Glycated Hemoglobin and Risk of Death in Diabetic Patients Treated With Hemodialysis: A Meta-analysis

Background: Studies investigating the association between glycated hemoglobin (HbA) level and mortality risk in diabetic patients receiving hemodialysis have shown conflicting results. 
Study Design: We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, Web of Science, and the Cochrane Library. 
Setting & Population: Diabetic patients on maintenance hemodialysis therapy. 
Selection Criteria for Studies: Observational studies or randomized controlled trials investigating the association between HbA values and mortality risk. Study authors were asked to provide anonymized individual patient data or reanalyze results according to a standard template. 
Predictor: Single measurement or mean HbA values. Mean HbA values were calculated using all individual-patient HbA values during the follow-up period of contributing studies. 
Outcome: HR for mortality risk. 
Results: 10 studies (83,684 participants) were included: 9 observational studies and one secondary analysis of a randomized trial. After adjustment for confounders, patients with baseline HbA levels =8.5% (=69 mmol/mol) had increased mortality (7 studies; HR, 1.14; 95% CI, 1.09-1.19) compared with patients with HbA levels of 6.5%-7.4% (48-57 mmol/mol). Likewise, patients with a mean HbA value =8.5% also had a higher adjusted risk of mortality (6 studies; HR,1.29; 95% CI, 1.23-1.35). There was a small but nonsignificant increase in mortality associated with mean HbA levels =5.4% (=36 mmol/mol; 6 studies; HR, 1.09; 95% CI, 0.89-1.34). Sensitivity analyses in incident (=90 days of hemodialysis) and prevalent patients (>90 days of hemodialysis) showed a similar pattern. In incident patients, mean HbA levels =5.4% also were associated with increased mortality risk (4 studies; HR, 1.29; 95% CI, 1.23-1.35). 
Limitations: Observational study data and inability to adjust for diabetes type in all studies. 
Conclusions: Despite concerns about the utility of HbA measurement in hemodialysis patients, high levels (=8.5%) are associated with increased mortality risk. Very low HbA levels (=5.4%) also may be associated with increased mortality risk. 

Degradable Polymer Networks and Star Polymers Based on Mixtures of Two Cleavable Dimethacrylate Crosslinkers: Synthesis, Characterization, and Degradation

Mixtures of two cleavable dimethacrylate crosslinkers, the hydrolyzable di(methacryloyloxy-1-ethoxy)methane (DMOEM) and the thermolyzable 1,1-ethylene-diol dimethacrylate (EDDMA), were used for the preparation of neat crosslinker polymer networks, randomly crosslinked polymer networks of methyl methacrylate (MMA), and star polymers of MMA, using group transfer polymerization in tetrahydrofuran (THF). All star polymers and randomly crosslinked polymer networks containing mixtures of the hydrolyzable DMOEM and the thermolyzable EDDMA crosslinkers gave THF-soluble final products when subjected to sequential thermolysis and hydrolysis, in this order. When applying sequential hydrolysis and thermolysis, only the star polymers with an EDDMA crosslinker content equal to or higher than 50% gave THF-soluble final products.

Squirrelpox Virus: Assessing Prevalence, Transmission and Environmental Degradation

Red squirrels (Sciurus vulgaris) declined in Great Britain and Ireland during the last century, due to habitat loss and the introduction of grey squirrels (Sciurus carolinensis), which competitively exclude the red squirrel and act as a reservoir for squirrelpox virus (SQPV). The disease is generally fatal to red squirrels and their ecological replacement by grey squirrels is up to 25 times faster where the virus is present. We aimed to determine: (1) the seropositivity and prevalence of SQPV DNA in the invasive and native species at a regional scale; (2) possible SQPV transmission routes; and, (3) virus degradation rates under differing environmental conditions. Grey (n = 208) and red (n = 40) squirrel blood and tissues were sampled. Enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qPCR) techniques established seropositivity and viral DNA presence, respectively. Overall 8% of squirrels sampled (both species combined) had evidence of SQPV DNA in their tissues and 22% were in possession of antibodies. SQPV prevalence in sampled red squirrels was 2.5%. Viral loads were typically low in grey squirrels by comparison to red squirrels. There was a trend for a greater number of positive samples in spring and summer than in winter. Possible transmission routes were identified through the presence of viral DNA in faeces (red squirrels only), urine and ectoparasites (both species). Virus degradation analyses suggested that, after 30 days of exposure to six combinations of environments, there were more intact virus particles in scabs kept in warm (25°C) and dry conditions than in cooler (5 and 15°C) or wet conditions. We conclude that SQPV is present at low prevalence in invasive grey squirrel populations with a lower prevalence in native red squirrels. Virus transmission could occur through urine especially during warm dry summer conditions but, more notably, via ectoparasites, which are shared by both species.

The Host Defence Peptide LL-37 is Susceptible to Proteolytic Degradation by Wound Fluid Isolated from Foot Ulcers of Diabetic Patients

The pleiotropic effects of host defence peptides (HDPs), including the ability to kill microorganisms, enhance re-epithelialisation and increase angiogenesis, indicates a role for these important peptides as potential therapeutic agents in the treatment of chronic, non-healing wounds. However, the maintenance of peptide integrity, through resistance to degradation by the array of proteinases present at the wound site, is a prerequisite for clinical success. In this study we explored the degradation of exogenous LL-37, one such HDP, by wound fluid from diabetic foot ulcers to determine its susceptibility to proteolytic degradation. Our results suggest that LL-37 is unstable in the diabetic foot ulcer microenvironment. Following overnight treatment with wound fluid, LL-37 was completely degraded. Analysis of cleavage sites suggested potential involvement of both host- and bacterial-derived proteinases. The degradation products were shown to retain some antibacterial activity against Pseudomonas aeruginosa but were inactive against Staphylococcus aureus. In conclusion, our data suggest that stabilising selected peptide bonds within the sequence of LL-37 would represent an avenue for future research prior to clinical studies to address its potential as an exogenously-applied therapeutic in diabetic wounds. 

The Application of Computational Chemistry and Chemometrics to Developing a Method for Online Monitoring of Polymer Degradation in the Manufacture of Bioresorbable Medical Implants

Bioresorbable polymers such as PLA have an important role to play in the development of temporary implantable medical devices with significant benefits over traditional therapies. However, development of new devices is hindered by high manufacturing costs associated with difficulties in processing the material. A major problem is the lack of insight on material degradation during processing. In this work, a method of quantifying degradation of PLA using IR spectroscopy coupled with computational chemistry and chemometric modeling is examined. It is shown that the method can predict the quantity of degradation products in solid-state samples with reasonably good accuracy, indicating the potential to adapt the method to developing an on-line sensor for monitoring PLA degradation in real-time during processing.

Degradation, Harm and Survival in a Women’s Prison:Special Issue on Gendered Violence

This article is derived in in-depth qualitative research in the women’s unit of a male prison in Northern Ireland. The researchers had unprecedented observational and interview access and moved freely within the unit including the punishment block. What follows focuses primarily on the experiences of women and girls, recording their accounts of the impact on their lives of a harsh and neglectful regime. It demonstrates how the institutionalisation of violation and neglect within women’s prisons is often gender specific. Finally, it considers the key research recommendations, noting official responses.

Effect of controlled periodic-based illumination on the photonic efficiency of photocatalytic degradation of methyl orange

The use of controlled periodic illumination with UV LEDs for enhancing photonic efficiency of photocatalytic decomposition processes in water has been investigated using methyl orange as a model compound. The impact of the length of light and dark time periods (T _ON/T _OFF times) on photodegradation and photonic efficiency using a UV LED-illuminated photoreactor has been studied. The results have shown an inverse dependency of the photonic efficiency on duty cycle and a very little effect on T _ON or T _OFF time periods, indicating no effect of rate-limiting steps through mass diffusion or adsorption/desorption in the reaction. For this reactor, the photonic efficiency under controlled periodic illumination (CPI) matches to that of continuous illumination, for the same average UV light intensities. Furthermore, under CPI conditions, the photonic efficiency is inversely related to the average UV light intensity in the reactor, in the millisecond time regime. This is the first study that has investigated the effect of controlled periodic illumination using ultra band gap UV LED light sources in the photocatalytic destruction of dye compounds using titanium dioxide. The results not only enhance the understanding of the effect of periodic illumination on photocatalytic processes but also provide a greater insight to the potential of these light sources in photocatalytic reactions. 

The degradation of microcystin-LR using doped visible light absorbing photocatalysts

Microcystins are one of the primary hepatotoxic cyanotoxins released from cyanobacteria. The presence of these compounds in water has resulted in the death of both humans and domestic and wild animals. Although microcystins are chemically stable titanium dioxide photocatalysis has proven to be an effective process for the removal of these compounds in water. One problem with this process is that it requires UV light and therefore in order to develop effective commercial reactor units that could be powered by solar light it is necessary to utilize a photocatalyst that is active with visible light. In this paper we report on the application of four visible light absorbing photocatalysts for the destruction of microcystin-LR in water. The rhodium doped material proved to be the most effective material followed by a carbon-modified titania. The commercially available materials were both relatively poor photocatalysts under visible radiation while the platinum doped catalyst also displayed a limited activity for toxin destruction. © 2009 Elsevier Ltd. All rights reserved.