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Purpose: To highlight the utility of Colorectal Nurse Specialist (CNS) supervised parental administration of rectal washouts in the management of Hirschsprung's disease (HD). Methods: Retrospective case note review of HD patients treated at a tertiary children's hospital in United Kingdom from January 2011 to December 2022. Data collected included demographics, complications, enterocolitis, obstructive symptoms and stomas. Primary pull-through (PT) is done 8–12 weeks after birth. Parental expertise in performing rectal washouts at home is ensured by our CNS team before and after PT. Results: PT was completed in 69 of 74 HD patients. Rectal washouts were attempted on 63 patients before PT. Failure of rectal washout efficacy necessitated a stoma in four patients (6.4%). Of the 65 patients who had PT and stoma closed, three (4.5%) required a further stoma over a mean follow-up period of 57 months (Range 7–144 months). Two of these had intractable diarrhoea due to Total Colonic Aganglionosis (TCA). One patient (1.5%) had unmanageable obstructive symptoms requiring re-diversion. Hirschsprung-associated enterocolitis (HAEC) requiring hospital admission occurred in 14 patients (21%). Conclusion: Our stoma rates are lower compared to recent UK data. This could potentially be due to emphasis on parental ability to perform effective rectal washouts at home under CNS supervision. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) in heart failure (HF) patients is common, present in 49%, and is associated with a higher mortality hazard ratio [2.34 (95% confidence interval 2.20–2.50); P < 0.001] and multiple hospital admissions. The management of HF in CKD can be challenging due to drug-induced electrolyte and creatinine changes, resistance to diuretics and infections related to device therapy. Evidence for improvement in mortality and HF hospitalizations exists in HF with reduced ejection fraction (HFrEF) in Stage 3 CKD patients from randomized controlled trials of angiotensin-converting enzyme inhibitor (ACEi) and mineralocorticoid receptor antagonist therapy but not in dialysis patients, where higher doses can cause hyperkalaemia. Evidence of improvement in cardiovascular death and HF hospitalizations has emerged with the angiotensin receptor neprilysin inhibitor ivabradine and more recently with sodium–glucose cotransporter inhibitors in HFrEF patients with CKD Stages 1–3. However, these studies have excluded CKD Stages 4 and 5 patients. Evidence for β-blocker therapy exists in CKD Stages 1–3 and separately in haemodialysis patients. Cardiac resynchronization therapy reduces HF hospitalizations and mortality in patients with CKD Stages 1–3 but has not been shown to do so in CKD Stages 4 and 5 or dialysis patients. Internal cardioverter and defibrillator therapy in HFrEF patients has been shown to be beneficial in CKD 3 patients but not in dialysis patients, where it is associated with high rates of infection. For HFpEF patients with CKD, therapy is symptomatic, as there is no proven therapy for improvement in survival or hospitalizations. HF patients with end-stage kidney disease with fluid overload may benefit from peritoneal dialysis. A multidisciplinary, personalized approach has been associated with better care and improved patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: To determine the management and outcomes of patients with gastro-oesophageal reflux (GOR) that requires further intervention following failure of Nissen fundoplication (NF). Methods: After institutional audit department approval, a retrospective review of paediatric patients who had further intervention following failure of primary NF between January 2006 and December 2015 for GOR at our centre was performed. Data are presented as median (range). Results: Of 820 patients who underwent NF, 190 (23%) received further procedures for GOR management at a median of 21 months of age (6–186); 90/190 (47%) had gastro-jejunal feeding (GJ). Of these, 67 (74%) remained on GJ feeds up to a median of 48 months and 23/90 (26%) had a second NF after GJ feeding. 97/190 (51%) had a redo fundoplication without having had a GJ; thus, 120/190 (63%) of patients having a further procedure went on to have a second NF after a median period of 15 months (1–70 months). Three patients (2%) had early emergency wrap revision 4 days after first fundoplication (we classed this as an 'early complication'). Of the seven patients who failed a 3rd NF, 4 continued GJ feeding, 2 of had oesophagogastric dissociation; 2 had 4th NF of which 1 was successful and 1 patient had gastric pacemaker and is successfully feeding orally. Patients who were finally successfully managed with GJ underwent 2 (2–5) tube changes/year. We found patients who had a previous GJ were more likely to have failure of the redo fundoplication than those who had not to have the GJ (16/24 vs. 30/90, p = 0.005). Conclusion: The chance of success decreases with every further attempt at fundoplication. The only factor significantly associated with failure of redo fundoplication was whether the patient previously had a GJ tube. In patients with failed fundoplications, when symptom free on jejunal feedings, further anti-reflux surgical intervention should be avoided. A randomized prospective study is needed for patient selection. [ABSTRACT FROM AUTHOR]

We discuss the extraction of the ground state 〈 K (p) | V μ (0) | B s (0) 〉 matrix elements from Euclidean lattice correlation functions. The emphasis is on the elimination of excited state contributions. Two typical gauge-field ensembles with lattice spacings 0.075, 0.05 fm and pion masses 330, 270 MeV are used from the O (a) -improved CLS 2-flavor simulations and the final state momentum is | p | = 0. 5  GeV. The b-quark is treated in HQET including the 1 / m b corrections. Fits to two-point and three-point correlation functions and suitable ratios including summed ratios are used, yielding consistent results with precision of around 2% which is not limited by the 1 / m b corrections but by the dominating static form factors. Excited state contributions are under reasonable control but are the bottleneck towards precision. We do not yet include a specific investigation of multi-hadron contaminations, a gap in the literature which ought to be filled soon. [ABSTRACT FROM AUTHOR]

The propagation of a low momentum heavy quark in a deconfined quark-gluon plasma can be understood in terms of a Langevin description. The momentum exchange with the plasma in thermal equilibrium can then be parametrized in terms of a single heavy quark momentum diffusion coefficient κ , which needs to be determined nonperturbatively. In this work, we study the temperature dependence of κ for a static quark in a gluonic plasma, with a particular emphasis on the temperature range of interest for heavy ion collision experiments. [ABSTRACT FROM AUTHOR]

Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. Currently, there is no consensus regarding the best time for stoma closure (SC). Our aim was to determine the outcomes of early versus late closure.Methods: Retrospective analysis of patients who underwent SC following stoma formation for NEC between Jan 2009 and July 2015 was done. Early (EC) versus late closure (LC) was defined as less than 10 weeks versus at or after 10 weeks of stoma formation.Results: Of 36 patients, M:F was 23:13. Indications for laparotomy were pneumoperitoneum (30) and gangrene (6). Postoperatively, 9/15 (60.0%) of EC group required ventilator support versus none in LC group (p < 0.05). It took longer to establish full feeds following EC (12 days) versus LC (8 days). Median duration of postoperative hospital stay following EC was 31 days (18-35) versus 7 days (4-54) following LC. Three patients were re-operated for intestinal obstruction (two following EC, one following LC). Three patients developed incisional hernia after EC versus none after LC (p < 0.05). One patient died after EC due to staphylococcus septicaemia.Conclusion: Early closure before 10 weeks of formation for NEC patients is associated with significant morbidity, increased ventilator requirements and chances of developing incisional hernia. [ABSTRACT FROM AUTHOR]

Introduction. Hypertension, particularly pulse pressure [PP] is a major risk factor for end-stage renal disease. However, the effect of individual components of hypertension namely PP, systolic [SBP] and diastolic blood pressure [DBP] on kidney function, in the general African population is unknown. Methods. Data were collected on 944 participants [aged 40-75 y], living in villages in the area around the city of Kumasi, Ghana, on demographics, medications, height, weight, BP and 24-hour creatinine clearance (CrCl). Results. The demographic and clinical characteristics were: age 55(11) [mean (SD)] years, females 62%, rural village-dwellers 52%, diabetes 1·5%, BMI 21(4) kg/m2, 24-hourCrCl as a measure of glomerular filtration rate (GFR) 84(23) ml/min/1.73 m2. 29% had BP >140/90 mmHg; SBP and DBP were 125/74(26/14) mmHg, PP was 51(17) mmHg. PP increased with age by 0.55(95% CI: 0.46,0.64) mmHg/year. PP was higher (53(17) v 49(15) mmHg; p < 0.001) in the semiurban participants. GFR decreased both with increasing PP [-0.19 (-0.27,-0.10 ml/min/1.73 m2/mmHg; p < 0.001] and SBP [-0.09 (-0.14,-0.03) ml/min/1.73 m2/mmHg; p < 0.001] but there was no significant relationship with DBP [-0.04 (-0.15,0.06)]. After adjusting for SBP, the relationship between GFR and PP became steeper [-0.31 (-0.50,-0.12) ml/min/1.73 m2/mmHg; p < 0.001]. Using multivariate regression analysis that included PP, age, gender, BMI, only increasing age [-0.75 (-0.88,-0.62)] and decreasing BMI [0.49 (0.16,0.81)] were associated with decreased kidney function. Conclusions. In this homogeneous West-African population, PP increased with age and had a steeper relationship with declining kidney function than SBP or DBP. [ABSTRACT FROM AUTHOR]

ABSTRACT Loading a capacitor into a metallic loop allows one to tune the resonance frequency of the induced current on the loop and enhance the current amplitude for the normally incident magnetic field. We show that in an array of variable-capacitor-loaded loops, a null spot of the magnetic field generated some distance away can be moved laterally and crossed the array by manipulating current amplitude of each loop via the variable capacitor. We develop an analytic model for expressing the curl of the current source on the loop by using the delta function so that the magnetic field behavior in the vicinity of the array is characterized together with physical insight. Moreover, the control of a null spot is explained by the decomposition of the curl of current sources. The concept of a null-spot control is crucial for manipulating the kilohertz/megahertz magnetic field. © 2015 Wiley Periodicals, Inc. Microwave Opt Technol Lett 57:2891-2895, 2015 [ABSTRACT FROM AUTHOR]

Sudden Cardiac Death in Chronic Kidney Disease The review discusses the epidemiology and the possible underlying mechanisms of sudden cardiac death (SCD) in chronic kidney disease (CKD), and highlights the unmet clinical need for noninvasive risk stratification strategies in these patients. Although renal dysfunction shares common risk factors and often coexists with atherosclerotic cardiovascular disease, the presence of renal impairment increases the risk of arrhythmic complications to an extent that cannot be explained by the severity of the atherosclerotic process. Renal impairment is an independent risk factor for SCD from the early stages of CKD; the risk increases as renal function declines and reaches very high levels in patients with end-stage renal disease on dialysis. Autonomic imbalance, uremic cardiomyopathy, and electrolyte disturbances likely play a role in increasing the arrhythmic risk and can be potential targets for treatment. Cardioverter defibrillator treatment could be offered as lifesaving treatment in selected patients, although selection strategies for this treatment mode are presently problematic in dialyzed patients. The review also examines the current experience with risk stratification tools in renal patients and suggests that noninvasive electrophysiological testing during dialysis may be of clinical value as it provides the necessary standardized environment for reproducible measurements for risk stratification purposes. [ABSTRACT FROM AUTHOR]

ABSTRACT: Aim: Cardiovascular disease (CVD) is the leading cause of death among chronic kidney disease (CKD) patients. The role of vitamin D remains controversial in this process. We evaluated the relationship between 25-hydroxyvitamin D, abnormal T helper cells (CD4+CD28null cells), systemic inflammation and atherosclerosis in CKD patients. Methods: A total of 101 stage 4-5 non-dialysis CKD patients and 40 healthy controls were studied. Common carotid artery intima media thickness (CCA-IMT) was measured with an ultrasound system. 25(OH) vitamin D and highly sensitive C-reactive protein (hsCRP) were measured in serum by enzyme linked immunosorbent assay. The frequency of circulating CD4+CD28null cells was evaluated by flowcytometry. Results: CKD subjects exhibited higher CCA-IMT (0.71 ± 0.01 vs 0.56 ± 0.01 mm, P < 0.0001), hsCRP (90.7 ± 5.8 vs 50.1 ± 8.6 µg/mL, P < 0.0001), CD4+CD28null cell frequency (9.1 ± 0.9 vs 3.6 ± 0.5%, P < 0.0001) and lower 25(OH) vitamin D levels (17.9 ± 1.9 vs 26.9 ± 3.5 ng/mL, P < 0.0001). In CKD subjects, serum 25 (OH) vitamin D level showed a strong inverse correlation with CCA-IMT ( r = −0.729, P < 0.0001) and correlated with CD4+CD28null cell frequency ( r = −0.249, P = 0.01) and hsCRP ( r = −0.2, P = 0.047). We also noted correlation of IMT with patient age ( r = 0.291, P = 0.004) and CD4+CD28null cells ( r = 0.34, P = 0.001). On multiple regression analysis, 25(OH) vitamin D level, diabetic status and CD4+CD28null cell frequency exhibited independent association with IMT in CKD subjects. Conclusions: Vitamin D deficiency, inflammatory activation and higher frequency of CD4+CD28null T lymphocyte population correlate with preclinical atherosclerotic changes in CKD population. These findings suggest possible linkage between vitamin D metabolism and T cell modulation - abnormalities that may contribute to development of atherosclerosis in CKD. [ABSTRACT FROM AUTHOR]

Abstract: We report a Density Functional Theory (DFT) study on the electrochemical deposition process of Mg. We studied the impact of the thermodynamics and the kinetics to the morphologies of the deposited phases. Our analysis showed that the free energy difference between high dimensional and low dimensional phases was higher for Mg than for Li as a result of the stronger Mgtrength. On the other hand, the migration barriers of Li and Mg showed close values. These findings indicated that the electrochemically deposited Mg essentially prefers to form crystalline layers in comparison with Li due to the intrinsic thermodynamic properties. It suggested that Mg anode provides not only high energy densities, but also the potential to avoid the issues caused by the growth of dendrites. [Copyright &y& Elsevier]

Abstract: Background: Cardiovascular morbidity and mortality are high in chronic kidney disease (CKD) patients compared to the general population. Systemic inflammation may contribute to endothelial dysfunction and accelerated atherosclerosis in CKD patients. We assessed the relationship among, endothelial dysfunction, early atherosclerosis and inflammation in predialysis, dialysis and post kidney-transplantation CKD patients. Methods and results: We studied 76 consecutive CKD patients; 38 predialysis, 18 haemodialysis and 22 kidney-transplant patients. A group of 65 age and gender matched controls were also studied. In both patients and controls, high-sensitivity C-reactive protein (CRP) levels, systemic endothelial function (brachial artery flow mediated dilation, FMD,%) and carotid artery intima-media thickness (IMT, mm) were measured. CKD patients had increased CRP levels (3.7 [1.0–6.0]mg/L vs 1.0 [0.5–2.1]mg/L; p <0.001), reduced FMD (2.2 [1.0–4.0] vs 5.6 [4.4–7.1]; p <0.001) and increased IMT (0.82±0.21 vs 0.67±0.16; p <0.001) values compared to controls. In CKD patients, a significant negative correlation was found between CRP levels and FMD responses (r =−0.51; p <0.001) while a significant positive correlation was found between CRP and IMT values (r =0.50; p <0.001). Increased CRP levels were an independent predictor of both abnormal FMD and IMT after adjusting for age, systolic and diastolic BP and total cholesterol. Compared with predialysis and kidney-transplant patients, haemodialysis subjects had significantly lower FMD and higher CRP and IMT values. Conclusions: CKD patients taken together have a higher inflammatory status compared to controls. Abnormal FMD responses and IMT values are more commonly found in dialysis patients. Our findings suggest that endothelial dysfunction and atherosclerotic changes correlate with inflammation. [Copyright &y& Elsevier]

Structural colors are caused by light interference from periodic multi-layer dielectric stacks and exhibit rich, highly-chromatic colors. However, avoiding a color shift due to angular variation remains a challenge. The design criteria for angle-independent structural colors have been studied by treating a quarter-wave stack of alternating dielectric material layers as a one-dimensional photonic crystal. A refractive index zone has been identified that exhibits narrowband omnidirectionality for structural colors in the visible wavelength range. It was found that a quarter-wave stack of high refractive index (RI) paired-layers (nH = 2.85 and nL = 2.5), which have low RI contrast (nH/nL = 1.14), is key in fabricating omnidirectional structural color materials. The theoretical predictions discussed here are verified experimentally using a titania/halfnia (TiO2/HfO2) multilayer stack. [ABSTRACT FROM AUTHOR]

The by-product chlorophosphazenes obtained from the reaction of PCl and NHCl at ∼ 140°, have been characterized by 2D P-N HMQC and DOSY NMR spectroscopy. These NMR spectra show that the byproducts are a very complex mixture. [ABSTRACT FROM AUTHOR]

Abstract: One of the major limitations to preclinical mouse therapeutic evaluation is the inherent difficulty in imaging small tumors in vivo. We present a rapid and reliable method to detect optic glioma (OPG) in a mouse neurofibromatosis-1 model (Nf1 flox/mutGFAP-Cre mice) in vivo using Manganese-Enhanced Magnetic Resonance Imaging (MEMRI). In a blinded study, 23 mice were chosen randomly from a cohort of Nf1 flox/mutGFAP-Cre mice and two sets of age-matched controls. In all cases, OPG presence or absence was correctly identified. In addition, the OPG size and shape were accurately measured in vivo, facilitating the use of this model for preclinical drug studies. [Copyright &y& Elsevier]

The inclusion complex of a new transition metal ligand, 2,4,9-trithia-tricyclo[3.3.1.1 3,7 ]decane-7-carboxylic acid (2,4,9-trithia-adamantane-7-carboxylic acid, TPCOOH) in ß-cyclodextrin was studied by 1 H NMR, 2D NOESY NMR spectroscopy, host-induced CD spectroscopy, and tandem mass spectrometry. 1 H NMR, MS–MS and NOESY data show that the TPCOOH guest forms a 1:1 inclusion complex with the host ß-cyclodextrin. The NOESY experiments also show that TPCOOH is oriented in the complex with the thioketal end preferentially located at the larger opening of ß-cyclodextrin. The orientation of the guest in the host molecule is also confirmed by the induced CD of the ligand, which shows a positive Cotton effect. An association constant of 660±20?M -1 was determined by 1 H NMR titration for the complex at room temperature in D2O. [ABSTRACT FROM AUTHOR]

A new resin has been synthesized by functionalisation of polystyrene-divinylbenzene (8%) with imidazole 4,5-dicarboxylic acid through –N=N– bonding. The resulting resin has been characterised by elemental analysis, thermogravimetric analysis, infrared spectroscopy, hydrogen ion capacity and metal ion capacity. The speciation study of vanadium has been studied by using this resin and the maximum exchange capacity was found to be 0.45 mmol g-1 for V4+ and that for V5+ was 1.57 mmol g-1 at pH 3 for both. The eluents malonic acid and sodium hydroxide have been used for the selective separation of vanadium(IV) and vanadium(V) species respectively. The effects of diverse ions on the sorption and recovery of each species have been studied. Finally, the developed method has been applied for the speciation and determination of these two species in natural water samples. [ABSTRACT FROM AUTHOR]

We consider the spectrum of a U(1) quantum link model where gauge fields are realized as S=1/2 spins and demonstrate a new mechanism for generating quantum many-body scars (high-energy eigenstates that violate the eigenstate thermalization hypothesis) in a constrained Hilbert space. Many-body dynamics with local constraints has attracted much attention due to the recent discovery of nonergodic behavior in quantum simulators based on Rydberg atoms. Lattice gauge theories provide natural examples of constrained systems since physical states must be gauge invariant. In our case, the Hamiltonian H=Okin+λOpot, where Opot (Okin) is diagonal (off-diagonal) in the electric flux basis, contains exact midspectrum zero modes at λ=0 whose number grows exponentially with system size. This massive degeneracy is lifted at any nonzero λ but some special linear combinations that simultaneously diagonalize Okin and Opot survive as quantum many-body scars, suggesting an "order-by-disorder" mechanism in the Hilbert space. We give evidence for such scars and show their dynamical consequences on two-leg ladders with up to 56 spins, which may be tested using available proposals of quantum simulators. Results on wider ladders point towards their presence in two dimensions as well. [ABSTRACT FROM AUTHOR]

It is known that total absorption of flexural waves in a thin beam is possible through the use of monopole-dipole scatterers. In this study, we introduce a pair of identical monopole scatterers for near-total absorption of flexural waves in a thin and wide beam. Despite the two scatterers being both of the monopole type, the resonant modes of the scatterer pair exhibit monopole and dipole properties. By selecting the proper width for the beam, the two resonant modes degenerate, which leads to the total absorption. Although the beam is considerably wide, the frequency range of interest remains below the cut-on frequency of the n = 1 propagating mode, ensuring one-dimensional flexural wave propagation. Further simulations and theoretical analysis revealed that the degeneracy of the monopole and dipole modes results from their interaction with a higher-order localized flexural mode. The simulation results demonstrate absorption exceeding 99%, complemented by experimental data showing approximately 90% absorption. [ABSTRACT FROM AUTHOR]

Guideline‐directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set‐up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up‐to‐date evidence. [ABSTRACT FROM AUTHOR]

Purpose: Acute kidney injury (AKI) associated with COVID‐19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID‐19 on the progression and clinical outcomes of patients with AKI. Methods: Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing‐risk and multi‐state models, have revealed insights into AKI progression dynamics associated with PCR‐confirmed COVID‐19 acquisition and death. Meta‐analyses of case fatality ratios among patients with AKI were also conducted. Results: The overall case‐fatality ratio was 0.33 [95% CI (0.20–0.36)]; higher in COVID‐19 positive (COVID+) patients 0.52 [95% CI (0.46–0.58)] than in their negative (COVID‐) counterparts 0.16 [95% CI (0.12–0.20)]. In AKI Stage‐3 patients, that was 0.71 [95% CI (0.64–0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25–0.44)] in the COVID‐ group and 28% died within 14 days. Among patients diagnosed with AKI Stage‐1 within 24 h, the probability of progression to AKI Stage‐3 on day 7 post admission was 0.22 [95% CI (0.17–0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID‐ patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage‐3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)]. Conclusion: These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage‐3 patients, significantly exacerbated by COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Misuse of computer information systems has caused significant losses to business and society, even though computing has benefited both businesses and professionals. To this end, several measures have been suggested that both prevent and deter losses. One deterrent measure is to identify individual and situational characteristics of people who act ethically/unethically. This study identifies specific characteristics that are associated with and may influence the ethical behavior intention of information systems employees when faced with ethical dilemmas. The results of the study show that individual and situational characteristics do influence ethical behavior intention. [ABSTRACT FROM AUTHOR]

Here, we show, analytically and numerically, that in a pair of metallic periodic-ladder structures placed with a central gap, the normally incident magnetic field is focused on a spot of 3 mm (0.6 × 10-5 free space wavelength) full width at half maximum at a 1 mm distance away at 600 kHz. The ladder structures are designed by exploiting the curl of the induced current at each unit cell in the periodic structure. This investigation paves the way for kilohertz magnetic field manipulations. [ABSTRACT FROM AUTHOR]

Arteriovenous grafts used for hemodialysis can produce high-output cardiac failure as a result of shunting of blood through the dialysis access. The following case demonstrates that the problem can occur shortly after graft formation and improved with graft ligation. It caused haemodynamic compromise because of previously undiagnosed, underlying valvular heart disease. It also caused a diagnostic difficulty in the immediate postoperative period as it was mistaken for postsurgical hemorrhage. [ABSTRACT FROM AUTHOR]

A 2-month-old girl came with breathlessness of 5 days. duration. Clinical examination and plain chest radiograph showed it to be pleural effusion. On sonographically guided aspiration, the effusion fluid was found to be chyle. Introduction of intercostal thoracic drainage tube and antibiotics helped the baby to recover. It is mainly the role of nutritional support in the form of using medium-chain-triglyceride.containing feed, which is discussed in details in the case report. There was no need of any surgery. [ABSTRACT FROM AUTHOR]

We study the O (4) Wilson-Fisher fixed point in 2 + 1 dimensions in fixed large-charge sectors identified by products of two spin- j representations (jL, jR). Using effective field theory we derive a formula for the conformal dimensions D (jL, jR) of the leading operator in terms of two constants, c3/2 and c1/2, when the sum jL + jR is much larger than the difference | jL - jR|. We compute D (jL, jR) when jL = jR with Monte Carlo calculations in a discrete formulation of the O (4) lattice field theory, and show excellent agreement with the predicted formula and estimate c3/2 = 1.068 (4) and c1/2 = 0.083 (3). [ABSTRACT FROM AUTHOR]

Sodium and fluid restriction has traditionally been advocated in patients with heart failure (HF) due to their sodium and water avid state. However, most evidence regarding the altered sodium handling, fluid homeostasis and congestion‐related signs and symptoms in patients with HF originates from untreated patient cohorts and physiological investigations. Recent data challenge the beneficial role of dietary sodium and fluid restriction in HF. Consequently, the European Society of Cardiology HF guidelines have gradually downgraded these recommendations over time, now advising for the limitation of salt intake to no more than 5 g/day in patients with HF, while contemplating fluid restriction of 1.5–2 L/day only in selected patients. Therefore, the objective of this clinical consensus statement is to provide advice on fluid and sodium intake in patients with acute and chronic HF, based on contemporary evidence and expert opinion. [ABSTRACT FROM AUTHOR]

Quantum link models (QLMs) are extensions of Wilson-type lattice gauge theories which realize exact gauge invariance with finite-dimensional Hilbert spaces. QLMs not only reproduce standard features of Wilson lattice gauge theories in equilibrium, but can also host new phenomena such as crystalline confined phases. The local constraints due to gauge invariance also provide kinetic restrictions that can influence substantially the real-time dynamics in these systems. We aim to characterize the nonequilibrium evolution in lattice gauge theories through the lens of dynamical quantum phase transitions, which provide general principles for real-time dynamics in quantum many-body systems. Specifically, we study quantum quenches for two representative cases, U(1) QLMs in (1+1)D and (2+1)D, for initial conditions exhibiting long-range order. Finally, we discuss the connection to the high-energy perspective and the experimental feasibility to observe the discussed phenomena in recent quantum simulator settings such as trapped ions, ultracold atoms, and Rydberg atoms. [ABSTRACT FROM AUTHOR]

We construct an efficient Monte Carlo algorithm that overcomes the severe signal-to-noise ratio problems and helps us to accurately compute the conformal dimensions of large-Q fields at the Wilson-Fisher fixed point in the O(2) universality class. Using it, we verify a recent proposal that conformal dimensions of strongly coupled conformal field theories with a global U(1) charge can be obtained via a series expansion in the inverse charge 1/Q. We find that the conformal dimensions of the lowest operator with a fixed charge Q are almost entirely determined by the first few terms in the series. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) experience excess cardiovascular morbidity and mortality that is unexplained by traditional cardiovascular risk factors. Vitamin D deficiency is highly prevalent in CKD and is associated with increased cardiovascular mortality in both the general population and in CKD patients. Vitamin D supplementation is a reasonably safe and simple intervention and meta‐analyses of observational studies have suggested that vitamin D supplementation in CKD improves cardiovascular mortality. However, randomized controlled trials examining the impact of vitamin D supplementation in improving surrogate markers of cardiovascular structure and function remain inconclusive. This review investigates the impact of vitamin D supplementation on surrogate end‐points and cardiovascular events from trials in CKD; and discusses why results have been heterogenous, particularly critiquing the effect of different dosing regimens and the failure to take into account the implications of vitamin D supplementation in study participants with differing vitamin D binding protein genotypes. SUMMARY AT A GLANCE: The authors of this review have assessed the impact of vitamin D supplementation on surrogate end‐points and cardiovascular events from trials in chronic kidney disease (CKD); and discussed why results have been heterogenous, particularly critiquing the effect of different dosing regimens and the failure to take into account the implications of vitamin D supplementation in study participants with differing vitamin D binding protein genotypes. They have stated that with consideration of the evidence they have shown, the nephrology community may be able to find the right dose of vitamin D for the right patient to improve cardiovascular morbidity and mortality in CKD population. [ABSTRACT FROM AUTHOR]

Aim: To conduct a systematic review of observational studies to explore the real‐world kidney benefits of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in a large and diverse population of adults with type 2 diabetes (T2D). Materials and Methods: We searched MEDLINE, EMBASE and Web of Science for observational studies that investigated kidney disease progression in adults with T2D treated with SGLT2 inhibitors compared to other glucose‐lowering therapies. Studies published from database inception to July 2022 were independently reviewed by two authors and evaluated using the Risk of Bias in Non‐randomized Studies of Interventions (ROBINS‐I) tool. A random‐effects meta‐analysis was performed on studies with comparable outcome data, reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: We identified 34 studies performed across 15 countries with a total population of 1 494 373 for inclusion. In the meta‐analysis of 20 studies, SGLT2 inhibitors were associated with a 46% lower risk of kidney failure events compared with other glucose‐lowering drugs (HR 0.54, 95% CI 0.47–0.63). This finding was consistent across multiple sensitivity analyses and was independent of baseline estimated glomerular filtration rate (eGFR) or albuminuria status. SGLT2 inhibitors were associated with a lower risk of kidney failure when compared with dipeptidyl peptidase‐4 inhibitors and a combination of other glucose‐lowering drug classes (HR 0.50, 95% CI 0.38–0.67 and HR 0.51, 95% CI 0.44–0.59, respectively). However, when compared to glucagon‐like peptide 1 receptor agonists there was no statistically significant difference in the risk of kidney failure (HR 0.93, 95% CI 0.80–1.09). Conclusions: The reno‐protective benefits of SGLT2 inhibitors apply to a broad population of adults with T2D treated in routine clinical practice, including those at lower risk of kidney events with normal eGFR and without albuminuria. These findings support the early use of SGLT2 inhibitors in T2D for preservation of kidney health. [ABSTRACT FROM AUTHOR]

Investigations of invisibility cloaks have been led by rigorous theories and such cloak structures, in general, require extreme material parameters. Consequently, it is challenging to realize them, particularly in the full visible region. Due to the insensitivity of human eyes to the polarization and phase of light, cloaking a large object in the full visible region has been recently realized by a simplified theory. Here, we experimentally demonstrate a device concept where a large object can be concealed in a cloak structure and at the same time any images can be projected through it by utilizing a distinctively different approach; the cloaking via one polarization and the image projection via the other orthogonal polarization. Our device structure consists of commercially available optical components such as polarizers and mirrors, and therefore, provides a significant further step towards practical application scenarios such as transparent devices and see-through displays. [ABSTRACT FROM AUTHOR]

Optical invisibility, which started in the pages of fiction before becoming an intriguing quest of humankind for over a century, has blossomed into a remarkable scientific journey toward reality over the last two decades. Perfect optical cloaking requires the total scattering of electromagnetic waves around an object at all angles, all polarizations, over a wide frequency range, irrespective of the medium. Such a device is still far-fetched, requiring the transformation of space around a cloaked region such that the phase velocity is faster than other areas to preserve the phase relationships. However, by simplifying the invisibility requirements, pioneering work on spherical transformation cloaks, carpet cloaks, plasmonic cloaks, and mantle cloaks has been realized in narrowband microwave, infrared, and even optical wavelengths. In this Tutorial, we review the theoretical basis for invisibility cloaking, from spherical transformational optics to non-Euclidian cases, and discuss their limitations. Subsequently, we highlight the recent trends in realizing reconfigurable intelligent cloaks to overcome the traditional limitations of wideband operation and parallel efforts in unidirectional cloaking. Because the human eye is insensitive to the phase and polarization of visible light, a class of ray optics cloaking devices has been recently developed by eliminating phase preservation requirements. Notably, we focus on the recent progress achieved on invisibility cloaks that function in natural incoherent light and can be realized using standard optical components. We conclude this Tutorial with a prospective of potential applications and the practicality of optical cloaks in everyday life. [ABSTRACT FROM AUTHOR]

The population with concomitant heart and kidney disease (often termed 'cardiorenal' disease) is expected to grow, significantly impacting public health and healthcare utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated and specialized care would be a positive shift towards improving patient outcomes and optimizing healthcare resources. This article aims to define the organizational aspects and key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency, cardiovascular disease and abnormal bone mineral metabolism are common in chronic kidney disease (CKD). Abnormal bone mineral metabolism has been linked to vascular calcification in CKD. Sclerostin has emerged as an important messenger in cross talk between bone-vascular axis. We analyzed sclerostin in subjects who participated in the randomized, double blind, placebo controlled trial investigating the effect of cholecalciferol supplementation on vascular function in non­diabetic CKD stage G3-4 and vitamin D ≤ 20 ng/ml [CTRI/2013/05/003648]. Patients were randomized (1:1) to receive either two directly observed oral doses of 300,000 IU of cholecalciferol or matching placebo at baseline and 8 weeks. Of the 120 subjects enrolled, 58 in the cholecalciferol group and 59 in the placebo group completed the study. At baseline, serum levels of sclerostin were similar in both groups (cholecalciferol - median;190pg/ml, IQR;140–260 pg/ml and placebo - median;180 pg/ml, IQR; 140–240 pg/ml, p = 0.67). 16 weeks after cholecalciferol supplementation, there was no change in level of sclerostin (mean change;1.10 pg/ml, 95%CI; −27.34 to 29.34 pg/ml, p = 0.25). However, a significant decrease in sclerostin level was noted in the placebo group (mean change; −31.94 pg/ml, 95%CI; −54.76 to −9.13 pg/ml, p = 0.002). Change (Δ) in sclerostin level at 16 weeks correlated negatively with Δ eGFR (r = −0.20, p = 0.03) and positively with Δuric acid (r = 0.37, p < 0.001) but not with Δ25(OH) D (r = 0.06, p = 0.54), Δ iPTH (r = − 0.03, p = 0.78) ΔFGF23 (r = − 0.08, p = 0.38) and Δ125 (OH) 2 D (r = − 0.04, p = 0.65). In conclusion, high dose cholecalciferol supplementation did not change sclerostin levels in non-diabetic stage 3–4 CKD subjects. [ABSTRACT FROM AUTHOR]

The article presents the author's opinion on the importance of a dedicated vascular access team. According to the author, for a dialysis physician, task of planning and maintaining proper vascular access could be agonizing. He states that the task becomes much easier if there is a dedicated vascular access team that shares the responsibilities and ensures the highest quality of access service.

Wide-angle, polarization-independent structural reflective colors from both directions based on a one-dimensional photonic crystal are demonstrated. Our device produces a distinct and saturated color with high angular tolerant performance up to ±70° for any polarization state of an incident light wave, which is highly desirable for a broad range of research areas. Moreover, the purity of the color and luminous intensity of the proposed device are improved as compared to conventional colorant-based color filters and colloidal glasses. The present approach may have the potential to replace existing color filters and pigments and pave the way for various applications, including color displays and image sensor technologies. [ABSTRACT FROM AUTHOR]

Aims: Increased pulse pressure (PP) is associated with increased cardiovascular mortality in haemodialysis (HD) patients. Autonomic imbalance is common in HD patients and predisposes to sudden cardiac death, but its relationship to PP is unknown. We investigated the relationship between cardiac autonomic modulation assessed by heart rate variability (HRV) and PP in HD patients. Methods: Continuous electrocardiograms recorded during HD sessions were repeated 5 times at 2-week intervals in stable HD patients. The high-frequency (HF) and low-frequency (LF) components and the LF/HF ratio of HRV were calculated during the first and last hour of the recordings. These values and the corresponding systolic blood pressure (SBP), diastolic blood pressure (DBP) and PP measurements were averaged in repeated recordings of each patient. Results: Seventy-six patients were included in the final analysis (aged 61 ± 15 years, 32% females, 37% diabetics). In male patients, LF/HF correlated inversely with pre- and post-HD PP (r = -0.369, p = 0.007 and r = -0.546, p = 0.000, respectively), positively with pre- and post-HD DBP (r = 0.358, p = 0.009 and r = 0.306, p = 0.028, respectively) and inversely with post-HD SBP (r = -0.350, p = 0.011). In female patients, LF/HF correlated positively with post-HD SBP (r = 0.422, p = 0.040). Conclusion: We observed an association between PP and HRV in male HD patients. Sex differences may be important for cardiac risk assessment. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end‐stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co‐transporter‐2 (SGLT‐2) inhibitors. SGLT‐2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno‐protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021 guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology. [ABSTRACT FROM AUTHOR]

Active acoustic metamaterials incorporate electric circuit elements that input energy into an otherwise passive medium to aptly modulate the effective material properties. Here, we propose an active acoustic metamaterial with Willis coupling to drastically extend the tunability of the effective density and bulk modulus with the accessible parameter range enlarged by at least two orders of magnitude compared to that of a non-Willis metamaterial. Traditional active metamaterial designs are based on local resonances without considering the Willis coupling that limit their accessible effective material parameter range. Our design adopts a unit cell structure with two sensor-transducer pairs coupling the acoustic response on both sides of the metamaterial by detecting incident waves and driving active signals asymmetrically superimposed onto the passive response of the material. The Willis coupling results from feedback control circuits with unequal gains. These asymmetric feedback control circuits use Willis coupling to expand the accessible range of the effective density and bulk modulus of the metamaterial. The extreme effective material parameters realizable by the metamaterials will remarkably broaden their applications in biomedical imaging, noise control, and transformation acoustics-based cloaking. [ABSTRACT FROM AUTHOR]

Background: Depressed heart rate variability (HRV) reflects abnormal cardiac autonomic regulation and has been linked with increased cardiovascular risk and sudden cardiac death. High parathyroid hormone (PTH) levels have also been associated with an increased risk of sudden cardiac death in haemodialysis (HD) patients. Our aim was to investigate the association between HRV indices and PTH in HD patients. Methods: Continuous intradialytic electrocardiograms were repeated in stable HD patients 5 times every 2 weeks. The absolute values of high-frequency (HF) and low-frequency (LF) HRV components were calculated every 5 min and averaged during the first and last hour of each recording (distinguished by subscripts F and L, respectively). Pre-HD PTH, corrected calcium, and phosphate levels were measured before the first recording. Results: Data were analysed for 75 subjects aged 60 ± 15, 32% females, 37% diabetics. Baseline biochemical parameters were PTH 44 ± 32 pmol/l, calcium 2.3 ± 0.2 mmol/l, and phosphate 1.6 ± 0.4 mmol/l. All HRV indices showed intra-subject stability over the 5 recordings. Diabetics had lower LFL compared to non-diabetics (-5.5 ± 0.5 vs. -5.2 ± 0.5 after logarithmic transformation, p = 0.012). In non-diabetics, PTH correlated negatively with LFL and HFL (LFL r = -0.340, p = 0.020, HFL r = -0.325, p = 0.026) and phosphate correlated negatively with LFF (r = -0.427, p = 0.003), HFF (r = -0.442, p = 0.002) and HFL (r = -0.307, p = 0.040). Conclusion: High PTH and phosphate are associated with depressed HRV in non-diabetic dialysis patients. Prospective studies are needed to evaluate the role of mineral abnormalities in autonomic imbalance and arrhythmic risk in HD patients. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Highlights: [•] Band structures of ZnTe:O alloy highly depends on the status of oxygen. [•] Clustered oxygen lowers the bandgap while isolated oxygen increases the bandgap. [•] The solar adsorption efficiency of ZnTe:O can be improved by oxygen clustering. [ABSTRACT FROM AUTHOR]

Abstract: The focus of this paper is to show that the magnetic force generated by a linear actuator may be enhanced through the optimization and design of the devices air-gap magnetic field distribution. Specifically, the use of a periodic ladder structure is proposed for magnetic field manipulation, and a simplified finite element analysis is adopted in lieu of a higher cost computational model. The optimal magnetic field distribution that maximizes the actuator force is then found via structural topology optimization. This force enhancement is explained using a Maxwell stress tensor analysis and validated through experimental studies. Finally, a periodic-ladder structure is designed for an equivalent optimal magnetic field distribution, and the linear actuator force enhancement is confirmed. [Copyright &y& Elsevier]