Publications by authors named "Jenny Gunton"

Background: Recent findings have highlighted that abnormal energy metabolism is a key feature of autosomal-dominant polycystic kidney disease (ADPKD). Emerging evidence suggests that nutritional ketosis could offer therapeutic benefits, including potentially slowing or even reversing disease progression. This systematic review aims to synthesise the literature on ketogenic interventions to evaluate the impact in ADPKD.

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Type 1 diabetes (T1D) is caused by the immune-mediated loss of pancreatic β-cells. Hypoxia-inducible factor 1α (HIF-1α) is a transcription factor which is crucial for cellular responses to low oxygen. Here, we investigate the role of β-cell HIF-1α in β-cell death and diabetes after exposure to multiple low-dose streptozotocin (MLDS).

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Vitamin D signals through the vitamin D receptor (VDR) to induce its end-organ effects. Hepatic stellate cells control development of liver fibrosis in response to stressors and vitamin D signaling decreases fibrogenesis. VDR expression in hepatocytes is low in healthy liver, and the role of VDR in hepatocyte proliferation is unclear.

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This prospective cohort study aimed to determine the relationship between serum vitamin C, D, and zinc on foot wound healing and compare time to healing in individuals who are deficient versus those who have adequate levels. One hundred adults with foot wounds were recruited from Blacktown high-risk foot service with a follow-up period of 12 months. Serum vitamin C, D, and zinc as well as routine baseline blood testing was undertaken.

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Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease.

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Objective: To conduct a multicenter case series characterizing the clinical characteristics at presentation and pancreatic volume changes of patients with checkpoint inhibitor-associated autoimmune diabetes (CIADM).

Research Design And Methods: Electronic medical records were reviewed with 36 consecutive patients identified with CIADM, as defined by (1) previous immune checkpoint inhibitor (ICI) therapy, (2) new-onset hyperglycemia (blood glucose level ≥ 11.1 mmol/L and/or glycosylated hemoglobin ≥ 6.

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Vitamin D deficiency, prevalent worldwide, is linked to muscle weakness, sarcopenia, and falls. Muscle regeneration is a vital process that allows for skeletal muscle tissue maintenance and repair after injury. PubMed and Web of Science were used to search for studies published prior to May 2023.

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Diabetes is a global public health burden and is characterized clinically by relative or absolute insulin deficiency. Therapeutic agents that stimulate insulin secretion and improve insulin sensitivity are in high demand as treatment options. CD47 is a cell surface glycoprotein implicated in multiple cellular functions including recognition of self, angiogenesis, and nitric oxide signaling; however, its role in the regulation of insulin secretion remains unknown.

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Globally, the call for Family-Friendly (FF) workplaces is loud and clear. However, this call is inaudible in medical workplaces, despite both well-established benefits of FF workplaces across businesses and well-known effects of work-family conflict on the well-being and practice of doctors. We aimed to use the Delphi consensus methodology to: (i) operationalise the Family-Friendly medical workplace and (ii) develop a Family-Friendly Self-Audit tool for medical workplaces.

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Article Synopsis
  • CIADM is a rare autoimmune diabetes complication that can occur in patients treated with immune checkpoint inhibitors, often presenting with diabetic ketoacidosis (DKA).
  • A systematic review of studies from 2014 to April 2022 identified that 99.5% of patients had prior exposure to anti-PD1 or anti-PD-L1 therapy, with a median onset time of 12 weeks after treatment initiation.
  • The presence of type 1 diabetes autoantibodies was found in 40.4% of patients and was linked to more severe cases of CIADM and an earlier onset.
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Objective: The goal of this study was to review the metabolic effects of fat transplantation.

Methods: Fat (adipose tissue [AT]) transplantation has been performed extensively for many years in the cosmetic reconstruction industry. However, not all fats are equal.

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The prevalence of type 1 diabetes (T1D) is rising steadily. A potential contributor to the rise is vitamin D. In this systematic review, we examined the literature around vitamin D and T1D.

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Article Synopsis
  • Vitamin C is a crucial nutrient that humans and animals cannot produce on their own, playing a key role in tissue regeneration and collagen formation.
  • A literature review of 18 studies indicated that vitamin C supplementation can enhance healing, particularly in pressure ulcers, despite issues like small sample sizes and mixed treatments in the studies.
  • Future research with larger and more focused studies on vitamin C is needed to better understand its impact on healing in various conditions, with a recommendation for its use in pressure ulcer treatment.
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  • VDR expression plays a role in metabolism and glucose homeostasis, particularly in pancreatic beta-cells.
  • Researchers studied VDR-null (VDRKO) mice at different ages to assess how the absence of VDR affects metabolic health.
  • Findings showed VDRKO mice had lower bone density and fat mass, but surprising effects on insulin sensitivity and glucose tolerance, especially differing between male and female mice.
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Beige and brown fat consume glucose and lipids to produce heat, using uncoupling protein 1 (UCP1). It is thought that full activation of brown adipose tissue (BAT) may increase total daily energy expenditure by 20%. Humans normally have more beige and potentially beige-able fat than brown fat.

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Immune checkpoint inhibitors have transformed the landscape of oncological therapy, but at the price of a new array of immune related adverse events. Among these is β-cell failure, leading to checkpoint inhibitor-related autoimmune diabetes (CIADM) which entails substantial long-term morbidity. As our understanding of this novel disease grows, parallels and differences between CIADM and classic type 1 diabetes (T1D) may provide insights into the development of diabetes and identify novel potential therapeutic strategies.

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Aim: To determine advantages conferred by a youth-specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data.

Methods: Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monitoring, HbA1c, albumin creatinine ratio, BP, retinopathy and diabetic ketoacidosis (DKA) for all WH T1D clinic attendees aged 16-25 between January 2017 and June 2018 (n = 269). Results were compared with data collected during the same time period from 2 separate Australian data registries, one longitudinal (Australasian Diabetes Data Network, ADDN) and one a spot survey (the Australian National Diabetes Audit, ANDA).

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Article Synopsis
  • A review of existing literature was conducted to explore links between vitamins and nutrients and foot ulcers in diabetes, examining studies up to September 2020.
  • Fifteen studies were included, showing a correlation between poor nutritional status and either the presence of foot ulcers or delays in healing.
  • However, the review found insufficient data to determine if these relationships are causal, indicating a need for further research on whether nutritional supplements can enhance foot ulcer healing.
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Article Synopsis
  • * Both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplant alone enhance long-term survival and significantly improve recipients' quality of life, outweighing potential downsides.
  • * SPK performed before dialysis offers better outcomes than after dialysis, which adversely affects survival rates, suggesting that kidney grafts should be preferentially allocated to SPK candidates.
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Despite the important function of neutrophils in the eradication of infections and induction of inflammation, the molecular mechanisms regulating the activation and termination of the neutrophil immune response is not well understood. Here, the function of the small GTPase from the RGK family, Gem, is characterized as a negative regulator of the NADPH oxidase through autophagy regulation. Gem knockout (Gem KO) neutrophils show increased NADPH oxidase activation and increased production of extracellular and intracellular reactive oxygen species (ROS).

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Islet transplantation, a therapeutic option to treat type 1 diabetes, is not yet as successful as whole-pancreas transplantation as a treatment for diabetes. Mouse models are commonly used for islet research. However, it is clear disparities exist between islet transplantation outcomes in mice and humans.

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Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30 %. We conducted a randomised, inactive-placebo controlled, double-blind trial of 500 mg of slow-release vitamin C in sixteen people with foot ulcers in the Foot Wound Clinic at Westmead Hospital.

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Article Synopsis
  • Hypoxia is a condition where there is not enough oxygen reaching body tissues, and hypoxia-inducible factors (HIFs) play a key role in how mammals respond to this lack of oxygen.
  • HIF-1α, a specific protein, is typically short-lived, and conditions like high blood sugar can weaken its stability; improving glucose control can increase HIF-1α and have various health benefits.
  • Despite the potential of manipulating HIF-1α as a treatment for diabetes and its complications, most current strategies have not shown effective clinical results, and more research is needed to understand the varied outcomes of these approaches.
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