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Recent trials of two classes of glucose-lowering drugs (SGLT2 inhibitors and GLP1RAs) have shown consistent cardiovascular and renal benefits that appear independent of glycaemic control. These results have prompted the Dutch College of General Practitioners (NHG) together with the Dutch Society of Internal Medicine (NIV) to update the treatment algorithm in patients with type 2 diabetes mellitus (T2D) at very high CVD risk. The use of SGLT2 inhibitors or GLP1RAs is now recommended in 3 groups of people with T2D. 1. patients with established CVD; 2. Patients with chronic kidney disease and a moderately to high CVD risk according to KDIGO; 3. patients with heart failure with reduced ejection fraction (HFrEF). Treatment algorithms differ for drug-naïve and drug-treated patients with T2D. In both drug-naïve and drug-treated patients the use of a SGLT2 inhibitor respectively as monotherapy or add-on is recommended as first step. If HbA1c is above the individual target, metformin will be added in drug-naive patients whereas GLP1-RAs could be considered in drug-treated patients. GLP1-RAs should also be considered when SGLT2-inhibitors are contraindicated.

Hart HE, Woudstra JG, Rutten GEHM. Screen metforminegebruikers op vitamine B12! Huisarts Wet 2012;55(10):444-7.

The radioisotope response characteristic of a proposed coincidence mode imaging system consisting of an appropriately designed focusing collimator with a gamma camera modified for second moment measurement are calculated for a range of design parameters. Analytic criteria for the detection of small filling defects imbedded in a radioactive medium are developed which directly relate to some of the practical complexities involved in lesion detection. The calculated performances indices of the system suggest that it may be possible to detect lesions significantly smaller than those currently observable.

It is shown that, for an idealized steady-state system of compartments in which time lags, diffusion and fatigue effects can be neglected, modified tracer methods can be used to obtain an approximate description of the characterizing non-linear differential equations of the system.

It is shown that the partitioned initial entry functions previously introduced in multicompartment analysis can be directly and uniquely determined from the experimental data.

The methods of C. W. Sheppard and A. S. Householder (Jour. App. Physcis,22, 510–20, 1951), H. D. Landahl (Bull. Math. Biophysics,16, 151–54, 1954) and H. E. Hart (Bull. Math. Biophysics,17, 87–94, 1955;ibid.,19, 61–72, 1957;ibid.,20, 281–87, 1958) are employed in studying the kinetics of generalN compartment systems. It is shown that the nature of the transfer processes occurring in fluid flow systems and the chemical processes occurring in quadratic systems and in catalyzed quadratic systems can in principle be completely determined for all polynomial dependencies. Systems involving three-body and higher-order interactions can be completely solved, however, only if supplementary information is available.

A method is developed for finding the transfer and localization rates and the volumes ofN compartment steady-state biological systems from experimental results. It is shown that a complete solution for certain systems in which the rates and volumes remain constant and in which there is access to all compartments can be obtained by using a single radioactive tracer. The information obtainable from experiments wherein some compartments are not accessible is analyzed for mammillary and catenary systems. Conservative systems are handled as special cases in which the localization is zero while anisotropic membranes separating compartments are shown to introduce no additional mathematical difficulty whenever all compartments are accessible. The limitations on the use of this method of multi-compartment tracer analysis are briefly discussed.

SummaryWithin 4 days after whole body x-irradiation (650 r), globule leucocytes were reduced to 1-2% of their normal number in the intestine of the rat. Reestablishment of normal numbers of cells began toward end of the first week after irradiation and was completed by the 5th week. The effect of irradiation on globule leucocytes was chiefly a local one, being prevented by shielding the intestine with lead during irradiation. Only with the LDioo 30 days dosage (800 r) was there a significant reduction in number of globule leucocytes in lead-shielded intestinal segments. This appeared to be the indirect result of stress induced by irradiation, since the effect was prevented by hypophysectomy. Hypophysectomy alone reduced markedly the number of intestinal globule leucocytes.

Tritiated latex particles and scintillant latex particles have been covalently coated with an antigen (human albumin) and both types of particles are than combined in dilute aqueous suspensions. The formation of antibody-induced dimer and higher-order aggregation resulted in scintillations that could be measured in a standard liquid-scintillation counter, energy-gated for H-3. Rabbit anti-human antiserum was easily detected at a titer of 1:10(6). Human albumin, in the inhibition mode, was also easily detected at 0.1 ng/ml. Since the samples are nondestructively assased, it was possible to examine the kinetics of aggregation under a variety of conditions.

An integral equation analysis of generaln compartment steady state systems imbedded in static media of arbitrary complexity has been developed. A set of initial entry functions can be found which serve to determine a corresponding set of partitioned initial entry functions. The partitioned functions, in turn, can be used to predict the probabilities and time courses of various transport histories and to determine all steady state rates of flow between measured compartments. The method is quite general, being completely applicable, for example, to closed systems, to cyclic systems and to systems in which relatively rapid (but finite) exchange between compartments occurs.

• The effectiveness of intracavitary injections of Y90in alleviating pleural and peritoneal effusions was tested in 16 patients with cancer. The effusion was completely halted in several cases, and the results were considered favorable in eight. In some the procedure as described did not halt the effusion, and in others the results proved difficult to evaluate. Tracer studies showed that this isotope, a pure beta-emitter with half-life of only 61 hours, remained well confined to the serous cavity and was well distributed within it. The procedure was well tolerated. Neither early nor late side-reactions were observed.

The focusing, resolving, and diffracting properties of a linear zone plate in the neighborhood of the principal positive focus are examined theoretically and experimentally. The theoretical analysis employs both elementary and Kirchhoff diffraction theory; the experimental work was done using a helium–neon gas laser and a 200-line plate. A numerical comparison between theory and experiment shows good agreement for the choice of parameters employed.