Objective To explore the effect of short-term intensive insulin treatment on pancreatic β-cell function and glycemia control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. Methods Twenty-seven newly diagnosed type 2 diabetic patients with fasting blood sugar (FPG)13.1mmol/L were treated by 2 weeks short-term intensive insulin treatment. FBS, Fasting blood insulin(FINS), glycosylated hemoglobin A1c (HbA1c), 2 hours postprandial blood sugar(PBS 2), Homa β and Homa IR were measured and compared between pre-treatment and post-treatment. Results After 2 weeks short-term intensive insulin treatment, the excellent control of FBS, PBS 2 in 23 out of 27 patients were achieved respectively in (5.6±2.3)days and (8.5±3.5)days. Homa β significantly increased, and HbA1c and Homa IR decreased comared with pre-treatment. Conclusions The excellent glycemia control and improvement of β-cell function can be induced by short-term intensive insulin treatment in newly diagnosed type 2 diabetic patients with severe hyperglycemia.
We aimed to determine the effective dose given to patients during neuroradiological C-arm computed tomography (CT) procedures.Measurements were performed on 48 patients using a dose-area product (DAP) meter. A PC-based Monte Carlo program (PCXMC, STUK, Helsinki, Finland) was used to calculate the effective dose from the DAP values of each patient. Organ doses were also measured with thermoluminescent dosimeters (TLDs) using a human-shaped phantom.The difference between the organ doses measured using TLDs and PCXMC was not significant (P > 0.05). The mean DAP for 48 patients was 9.41±2.50 Gy·cm2; the mean effective dose for all procedures was 0.30±0.08 mSv. The coefficient for the correlation (R2) between the DAP and the effective dose was 0.97. The conversion factor between the effective dose and DAP was 0.030-0.035 mSv·Gy(-1)·cm(-2).DAP can be used as a dose indicator to calculate the organ dose and effective dose of patients based on Monte Carlo simulation. This method can provide important information on the absorbed dose and enhance the radiation protection of patients during C-arm CT procedures.
Objective To evaluate the imaging findings and diagnostic value of X-ray film,Intravenous pyelography (IVP) and CT in medullary sponge kidney.Methods The imaging manifestations of 14 cases were studied retrospectively and the diagnostic value of X-ray film, IVP and CT were analyzed combining with literature.14 cases were examined by X-ray film. Among 14 cases,seven cases were examined by IVP and ten cases were examined by CT. Results X-ray plain film showed a cluster of round and oval high density images in renal papillae within kidney. IVP showed dilated collecting ducts and calculus within ducts. Unenhanced CT revealed multiple small calculus in renal pyramid.After enhancement,the contrast medium around the small stone were seen in dilated collecting ducts,and the pyramids without calculus presented a striped or small cyst-like collection of contrast medium. The renal function was normal. Conclusion X-ray film,IVPand CT are of diagnostic characteristics for medullary sponge kidney. CT can make definite diagnosis.
INTRODUCTION: Sepsis-induced acute kidney injury (AKI) is the dominating AKI etiology in critically ill patients and substantially associated with risk of death.In the absence of kidney-specific therapeutic alternatives, renal replacement therapy (RRT) is often the final therapeutic option.However, whether and when to start RRT is an ongoing controversy.A major issue that persists is to differentiate patients with progressive AKI and need for RRT from those with autonomous renal recovery.We investigated the diagnostic value of the soluble urokinase-type plasminogen activator receptor (suPAR) and the product of the two G1-cell cycle arrest and tubular injury biomarkers tissue inhibitor of metalloproteinase-2 and insulin-like growth factorbinding protein 7 ([TIMP-2]*[IGFBP7]) to predict future need for RRT.METHODS: In a prospective, observational trial, 100 critically ill patients were enrolled immediately after the fulfillment of Sepsis-3 criteria.Serum SuPAR levels were measured once at inclusion, and urinary [TIMP-2]*[IGFBP7] levels were measured over time.The primary clinical endpoint was the occurrence of need for RRT (predefined criteria) within 7 days.Area under the receiver-operating characteristic curves (AUC-ROC) were calculated.RESULTS: 19 patients developed need for RRT within sevend days after study inclusion.Urinary [TIMP-2]*[IGFBP7] levels after 24h and suPAR levels at inclusion outperformed all routine parameters of renal impairment with AUC's of 0.89 (95% CI 0.80-0.98,p < 0.0001) and 0.83 (0.75-0.92, p < 0.0001), respectively.The best discrimination ability for the primary outcome measure was achieved for [TIMP-2]*[IGFBP7] after 24h of sepsis therapy, applying a cut-off value of 0.60 (ng/ml)^2/ 1000 (sensitivity 90.9%, specificity 67.1%).SuPAR performed best by applying a cutoff value of 8.53 ng/mL (sensitivity 84.2%, specificity 82.7%).The diagnostic value of suPAR and [TIMP-2]*[IGFBP7] persisted even in a subset of patients with moderate to severe AKI at the time of inclusion and after adjustment for confounders.In the same subset of patients, the diagnostic accuracy of surrogate parameters of renal function diminished.Of note, the combination of [TIMP-2]*[IGFBP7] or suPAR with Cystatin C resulted in an additive improvement of diagnostic accuracy with AUC's of 0.93 (0.86-1.00) and 0.89 (0.82-0.96), respectively.CONCLUSIONS: [TIMP-2]*[IGFBP7] and suPAR provide an excellent and superior diagnostic accuracy for RRT prediction compared to standard parameters of kidney function.Urinary [TIMP-2]*[IGFBP7] levels after 12h-24h of sepsis therapy are suggested as an excellent diagnostic tool to monitor the success of kidney-directed sepsis therapy, whereas suPAR predicts the need for RRT already at baseline.To promote the significance of both biomarkers for clinical decision making, beneficial effects on outcomes need to be demonstrated in future studies.
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