Lupus Erythematosus Disease Area and Severity Index – Activity Score (CLASI-AS). Blood was analyzed for WBHCQ concentration using a high-performance liquid chromatography technique. Statistical analysis was done using R studio version 1.2.1335. A total of 88 subjects (male : female, 4.5:1) with a median age of 41 years old were recruited. The median duration CLE was 5 years. The majority had acute cutaneous lupus (n = 45, 51.1%). The median WBHCQ was 946.8 ng/mL. Indians were found to have the highest WBHCQ (median ± interquartile range [IQR], 1515.4 ± 1494.8 ng/mL). Males had a lower WBHCQ (median ± IQR, 733.5 ± 573.8 ng/mL) than females (995.5 ± 925.1 ng/mL). However, no statistically significant association between race and sex with WBHCQ was demonstrable (p = 0.247, p = 0.066). No correlation was demonstrated between WBHCQ and CLASI-AS (r = −0.02, p = 0.851). A positive correlation was found between HCQ dosage (ideal bodyweight) and WBHCQ (r = 0.24, p = 0.027). No other factors were found associated with WBHCQ. Indians and females were observed to have higher WBCHQ; however, no significant correlation was identified. Further study is required to confirm the finding

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Nasal carriers are more likely to acquire exogenous Staphylococcus aureus strains than non-carriers

We performed a prospective observational study in a clinical setting to test the hypothesis that prior colonization by a Staphylococcus aureus strain would protect, by colonization interference or other processes, against de novo colonization and, hence, possible endo-infections by newly acquired S. aureus strains. Three hundred and six patients hospitalized for >7 days were enrolled. For every patient, four nasal swabs (days 1, 3, 5, and 7) were taken, and patients were identified as carriers when a positive nasal culture for S. aureus was obtained on day 1 of hospitalization. For all patients who acquired methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus via colonization and/or infection during hospitalization, strains were collected. We note that our study may suffer from false-negative cultures, local problems with infection control and hospital hygiene, or staphylococcal carriage at alternative anatomical sites. Among all patients, 22% were prior carriers of S. aureus, including 1.9% whom carried MRSA upon admission. The overall nasal staphylococcal carriage rate among dermatology patients was significantly higher than that among neurosurgery patients (n = 25 (55.5%) vs. n = 42 (16.1%), p 0.005). This conclusion held when the carriage definition included individuals who were nasal culture positive on day 1 and day 3 of hospitalization (p 0.0001). All MRSA carriers were dermatology patients. There was significantly less S. aureus acquisition among non-carriers than among carriers during hospitalization (p 0.005). The mean number of days spent in the hospital before experiencing MRSA acquisition in nasal carriers was 5.1, which was significantly lower than the score among non-carriers (22 days, p 0.012). In conclusion, we found that nasal carriage of S. aureus predisposes to rather than protects against staphylococcal acquisition in the nose, thereby refuting our null hypothesis. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved

Separation of chitosan by degree of acetylation using simple free solution capillary electrophoresis

Chitosan is a biopolymer of increasing significance, as well as a renewable and sustainable material. Its main molecular characteristics are molar mass and degree of acetylation (composition). Precise average degrees of acetylation were measured by quantitative 1H solution-state NMR spectroscopy. While number-average degrees of acetylation had already been determined by 1H NMR spectroscopy, weight-average degrees of acetylation are also determined and may be more relevant for some properties, such as mechanical properties. We report the first separation of chitosan according to its degree of acetylation using free solution capillary electrophoresis. Capillary electrophoresis separates chitosan in the ‘critical conditions’: the molar mass plays little role and the separation is by the degree of acetylation. It characterises the heterogeneity of chitosan samples in terms of composition (dispersity of the distribution of degrees of acetylation). This heterogeneity (broad distribution of degrees of acetylation) cannot be neglected contrary to a common assumption found in the literature. This fast and easy separation will allow establishing a structure–property relationships