On fixed gain recursive estimators with discontinuity in the parameters

In this paper we estimate the tracking error of a fixed gain stochastic approximation scheme. The underlying process is not assumed Markovian, a mixing condition is required instead. Furthermore, the updating function may be discontinuous in the parameter.Comment: Thoroughly revised, Assumption 3.4 strengthene

Immunoglobulin G4-related disease with large-size vessel involvement is more diverse than originally thought

[No abstract available

The vicious cycle of intradialytic hypotension, inflammation and myocardial Stunning: Overview of pathophysiological aspects

Intradialytic hypotension (IDH) represents a well-known and intractable complication in hemodialysis patients. Despite the innovations in hemodialysis techniques, its tenacious presence indicates the complexity of underlying pathophysiological mechanisms. The need of an integrated approach in understanding its pathogenesis is thought to be imperative as it may prevent devastating consequences through the implementation of more successful avoidance tactics. It is well established that IDH has been associated with impaired myocardial function and peripheral vascular resistance, attributed to either the hemodialysis procedure per se or patients' unique features. This review aims to describe traditional risk factors of IDH and focus on non- traditional but crucial factors of hemodynamic instability related to endothelial dysfunction. In particular, chronic subclinical inflammation may be considered the missing link in the vicious cycle of IDH, ischemia and myocardial stunning. Repeated episodes of enteric ischemia during hemodialysis represent an additional source of chronic systemic inflammation that induces the phenomenon of bacterial or endotoxin translocation through the impaired enteric epithelial cell barrier. Thus, increased endothelial dysfunction and oxidative stress result in decreased left ventricular pumping function and finally permanent systolic dysfunction through genetic adaptations. In total, these pathophysiological mechanisms preserve the vicious cycle of IDH

Diabetogenic Effects Associated with Psychiatric Treatment

Purpose of Review: Mental health disorders, such as schizophrenia, bipolar disorder, and anxiety and depression disorder, are associated with increased risk for type 2 diabetes. Studies report varying rates of type 2 diabetes among people with severe mental illness, ranging 1.5–5.0-fold elevated risk than in the general population, whereas the etiology is complex and multifactorial. Among other factors, this is partly attributed to adverse metabolic effects of antipsychotic and antidepressant medications. This review aims to summarize literature evidence on the diabetogenic effect of commonly used psychiatric medications. Recent Findings: From the first generation antipsychotics, thioridazine and clorpromazine are associated with high, while fluphenazine, aloperidol, and perphenazide with low risk for type 2 diabetes. From the second generation antipsychotics, the highest risk for type 2 diabetes has been found with olanzapine and clozapine, while the risk is low to moderate with the other medications of this category. Anticonvulsants, mood stabilizers, tricyclic, and tetracyclic antidepressants increase mildly to moderately the risk. Selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, serotonin modulators and stimulators, serotonin antagonists and reuptake inhibitors, norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors have not been associated with increased risk for type 2 diabetes. Summary: First and second generation antipsychotics have been associated with increased risk, while anticonvulsants, mood stabilizers, and antidepressants increase modestly the risk for type 2 diabetes. Healthcare professional should be aware of the potential diabetogenic effect of antipsychotic medications and prompt screening is required for the early diagnosis of type 2 diabetes in this population. © 2018, Springer International Publishing AG, part of Springer Nature

B12 deficiency in chronic kidney disease: Early recognition matters

[No abstract available

Rosuvastatin and Colchicine combined myotoxicity: lessons to be learnt

Statins and colchicine co-administration consists of a potentially catastrophic drug-drug interaction since it provokes myotoxicity, myopathy and various degrees of rhabdomyolysis. Lipophilic statins and colchicine are biotransformed in the liver, primarily via CYP3A4 enzyme system leading to elevated blood levels of both agents and resulting in increased potential for combined myotoxicity. Hence, it would be of great clinical importance not only the awareness of this devastating complication but also the more advantageous type of statin that we should choose to achieve the recommended therapeutic goals regarding LDL levels with minimal myopathy risk. Therefore, once colchicine's use is commenced, a hydrophilic statin selection, such as rosuvastatin, seems favorable regarding the risk of myotoxicity. Herein, we aim to describe a patient with chronic kidney disease stage III and nephrotic syndrome that developed acute rhabdomyolysis soon after the administration of rosuvastatin while receiving colchicine. To the best of our knowledge, this is the first report of the combined effect of rosuvastatin and colchicine in the setting of chronic kidney disease leading to myotoxicity. © 2021. Japanese Society of Nephrology

Transcription of the tumor suppressor genes p53 and rb in lymphocytes from patients with chronic kidney disease: Evidence of molecular senescence?

Patients suffering from renal failure exhibit an impaired immune system function. We wanted to investigate the transcription of the tumor suppressor genes p53 and RB to record, if these cells could be stimulated in vitro in order to divide, after the addition of antigenic and inflammatory factors. This expression was measured by real-time PCR in peripheral blood mononuclear cells (PBMCs) from three different groups: ten healthy individuals, ten patients with chronic kidney disease (CKD), and ten dialysis patients with end stage renal disease (ESRD). The transcription rate of these genes was also measured after the cultivation of PBMCs under four different conditions: just with the culture medium, with lipopolysaccharide (LPS), with C-reactive protein (CRP), and with lipoxin A(LXA-LPS. Our results show that in most cases after the cultivation with additives, the transcription levels were higher in dialysis patients compared to those of the other two groups. Our findings serve as indications of cellular senescence on a molecular level, while it seems that these cells are less easily stimulated in vitro in order to duplicate. © 2012 Vasileios Kordinas et al