Hybrid closed Loop improved glucose control compared to sensor-augmented pumps in outpatients with type 1 diabetes in real-life conditions with telehealth monitoring.

OBJECTIVES: The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings. RESEARCH DESIGN AND METHODS: This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM (n = 26) or pump users who only changed their device (n = 51), with predictive low glucose management (n = 8) or with Hybrid Closed Loop using Medtronic 780G (n = 36) systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. All subjects received diabetes and carbohydrate-counting education if needed at time of initiation and were proposed a telehealth monitoring by a diabetic nurse educator. RESULTS: There was no episodes of severe hypoglycemia or diabetic ketoacidosis nor serious pump-related adverse events despite outpatient model of care. While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. Time in target range 3.9-10 mmol/L (70-180 mg/dl) also improved and was optimal with closed loop with 30/36 (83%) subjects with time in range above 70%. CONCLUSIONS: Initiation of insulin pump therapy for outpatients is safe with a dedicated facility. Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.

[The clinical and pathogenic significance of the chronic specific infection in the gastroenterology].

As a result of the integrative evaluation of clinical and laboratory results of 610 patients with pathology of the digestive system, which was accompanied with the chronic specific infection (CSI) such as VHA, VHE, VHB, VHC, VHD, GB, F, TTV, SEN; types I and II herpes virus, cytomegalovirus, toxoplasmosis. The conception of the systemic polyglandulopathy was formulated. The authors have analyzed some pathogenic mechanisms and clinical pecularities of the chronic specific infection in patients with the diseases of the digestive system and the principles of the diagnosis and complex treatment were proposed.

[The ultrasonic diagnosis of the phasic interdigestive activity of the pancreas and the main pancreatic duct in healthy subjects and chronic pancreatitis patients]. / Ul'trazvukovaia diagnostika faznoi mezhpishchevaritel'noi aktivnosti podzheludochnoi zhelezy i glavnogo pankreaticheskogo protoka u zdorovykh i bol'nykh khronicheskim pankreatitom.

Sixteen healthy subjects and 113 patients with chronic pancreatitis were studied for ultrasonic dynamics of phase interdigestive activity of pancreas and calibre of the main pancreatic duct (MPD). Both in healthy individuals and patients, the gland sizes and MPD calibre change with phases of interdigestive motility of duodenum. The largest sizes in healthy subjects are found in phase 2 irregular contractions of duodenum, the least ones--in patients with grave disease course. This is an important differential and diagnostic criterion between chronic pancreatitis and normal functional state of pancreas corresponding to a certain phase of interdigestive motility of duodenum. Phase-dependent sizes of pancreas and MPD calibre are to be taken into account in conducting ultrasonography of pancreas and interpretation of the results obtained.

[The ultrasonic diagnosis of the interdigestive phase motility of the gallbladder in healthy subjects and duodenal peptic ulcer patients]. / Ul'trazvukovaia diagnostika faznoi mezhpishchevaritel'noi motoriki zhelchnogo puzyria u zdorovykh i bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

The contractile function and tone of the gallbladder were studied under basal conditions with regard to phases of interdigestive motility of duodenum in 100 patients with duodenal ulcer and 20 healthy controls. It has been ascertained that in healthy subjects and patients with ulcer disease, the gallbladder tends to function in a manner consistent with phases of interdigestive motility of duodenum. Patients with ulcer disease show hypermotoric dyskinesia of the gallbladder and biliary tract evidenced by diminution of its capacity as well as by hypertonicity. It is necessary that ultrasonics to study the gallbladder be used with regard to phases of the interdigestive motility of duodenum, the latter consideration being important in studying the gallbladder's motor function. The most significant results are obtainable during the second phase of duodenal irregular contractions (2 phases).

[The interdigestive motility of the gallbladder in patients with gastric and duodenal peptic ulcer]. / Mezhpishchevaritel'naia motorika zhelchnogo puzyria u bol'nykh iazvennoi bolezn'iu zheludka i dvenadtsatiperstnoi kishki.

As many as 30 patients with uncomplicated ulcer disease and 8 essentially healthy individuals were studied for the tone and contractile function of the gallbladder under basal conditions with regard to the phases of duodenal interdigestive motility. In normals, the gallbladder functions according to phases of duodenal interdigestive motility while the clinical picture in those patients with ulcer disease is distinguished by predominance of hypermotor dyskinesia of the gallbladder and bile tract, which fact is manifested by reduction of its capacity as well as hypertone and discordant work of Lütken's--and Oddi sphincters leading to untimely and incomplete outgo of the bladder bile. Ultrasonic investigation of the gallbladder is to be carried out with due regard to its phase-associated interdigestive motility.

[The clinical significance of phasic duodenal intubation and ultrasonic monitoring of the gallbladder in healthy subjects]. / Klinicheskoe znachenie pofaznogo duodenal'nogo zondirovaniia i ul'trazvukovogo monitoringa zhelchnogo puzyria u zdorovykh lits.

Overall twelve essentially healthy subjects were evaluated for the tone and contractile function of the gallbladder according to phases of interdigestive motility of duodenum as were for effects on these functions of phase-by-phase administration of 30 ml of 33% solution of magnesium sulphate. The gallbladder in healthy individuals was found out to function according to phases of duodenal interdigestive motility and be ready to evacuate bile during phase II. Prior diagnostic techniques did not take advantage of interdigestive phase of duodenal and gallbladder motility during which phase a standard stimulating agent was routinely employed. This can lead to wrong diagnosis of the functional state of the biliary tract, gallbladder and their sphincters in the interdigestive period: incomplete gallbladder emptying from bile in case the stimulating agent is being introduced during phase I or III; hyperdiagnosis of cholecystitis; heterodirectivity of the same patient's notion about type of dyskinesias of the gallbladder and biliary tract.

[The interdigestive phasic motility of the gallbladder and bile excretion in healthy subjects and in patients with duodenal peptic ulcer]. / Mezhpishchevaritel'naia faznaia motorika zhelchnogo puzyria i ékskretsiia zhelchi u zdorovykh i bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Interdigestive phasic motility of the gallbladder and bile excretion into the duodenum were studied in 100 patients with duodenal ulcer (DU) and 20 healthy subjects. Gall bladder motility and bile excretion in both healthy and DU subjects directly depended on interdigestive phasic activity of the duodenum and gastric antrum. In health, gallbladder volume reached its maximum within termination of phase II, minimum in the end of phase III-beginning of phase I. Maximal bile production occurred at phase II-III and coincided with pH decline in the stomach. The mixture of the vesicular and duct bile flowed out in the end phase III-beginning of phase I. The range of volumetric bladder contraction made up 33% of its capacity. In DU patients this reached 35%, the bladder capacity was reduced, the maximum bile production occurred at phase II, bile flowed out intermittently, its color changed from achromatic to dark yellow. The latter fact suggests hypertensive and hypermotor dyskinesia of the gallbladder as well as its sphincter system and bile duct functional impairment. This requires adequate therapeutic correction with consideration of relevant motor and secretory disturbances.

[The volume of circulating blood during surgery of the aorta performed under epidural anesthesia]. / Ob"em tsirkuliruiushchei krovi pri operatsiiakh na aorte v usloviiakh épidural'noi anestezii.

Various methods of circulating blood volume (CBV) determination have been compared. The calculation method based on anthropometric to hemodynamic parameter ratio was shown to be optimal during surgery on the aorta and major vessels. Epidural anesthesia in 15% CBV deficit in the preoperative period and anesthetic administration into the epidural space intraoperatively in 10% CBV deficit were contraindicated. Epidural anesthesia caused CBV reduction, with its maximum changes observed upon blood flow recovery in the vascular bed. 10-15 ml/kg, 15-20 ml/kg and 20-30 ml/kg blood loss was 2.5,3 and 3.5 times overcompensated, respectively.

[Venous occlusive plethysmography in assessment of hemodynamics in arterial thrombosis of the lower extremities]. / Primenenie venoznoi okkliuzionnoi pletizmografii v otsenke gemodinamiki pri tromboze arterii nizhnikh konechnostei.

With the use of a method of venous occlusive plethysmography changes, in regional arterial and venous hemodynamics in 75 patients with arterial thrombosis as well as in 47 after reconstructive intervention at the immediate period, and in 25--at the late period were studied. It was established that in ischemia progression, the volume blood flow rate at rest and maximum rate decreased, indicating severe impairement in reserve possibilities of blood flow, maximum venous outflow reduced, venous filling of the vessels increased. In thrombosis, rough disorders in reserve possibilities of blood flow in the aorto-iliac segment were noted. After operation, dynamics of the indices didn't depend on type of reconstructive intervention and was determined only by adequacy of blood flow restoration in the extremity.

[The characteristics of epidural anesthesia in operations on the aorta and vessels of the lower extremities]. / Osobennosti épidural'noi anestezii pri operatsiikh na aorte i sosudakh nizhnikh konechnostei.

Under study were the parameters of microcirculation in 84 patients operated on the vessels in the aorto-ilio-femoral zone, in 33 patients operated on the vessels in the femoro-popliteal zone. In all of them epidural anesthesia was used. In 25 patients operations on the aorta and main vessels were fulfilled under conditions of epidural anesthesia with catheterization of the epidural space at two levels. The dynamics of microcirculation parameters allows to state that the epidural anesthesia with catheterization of the epidural space at two levels is more rational for patients in operations on the vessels in the aorto-ilio-femoral zone since it gives adequate anesthesia during operation and better tissue blood flow in lower extremities.

[Prognostic decisions in organizing rescue and other emergency accident-recovery operations in extreme situations]. / Prognosticheskie resheniia pri organizatsii spasatel'nykh i drugikh neotlozhnykh avariino-vosstanovitel'nykh rabot v chrezvychainykh situatsiiakh.

The existing classifications of emergency situations have been analysed in the article. Based on their own experience, the authors propose a new approach to a problem of forecasting the activities of medical service in liquidation of the consequences of catastrophes. The classification worked out by the authors is specially tabulated, that makes it possible to take rapid prognostic decisions on organization of rescue and emergency actions.

[Evaluation of compensatory possibilities of the cardiovascular system in patients before reconstructive operations on the aorta and major arteries]. / Otsenka kompensatornykh vozmozhnostei serdechno-sosudistoi sistemy bol'nykh, podvergaiushchikhsia rekonstruktivnym operatsiiam na aorte i magistral'nykh arteriiakh.

To determine functional reserves of cardiovascular system, two procedures were comparatively studied in evaluation of central hemodynamics: tetrapolar chest rheography under isovolemic loading and rheopolyglucin test. Close correlation registered in results of the tests allowed the authors to employ subsequently the isovolemic test alone. The patients with circulatory subcompensation and decompensation received 7-14-day preoperative cardiostimulation.

[Water-electrolyte balance in patients during operation on the aorto-femoral segment using various types of anesthesia]. / Vodno-élektrolitnyi balans u bol'nykh vo vremia operatsii na aorto-bedrennom segmente pri ispol'zovanii razlichnykh vidov anestezii.

The indices of aqueous-electrolyte metabolism in patients, who underwent the reconstructive operations on the aorta, were studied. In patients with concomitant diabetes mellitus, a method of choice for anesthesia is an epidural anesthesia, with ischemic heart disease--combined epidural anesthesia. The most severe changes in electrolyte metabolism were noted after restoration of blood flow in blood loss of more than 10 ml/kg, under conditions of epidural anesthesia these shifts are less pronounced.

[Anesthesiologic management of surgery of the aorta and the major vessels in patients with diabetes mellitus]. / Anesteziologicheskoe obespechenie operatsii na aorte i magistral'nykh sosudov u bol'nykh sakharnym diabetom.

In 23 patients with diabetes mellitus, the effectiveness of anesthesiologic support of the operations on the aorta and major vessels, which was based on combined epidural anesthesia performed using the conventional technique, was analysed. Sugar concentration in the blood was maintained at a level of no more than 11 mmol/l. Use of the method permitted to provide an adequate anesthesia, stable concentration of glucose in the blood, constant aqueous-electrolyte balance and acid-base state.