scholarly journals Factors Affecting the Absorption of Subcutaneously Administered Insulin: Effect on Variability

2018 ◽  
Vol 2018 ◽  
pp. 1-17 ◽  
Author(s):  
A. K. J. Gradel ◽  
T. Porsgaard ◽  
J. Lykkesfeldt ◽  
T. Seested ◽  
S. Gram-Nielsen ◽  
...  
Keyword(s):  
Injection Site ◽  
Subcutaneous Tissue ◽  
Injection Technique ◽  
Insulin Absorption ◽  
Physiological Factors ◽  
Insulin Effect ◽  
Factors Affecting ◽  
Glucose Levels ◽  
Long Term Prognosis

Variability in the effect of subcutaneously administered insulin represents a major challenge in insulin therapy where precise dosing is required in order to achieve targeted glucose levels. Since this variability is largely influenced by the absorption of insulin, a deeper understanding of the factors affecting the absorption of insulin from the subcutaneous tissue is necessary in order to improve glycaemic control and the long-term prognosis in people with diabetes. These factors can be related to either the insulin preparation, the injection site/patient, or the injection technique. This review highlights the factors affecting insulin absorption with special attention on the physiological factors at the injection site. In addition, it also provides a detailed description of the insulin absorption process and the various modifications to this process that have been utilized by the different insulin preparations available.

64 STATISTICAL ANALYSIS OF PROGNOSTIC FACTORS AFFECTING LONG-TERM PROGNOSIS AFTER ENDOSCOPIC TREATMENT OF ESOPHAGEAL VARICES

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Nishimura
Keyword(s):  
Prognostic Factors ◽  
Esophageal Varices ◽  
Endoscopic Treatment ◽  
Survival Period ◽  
Term Survival ◽  
Gastroesophageal Varices ◽  
Long Term Survival ◽  
Factors Affecting ◽  
Long Term Prognosis

Abstract   Gastroesophageal varices are present in approximately 50% of patients with cirrhosis, and their rupture is a life-threatening complication. However, mortality rates have declined due to the progress in the management of these patients. Especially advances in endoscopic treatment have contributed to the improved survival rates. In this study, we investigated the prognostic factors associated with long-term survival after endoscopic treatment for esophageal varices. Methods The subjects were 260 patients who underwent initial endoscopic treatment for esophageal varices in our hospital between January 1997 and June 2019. Among them, 160 successfully followed up. The patients’ characteristics were: mean age, 65.4 years (29–85); 109 men and 51 women; and median survival period, 53 months. For analysis, subjects were divided into long-term survival and non-long-term survival groups (n = 59 for each) with a 53-month survival period as a cut-off value. Results The long-term/non-long-term survival group had a preoperative Child-Pugh score of 6.2 ± 1.1/7.4 ± 2.0 (p < 0.01) and hepatocellular carcinoma (HCC) presence rate was 25.4%/55.9% (p < 0.01), significantly higher in the non-long-term group. Analysis of the factors affecting survival period using Cox proportional hazards model showed that Child-Pugh score B or C [hazard ratio(HR):2.0143, p < 0.05], total bilirubin value≧ 2 [HR:2.5573, p < 0.05], and presence of HCC [HR:2.2450, p < 0.01] were noted as significant factors. Only presence of HCC was found to be a significant factor affecting the long-term survival using multiple logistic regression analysis [odds ratio:0.3463, p < 0.05]. Conclusion Our study revealed that liver function and the presence of HCC affect long-term prognosis after endoscopic treatment for esophageal varices.

scholarly journals Anti-NMDAR encephalitis

2019 ◽  
Vol 7 (1) ◽  
pp. e633 ◽  
Author(s):  
Xiaolu Xu ◽  
Qiang Lu ◽  
Yan Huang ◽  
Siyuan Fan ◽  
Lixin Zhou ◽  
...  
Keyword(s):  
Ovarian Teratoma ◽  
Long Term Outcomes ◽  
First Line ◽  
Factors Affecting ◽  
First Line Therapy ◽  
Nmdar Encephalitis ◽  
Clinical Presentations ◽  
Long Term Prognosis

ObjectiveTo describe the detailed clinical characteristics, immunotherapy, and long-term outcomes of patients with anti-NMDA receptor (NMDAR) encephalitis in China.MethodsA single-center, prospective study. Patients who met the diagnostic criteria were enrolled from 2011 to 2017 and followed up. The clinical features, treatment, and long-term outcomes were collected prospectively. Factors affecting the long-term prognosis were analyzed.ResultsThe study included 220 patients. The most common clinical presentations were psychosis (82.7%) and seizures (80.9%). Of the patients, 19.5% had an underlying neoplasm; of which ovarian teratoma was 100% of tumors in females and only one male had lung cancer. Most patients (99.5%) received first-line therapy (glucocorticoids, IV immunoglobulin, or plasmapheresis alone or combined), and only 7.3% received second-line immunotherapy (rituximab, cyclophosphamide alone, or combined). Long-term immunotherapy (mycophenolate mofetil or azathioprine >1 year) was administered to 53.2% of patients. During the first 12 months, 207 (94.1%) patients experienced improvement, and 5 (2.3%) died, whereas 38 (17.3%) experienced relapses. At 12-month follow-up, 92.7% had favorable clinical outcomes (modified Rankin Scale score ≤2).ConclusionsPatients in China present with psychosis and seizure frequently but have a low percentage of underlying neoplasms. Re-enforced first-line immunotherapy is effective in managing anti-NMDAR encephalitis in the acute phase. Although relapse is relatively common, with combined first-line and long-term immunotherapy, most patients reached favorable outcomes.

scholarly journals Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study

2021 ◽  
Vol 11 (1) ◽  
pp. 6
Author(s):  
Mª José Carrera ◽  
Pedro Moliner ◽  
Gemma Llauradó ◽  
Cristina Enjuanes ◽  
Laura Conangla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariable Analysis ◽  
Acute Hyperglycemia ◽  
Glucose Levels ◽  
Long Term Prognosis ◽  
Shape Curve ◽  
A Prospective Study ◽  
The Impact ◽  
The Relationship

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.

scholarly journals Review of the Long-Term Implantable Senseonics Continuous Glucose Monitoring System and Other Continuous Glucose Monitoring Systems

2020 ◽  
Vol 15 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Jeffrey I. Joseph
Keyword(s):  
Continuous Glucose Monitoring ◽  
Subcutaneous Tissue ◽  
Glucose Monitoring ◽  
Clinical Trial Data ◽  
Diabetes Patient ◽  
Glucose Levels ◽  
Study Results ◽  
And Performance ◽  
Patient Use

The article published by Kevin Cowart in this issue of the Journal of Diabetes Science and Technology (JDST) is a detailed overview of the clinical trial data and analysis used to demonstrate the safety and effectiveness of the Eversense continuous glucose monitoring (CGM) System for regulatory approval and clinical acceptance. The article describes the published study results for safety, accuracy, reliability, ease of insertion/removal, adverse events, and ease of diabetes patient-use for controlling their glucose levels short and long term. The author nicely compares Eversense CGM System safety and performance with the short-term subcutaneous tissue CGM systems being commercialized by Dexcom, Medtronic Diabetes, and Abbott Diabetes. This comparison may help the clinician define which type of patient with diabetes might benefit the most from the long-term implantable CGM system. The majority of studied patients describe a positive experience managing their diabetes with the Eversense CGM System and request implantation of a new sensor 90 or 180 days later.

scholarly journals The Influence of Different Treatment Strategies on the Long-Term Prognosis of T1 Stage Esophageal Cancer Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Liang Pan ◽  
Xingyu Liu ◽  
Weidong Wang ◽  
Linhai Zhu ◽  
Wenfeng Yu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Tumor Size ◽  
Factors Affecting ◽  
Ajcc Stage ◽  
Size Grade ◽  
T1 Stage ◽  
Long Term Prognosis ◽  
Better Than

ObjectiveTo compare the long-term prognosis effects of non-esophagectomy and esophagectomy on patients with T1 stage esophageal cancer.MethodsAll esophageal cancer patients in the study were included from the National Surveillance Epidemiology and End Results (SEER) database between 2005-2015. These patients were classified into non-esophagectomy group and esophagectomy group according to therapy methods and were compared in terms of esophagus cancer specific survival (ECSS) and overall survival (OS) rates.ResultsA total of 591 patients with T1 stage esophageal cancer were enrolled in this study, including 212 non-esophagectomy patients and 111 esophagectomy patients in the T1a subgroup and 37 non-esophagectomy patients and 140 esophagectomy patients in the T1b subgroup. In all T1 stage esophageal cancer patients, there was no difference in the effect of non-esophagectomy and esophagectomy on postoperative OS, but postoperative ECSS in patients treated with non-esophagectomy was significantly better than those treated with esophagectomy. Cox proportional hazards regression model analysis showed that the risk factors affecting ECSS included race, primary site, tumor size, grade, and AJCC stage but factors affecting OS only include tumor size, grade, and AJCC stage in T1 stage patients. In the subgroup analysis, there was no difference in either ECSS or OS between the non-esophagectomy group and the esophagectomy group in T1a patients. However, in T1b patients, the OS after esophagectomy was considerably better than that of non-esophagectomy.ConclusionsNon-esophagectomy, including a variety of non-invasive procedures, is a safe and available option for patients with T1a stage esophageal cancer. For some T1b esophageal cancer patients, esophagectomy cannot be replaced at present due to its diagnostic and therapeutic effect on lymph node metastasis.

An Alternative Method for Preventing Extravasation Complications in Vascular Access Catheters with Reservoirs for Subcutaneous Infusion: THE Double Injection Technique

2002 ◽  
Vol 88 (5) ◽  
pp. 411-413
Author(s):  
Faruk O Aytekin ◽  
Koray Tekin ◽  
Hilmi Kocaoglu ◽  
Ergun Erdem
Keyword(s):  
Cancer Patients ◽  
Subcutaneous Tissue ◽  
Injection Technique ◽  
Obese Patients ◽  
Single Institution ◽  
Easy Method ◽  
Subcutaneous Infusion ◽  
Accidental Infusion ◽  
Intravascular Access

Long-term intravascular access catheters with reservoirs are a common requirement for cancer patients. Complications resulting from the use of these devices have been studied in several single-institution investigations, the consensus being that they are safe and have a low complication rate. However, extravasation may occur especially in obese patients due to accidental infusion of the subcutaneous tissue. To prevent this problem we describe an easy method that could be an alternative to the widely used ultrasonography-guided injection method.

Renovascular reconstruction: Factors affecting long-term prognosis in 919 patients followed up to 31 years

1989 ◽  
Vol 63 (15) ◽  
pp. 1085-1092 ◽  
Author(s):  
Gerald M. Lawrie ◽  
George C. Morris ◽  
Donald H. Glaeser ◽  
Michael E. DeBakey
Keyword(s):  
Factors Affecting ◽  
Long Term Prognosis
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