Salt, hypertension and renal disease: comparative medicine, models and real diseases.

Dogs are well established as experimental animals for the study of both renal disease and hypertension, but most work is based on surgical or pharmacological models and relatively little on spontaneous diseases. This review argues for the latter as an underexploited aspect of comparative medicine. The most important feature of canine hypertension may not be the ease with which models can be produced but the fact that dogs are actually rather resistant to hypertension, and perhaps to its effects, even when they have chronic renal failure. The importance of natural models of chronic renal failure is strengthened by the evidence that self-sustaining progression is a consequence of extreme nephron loss, that is, a late event, rather than the dominant feature of the course of the disease. The role of salt in hypertension is discussed and emphasis given to the importance of understanding the physiological basis of nutritional requirement and recognizing that it is unlikely to exceed 0.6 mmol/kg/day for most healthy adult mammals except during pregnancy or lactation. Such a perspective is essential to the evaluation of experiments, whether in animals or humans, in order to avoid arbitrary definitions of ''high'' or ''low'' sodium intake, and the serious misinterpretations of data which result. An age-related rise in arterial pressure may well be a warning of excess salt intake, rather than a normal occurrence. Problems of defining hypertension in the face of variability of arterial pressure are also discussed.     

Holistic Approach to Functional Constipation: Perspective of Traditional Persian Medicine

Traditional Persian medicine (TPM) proposes a different viewpoint to the chronic diseases. Diagnosis and implemented treatment are based on individual differences among patients. Constipation or Ea''teghal-e-batn is a condition in which the patient develops difficult or painful defecation. Based on TPM concepts, the first digestion step starts from halq (oral cavity), and ends via defecation from the maq''ad (anus). Avicenna believed that four faculties, ha''zemeh (digestive), ja''zebeh (absorptive), ma''sekeh (retentive) and da''fe''eh (propulsive), are involved in the process of digestion and absorption of the ingested food and expelling the waste materials. The bowel movement and appearance of the stool is a measure for evaluating the gastrointestinal healthy function. Defecation should be with no pain and fecal material should have no burning and acuity. Low food intake or foods with dry temperament, dryness of gastrointestinal tract, diaphoresis and heavy exercise as well as intestine sensory loss were discussed as main causes of constipation. Management of constipation in TPM includes dietary schemes, oil massages and subsequently simple herbal medicines. According to TPM theories, the first step in treating a disease is the elimination of disease causes (asbab e-maraz) and also providing the causes of health (asbab-e-sehhat). Health care providers should know the proper condition which the herbal medicines should be administered in and be able to guide the patients about the benefits and hazards of herbal remedies, commonly used in their living origin.     

小肠Crohn's病患者肠黏膜中DLG1和DLG5表达的临床观察

目的 探讨小肠型克罗恩病(CD)肠黏膜中DLG1和DLG5的表达以及与临床关联分析.方法 收集CD患者小肠手术切除标本45例,另收集15例小肠肿瘤以及右半结肠肿瘤手术标本中正常小肠组织作为对照组,采用免疫组织化学方法研究DLG1和DLG5在CD组患者和对照组小肠黏膜上皮组织中的表达,并进行临床观察分析.结果 与对照组比较,CD患者小肠黏膜上皮细胞DLG1主要表达在细胞质中,两组患者DLG1表达部位有明显差别(P<0.01),表达量无明显差别.与对照组比较,CD组患者小肠黏膜上皮细胞DLG5均表达在细胞质中,CD组患者DLG5的表达量明显降低(P<0.01).DLG1表达部位和DLG5表达量与CD患者临床特征无明显关联.结论 DLG5表达降低可能参与CD的发病过程.     

NON-PENETRATING ABDOMJNAL INJURIES WITH RUPTURE OF GASTRO-INTESTINAL TRACT WITH REPORT OF Two CASES HUNGHSI SU, M.B., AND P.C.TLTNG,M.D

The gastro-intestinal tract fromfthe stomach down to the rectum may be ruptured at any point by non-penetrating violence, the small iptestine probably being ruptured more frequently than the stomach and the Jarge intestine. Accidents in eivilian life from ''the automobiles and heavy industries as well as in modern warfare from underwater blasts (.1) produce innumerable intra-abdominal injuries. In these cases early diagnosis is of paramount importance, and their mortality can be greatly rpduced if operation is performed at the easrliest possible moment. The following two cases may serve as illustrations.     

Diagnosis of Chagas' cardiomyopathy. Non-invasive techniques.

The natural history of Chagas'' disease and its manifestations when the heart is involved are detailed clinically and pathologically. Three phases are recognized: the acute phase, lasting from 1-3 months, the latent phase, which may last from 10-20 years, and the chronic phase, which has the most serious manifestations. This phase is subdivided into three clinical stages. An analysis of the varied cardiac manifestations on 235 patients is included.     

Spiritual needs of patients with chronic pain diseases and cancer - validation of the spiritual needs questionnaire

Purpose

For many patients confronted with chronic diseases, spirituality/religiosity is a relevant resource to cope. While most studies on patients'' spiritual needs refer to the care of patients at the end of life, our intention was to develop an instrument to measure spiritual, existential and psychosocial need of patients with chronic diseases.

Methods

In an anonymous cross-sectional survey, we applied the Spiritual Needs Questionnaire (SpNQ version 1.2.) to 210 patients (75% women, mean age 54 ± 12 years) with chronic pain conditions (67%), cancer (28%), other chronic conditions (5%). Patients were recruited at the Community Hospital Herdecke, the Institute for Complementary Medicine (University of Bern), and at a conference of a cancer support group in Herten.

Results

Factor analysis of the 19-item instrument (Cronbach''s alpha = .93) pointed to 4 factors which explain 67% of variance: Religious Needs, Need for Inner Peace, Existentialistic Needs (Reflection/Meaning), and Actively Giving. Within the main sample of patients with chronic pain and cancer, Needs for Inner Peace had the highest scores, followed by Self competent Attention; Existentialistic Needs had low scores, while the Religious Needs scores indicate no interest. Patients with cancer had significantly higher SpNQ scores than patients with chronic pain conditions. There were just some weak associations between Actively Giving and life satisfaction (r = .17; p = .012), and negatively with the symptom score (r = -.29; p < .0001); Need for Inner Peace was weakly associated with satisfaction with treatment efficacy (r = .24; p < .0001). Regression analyses reveal that the underlying disease (i.e., cancer) was of outstanding relevance for the patients'' spiritual needs.

Conclusion

The preliminary results indicate that spiritual needs are conceptually different from life satisfaction, and can be interpreted as the patients'' longing for spiritual well-being. Methods how health care professionals may meet their patients'' spiritual needs remain to be explored.     

Compression syndromes caused by substernal goitres.

Enlargement of the thyroid is common, especially in areas of endemic iodine deficiency. Substernal enlargement of a goitre can cause compression of several mediastinal structures. As a consequence of tracheal compression and tracheomalacia, syndromes of chronic respiratory distress occur and intercurrent upper respiratory infections may lead to acute respiratory failure. Superior vena cava syndrome secondary to compression by a substernal goitre may be complicated by venous thrombosis. Although dysphagia is the most frequent oesophageal symptom of a substernal goitre, upper gastrointestinal bleeding from ''downhill'' oesophageal varices may be an initial presentation. Arterial compression or thyrocervical steal syndrome by large substernal goitres occasionally cause cerebral hypoperfusion and stroke. Recurrent and phrenic nerve palsies, as well as Horner''s syndrome, occur secondary to non-malignant mediastinal goitres and may resolve after surgery. Substernal goitres rarely cause therapy-resistant pleural effusions, chylothorax and pericardial effusion. In conclusion, although cervical goitres are easily recognised, the initial presentation of mainly substernal goitres may be unusual.     

沈洪教授运用六经辨证治疗溃疡性结肠炎经验探析

溃疡性结肠炎是一种慢性非特异性炎症性肠病，中医病名为"久痢""肠澼"。沈洪教授认为本病病位在大肠，属阳明腑病，但与伤寒六经均关系密切。本病初起正盛邪实，首犯三阳经；病久正虚邪恋，病入三阴经。疾病分期可按六经传变并提出分经辨治，确立以开阖阳明、宣利枢机、升发少阳、温阳化湿、培元固本、平调寒热的治法，验之临床，收效颇多。     

Femoral hernia appendix causing small intestinal obstruction.

An 88 year old woman presented with a painful, irreducible right femoral hernia and small intestinal obstruction. At laparotomy, some distal small intestine was found to have twisted around an uninflamed appendix which was acting as a ''band'', with its tip fixed in the femoral hernia sac. Although the association between the appendix and femoral hernia is well recognized, the production of small intestinal obstruction by this particular mechanism has not been previously reported.     

New treatments for patients with type 2 diabetes mellitus.

In subjects with type 2 diabetes, both defects of insulin secretion and insulin resistance contribute to the development of hyperglycaemia. The major goals of treatment are to optimise blood glucose control, and normalise the associated lipid disturbances and elevated blood pressure. Pharmacologic treatment is often necessary. This paper discusses new forms of oral treatment for subjects with type 2 diabetes. These include a new sulphonylurea compound glimepiride (Amaryl), which binds to a different protein of the putative sulphonylurea receptor than glibenclamide, and seems to have a lower risk of hypoglycaemia. A new class of drugs with insulin secretory capacity, of which repaglinide (NovoNorm) is the leading compound, is now in phase III clinical trials. Alpha-glucosidase inhibitors reversibly inhibit alpha-glucosidase enzymes in the small intestine, which delays cleavage of oligo- and disaccharides to monosaccharides. This leads to a delayed and reduced blood glucose rise after a meal. Two compounds are in development or have been marketed, ie, miglitol and acarbose (Glucobay). Another new class of drugs is the thiazolidine-diones, which seem to work by enhancing insulin action. The ''insulin sensitising'' effects of the leading compounds, troglitazone and BRL 49653C, do not involve any effect on insulin secretion. These drugs also seem to beneficially influence serum cholesterol and triglyceride levels. Oral antihyperglycaemic agents can be used only during a limited period of time in most patients, after which the diabetic state ''worsens'' and insulin therapy has to be started. In this light, two new forms of treatment which require subcutaneous injections are also discussed: the synthetic human amylin analogue AC137 (pramlintide) and glucagon-like peptide-1 (7-36)-amide, a strong glucose-dependent stimulator of insulin secretion. It remains to be seen whether these compounds can be developed further for clinical use in patients with diabetes.     

Jewish ethical guidelines for resuscitation and artificial nutrition and hydration of the dying elderly.

The bioethical issues confronting the Jewish chaplain in a long-term care facility are critical, particularly as life-support systems become more sophisticated and advance directives become more commonplace. May an elderly competent patient refuse CPR in advance if it is perceived as a life-prolonging measure? May a physician withhold CPR or artificial nutrition and hydration (which some view as basic care and not as therapeutic intervention) from terminal patients with irreversible illnesses? In this study of Jewish ethics relating to these issues, the author carefully examines the moral implications and legal precedents in the literature. Jewish ethics, affirming a ''sanctity of life'' position, suggest that while an elderly person may direct in advance that CPR not be administered in most instances, in the absence of a DNR (Do Not Resuscitate) order, CPR must be performed. In reference to ''tube-feeding'', while there is some debate about whether elderly patients may refuse the initiation of ''tube-feeding'', there is a consensus that once initiated, it may not be withdrawn.     

Occult small bowel adenocarcinoma complicating Crohn's disease: a report of three cases.

Three patients with Crohn''s disease are described who were treated by ileal resection for intestinal obstruction. Histological examination of the resected specimen in each case established the diagnosis of adenocarcinoma of the small intestine complicating Crohn''s disease. This diagnosis should be considered in patients with longstanding macroscopic Crohn''s disease who present with severe or recurrent symptoms. The diagnosis may not be apparent on routine radiological examination or even macroscopically at laparotomy.     

Validation of the brief multidimensional life satisfaction scale in patients with chronic diseases

Objective

We intended to determine the reliability of a brief life satisfaction scale in a sample of patients with chronic diseases, and to analyze its external validity.

Methods

Reliability and factor analysis of the 8-item ''Brief Multidimensional Life Satisfaction Scale'' (BMLSS) were performed according to standard procedures. The test sample contained 979 individuals (mean age 54 ± 11 years). Forty-two percent had cancer, 22% chronic pain conditions, 10% depressive disorders, 6% other chronic diseases, and 20% were healthy.

Results

Reliability analysis of the 8-item pool revealed a good internal consistency coefficient (Cronbach''s alpha = .869), and a single-factor structure which explains 53% of variance. The BMLSS sum scores significantly differed with respect to the underlying disease, family status, duration of disease, and age. The highest scores were found in healthy individuals, and the lowest in patients with chronic pain conditions and depressive disorders. In cancer patients, the BMLSS correlated negatively with Depression/Anxiety (HADS), Fatigue (CFS-D), and positively with SF-12''s mental health and to a weaker content also with physical health. Stepwise regression analyses revealed that life satisfaction can be predicted best by (the absence of) depression, but also by Conscious Living (AKU), which is an active cognitive-behavioral style in terms of adaptive coping.

Conclusions

The evaluation of the BMLSS revealed that the instrument has good psychometric properties and can be regarded as a brief, reliable and valid measure of LS in patients with chronic diseases. The instrument can be an important additive to existing health-related quality of life questionnaires, since it captures dimensions that contribute to quality of life but are not health related.     

从糖尿病肾病病机论中医药对糖尿病肾病治疗的研究进展

糖尿病是当前威胁全球人类健康的最重要的非传染性疾病之一,其中20%~40%会发生糖尿病肾病（DN）。DN是糖尿病常见的难治性并发症,早期表现为微量白蛋白尿,继之出现临床蛋白尿,最后进展为慢性肾功能不全,直至终末期肾损害的发生。DN当属中医"消渴"、"水肿"等范畴,病机多为气阴两虚兼瘀滞,治疗上多以补虚、化瘀、去浊为主,在临床上得到显著疗效。     

雌激素在干燥综合征中的研究进展

干燥综合征(Sjögren''s syndrome,SS)是一种慢性自身免疫性疾病,主要累及外分泌腺体,临床主要表现为口干、眼干,也可涉及全身多个系统。根据病因,SS可分为原发性和继发性。随着社会发展,SS的患病率呈逐年上升趋势,其确切病因和发病机制尚不明确。流行病学调查发现,原发性干燥综合征（Primary Sjögren''s syndrome,pSS）的发病呈明显的性别和年龄差异,好发于女性,男女之比为1∶9～1∶10,好发年龄为30～60岁,而女性体内雌激素变化较男性大,提示人体雌激素水平的变化可能在pSS的发生和发展中起着重要作用。本文就雌激素在SS中的研究进展进行综述。     

甲状腺激素及抗体表达水平与糖尿病周围神经病变的相关性分析

目的 探讨甲状腺激素及抗体表达水平与糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）的相关性。方法 选取2021年1月至2022年2月绍兴市人民医院肌电图室就诊的糖尿病患者186例,按照合并DPN的情况分为DPN组（n=68）和non-DPN组（n=118）。比较两组患者的身高、体质量、体质量指数（body mass index,BMI）、糖化血红蛋白（glycosylated hemoglobin,HbA1c）、游离三碘甲状腺原氨酸（free triiodothyronine,FT3）、游离甲状腺素（free thyroxine,FT4）、促甲状腺激素（thyroid-stimulating hormone,TSH）、甲状腺球蛋白抗体（thyroglobulin antibody,TGAb）、甲状腺过氧化物酶抗体（thyroid peroxidase autoantibody,TPOAb）,以及患者的年龄、糖尿病病程、糖尿病慢性并发症情况。结果 与NDPN组比较,DPN组患者年龄更大、DM病程更长,高血压患病率、糖尿病慢性并发症比例更高,FT3水平更低,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,患者年龄、糖尿病病程、高血压及糖尿病慢性并发症与DPN呈正相关（P<0.05）,FT3与DPN呈负相关（P<0.05）。Logistic回归分析结果显示,糖尿病病程、FT3是DPN的影响因素（P<0.05）。结论 糖尿病患者积极监测FT3的变化或可为DPN的预测提供参考,积极控制甲状腺疾病,使甲状腺功能恢复正常,这或许能够保护周围神经,延缓糖尿病周围神经病变的发生和发展。     

超声引导下设置骨科下肢手术止血带压力值的应用效果探讨

目的 探讨甲状腺激素及抗体表达水平与糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）的相关性。方法 选取2021年1月至2022年2月绍兴市人民医院肌电图室就诊的糖尿病患者186例,按照合并DPN的情况分为DPN组（n=68）和non-DPN组（n=118）。比较两组患者的身高、体质量、体质量指数（body mass index,BMI）、糖化血红蛋白（glycosylated hemoglobin,HbA1c）、游离三碘甲状腺原氨酸（free triiodothyronine,FT3）、游离甲状腺素（free thyroxine,FT4）、促甲状腺激素（thyroid-stimulating hormone,TSH）、甲状腺球蛋白抗体（thyroglobulin antibody,TGAb）、甲状腺过氧化物酶抗体（thyroid peroxidase autoantibody,TPOAb）,以及患者的年龄、糖尿病病程、糖尿病慢性并发症情况。结果 与NDPN组比较,DPN组患者年龄更大、DM病程更长,高血压患病率、糖尿病慢性并发症比例更高,FT3水平更低,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,患者年龄、糖尿病病程、高血压及糖尿病慢性并发症与DPN呈正相关（P<0.05）,FT3与DPN呈负相关（P<0.05）。Logistic回归分析结果显示,糖尿病病程、FT3是DPN的影响因素（P<0.05）。结论 糖尿病患者积极监测FT3的变化或可为DPN的预测提供参考,积极控制甲状腺疾病,使甲状腺功能恢复正常,这或许能够保护周围神经,延缓糖尿病周围神经病变的发生和发展。     

Malignant change in dermatitis artefacta.

Dermatitis artefacta is a chronic skin lesion produced by self-trauma. Avoidance of further trauma, topical steroids and psychological therapy all play a part in the treatment of such lesions. Unresolved lesions may become large and disfiguring and subject to infection. We report a case of one such lesion in an elderly woman who persistently excoriated a cholecystectomy scar over 40 years. Malignant transformation occurred in a manner analogous to the neoplastic change observed in other types of chronic ulcer (Marjolin''s ulcer). The squamous cell carcinoma presented with widespread metastases from which the patient eventually died. Recent literature concerning Marjolin''s ulcers is reviewed and it is noted that this is the first reported case of death caused by malignant change in dermatitis artefacta.     

妊娠及阴道分娩对盆底功能影响

盆底功能障碍性疾病(Pelvic floordysfunction,PFD)为危害妇女健康的最常见慢性疾病之一,其中妊娠与阴道分娩是盆底损伤的最主要危险因素。当妊娠和阴道分娩带来的损伤和机体的自身恢复失平衡,就表现为盆底功能障碍。本文对妊娠和阴道分娩过程对女性盆底组织的影响进行概述。