健康托管对机关代谢综合征高危人群行为与相关指标的影响

目的 探讨对机关代谢综合征高危人群实施健康托管的效果.方法 对148名符合代谢综合征高危人群诊断标准的机关干部实施一对一健康托管,并提供网络平台实现自我管理,1年后对健康行为及体质量、腰围、血压等指标进行评价.结果 健康托管后机关代谢综合征高危人群的运动行为明显加强,收缩压、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖及血尿酸显著改善,差异有统计学意义(均P＜0.01).结论 对机关代谢综合征高危人群实施健康托管,在疾病早期进行综合干预,可使高危人群形成良好的健康行为,降低代谢综合征风险.     

Diabetes,Hypertension and Hyperlipidemia: Prevalence Over Time and Impact on Long‐Term Survival After Liver Transplantation

With increasing short‐term survival, the transplant community has turned its focus to delineating the impact of medical comorbidities on long‐term outcomes. Unfortunately, conditions such as diabetes, hypertension and hyperlipidemia are difficult to track and often managed outside of the transplant center by primary care providers. We collaborated with Kaiser Permanente Northern California to create a database of 598 liver transplant recipients, which incorporates diagnostic codes along with laboratory and pharmacy data. Specifically, we determined the prevalence of diabetes, hypertension and hyperlipidemia both before and after transplant and evaluated the influence of disease duration as a time‐dependent covariate on posttransplant survival. The prevalence of these comorbidities increased steadily from the time of transplant to 7 years after transplant. The estimated risk for all‐cause mortality (hazard ratio = 1.07 per year increment, 95% CI 1.01–1.13, p < 0.02) and mortality secondary to cardiovascular events, infection/multisystem organ failure and allograft failure (hazard ratio = 1.08 per year increment, 95% CI 1.00–1.16, p = 0.05) increased for each additional year of diabetes. No associations were found for duration of hypertension and hyperlipidemia. Greater attention to management of diabetes may mitigate its negative impact on long‐term survival in liver transplant recipients.     

Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms

Study Type – Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? The metabolic syndrome, or Syndrome X, has traditionally been associated with an increased risk of cardiovascular disease and sexual dysfunction. Emerging data however now suggest that the metabolic syndrome may also have a heretofore unrecognized negative effect on voiding function as well. Weight loss through either behavioural modification or bariatric surgery has been shown to lead to improvement in stress and urge incontinence as well as LUTS. A potential relationship may be drawn between obesity and BPH. This study adds the knowledge that WC can represent a simple metric not only for elements of the metabolic syndrome but also for worsened voiding. These obese men may be at high risk of male pelvic dysfunction.

OBJECTIVES

• ? To determine if central obesity as measured by waist circumference (WC) is a risk factor in metabolic dysfunction, which includes hypertension, dyslipidaemia and type 2 diabetes (DM2).
• ? To test the hypothesis that central obesity and WC are associated with and predictive of the severity of voiding dysfunction.

METHODS

• ? Men aged ≥40 years with moderate or severe lower urinary tract symptoms (LUTS, International Prostate Symptom Score ≥ 8) with no previous treatment were included for study.
• ? Subjects were divided into three groups according to WC (<90, 90–99 and ≥100 cm).
• ? Baseline parameters including International Prostate Symptom Score, prostate volume, serum prostate‐specific antigen, presence of erectile dysfunction and ejaculatory dysfunction, and the prevalence of hypertension, coronary artery disease and DM2 were compared among the three WC categories.
• ? The association between WC and all parameters assessed was tested using multivariate logistic regression analysis.

RESULTS

• ? In the 409 consecutive men analysed, WC was significantly and positively associated with prostate volume, serum prostate‐specific antigen and International Prostate Symptom Score.
• ? Higher WCs were also significantly associated with a greater prevalence of hypertension, coronary artery disease, DM2 and obesity as well as the presence of erectile dysfunction and ejaculatory dysfunction.

CONCLUSIONS

• ? Increased WC is associated with worsened voiding.
• ? There was a significantly increased prevalence of components of the metabolic syndrome in patients with higher WC.
• ? Obese men, in particular those with other features of the metabolic syndrome, are at increased risk of male pelvic dysfunction and can be easily recognized by measurement of WC.

     

Disorders of glucose metabolism in the context of human immunodeficiency virus infection

PURPOSE: To discuss the pathophysiology and the current treatment approaches for the dysregulation of glucose metabolism in the context of human immunodeficiency virus (HIV) infection. DATA SOURCES: Selected research, clinical studies, clinical guidelines, and review articles. CONCLUSIONS: In HIV infection, multiple factors are associated with the pathogenesis of glucose dysregulation. Studies suggest that protease inhibitors, a class of antiretroviral agent, as well as viral factors, lipodystrophy, hepatitis C infection, injection drug use, and second-generation antipsychotics have been implicated in the development of glucose disorders and diabetes. Current treatment recommendations are based on extrapolated data from non-HIV diabetic patients. More research is needed to establish the most appropriate management for the disorders of glucose metabolism in the context of HIV infection. IMPLICATIONS FOR PRACTICE: If left untreated, patients are at increased risk for cardiovascular disease and complications associated with untreated diabetes.     

Serum osmolal gap in clinical practice: usefulness and limitations

Background: Although serum osmolal gap can be a useful diagnostic tool, clinicians are not familiar with its use in clinical practice.

Objectives: The review presents in a series of questions-answers and under a clinical point of view the current data regarding the use of osmolal gap.

Discussion: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view.

Conclusions: The calculation of osmolal gap is crucial in the differential diagnosis of many patients presenting in emergency departments with possible drug or substance overdose as well as in comatose hospitalized patients.     

运动及饮食疗法对代谢综合征患者及高危者的治疗作用

目的：探讨运动训练及饮食控制对以超重或肥胖为基础的代谢综合征患者及高危者的治疗改善作用。方法：以超重或肥胖为基础的代谢综合征患者及高危者共197例．进行6周运动训练及饮食控制治疗．观察治疗后代谢综合征各组成成分的变化。结果：治疗后受试者具有的代谢综合征组成成分的个数明显减少（P〈0．001）。体重、BMI、收缩压、舒张压、甘油三酯治疗后明显降低（P〈0．05），高密度脂蛋白胆固醇明显提高（P=0．001）。患者组改善较高危组明显（P〈0．001）。结论：对于以肥胖或超重为基础、年龄较轻的代谢综合征患者和高危者，短期低能量饮食配合中等强度规律运动．可以取得较好的治疗效果。     

Mitochondrial function following downhill and/or uphill exercise training in rats

Introduction: The goal of this study was to compare the effects of downhill (DH), uphill (UH), and UH‐DH exercise training, at the same metabolic rate, on exercise capacity and skeletal muscle mitochondrial function. Methods: Thirty‐two Wistar rats were separated into a control and 3 trained groups. The trained groups exercised for 4 weeks, 5 times per week at the same metabolic rate, either in UH, DH, or combined UH‐DH. Twenty‐four hours after the last training session, the soleus, gastrocnemius, and vastus intermedius muscles were removed for assessment of mitochondrial respiration. Results: Exercise training, at the same metabolic rate, improved maximal running speed without specificity for exercise modalities. Maximal fiber respiration was enhanced in soleus and vastus intermedius in the UH group only. Conclusions: Exercise training, performed at the same metabolic rate, improved exercise capacity, but only UH‐trained rats enhanced mitochondrial function in both soleus and vastus intermedius skeletal muscle. Muscle Nerve 54 : 925–935, 2016     

腹型肥胖对炎性因子及代谢综合征的影响

目的腹型肥胖则是一系列代谢紊乱的始动因素,本研究的目的是研究腹型肥胖与体内炎性因子水平及代谢综合征(metabolic syndrome,MS)之间的关系,为儿童肥胖尤其是腹型肥胖的治疗提供一定理论依据。方法选取2011-2012年于西安交通大学第二附属医院儿科内分泌门诊就诊的单纯性肥胖儿童85例,根据腰围将其分为腹型肥胖组及非腹型肥胖组。测量研究对象的身高,体重,腰围及臀围;抽取空腹血并检测血脂,血糖以及超敏C反应蛋白(highsensitivity C-reactive protein,hs-CRP)及内脂素水平。结果腹型肥胖患儿体质指数(body mass index,BMI)、腰围、腰臀比均显著高于非腹型肥胖患儿(P均0.05);腹型肥胖组MS检出率显著高于非腹型肥胖组(P0.05);腹型肥胖患儿与非腹型肥胖患儿比较,高血压、高血糖、高TG血症、低HDL-C血症的患病人数在两组间差异均具有统计学意义(P0.05);腹型肥胖患儿血清中hs-CRP及内酯素的水平均显著高于非腹型肥胖组。结论腹型肥胖儿童比非腹型肥胖儿童更容易患MS,儿童腹部脂肪分布与甘油三酯及体内炎症因子增高关系较为密切。因此,应积极防治肥胖,尤其是腹型肥胖。