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Randomized trials in adults have shown reduced all-cause and cardiovascular mortality on hemodiafiltration (HDF) compared to high-flux hemodialysis (HD), but the mechanisms leading to improved outcomes are not clear. We studied biomarkers of inflammation, oxidative stress, anti-oxidant capacity and endothelial dysfunction in 22 children (13 female, age 8-15 years). All children received HD for at least 3 months, and were then switched to HDF, keeping all dialysis related parameters and dialysis time constant. All the biomarkers of inflammation (ß2-microglobulin, IL-6, IL-10, high sensitive C-reactive protein [hsCRP]), oxidative stress (nitrotyrosine, advanced glycation end-products [AGEs], oxidized low density lipoprotein [ox-LDL] and anti-oxidant capacity) and endothelial dysfunction (asymmetric dimethyl arginine [ADMA], symmetric dimethyl arginine [SDMA]), were comparable between incident and prevalent patients on HD, suggesting that even a short dialysis vintage of 3 months on HD increases inflammation and endothelial stress. After 3 months of HDF therapy there was a significant reduction in ß2-microglobulin (p<0.001), hCRP, ADMA, SDMA, AGEs, ox-LDL (p<0.01 for all) and an increase in total antioxidant capacity (p<0.001) compared to HD. All children were maintained on the same dialyser, dialysis water quality, dialysis time and blood flow speeds suggesting that improved clearances on HDF led to an improved biomarker profile. Even in children with residual renal function there was a significant reduction in ß2 microglobulin, hsCRP, SDMA, ox-LDL and AGEs on HDF compared to HD. Children with a lower blood flow had higher inflammatory status (higher IL-6/IL-10 ratio; p = 0.04, r = -0.43). Children who achieved a higher convective volume (≥median 12.8L/m2) had lower ox-LDL (p = 0.02). In conclusion, we have shown that a significant improvement in inflammation, antioxidant capacity and endothelial risk profile is achieved even within a short time (3 months) on HDF compared to HD treatment. ClinicalTrials.gov: NCT02063776.

PurposeThis study aims to investigate the effect of speckle pattern on displacement measurements using different speckle diameters and coverage ratios.Design/methodology/approachIn order to compare the coverage ratio and speckle diameter during the evaluation of the correlation of digital images (DIC) study, template speckle plates were produced on a computer numerical control (CNC) punch press with 600 punches per minute. After the speckle plates were manufactured, the speckled pattern was randomly painted on a plain white side through the manufactured template plates, and then tensile tests were performed under the same loading conditions for each sample to observe displacement variation via correlation parameters.FindingsDuring the manufacturing of templates with thin plates, a punch diameter of less than 1.7 mm will cause tool failure; therefore, uniform speckle size can be assessed before operation. A higher coverage ratio resulted in more accurate and reliable results in displacement data. With smaller coverage, the facet size should be increased to achieve favorable results.Research limitations/implicationsIf thick template plates are selected, speckle painting cannot be done properly; therefore, template thickness shall also be assessed before operation.Practical implicationsFor randomly distributed DIC templates, increasing coverage beyond 50% does not make sense due to difficulties in the production process in the punch press.Originality/valueEvaluating DIC results via templates manufactured in a punch press with different speckle diameters and coverage ratios is a new topic in literature.

BackgroundThe aim of the study is to identify the effect of salt intake and diabetes itself on blood pressure (BP) profile and microalbuminuria in children with type one diabetes mellitus (T1DM). Our hypothesis is that higher amount of salt consumption and/or hyperglycemia may impair blood pressure pattern in children with T1DM.MethodsThis cross-sectional study included 84 children and adolescents with T1DM (62% females, age 13.9 ± 3.2 years, disease duration 7.3 ± 3.1 years, 43% poorly controlled diabetes) and 54 aged- and sex-matched healthy children with an adequately collected 24-h urine samples. Urine sodium, creatinine, and microalbumin were measured and salt intake was assessed on the basis of sodium excretion in 24-h urine. Blood pressure profile of the children with T1DM was evaluated with 24-h ambulatory blood pressure monitoring.ResultsCompared to the children with well-controlled diabetes, children with poorly controlled diabetes had significantly higher standard deviation scores (SDS) of nighttime systolic BP (0.22 ± 1.28 vs − 0.87 ± 0.76, p = 0.003) and lower dipping in diastole (13.4 ± 5.9 vs 18.4 ± 8.1, p = 0.046). Among T1DM group, children with the highest quartile of salt intake had higher nighttime systolic and diastolic BP-SDS (0.53 ± 1.25 vs − 0.55 ± 0.73, p = 0.002 and 0.89 ± 1.19 vs 0.25 ± 0.63, p = 0.038, respectively) and lower dipping in systole compared to their counterparts (7.7 ± 5.0 vs 11.5 ± 6.1, p = 0.040). High averaged HbA1c was independently associated with higher both daytime and nighttime systolic BP-SDS (p = 0.010, p < 0.001) and nighttime diastolic BP-SDS (p = 0.001), and lower diastolic dipping (p = 0.001). High salt intake was independently associated with higher nighttime systolic BP-SDS (p = 0.002) and lower systolic dipping (p = 0.019). A 24-h MAP-SDS was the only independent risk factor for microalbuminuria (p = 0.035).ConclusionBeside poor diabetic control, high salt consumption appears to be an important modifiable risk factor for impaired BP pattern, which contributes to the development of diabetic kidney disease in children with T1DM.

ObjectiveTo evaluate both humoral and cellular immune responses to the COVID-19 messenger RNA (mRNA; BNT162b2) vaccine in patients with childhood-onset SLE (cSLE) compared with healthy controls and patient controls (kidney transplant (KTx) recipients).MethodsThis single-centre, cross-sectional and case–control study included 16 patients with cSLE, 19 healthy controls and 19 KTx recipients. We assessed SARS-CoV-2-specific humoral (anti-SARS-CoV-2 IgG, neutralising antibody (nAb)) and cellular (interferon gamma release assay (IGRA)) immune responses at least 1 month after administration of two doses of the mRNA vaccine.ResultsHumoral immune response rates (anti-SARS-CoV-2 IgG and nAb seropositivity) in patients with cSLE were comparable to healthy controls (100% vs 100% and 100% vs 95%, respectively) but significantly higher than in KTx recipients (74% and 42%, p<0.05 for both). Cellular immune response rate measured by IGRA was lower in patients with cSLE compared with healthy controls (56.3% vs 89.5%, p=0.050) and comparable to KTx recipients (63%). IGRA-negative patients with cSLE had significantly lower total leucocyte and lymphocyte counts at vaccination time as compared with their counterparts (p=0.008 and p=0.001, respectively). No differences were found in disease activity or immunosuppressive therapies between IGRA-negative and IGRA-positive patients with cSLE.ConclusionPatients with cSLE showed robust humoral but compromised cellular immune responses to the COVID-19 mRNA vaccine, associated with lower lymphocyte counts. These findings highlight the need for further research to enhance vaccine efficacy in this vulnerable group.

Background Cardiovascular disease (CVD) is an important complication of chronic kidney disease (CKD) in children. However, it is not well known when and how cardiovascular alterations start. Methods This cross-sectional, controlled study consisted of 25 patients and 28 healthy controls. 24-h ambulatory blood pressure monitoring, aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT) and carotid distensibility (distensibility coefficient and β stiffness index), and echocardiography were assessed to evaluate CVD. Routine biochemical parameters, fibroblast growth factor-23 (FGF23) and high sensitive C- reactive protein were measured to determine cardiovascular risk factors. Results Hypertension was found in 12 patients (48 %). Patients had higher FGF23 levels and aPWV-standard deviation score (SDS) as compared to the controls ( p  = 0.003 and p  = 0.002, respectively). Aortic PWV-SDS was predicted by increased daytime systolic blood pressure load ( β  = 0.512, p  = 0.009, R 2  = 0.262). Neither cIMT nor distensibility differed between the groups; however, older age and high level of FGF23 were independent predictors of β stiffness index in patients ( β  = 0.507, p  = 0.005, R 2  = 0.461 and β  = 0.502, p  = 0.005, R 2  = 0.461, respectively). As compared to controls, patients had worse left ventricular diastolic function [lower E/A ratio p  = 0.006) and increased left atrial dimension ( p  < 0.001)]. Conclusions Cardiovascular deteriorations appear in children with stage-2 CKD. Good control of BP and decreasing the level of FGF23 may be useful to slow down the progression of cardiovascular complications.

A facile approach to fabricate dye-sensitized solar cells (DSSCs) is demonstrated by depositing (001) oriented zinc oxide (ZnO) nanostructures on both glass and flexible substrates at room temperature using pulsed laser deposition. Unique crystallographic characteristics of ZnO combined with highly non-equilibrium state of pulsed laser-induced ablated species enabled highly crystalline ZnO nanostructures without aid of any chemically induced additives or organic/inorganic impurities at room temperature. Film morphology as well as internal surface area is tailored by varying ambient oxygen pressure and deposition time. It is revealed that the optimization of these two experimental factors was essential for achieving structure providing large surface area as well as efficient charge collection. The DSSCs with optimized ZnO photoanodes showed overall efficiencies of 3.89 and 3.4 % on glass and polyethylene naphthalate substrates, respectively, under AM 1.5G light illumination. The high conversion efficiencies are attributed to elongated electron lifetime and enhanced electrolyte diffusion in the high crystalline ZnO nanostructures, verified by intensity-modulated voltage spectroscopy and electrochemical impedance measurements.

BackgroundThis study aims to identify epidemiological and clinical characteristics of patients and report our experience with eculizumab treatment during an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) in Istanbul in 2015.MethodsThirty-two children (21 females, median age 3.25 years) were included in this study. Demographic, clinical and laboratory data, and treatment details were retrospectively collected. Renal outcomes were assessed at last follow-up visit. To assess the effect of eculizumab on prognosis of STEC-HUS, subgroup analysis was performed on patients who required dialysis.ResultsA high number of cases occurred within a certain region of Istanbul. Stool samples were cultured from 21 patients (65%), and enteroaggregative E. coli (EAEC; n = 7) and enterohemorrhagic E. coli (EHEC; n = 3) strains were detected. Rates of dialysis treatment, neurological manifestations, and death were 59%, 25%, and 3%, respectively. Mean follow-up duration was 8.6 ± 2.6 months (range 3–12 months). None of the patients (n = 25) was on dialysis at the final visit. The complete renal recovery rate was 54%. Nine patients were treated with eculizumab. At final follow-up visit, no differences in estimated glomerular filtration rate, proteinuria level, or hypertension incidence were observed between patients treated with eculizumab and those not treated with eculizumab.ConclusionsAn outbreak of EAEC occurred in a specific region of Istanbul. Livestock markets were suspected as the source. Evidence for beneficial effects of eculizumab on renal outcome was not clear in this cohort.

Purpose To investigate the role of acoustic radiation force impulse (ARFI) elastography in the detection of renal parenchymal damage in kidneys with and without ureteropelvic junction obstruction (UPJO). Methods Twenty-five pediatric patients with a diagnosis of UPJO who underwent surgery and 15 pediatric patients with conservatively managed UPJO were prospectively evaluated with ARFI elastography. Sixteen healthy volunteers constituted the control group. Shear wave velocity (SWV) measurements in the upper, mid, and lower poles of the affected kidney were performed. SWV values of kidneys based on presence of UPJO and hydronephrosis grade were compared. The correlation of SWV values with residual renal function obtained from diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine-3 renal scan was evaluated. Results Significantly, higher SWV values were found in control kidneys compared to kidneys affected by UPJO. The median SWVs were 2.82 (2.51–3.07) m/s for the control kidneys and 2.36 (2.09–2.53) m/s for the kidneys in the UPJO group ( p  < 0.001). When UPJO patients were grouped according to the grade of hydronephrosis, grade 0 hydronephrotic kidneys [2.35 (2.11–2.50) m/s] and grade 3–4 hydronephrotic kidneys [1.86 (1.96–2.25) m/s] had significantly lower SWV values compared to grade 1–2 hydronephrotic kidneys [2.62 (2.37–2.90) m/s] ( p  < 0.05). Conclusions ARFI as a noninvasive, radiation-free procedure for evaluating parenchymal stiffness may prove useful in the diagnostic work-up and follow-up of children with UPJO-induced renal disease.