Background Little is known about changes in the pancreas as the course of type 1 diabetes progresses. Recently, shear wave elastography (SWE) emerged as a tool for assessing pancreatic stiffness in chronic pancreatitis and pancreatic cancer with a few studies assessing it in diabetes. Objective To compare pancreatic SWE in children with recent-onset and long-standing type 1 diabetes to healthy controls and to correlate it with diabetes duration, glycated hemoglobin (HbA1C), functional B cell reserve (fasting C-peptide) and diabetic complications. Materials and methods Fifty children with type 1 diabetes (25 with recent-onset and 25 with long-standing type 1 diabetes) and 50 controls were enrolled. Diabetes duration, insulin therapy, fundoscopic examination of the eyes and the neuropathy disability score were assessed. Fasting C-peptide, lipids, HbA1C and urinary albumin-creatinine ratio were measured. Pancreatic SWE was measured using the General Electric Logiq P9 ultrasound system. Results The mean SWE of the studied children with recent-onset type 1 diabetes was 4.81±0.62 kilopascals (Kpa), those with long-standing type 1 diabetes was 7.10±1.56Kpa and for controls was 5.57±0.27 Kpa (P<0.001). SWE was positively correlated to diabetes duration (P<0.001) and negatively correlated to fasting C-peptide (P<0.001). Regarding diabetes complications, SWE was positively correlated to frequency of severe hypoglycemia (P=0.005), HbA1C (P=0.03), low-density lipoproteins (P<0.001) and cholesterol (P<0.001) and significantly related to diabetic neuropathy (P=0.04) and nephropathy (P=0.05). Diabetes duration, fasting C-peptide, HbA1C and frequency of severe hypoglycemia were the significant independent variables related to SWE increase by multivariable regression analysis. Conclusion Pancreatic SWE changes significantly with duration of type 1 diabetes, being lowest in those with recent-onset type 1 diabetes and highest in those with long-standing type 1 diabetes, particularly those with diabetic nephropathy and neuropathy.
The qualification thesis consists of an explanatory note and a graphic part (illustrative material -slides). The volume of the graphic part of the qualification work is 16 slides. The volume of the explanatory note is 61 printed pages of A4 format (210×297).
Background Benign prostatic hyperplasia (BPH) is inescapable with aging and can cause lower urinary tract symptoms, worsening the quality of life. New pathophysiologic mechanisms of BPH development are currently under study to modulate its management. The valvular destruction of the spermatic veins (varicoceles development) incurs a testicular-prostatic hydrostatic pressure gradient, which conveys free undiluted testosterone to the prostate via a testicular-prostatic backdoor passage. Subsequently, prostatic congestion and androgen-dependent prostatic hyperplasia occur resulting in lower urinary symptoms development. The purpose of our study is to detect the effect of testicular venous sclerotherapy on the prostatic enlargement and the related urinary symptoms. Results Our single-arm interventional study included 36 patients with an age range of 40–80 years. The patients complained of urinary symptoms and had prostatomegaly with varicoceles by sonography. A median international prostatic symptom score (IPSS) of 19 and a quality of life (QoL) score ranging (3–6) reflected the severity of the urinary symptoms. Venography showed reflux in all cannulated spermatic veins with subsequent sclerotherapy on the left side and bilaterally in 80.6% and 11.1% of the patients, respectively. The technical and clinical success rates reached 91.7% and 83.3%, respectively, with a statistically significant reduction in the IPSS and QoL scores. We observed a statistically insignificant improvement in the sexual satisfaction, prostatic volumes, post-void residual volumes, and PSA levels. Minimal self-limiting complications occurred with an overall rate of 38.9%. Only 16.66% of cases needed further surgery, while the rest had sufficient symptomatic relief post sclerotherapy. Conclusion Varicoceles sclerotherapy can be employed to resolve the testicular venous insufficiency and mitigate the severity of the prostatic-related urological symptoms in middle-aged and elderly men, so varicoceles can be considered a confounding variable in the development of the prostatic-related lower urinary tract symptoms.
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