Recently, the albuminocentric view of diabetic kidney disease (DKD) in type 2 diabetes (T2DM) has been changing. Therefore, the relationship between diabetic retinopathy (DR) and chronic kidney ...disease (CKD) has to be addressed according to this new clinical presentation of DKD. The aim of this study was to evaluate, in a real-world setting, the correlation DR–DKD in T2DM.
A total of 2068 type 2 diabetic patients enrolled in a multicenter cross-sectional study were investigated. Albuminuric subjects were largely prevalent among subjects with DR (p = 0.019). In the whole study population, no difference in albumin excretion rate (AER) was observed between presence/absence of DR; instead, AER was significantly higher among patients with glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (CKD) (p = 0.009), above all in those with CKD and AER ≥0.03 g/24 h (p = 0.005). Multivariate analysis confirmed that eGFR (O.R. 0.976; 95% C.I.: 0.960–1.028; p < 0.001) and AER (O.R. 1.249; 95% C.I. 1.001–1.619; p = 0.004) were independently associated with DR and HDL–cholesterol (O.R.: 1.042; 95% C.I.: 1.011–1.120; p = 0.014). Additionally, among patients with eGFR <60 mL/min/1.73 m2 and albuminuria, both eGFR and AER significantly varied between those with/without DR (p = 0.012 and p = 0.005, respectively), and this finding was observed among only albuminuric patients. Analogous results were obtained considering DR classification. AER was significantly higher among subjects with either proliferative DR (PDR) or severe nonproliferative DR (NPDR), with regard to mild NPDR (0.498 and 0.938 g/die vs. 0.101 g/die; p < 0.001, respectively). Similar results were obtained in the specular subgroups.
In T2DM with DKD, the AER seems to be related to the presence of DR. This association is confirmed above all in those with more severe DR.
•The albuminocentric view of diabetic kidney disease in T2DM has been changing.•Relationship between DR and CKD was studied according to albuminuric phenotype.•AER is significantly higher in those with DR and CKD along with albuminuria.•In T2DM with diabetic kidney disease, AER is above all related to severe DR.•Albuminuria might represent a link between DR and diabetic kidney disease.
Background and aims
Recent studies suggest a potential relationship between rosacea and Helicobacter pylori (H. pylori) infection or small intestinal bacterial overgrowth (SIBO), but there is no firm ...evidence of an association between rosacea and H. pylori infection or SIBO. We performed a prospective study to assess the prevalence of H. pylori infection and/or SIBO in patients with rosacea and evaluated the effect of H. pylori or SIBO eradication on rosacea.
Methods
We enrolled 90 patients with rosacea from January 2012 to January 2013 and a control group consisting of 90 patients referred to us because of mapping of nevi during the same period. We used the 13C Urea Breath Test and H. pylori stool antigen (HpSA) test to assess H. pylori infection and the glucose breath test to assess SIBO. Patients infected by H. pylori were treated with clarithromycin-containing sequential therapy. Patients positive for SIBO were treated with rifaximin.
Results
We found that 44/90 (48.9%) patients with rosacea and 24/90 (26.7%) control subjects were infected with H. pylori (p = 0.003). Moreover, 9/90 (10%) patients with rosacea and 7/90 (7.8%) subjects in the control group had SIBO (p = 0.6). Within 10 weeks from the end of antibiotic therapy, the skin lesions of rosacea disappeared or decreased markedly in 35/36 (97.2%) patients after eradication of H. pylori and in 3/8 (37.5%) patients who did not eradicate the infection (p < 0.0001). Rosacea skin lesions decreased markedly in 6/7 (85.7%) after eradication of SIBO whereas of the two patients who did not eradicate SIBO, one (50%) showed an improvement in rosacea (p = 0.284).
Conclusions
Prevalence of H. pylori infection was significantly higher in patients with rosacea than control group, whereas SIBO prevalence was comparable between the two groups. Eradication of H. pylori infection led to a significant improvement of skin symptoms in rosacea patients.
Intensity modulated radiotherapy is a widely used technique for accurately targeting cancerous tumours in difficult locations. As treatments are becoming more complex, new methods need to be ...developed to monitor them. Monolithic active pixel sensors are a viable candidate for providing upstream beam monitoring during treatment. A MAPS based system can be made thin enough to have less than 1% attenuation. We have already demonstrated leaf position resolutions below 130µm at the iso-centre for 5mm wide leaves sampled 34 times per second. We have shown that the signal due to therapeutic photons can be determined and thus the dose in patient. Furthermore, the sensor works well inside an MR-linac, allowing leaf position verification even in that challenging environment.
Multileaf collimators (MLCs) are an essential component in modern radiotherapy that shape the X-ray treatment beam. Currently, MLC leaf position accuracy is verified to ±1 mm every month. However, ...leaf position accuracy can drift between verification dates and treatment verification only occurs pretreatment. To prevent serious errors, it would be highly beneficial to use a real-time verification system. We are developing a system based on monolithic active pixel sensors (MAPSs). MAPS are radiation hard under photon and electron irradiation, have high readout rates, low attenuation and are suitable for high-resolution applications making them an ideal upstream radiation detector. Here, we report results using the Lassena MAPS, which measures <inline-formula> <tex-math notation="LaTeX">12\times14 </tex-math></inline-formula> cm 2 and is three-side buttable, allowing full treatment fields to be monitored. The Lassena detector was placed in the treatment field of an Elekta Synergy LINAC which has an MLC leaf width of 0.5 cm. An MLC leaf was extended to ten different positions within the field. Sobel-based methods were used to reconstruct the leaf edge position. Correspondence between reconstructed and set leaf position was excellent and resolutions ranged between 60.6± 8 and <inline-formula> <tex-math notation="LaTeX">109\pm 12~\mu \text{m} </tex-math></inline-formula> for a central leaf with leaf extensions ranging from 1 to 35 mm using ~0.3 s of treatment beam time while the sensor was placed at an SSD of 85 cm.
Monolithic active pixel sensor (MAPS) devices are an effective tool for upstream verification of intensity-modulated radiotherapy (IMRT) treatments. It is crucial to measure with high precision the ...positions of the multi-leaf collimators (MLCs) used to shape the beam in real time, in order to enhance the quality and safety of treatments. This article describes r-UNet, a deep learning-based solution for leaf position reconstruction. The model is used to analyze the high-resolution images produced by a Lassena MAPS device in order to automatically determine the leaf positions. Image segmentation and leaf position estimation are performed simultaneously in a multitask setting. r-UNet obtained an average Dice coefficient of 0.96 ± 0.03 for the reconstructed image masks in the held-out test set; whilst the mean squared error (MSE) resulting from the estimation of the MLC positions is 0.003 mm, with a resolution ranging between 45 and 53 <inline-formula> <tex-math notation="LaTeX">\mu \text{m} </tex-math></inline-formula> for leaf extensions between 1 and 35 mm. On unseen leaf positions, r-UNet yielded a single-leaf resolution between 54 and 88 <inline-formula> <tex-math notation="LaTeX">\mu \text{m} </tex-math></inline-formula> depending on the leaf extension, and an average MSE of 0.07 mm. These results were obtained using single frames of data collected at 34 frames/s.
The current trend in X-ray radiotherapy is to treat cancers that are in difficult locations in the body using beams with a complex intensity profile. Intensity-modulated radiotherapy (IMRT) is a ...treatment which improves the dose distribution to the tumor whilst reducing the dose to healthy tissue. Such treatments administer a larger dose per treatment fraction and hence require more complex methods to verify the accuracy of the treatment delivery. Measuring beam intensity fluctuations is difficult as the beam is heavily distorted after leaving the patient and transmission detectors will attenuate the beam and change the energy spectrum of the beam. Monolithic active pixel sensors (MAPSs) are ideal solid-state detectors to measure the 2-D beam profile of a radiotherapy beam upstream of the patient. MAPS sensors can be made very thin (<inline-formula> <tex-math notation="LaTeX">{\sim }30~\mu \text{m} </tex-math></inline-formula>) with still very good signal-to-noise performance. This means that the beam would pass through the sensor virtually undisturbed (<1% attenuation). Pixel pitches of between <inline-formula> <tex-math notation="LaTeX">2{~\mu }\text{m} </tex-math></inline-formula> to <inline-formula> <tex-math notation="LaTeX">100~{\mu }\text{m} </tex-math></inline-formula> are commercially available. Large area devices (<inline-formula> <tex-math notation="LaTeX">{\sim }15 \times 15 </tex-math></inline-formula> cm 2 ) have been produced. MAPS can be made radiation hard enough to be fully functional after a large number of fractions. All this makes MAPS a very realistic transmission detector candidate for beam monitoring upstream of the patient. A remaining challenge for thin, upstream sensors is that the detectors are sensitive to the signal of both therapeutic photons and electron contamination. Here, a method is presented to distinguish between the signal due to electrons and photons and thus provide real-time dosimetric information in very thin sensors that does not require Monte Carlo simulation of each linear accelerator treatment head.
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