低碳水化合物高营养密度膳食对肥胖儿童青少年的减重效果及糖脂代谢的影响

目的探讨低碳水化合物高营养密度膳食对肥胖儿童青少年的减重效果及糖脂代谢的影响。 方法选取2020年6月至2021年6月惠州市中心人民医院肥胖门诊及营养门诊的肥胖儿童青少年（7~18岁）37例作为研究组,选取同期22例肥胖儿童青少年作为对照组,对照组采用平衡膳食及生活方式、运动宣教干预,研究组在生活方式、运动宣教干预的基础上,采用低碳水化合物高营养密度膳食干预,共干预8周,比较两组干预前后BMI、腰臀比、身体成分分析数据以及代谢指标水平。 结果两组患者干预前的BMI、腰围、臀围、腰臀比、体脂率、内脏脂肪面积对比差异均无统计学意义（P>0.05）,在干预8周后,研究组的BMI、腰围、臀围、腰臀比、体脂率和内脏脂肪面积显著低于对照组,差异具有统计学意义（P<0.05）;干预前两组的空腹血糖（FPG）、餐后2 h血糖（2hPG）、空腹胰岛素（FINS）、餐后2 h胰岛素（2hINS）、血尿酸（UA）、血清胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）比较差异均无统计学意义（P>0.05）,干预8周后研究组的FPG、2hPG、FINS、2hINS、UA、TC、TG、LDL-C水平均显著低于干预前,且显著低于对照组,差异具有统计学意义（P<0.05）。 结论低碳水化合物高营养密度膳食短期内可以有效使肥胖儿童青少年减重,减少体脂率和内脏脂肪面积,改善其糖脂代谢。     

中华医学会《国际内分泌代谢杂志》稿约

如今,肥胖是全球性的健康问题.肥胖可以引发多种相关疾病,如高血压,冠心病、脑血管疾病、糖尿病、高脂血症、高尿酸血症、女性月经不调、睡眠呼吸暂停综合征等,还可增加患恶性肿瘤的几率.肥胖相关的代谢紊乱如高血糖、高甘油三酯血症和高血压等严重影响人们的健康及生活质量,因此,肥胖的治疗需得到重视.减轻体重可以改善有肥胖相关风险因素及合并症的患者的健康状况.然而关于减重的治疗方法有许多种,以饮食、运动及行为干预治疗为主导的治疗方法效果显著.但有些患者很难通过这种方式达到预期减肥目的.     

单纯性肥胖儿童综合减重干预后维生素D水平变化及作用探讨

目的 探讨单纯性肥胖儿童综合减重干预后维生素D水平变化及作用。方法 选择2020年10月至2021年3月武汉市某小学的体检儿童作为研究对象,年龄7～14岁,其中单纯性肥胖儿童43例(肥胖组),体重(Wt)正常儿童50名(对照组)。对肥胖组进行3个月的综合减重干预,内容包括饮食、运动指导和健康宣教等。检测正常组及肥胖组干预前后血清25羟基维生素D[25-(OH)D]水平,以及人体学指标和代谢相关指标。结果 与对照组相比,干预前肥胖组Wt、腰围(WC)、体质量指数(BMI)、BMI-Z、体脂率(PBF)、空腹血胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)更高,空腹血糖(FBG)、高密度脂蛋白胆固醇(HDL-C)水平更低,差异有统计学意义(P<0.05)。经干预后,肥胖组的WC减小,BMI-Z、25-(OH)D水平降低,总胆固醇(TC)水平升高,与干预前比较差异有统计学意义(P<0.05)。Pearson相关分析结果显示25-(OH)D与Wt、WC、BMI、BMI-Z、FINS、HOMA-IR呈负相关(P<0.05),与HDL-C呈正相关(...     

中国儿童和青少年肥胖症外科治疗指南（2019版）

近年来，中国儿童和青少年的肥胖症患病率迅猛增加。肥胖症可以引发2型糖尿病、高血压病、高脂血症、高尿酸血症等一系列代谢紊乱性疾病。饮食控制、体育锻炼及现有的药物等对儿童和青少年肥胖症的治疗效果并不确切，越来越多的循证医学证据表明减肥手术能显著减轻肥胖症儿童青少年的体重，并缓解肥胖相关的代谢病。随着减重代谢外科在我国的快速普及，中国肥胖儿童和青少年选择减肥手术治疗肥胖症的例数逐渐增多，但仍缺少相应的基于临床研究证据的诊疗规范。因此，中国医师协会外科医师分会肥胖和糖尿病外科医师委员会于2018年6月发起编写首版《中国儿童和青少年肥胖症外科治疗指南》，旨在为该领域临床医生的临床决策提供参考依据，同时鼓励针对此临床问题进行深入的研究，以期积累国人特征的循证医学证据，为中国儿童和青少年肥胖症外科治疗的临床决策提供更高级别的证据。     

肥胖致肾脏病的发病机制及治疗进展

随着人口老龄化、生活方式和饮食结构的改变,肥胖、2型糖尿病及高血压病等代谢相关性疾病的发病率逐年增加,它们均可增加肾脏疾病的发生风险,使慢性肾脏病的患病率呈递增趋势。研究发现肥胖状态下肾脏损伤与蛋白尿产生、代谢调节失衡、肠道菌群紊乱及内分泌激素水平变化有关,导致炎症反应,加速肾小球硬化和小管间质萎缩。肥胖相关性肾脏疾病的治疗方式主要包括饮食控制和规律运动,减重药物和手术适用于特定人群。肥胖与肾脏疾病发病机制的进一步研究有助于制定个体化疗法,更好地干预肥胖相关性肾病的进展。     

减重手术在老年肥胖病人的应用

正随着生活水平的提高,肥胖病人的人数近年来日益增多,肥胖带来了一系列并发疾病,降低了病人的生活质量。目前,体质量管理手段主要包括饮食、运动、认知行为疗法、药物和手术等[1]。减重手术是治疗肥胖最有效的手段,其减重效果和对肥胖相关并发症的     

内镜技术在减重治疗中的应用进展

<正>根据世界卫生组织定义，肥胖是指对健康构成威胁的异常或过度的脂肪堆积。自20世纪70年代以来，全球成人肥胖率增长近2倍，儿童和青少年的增长幅度甚至更大^[1-3]。目前，已有近70%的成年人被归类为超重或肥胖，而在40年前，这一比例还不到40%^[4]。作为全球公共卫生、临床和科学领域面临的重大挑战，肥胖及其所引发的一系列并发症，如糖尿病、心脑血管疾病、代谢综合征、死亡率增加等，严重威胁着人类的健康。肥胖的治疗方法主要包括生活方式调整、药物治疗及手术治疗。外科减重手术是一种有效的治疗方法，但由于受到术后并发症、相关费用及不可逆性等限制，只有1%的符合条件的患者进行了手术治疗^[5]。与传统手术相比，内镜下减重治疗(endoscopic bariatric therapy,EBT)提供了一种可逆性、微创性和经济性的方案，可作为外科减重手术的桥梁或替代治疗供患者选择(表1)。本文就目前内镜技术在减重治疗中的应用进展作一综述。     

家庭护理与生活方式强化管理联用对儿童青少年1型糖尿病患儿血糖水平及效果分析

目的 讨论家庭护理与生活方式强化管理联用对儿童青少年1型糖尿病患儿实施效果分析。方法 选取2019年6月—2022年6月泉州市儿童医院80例儿童青少年1型糖尿病患儿,随机分为对照组40例（常规护理）与研究组40例（对照组基础上实施家庭护理与生活方式强化管理联用模式）。观察血糖水平、糖尿病控制状况、生活质量。结果 干预后研究组空腹血糖、餐后2 h血糖及糖化血红蛋白三项血糖指标均明显低于对照组,差异有统计学意义（P<0.05）。干预后研究组糖尿病自觉症状、治疗目标、治疗情况、疾病认知、生活习惯、生存技能6项糖尿病控制状况维度指标均明显高于对照组,差异有统计学意义（P<0.05）。干预后研究组情感、躯体、学校功能、社交维度4项生活质量维度指标及总分指标均明显高于对照组,差异有统计学意义（P<0.05）。结论 儿童青少年1型糖尿病患儿接受家庭护理与生活方式强化管理联用措施利于控制血糖水平,提高病情控制水平,提高生活质量。     

2010～2011年度肥胖研究进展

随着全球经济快速发展,肥胖已成为危害人类健康的世界性问题.肥胖的发生除了与生活方式密切相关外,越来越多的证据提示基因异常亦有着重要的影响,其中表观遗传机制近年来受到广泛的关注.不同的生活模式也与肥胖发生密切相关.肥胖在全球的急剧蔓延之势使得减重问题刻不容缓.治疗肥胖应在饮食干预、体力活动、适当的药物治疗、手术治疗及认知教育等多方面联合干预.此外,科学家研制出多种针对不同靶点的抗肥胖疫苗可能成为今后肥胖治疗的新途径.     

2型糖尿病患者体重管理的研究进展与思考

全球2型糖尿病患者人数仍在增加, 其中肥胖问题不容忽视。肥胖不仅可能导致2型糖尿病的发生, 也会进一步增加2型糖尿病患者的心血管疾病风险。因此, 近年来2型糖尿病疾病管理的目标已经从控制血糖转变为"控糖、减重"双重管理。现有的减重策略包括生活方式干预、药物治疗和代谢手术, 其中药物治疗的发展与日俱进。新型的双重或三重肠道激素受体激动剂的研发, 将为2型糖尿病合并超重/肥胖患者提供更多治疗选择。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.