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Endocytosis mediated simply by an atypical CUBAM complex modulates slit diaphragm characteristics throughout nephrocytes.
BACKGROUND Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in Type 2 Diabetes Mellitus (T2DM) patients receiving total parenteral nutrition (TPN). AIMS To determine the predictors of hypoglycemia in hospitalized T2DM patients receiving total parenteral nutrition (TPN). DESIGN Post-hoc analysis of the INSUPAR study, which is a prospective, open-label, multi-center, clinical trial on adult inpatients with Type 2 Diabetes in a non-critical setting with indication for TPN. RESULTS The study included 161 patients, 31 (19.3%) had hypoglycemic events, none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to the admission, glycemic variability (GV), belonging to the Glargine insulin group in the INSUPAR trial, mean daily g of lipids in TPN, mean insulin per 10 g of carbohydrates, duration of TPN and increase of urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of Glargine insulin and TPN duration were risk factors for hypoglycemia. CONCLUSION The presence of DM with end-organ damage complications, longer TPN duration, belonging to the Glargine insulin group and greater GV are factors associated with the risk of hypoglycemia in diabetic non-critically ill inpatients with parenteral nutrition.Objective To analyze the effects of methimazole (MMI)-containing combination regimens on the thyroid status and relapse rates in patients with Graves' hyperthyroidism (GH) using a network meta-analysis to provide guidance for clinical application. Methods We conducted a literature review which identified 21 trials for inclusion. The major outcomes were the serum free triiodothyronine (FT3) and free thyroxine (FT4) concentrations. The secondary outcome was the relapse rate. A network meta-analysis was used to compare multiple regimens to identify the most advantageous regimen. Results The types of combined drugs included antioxidant complexes, selenium, vitamin D3, cholestyramine, risedronate, iodine, potassium bromide, immunosuppressants, and β-adrenergic antagonists. Regarding the FT3 results, the rank probability of the best result showed that potassium bromide (0.897) and vitamin D3 (0.833) had relative advantages in reducing FT3 at the 1-month time point. According to the time trend analysis, compared with the control treatment, cholestyramine and iodine showed advantages in reducing FT3 during the early stage (0-3 month). The immunosuppressants showed advantages in reducing FT3 during the late stage (>9 month) but not the early stage. Regarding the FT4 results, potassium bromide had the highest p-score (0.965) at the 1-month time point. find more Iodine and cholestyramine had advantages in reducing FT4 during the early stage. The immunosuppressants had advantages during both the early and late stages. Conclusion MMI combined with cholestyramine or iodine was shown to regulate serum FT3 and FT4 during the early stage. MMI combined with immunosuppressants had a long-term advantage in FT3/FT4 regulation and reduced the relapse rate.Objective To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves' disease (GD) and the ultrasonographic changes of the thyroid gland. Methods All of 117 juvenile patients (25 males and 92 females aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6-29.9 mCi (median 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and thrice in 2. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results At the latest follow-up more than 12 months after RIT (n=111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4-17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I, and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion Over a median follow-up period of 95 months (range 4-226 months) RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies are required to confirm the long-term safety of RIT for juvenile GD.OBJECTIVES It is unclear whether the institution of gluten free diet (GFD) is beneficial in patients with type 1 diabetes (T1DM) and subclinical celiac disease (CD). PRIMARY OBJECTIVE To evaluate the effect of GFD on frequency of hypoglycemia, in patients with T1DM and subclinical CD. Secondary; effect of GFD on height, weight, glycosylated hemoglobin (HbA1c), insulin dose requirement and bone mineral homeostasis. METHODS Prospective open label randomized controlled trial (RCT). Patients with T1DM and subclinical CD were randomized to receive GFD or a normal diet for one year. Primary outcome was frequency of hypoglycemic episodes (blood glucose less then 70 mg/dl) measured by self-monitoring of blood glucose (SMBG) at 6th month in the two groups. RESULTS 320 T1DM patients were screened for CD. 30 eligible patients were randomized to receive GFD (n=15) or a normal diet (n=15). Mean number of hypoglycemic episodes/month recorded by SMBG and mean time spent in hypoglycemia measured by CGM (mins) in GFD group vs. non GFD group at 6th month was 2.3 vs 3.4 (p=0.5) and 124.1 vs 356.9 (p=0.1) respectively. Mean number of hypoglycemic episodes/month significantly declined in GFD group (3.5 at baseline vs. 2.3 at 6th month, p=0.03). Mean HbA1c declined by 0.73% in GFD group and rose by 0.99% in non GFD group, at study completion. CONCLUSION This is the first RCT to assess the effect of GFD in T1DM and subclinical CD. A trend towards decrease in hypoglycemic episodes and better glycemic control was seen in patients receiving GFD.
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