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Objective To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. Design Network meta-analysis. Data sources Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. Eligibility criteria for selecting studies Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. Main outcome measures Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. Results 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 3 to 40 fewer deaths in 1000 patients over five years; see interactive decision support tool ( https://magicevidence.org/match-it/200820dist/#!/ ) for all outcomes. Conclusions In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with some differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. Systematic review registration PROSPERO CRD42019153180.

In order to investigate the necessary device improvements for high-temperature CO sensing with SiC metal insulator semiconductor field effect transistor (MISFET)-based chemical gas sensors, devices employing, as the gas-sensitive gate contact, a film of co-deposited Pt/Al2O3 instead of the commonly used catalytic metal-based contacts were fabricated and characterized for CO detection at elevated temperatures and different CO and O2 levels. It can be concluded that the sensing mechanism at elevated temperatures correlates with oxygen removal from the sensor surface rather than the surface CO coverage as observed at lower temperatures. The long-term stability performance was also shown to be improved compared to that of previously studied devices.

The introduction of silicon carbide as the semiconductor in gas-sensitive field effect devices has disruptively improved this sensor platform extending the operation temperature to more than 600 °C ...

Owing to their higher intrinsic electrical conductivity and chemical stability with respect to their oxide counterparts, nanostructured metal sulfides are expected to revive materials for resistive chemical sensor applications. Herein, we explore the gas sensing behavior of WS2 nanowire-nanoflake hybrid materials and demonstrate their excellent sensitivity (0.043 ppm-1) as well as high selectivity towards H2S relative to CO, NH3, H2, and NO (with corresponding sensitivities of 0.002, 0.0074, 0.0002, and 0.0046 ppm-1, respectively). Gas response measurements, complemented with the results of X-ray photoelectron spectroscopy analysis and first-principles calculations based on density functional theory, suggest that the intrinsic electronic properties of pristine WS2 alone are not sufficient to explain the observed high sensitivity towards H2S. A major role in this behavior is also played by O doping in the S sites of the WS2 lattice. The results of the present study open up new avenues for the use of transition metal disulfide nanomaterials as effective alternatives to metal oxides in future applications for industrial process control, security, and health and environmental safety., Funding received from Bio4Energy programme, Academy of Finland (projects Suplacat and ClintoxNP (No. 268944)), University of Oulu (More than Moore research community) and University of Oulu Graduate School (Infotech Oulu) is acknowledged. We acknowledge support from the EU (No. ERC-2016-AdG-694097 QSpec-NewMat) and the Basque Government “Grupos Consolidados UPV/EHU” (No. IT578-13). J. J. B. and L. D. X. thank the EU for the Marie Curie Fellowship (Nos. H2020-MSCA-IF-2016-751047 and H2020-MSCA-IF-2015-709382). A. P. P. thanks postdoctoral fellowship from the Spanish “Juan de la Cierva-incorporación” program (No. IJCI-2014-20147). We also would like to acknowledge Sami Saukko (Center of Microscopy and Nanotechnology, University of Oulu) for his assistance with TEM analyses. A. L. S. acknowledges the Swedish Government Strategic Research Area in Materials Science on Functional Materials at Linköping University (Faculty Grant SFO-Mat-LiU No. 2009-00971).

High frequency measurements at 50 MHz – 10 GHz were performed for the first time using interdigitated electrodes on a low temperature co-fired ceramic substrate to analyze fungal spores. Wet and dry spore generation methods were evaluated and tested with two different fungal species. The dry generation method was found feasible for RF measurements, since the component capacitance increased 14–21% in the 2–6 GHz range, but for the wet generation method the capacitance decreased only slightly (

Background Owing to its longer treatment duration—up to 8 hours per dialysis treatment—in-center thrice-weekly nocturnal hemodialysis (HD) is receiving greater attention. To better understand the evidence for in-center nocturnal HD, we sought to systematically review the literature to determine the effects of in-center nocturnal HD versus conventional HD on clinically relevant outcomes. Study Design We searched MEDLINE, Embase, Evidence-Based Medicine Reviews (EBMR), Web of Science, and Scopus from the earliest date in the database to November 2016. Setting & Population Adults receiving in-center nocturnal HD compared with those receiving conventional HD. Selection Criteria for Studies All quasi-experimental and observational studies were considered; randomized trials were sought but not found. Predictor Nocturnal vs conventional in-center HD. Outcomes Indexes of blood pressure and left ventricular hypertrophy, markers of anemia, measures of bone mineral metabolism, nutrition, quality of life, sleep quality, episodes of intradialytic hypotension, hospitalization, and mortality. Results Of 2,086 identified citations, 21 met the inclusion criteria, comprising a total of 1,165 in-center nocturnal HD patients and 15,865 conventional HD patients. Although there was substantial heterogeneity in reporting of outcomes, we pooled data for measures of blood pressure, anemia, and mineral metabolism. Though heterogeneity was generally high, in-center nocturnal HD was associated with improved systolic blood pressure (−3.18 [95% CI, −5.58 to −0.78) mm Hg, increased hemoglobin levels (0.53 [95% CI, 0.11-0.94] g/dL), and lower serum phosphate levels (−0.97 [95% CI, −1.48 to −0.46] mg/dL). Limitations No randomized trials have been conducted to address the clinical effects of in-center nocturnal HD. The quality of the observational literature contributing to the results of this review was generally poor to moderate. Confounded outcomes are a significant concern. Publication bias and outcome reporting bias remain possibilities. Conclusions Relative to conventional HD, in-center nocturnal HD was associated with improvements in several clinically relevant outcomes. Other benefits may not have been detected due to small sample sizes of included studies; no prespecified outcome was worse with in-center nocturnal HD.

Ruthenium(IV)oxide (RuO 2 ) is a material used for various purposes. It acts as a catalytic agent in several reactions, for example oxidation of carbon monoxide. Furthermore, it is used as gate material in gas sensors. In this work theoretical and computational studies were made on adsorbed molecules on RuO 2 (110) surface, in order to follow the chemistry on the molecular level. Density functional theory calculations of the reactions on the surface have been performed. The calculated reaction and activation energies have been used as input for thermodynamic and kinetics calculations. A surface phase diagram was calculated, presenting the equilibrium composition of the surface at different temperature and gas compositions. The kinetics results are in line with the experimental studies of gas sensors, where water has been produced on the surface, and hydrogen is found at the surface which is responsible for the sensor response.

Metal Oxide Semiconductor (MOS) capacitor devices comprised of monolayer iron oxide-coated as well as non-coated polycrystalline Pt deposited on oxidized silicon carbide substrates have been fabricated and their usefulness as realistic model systems in catalyst studies development was evaluated. The CO oxidation characteristics of both iron oxide- and non-coated Pt catalysts were investigated using mass spectrometry, monitoring the carbon dioxide production rate for different combinations of carbon monoxide (CO) and oxygen concentrations at various temperatures. Additionally, the output capacitance of the MOS model catalysts was recorded for each individual CO oxidation activity. A low-temperature shift in CO oxidation characteristics for the monolayer-coated compared to the non-coated Pt catalysts was observed, similar to that previously reported for monolayer iron oxide grown on single-crystalline Pt substrates. A strong correlation between the output capacitance of the MOS structures and the CO oxidation characteristics was found for both monolayer- and non-coated model catalysts. Furthermore, the devices exhibit retained MOS electrical output and CO oxidation characteristics as well as an unaffected catalyst surface composition, as confirmed by photoelectron spectroscopy, even after 200 h of continuous model catalyst operation. In addition to the implications on practical applicability of monolayer iron oxide coating on widely used polycrystalline Pt films in real-world catalysts and sensors, the findings also point to new possibilities regarding the use of MOS model systems for in situ characterization, high throughput screening, and tailoring of e.g. catalyst- and fuel-cell-electrode materials for specific applications. (C) 2016 Elsevier Inc. All rights reserved. Funding Agencies|VINN Excellence Center in research and innovation on Functional Nanoscale Materials (FunMat) by the Swedish Governmental Agency for Innovation Systems (VINNOVA); Swedish Research Council (VR) [2015-04062]; Swedish Foundation for Strategic Research (SSF) through the Future Research Leaders 5 program

Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.

IntroductionFasting during the month of Ramadan is a significant Islamic religious practice that involves abstinence from food, drink and medication from dawn to dusk. As just under a quarter of the world’s population identifies as Muslim, the effect of fasting on chronic conditions, such as chronic kidney disease (CKD) is a topic of broad relevance. To date, the information in this area has been mixed, with many limitations of previous studies. This study aims to synthesise the evidence of the effect of Ramadan fasting on changes on kidney function, risk factors, episodes of acute kidney injury and impact on the quality of life in patients with CKD or kidney transplant.Methods and analysisA systematic review of the literature will be conducted, using electronic databases such as MEDLINE, Embase, Global Health, CINAHL and Scopus. Original research and grey literature on the effect of Ramadan fasting in adult patients with CKD or renal transplantation will be included. Two reviewers will independently screen articles for inclusion in the review and independently assess the methodology of included studies using a customised checklist. Mean difference or risk ratio will be reported for continuous or dichotomous outcomes and results will be pooled using a random-effects model where heterogeneity is reasonable. If possible, subgroups (CKD status, setting, season and risk of bias) will be analysed for effect modification with fasting and the outcomes of interest. Risk of bias will be assessed using the Downs and Black checklist.Ethics and disseminationThe results will be disseminated using a multifaceted approach to engage all stakeholders (patients, practitioners and community leaders). Research ethics board approval is not required as this is a systematic review of previously published research.PROSPERO registration numberCRD42018088973.

Calcineurin inhibitors (CNI; cyclosporine, tacrolimus) are critical for kidney transplant immunosuppression, but have multiple potential drug interactions, such as with macrolide antibiotics. Macrolide antibiotics (clarithromycin, erythromycin, and azithromycin) are often used to treat atypical infections. Clarithromycin and erythromycin inhibit CNI metabolism and increase the risk of CNI nephrotoxicity, while azithromycin does not.To determine the frequency of CNI-macrolide co-prescriptions, the proportion who receive post-prescription monitoring, and the risk of adverse drug events in kidney transplant recipients.Retrospective cohort study.We used linked health care databases in Alberta, Canada.We included 293 adult kidney transplant recipients from 2008-2015 who were co-prescribed a CNI and macrolide.The primary outcome was a composite of all-cause hospitalization, acute kidney injury (creatinine increase ≥0.3 mg/dL or 1.5 times baseline), or death within 30 days of the macrolide prescription.We identified CNI-macrolide co-prescriptions and compared outcomes in those who received clarithromycin/erythromycin versus azithromycin. We used a linear mixed-effects model to examine the mean change in serum creatinine and estimated glomerular filtration rate (eGFR).Of the 293 recipients who were co-prescribed a CNI and a macrolide, 38% (n = 112) were prescribed clarithromycin/erythromycin while 62% (n = 181) were prescribed azithromycin. Compared with azithromycin users, clarithromycin/erythromycin users were less likely to have outpatient serum creatinine monitoring post-prescription (56% vs 69%,We did not have CNI levels to correlate with the timing of CNI-macrolide co-prescriptions. We also did not have information regarding the indications for macrolide prescriptions.Clarithromycin and erythromycin were frequently co-prescribed in kidney transplant recipients on CNIs despite known drug interactions. Clarithromycin/erythromycin use was associated with a higher risk of hospitalization compared with azithromycin users. Safer prescribing practices in kidney transplant recipients are warranted.Les inhibiteurs de la calcineurine (CNI : cyclosporine, tacrolimus) sont essentiels à l’immunosuppression suivant une transplantation rénale. Ils présentent toutefois de nombreux risques d’interactions médicamenteuses avec les antibiotiques macrolides (clarithromycine, érythromycine et azithromycine) employés couramment pour traiter les infections atypiques. La clarithromycine et l’érythromycine inhibent le métabolisme des CNI et augmentent leurs risques de néphrotoxicité, ce qui n’est pas le cas de l’azithromycine.Déterminer la fréquence de co-prescription d’un CNI et d’un macrolide chez les receveurs d’une greffe rénale, la proportion de patients ayant fait l’objet d’un suivi post-prescription et le risque d’effets indésirables attribuables aux médicaments.Une étude de cohorte rétrospective.Les banques de données couplées du système de santé de l’Alberta (Canada).Nous avons inclus 293 adultes receveurs d’un rein entre 2008 et 2015 et à qui on avait co-prescrit un CNI et un macrolide.Le principal résultat attendu était une combinaison d’hospitalisation toutes causes, d’insuffisance rénale aigüe (hausse minimale de 0,3 mg/dL de la créatinine sérique ou équivalente à 1,5 fois la valeur mesurée initialement), ou de décès du patient dans les 30 jours suivant la prescription d’un macrolide.Nous avons répertorié les co-prescriptions CNI-macrolide et comparé les résultats des patients traités par clarithromycine/érythromycine à ceux traités avec l’azithromycine. Nous avons employé un modèle linéaire à effets mixtes pour établir les variations moyennes dans les mesures de créatinine sérique et de DFGe.Des 293 receveurs d’un rein ayant reçu une co-prescription CNI-macrolide, 38 % (n = 112) ont été traités avec la clarithromycine/érythromycine et 62 % (n = 181) avec l’azithromycine. Les patients ayant reçu de la clarithromycine/érythromycine étaient moins susceptibles de faire l’objet d’un suivi ambulatoire du taux de créatinine sérique post-prescription (56 % contre 69 % pour l’azithromycine, p = 0,03). Aucune différence significative n’a été observée entre les deux groupes quant au principal résultat attendu (17 % contre 11 %; p = 0,11). Cependant, les patients traités par clarithromycine/érythromycine présentaient un risque supérieur d’hospitalisation toutes causes (10 % contre 3 %; p = 0,02), et la moyenne de décroissance du DFGe pour ces patients était significativement supérieure (-5,4 mL/min/1,73 mNous n’avions pas les niveaux de CNI corrélés avec le moment de la co-prescription CNI-macrolide, ni les indications justifiant l’ordonnance de macrolide.La clarithromycine et l’érythromycine ont été fréquemment co-prescrites aux receveurs d’une greffe rénale traités avec des CNI, malgré la connaissance des interactions médicamenteuses. Les patients recevant de la clarithromycine/érythromycine sont plus susceptibles d’être hospitalisés que ceux recevant de l’azithromycine. L’adoption de pratiques de prescription plus sûres est justifiée chez les receveurs d’une greffe rénale.

Static and dynamic responses of a silicon carbide field-effect transistor gas sensor have been investigated at two different gate biases in several test gases. Especially the dynamic effects are gas dependent and can be used for gas identification. The addition of ultraviolet light reduces internal electrical relaxation effects, but also introduces new, temperature-dependent effects.