A 45-year-old male patient with type 2 diabetes developed euglycemic diabetic ketoacidosis(euDKA)after combined use of ertugliflozin and metformin.Four days after medication,the patient developed chest tightness,shortness of breath,fever,accompanied by urinary frequency and dysuria.Laboratory findings showed random blood glucose of 6.5 mmol·L-1,ketone bodies of 3.1 mmol·L-1,and metabolic acidosis on arterial blood gas analysis(pH 7.27,actual bicarbonate 6.9 mmol·L-1).EuDKA was diagnosed,with suspected urinary tract infection.Ertugliflozin was promptly discontinued.Treatments such as fluid resuscitation,low-dose insulin infusion via pump,electrolyte correction,and anti-infective therapy were administred.Symptoms gradually improved,and ketone bodies turned negative after three days.Using the Naranjo's Assessment Scale,the association between euDKA and the suspected drug ertugliflozin was rated as"probable"(score 7).This case suggested that concomitant use of SGLT2 inhibitors and metformin,especially with co-existing infection,may significantly increase the risk of euDKA.Enhanced medication evaluation and monitoring were recommended in clinical practice.

A 45-year-old male patient with type 2 diabetes developed euglycemic diabetic ketoacidosis(euDKA)after combined use of ertugliflozin and metformin.Four days after medication,the patient developed chest tightness,shortness of breath,fever,accompanied by urinary frequency and dysuria.Laboratory findings showed random blood glucose of 6.5 mmol·L-1,ketone bodies of 3.1 mmol·L-1,and metabolic acidosis on arterial blood gas analysis(pH 7.27,actual bicarbonate 6.9 mmol·L-1).EuDKA was diagnosed,with suspected urinary tract infection.Ertugliflozin was promptly discontinued.Treatments such as fluid resuscitation,low-dose insulin infusion via pump,electrolyte correction,and anti-infective therapy were administred.Symptoms gradually improved,and ketone bodies turned negative after three days.Using the Naranjo's Assessment Scale,the association between euDKA and the suspected drug ertugliflozin was rated as"probable"(score 7).This case suggested that concomitant use of SGLT2 inhibitors and metformin,especially with co-existing infection,may significantly increase the risk of euDKA.Enhanced medication evaluation and monitoring were recommended in clinical practice.

Objective To investigate the clinical value of bone metabolism biochemical marker N-MID,TP1NP and beta-CTx combined with whole body bone scintigraphy in early diagnosis of bone metastasis of tumor.Methods The concentration of the 3 markers were measured by the electrochemical luminescence analysis method in 30 cases of healthy control group and 210 cases of patients with malignant tumor,which were divided into non bone metastasis group(45 cases) and bone metastasis group(165 cases).The bone metastasis group were divided into 4 grades(0-grade Ⅲ) by Soloway classification according to whole body bone imaging.Results The levels of serum N-MID,TP1NP and beta-CTx in 165 malignant tumor patients with bone metastasis were significantly higher than in 45 malignant tumor patients with bone metastasis and in 30 healthy control group,the difference was statistically significant(P<0.05).With the increase of the number of metastatic lesions in the bone metastasis group,the serum levels of N-MID,TP1NP,and beta-CTx were increased gradually,and they were positively correlated with the progression of the disease.According to the analysis of ROC curve,the cut-off value,sensitivity and specificity in the diagnosis of tumor bone metastasis were 17.59 ng/mL,70.3％,88.9％ for serum N-MID,43.04 ng/mL,78.2％,95.6％ for TP1NP,and 0.48 ng/mL,73.9％,93.3％ for beta-CTx.Under the ROC curve(AUC) was 0.831 for serum N-MID,0.890 for TP1NP,and 0.869 for beta-CTx.The sensitivity and specificity of three bone metabolic markers in the diagnosis of bone metastasis of malignant tumor were significantly higher.Conclusion Bone metabolism biochemical markers:Serum N-MID,TP1NP and beta-CTx for diagnosis of bone metastasis of malignant tumor are sensitive,accurate and simple,which can significantly improve the efficiency of diagnosis of bone metastasis,and can be combined with whole-body bone scintigraphy in early diagnosis of bone metastasis with malignant tumor.

Objective To evaluate the predictive effect of Braden scale for the risk of development of pressure ulcers (PU) in the department of neurology bedridden patients and to explore subgroup preventive measures. Methods 400 cases newly hospitalized bedridden patients in the department of neurology were collected with no pressure ulcers at the first evaluation and pressure ulcer risk was continuously predicted by a Braden scale skin assessment. The high-risk, middle-risk and low-risk groups were randomized into the experimental group and the control group respectively. Routine preventive measures were taken for the control group while the air fluidized bed for the high-risk group, the sponge mattress for the middle-riskgroup, and turning the body over every 4 hours for low-risk group. Other preventive procedures were undertaken simultaneously in beth the experimental and the control groups. Results The area under the ROC curve (AUC)was 0.771 and 0.828 at the first and last time Braden scale scores respectively. Such vMues as sensitiveness, specificity, positive predictive value, negative predictive value were found in higher level,when the diagnosis value was 17. There was no significant difference of incidence rate of the subgroup pressure ulcers between the high-risk, middle-risk, low-risk groups compared to the control group. Conclusions The effect of predicting pressure ulcer risk for bedridden patients in the department of neurology with Braden scale was fairly good, while the score 17 as the diagnosis value was ideal. The air fluidized bed for the high-risk group and the sponge mattress for the middle-risk group resulted in no significant decrease of incidence rate of the pressure ulcer, while taming over the patients' body every 4 hours for low-risk groups showed acceptable and therefore saving medical resources.