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AIM: To estimate the urinary excretion of markers for podocyte injury, to specify their value for the early diagnosis of diabetic nephropathy (DN), and to access the risk of its progression in patients with diabetes mellitus (DM) with varying degrees of albuminuria/proteinuria. SUBJECT AND METHODS: Seventy-four diabetic patients (30 with type 1 DM and 44 with type 2 DM) were examined and divided into 3 groups according to the urinary concentration in one urinary portion: 1) 41 patients with normal albuminuria (NAU) (<20 mg/l); 2) 13 patients with microalbuminuria (MAU) (20-200 mg/l); 3) 20 patients with proteinuria (PU) (>200 mg/l). A control group included 10 healthy individuals. The urinary levels of the podocyte structural proteins nephrin and podocin were determined by enzyme immunoassay. RESULTS: Nephrinuria (NU) was detected in 63, 77, and 80% of the patients with NAU, MAU, and PU, respectively. Podocinuria (PDU) was found in 78, 54, and 83% of those with NAU, MAU, and PU, respectively. NU in DN with PU was significantly higher than that in DM with NAU. In the NAU, MAU, and PU subgroups, podocin excretion was equally higher and did not differ between the types of DM. There was a direct correlation of NU with albuminuria, which was stronger in the MAU subgroup. In the patients with DM with varying degrees of albuminuria, the values of NU and PDU correlated directly to serum creatinine levels and inversely with glomerular filtration rate. NU directly correlated with glycated hemoglobin levels in the patients with types 1 and 2 DM of less than 5 years' duration and a direct significant correlation of systolic blood pressure with NU was found in those with type 2 DM. CONCLUSION: Determination of urinary nephrin and podocin levels may be used for the early preclinical diagnosis of DN and the monitoring of the glomerular apparatus in DM.
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The purpose of the present study was to develop a method for the objective registration of the stapedial reflex at the contralateral ear during cochlear implantation surgery on the affected one. The excessive pressure in the middle ear (up to 500 daPa) was compensated by the administration of an additional air volume (1 liter) into the AA220 impedance meter pneumatic circuit. A syringe was used to measure variations of pressure in the new pneumatic circuit. Eight of the 12 patients demonstrated coincident visual and objective reflex thresholds. In the remaining 4 patients, the visually apparent stapedial reflex thresholds proved higher than those obtained objectively by the standard procedure of impedancemetry. It is concluded that the objective registration of the stapedial reflex excludes the effect of subjective factors interfering with its estimation and provides the possibility for comparative intra- and postoperative studies using one and the same instrument.
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Pruebas de Impedancia Acústica/métodos , Implantación Coclear/métodos , Reflejo Acústico/fisiología , Estapedio/fisiología , HumanosRESUMEN
The tuning of the speech processors of cochlear implants implies the measurement of the threshold perception levels and the achievement of the maximally comfortable level of loudness in each auditory channel. The authors present a detailed description of the approach to the optimal tuning including the sequence of procedures and manipulations for this purpose, from the first tuning to the achievement of the desired result. This algorithm summarizes the worldwide and the authors' own experience based on the original investigations that have been carried in the Sankt-Peterburg Research Institute of Otorhinolaryngology and Speech during more than 15 years.
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Calibración/normas , Implantación Coclear/instrumentación , Implantes Cocleares/normas , Sordera/cirugía , Sonido , Algoritmos , Percepción Auditiva , Implantación Coclear/normas , Potenciales Microfónicos de la Cóclea , Estimulación Eléctrica/instrumentación , Seguridad de Equipos/métodos , Seguridad de Equipos/normas , Humanos , Acústica del LenguajeRESUMEN
Monitoring of implant reference and active electrode impedance was carried out intraoperatively, at the first fitting, during the first two weeks after the first fitting, and within the next 6 months. It was shown that impedance of the electrodes during surgery was significantly lower than after the first fitting. Moreover, the intraoperative impedance of all active electrodes was significantly lower than in the postoperative period. Overall, the impedance tended to decrease from the first day of fitting to the 10th day after it. It became stabilized within 6 months after the first fitting when impedance of the reference electrode significantly increased. A putative explanation of the results of the monitoring is proposed.
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Pruebas de Impedancia Acústica/métodos , Cóclea/cirugía , Implantes Cocleares , Monitoreo Fisiológico/métodos , Impedancia Eléctrica , Estudios de Seguimiento , Humanos , Monitoreo Intraoperatorio/métodos , Periodo Posoperatorio , TelemetríaRESUMEN
Impedance measurement as an objective method of hearing examination is widely used in cochlear implantation. Stapedial reflex is measured intraoperatively and during the procedure of cochlear implant fitting. It was found that reflex threshold levels and most comfortable levels vary significally in one patient and between all patients. Thus, reflexometry is a convenient method of fitting speech processors of cochlear implants in children but the subjective method of fitting is more effective.