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Diarrhea and Acute Renal Injury Culminating in Metformin-Induced Lactic Acidosis

Open Journal of Nephrology 2023年第3期13卷 195-200页

作者： Kamel El-Reshaid Abdulmohsen Al-Bader department of Medicine Faculty of Medicine Kuwait University Kuwait City Kuwait department of otolarygology Ministry of Health Kuwait City Kuwait

Background: Metformin (M) is an effective first-line hypoglycemic agent in obese type 2 diabetes mellitus due to its low cost and safety profile. The Case: A 66-year-man presented with shock due to lactic acidosis induced by M-supersaturation subsequent to acute renal failure following infective diarrhea. The drug has been used, by this patient, for >10 years without complication. Physical examination, laboratory tests, radiological investigations and blood cultures did not show evidence of new cardiac, hepatic and septic insult. Despite discontinuation of M and 2-days of aggressive hydration, bicarbonate infusions and pressors;toxic levels of the drug persisted and shock-state culminated in severe and oliguric renal failure with serum urea and creatinine up to 50 mmol/L and 1270 umol/L, respectively. Hence, continuous venovenous hemodiafiltration (CVVHDF) was used, for 16-hours, to remove the drug, correct his acidosis and support his severe renal complications. Hours after the procedure;drug level, lactic acidosis and its associated shock improved followed by gradual renal recovery. The patient was discharged after 6 days and serum creatinine reached his base line (180 umol/L) 2 weeks later. The drug was not recommended for his future use. Conclusion: M-induced lactic acidosis, should be considered in assessment of shock in M-treated patients and management of unstable patients indicates early-use of CVVHDF.

关键词： CVVHDF Diabetes Mellitus Diarrhea Lactic Acidosis Metformin Shock

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Expression of IL-17 and Syndecan-1 in Nasal Polyps and Their Correlation with Nasal Polyps

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2017年第3期37卷 412-418页

作者：龚国清任芳芳王彦君万浪陈删袁杰杨传梅刘邦华孔维佳 department of Otolaryngology Union Hospital Tongji Medical College Huazhong University of Science and Technology department of Otolaryngology The Fifth Affiliated Hospital of Zhengzhou University department of otolarygology Huangshi Central Hospital

Nasal polyp(NP) is a common chronic inflammatory disease of the nasal cavity and sinuses. Although some authors have suggested that NP is related to inflammatory factors such as interleukin(IL)-1β, IL-5, IL-8, granulocyte-macrophage colony-stimulating factor(GM-CSF), tumor necrosis factor(TNF)-α, and IL-17, the mechanisms underlying the pathogenesis and progression of NP remain obscure. This study investigated the expression and distribution of IL-17 and syndecan-1 in NP, and explored the roles of these two molecules in the pathogenesis of eosinophilic chronic rhinosinusitis with nasal polyps(Eos CRSwNP) and non-Eos CRSwNP. Real-time PCR and immunohistochemistry were used to detect the expression of IL-17 and syndecan-1 in samples [NP, unciform process(UP) from patients with CRS, and middle turbinate(MT) from healthy controls undergoing pituitary tumor surgery]. The results showed that the expression levels of IL-17 and syndecan-1 were upregulated in both NP and UP tissues, but both factors were higher in NP tissues than in UP tissues. There was no significant difference in IL-17 levels between the Eos CRSw NP and non-Eos CRSwNP samples, and syndecan-1 levels were increased in the non-Eos CRSwNP tissues as compared with those in Eos CRSwNP tissues. In all of the groups, there was a close correlation between the expression of IL-17 and syndecan-1 in nasal mucosa epithelial cells, glandular epithelial cells, and inflammatory cells, suggesting that IL-17 and syndecan-1 may play a role, and interact with each other, in the pathogenesis of non-Eos CRSwNP.

关键词： interleukin-17 syndecan-1 nasal polyps

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