Welcome to The Royal Devon Research Repository

The Royal Devon Research Repository contains research outputs from staff at the Royal Devon University Healthcare NHS Foundation Trust.

You can browse items by Title, Author, Subject or Community/Collection, or use the search function to find specific topics.

The repository contains details of published, peer-reviewed journal articles, reviews, book chapters, conference abstracts and posters. Full-text of journal articles have been included where publisher's permissions allow.

If you are a member of Royal Devon University Healthcare NHS Foundation Trust and you'd like to submit an item to the repository, please fill in this online form. If you have a list of publications you'd like to submit, please e-mail the repository admin team: rde-tr.ResearchRepository@nhs.net.

For more information or help, please contact The Royal Devon Research Repository admin team:
Email: rde-tr.ResearchRepository@nhs.net
Telephone: Exeter Health Library, 01392 406800

Recent Submissions

  • Item
    Digital tools in cardiac reperfusion pathways: A systematic review
    (HighWire, 2024-03-01) Chhatwal, K.; Deighton, A.; Dhir, A.; Kumar, V. V.; Titus-Glover, S.; Shah, D.; Holt, L.
    With health and surgery increasingly aided by digital technologies, there exists a growing impetus to understand how such tools must integrate into existing clinical pathways to ensure a positive impact on patient and organisational outcomes. Consequently, this study sought to collate evidence on the use of digital technology in cardiac reperfusion surgeries. We systematically searched three scientific databases for relevant articles. In total, 1,092 articles were retrieved, with 126 screened using inclusion/exclusion criteria, and 21 selected for analysis. Articles reported on the use of virtual reality, mHealth and telehealth in cardiovascular reperfusion procedures, ranging from surgical training regimens to postoperative rehabilitation. Here, despite clinical advantages, limitations were highlighted, including cost, ineffective interfaces and extensive training needed to operate novel digital tools. Nevertheless with further development and input from patient stakeholders, many limitations look set to dematerialise and provide tangible improvements to the benefit of patients and hard-pressed health institutions.
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    Adenylyl Cyclase in Ocular Health and Disease: A Comprehensive Review
    (MDPI, 2024-06-01) Thompson, P.; Vilkelyte, V.; Woronkowicz, M.; Tavakoli, M.; Skopinski, P.; Roberts, H.
    Adenylyl cyclases (ACs) are a group of enzymes that convert adenosine-5'-triphosphate (ATP) to cyclic adenosine 3',5' monophosphate (cAMP), a vital and ubiquitous signalling molecule in cellular responses to hormones and neurotransmitters. There are nine transmembrane (tmAC) forms, which have been widely studied; however, the tenth, soluble AC (sAC) is less extensively characterised. The eye is one of the most metabolically active sites in the body, where sAC has been found in abundance, making it a target for novel therapeutics and biomarking. In the cornea, AC plays a role in endothelial cell function, which is vital in maintaining stromal dehydration, and therefore, clarity. In the retina, AC has been implicated in axon cell growth and survival. As these cells are irreversibly damaged in glaucoma and injury, this molecule may provide focus for future therapies. Another potential area for glaucoma management is the source of aqueous humour production, the ciliary body, where AC has also been identified. Furthering the understanding of lacrimal gland function is vital in managing dry eye disease, a common and debilitating condition. sAC has been linked to tear production and could serve as a therapeutic target. Overall, ACs are an exciting area of study in ocular health, offering multiple avenues for future medical therapies and diagnostics. This review paper explores the diverse roles of ACs in the eye and their potential as targets for innovative treatments.
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    Not all knees are the same
    (British Editorial Society of Bone and Joint Journal, 2024-06-01) MacDessi, S. J.; van de Graaf, V. A.; Wood, J. A.; Griffiths-Jones, W.; Bellemans, J.; Chen, D. B.
    The aim of mechanical alignment in total knee arthroplasty is to align all knees into a fixed neutral position, even though not all knees are the same. As a result, mechanical alignment often alters a patient's constitutional alignment and joint line obliquity, resulting in soft-tissue imbalance. This annotation provides an overview of how the Coronal Plane Alignment of the Knee (CPAK) classification can be used to predict imbalance with mechanical alignment, and then offers practical guidance for bone balancing, minimizing the need for soft-tissue releases.
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    Phenotypic characterization of nonautoimmune diabetes in adult Ugandans with low body mass index
    (SAGE, 2024-05-27) Kibirige, D.; Sekitoleko, I.; Lumu, W.; Thomas, N.; Hawkins, M.; Jones, A. G.; Hattersley, A. T.; Smeeth, L.; Nyirenda, M. J.
    BACKGROUND: Type 2 diabetes is common in relatively lean individuals in sub-Saharan Africa. It is unclear whether phenotypic differences exist between underweight and normal-weight African patients with type 2 diabetes. This study compared specific characteristics between underweight (body mass index <18.5 kg/m(2)) and normal-weight (body mass index of 18.5-24.9 kg/m(2)) adult Ugandans with new-onset nonautoimmune diabetes. METHODS: We collected the demographic, clinical, anthropometric, and metabolic characteristics of 160 participants with nonobese new-onset type 2 diabetes (defined as diabetes diagnosed <3 months, body mass index <25 kg/m(2), and absence of islet-cell autoimmunity). These participants were categorized as underweight and normal weight, and their phenotypic characteristics were compared. RESULTS: Of the 160 participants with nonobese new-onset type 2 diabetes, 18 participants (11.3%) were underweight. Compared with those with normal weight, underweight participants presented with less co-existing hypertension (5.6% versus 28.2%, p = 0.04) and lower median visceral fat levels [2 (1-3) versus 6 (4-7), p < 0.001], as assessed by bioimpedance analysis. Pathophysiologically, they presented with a lower median 120-min post-glucose load C-peptide level [0.29 (0.13-0.58) versus 0.82 (0.39-1.50) nmol/l, p = 0.04] and a higher prevalence of insulin deficiency (66.7% versus 31.4%, p = 0.003). CONCLUSION: This study demonstrates that nonautoimmune diabetes occurs in underweight individuals in sub-Saharan Africa and is characterized by the absence of visceral adiposity, reduced late-phase insulin secretion, and greater insulin deficiency. These findings necessitate further studies to inform how the prevention, identification, and management of diabetes in such individuals can be individualized. Type 2 diabetes in underweight Ugandans In this study that investigated how type 2 diabetes presents in adult Ugandans with normal body mass index, about one in ten were underweight. Type 2 diabetes in these individuals was characterized by a low prevalence of hypertension, lower body fat levels, and features of reduced insulin production by the pancreas. eng
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    Polygenic scores for cardiovascular risk factors improve estimation of clinical outcomes in CCB treatment compared to pharmacogenetic variants alone
    (Springer Nature, 2024-04-01) Türkmen, D.; Bowden, J.; Masoli, J. A. H.; Delgado, J.; Kuo, C. L.; Melzer, D.; Pilling, L. C.
    Pharmacogenetic variants are associated with clinical outcomes during Calcium Channel Blocker (CCB) treatment, yet whether the effects are modified by genetically predicted clinical risk factors is unknown. We analyzed 32,000 UK Biobank participants treated with dihydropiridine CCBs (mean 5.9 years), including 23 pharmacogenetic variants, and calculated polygenic scores for systolic and diastolic blood pressures, body fat mass, and other patient characteristics. Outcomes included treatment discontinuation and heart failure. Pharmacogenetic variant rs10898815-A (NUMA1) increased discontinuation rates, highest in those with high polygenic scores for fat mass. The RYR3 variant rs877087 T-allele alone modestly increased heart failure risks versus non-carriers (HR:1.13, p = 0.02); in patients with high polygenic scores for fat mass, lean mass, and lipoprotein A, risks were substantially elevated (HR:1.55, p = 4 × 10(-5)). Incorporating polygenic scores for adiposity and lipoprotein A may improve risk estimates of key clinical outcomes in CCB treatment such as treatment discontinuation and heart failure, compared to pharmacogenetic variants alone.

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