重视老年下肢动脉硬化疾病的早期诊断

<正> 外周动脉疾病(peripheral arterial disease,PAD)是指除了冠状动脉以外其他的动脉系统疾病,包括颈动脉、上肢动脉、下肢动脉和内脏动脉(内脏动脉包括腹主动脉、肾动脉和肠系膜动脉)。其中,下肢动脉硬化疾病(lower extremity atherosclerotic disease,LEAD)是发病很普遍的动脉系统疾病,下肢动脉狭窄引起的跛行和坏疽是老年人致     

老年外周动脉疾病的诊治

<正>动脉粥样硬化性疾病严重威胁老年人的健康,以动脉粥样硬化为主要病因的外周动脉疾病(PAD)也越来越多地受到临床医师的重视。PAD广义上指除冠状动脉和颅内动脉以外的其他动脉疾病,包括颈动脉、四肢动脉和内脏动脉,其特点是动脉系统不能将富氧血液送达外周组织。狭义PAD则指临床上最常见的下肢动脉粥样硬化性狭窄/闭塞病变,我们着重讨论后者。PAD患病率随年龄增长而增高。流行病学调查显示,60岁以上人群PAD患病率约18%,跛行患者7%。我国目前约有3000万PAD患者。虽大多数     

外周动脉疾病的诊治现状

<正>外周动脉疾病(PAD)是指心、脑动脉以外的主动脉及其分支血管狭窄、闭塞或瘤样扩张疾病,主要病因是动脉粥样硬化。PAD发生部位不同,其表现也不同,如四肢、腹腔动脉、颈动脉、肾动脉等缺血性改变[1]。狭义的PAD指下肢动脉硬化闭塞性疾病,因其高患病率和心脑血管事件发生率而引起高度关注。对该病的发生发展、如何早发现、早治疗等,均有很多未曾探知的领域。现将重点讨论狭义PAD。1 PAD的特点     

糖尿病下肢动脉疾病与微血管病变的相关性

正外周动脉疾病(peripheral artery disease,PAD)是动脉进展性狭窄、闭塞或瘤样扩张的一系列病变,其所涉及的主要动脉为主动脉及其非冠状动脉分支动脉,包括颈动脉、上肢动脉、内脏动脉及下肢动脉。下肢动脉疾病是常见的PAD之一。动脉粥样硬化是引起PAD的主要原因。欧洲及北美动脉疾病患病人数约为2700万,美国成人动脉疾病     

维生素与外周动脉疾病

外周动脉疾病(peripheral arterial disease,PAD)是指发生在冠状动脉以外的主动脉及其分支管腔的狭窄、闭塞,其病理基础主要为动脉粥样硬化.目前,PAD在年龄＞40岁的人群中普遍存在,且随着年龄的增加而增加[1].研究表明,PAD是心脑血管病及全因死亡率的独立危险因素,且对于心脑血管病的发生具有...     

美国心脏病学会和美国心脏学会新版外周动脉疾病诊疗指南解读

美国心脏病学会和美国心脏学会(ACC/AHA)最近更新了外周动脉疾病(PAD)诊疗指南,全文发表在Cir-culation[2006,113(11):463]上,该指南主要目的是早期检测和治疗PAD,以预防残疾,降低病死率。指南所指的PAD是指除冠状动脉之外的主动脉及其分支动脉的狭窄、闭塞或瘤样扩张疾病,因此     

阿司匹林是治疗外周动脉疾病的最佳药物吗？

<正>门诊有患者咨询,"对于我的腿上的外周动脉疾病,有什么药比阿司匹林更有效吗?"外周动脉疾病(PAD)是指下肢动脉阻塞导致血液流动减慢,狭窄常由动脉粥样硬化斑块引起。根据一项对5000多名PAD患者的大型科学研究结果,有关部门建议PAD患者每天服用一片阿司匹林。     

近期国内外新发布指南

1外周动脉粥样硬化性血管病的定义和关键数据发布 2011年12月5日,美国ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN联合在Circulation杂志上发布了《外周动脉粥样硬化性血管病的定义和关键数据》,提供了PAVD的数据标准,包括下肢外周动脉疾病（PAD）、腹部主动脉瘤（AAA）、肾脏和肠系膜动脉病以及颅外颈动脉病。     

外周动脉疾病抗血小板治疗策略

<正>随着社会经济发展与人口老龄化,外周动脉疾病(pe-ripheral arterial disease,PAD)在60岁以上人群中的发病率逐年上升。PAD多为腹主动脉分叉以下动脉受累发生动脉粥样硬化进而导致管腔狭窄或闭塞,病程进展十分隐匿,大部     

下肢动脉粥样硬化性疾病诊治中国专家建议(2007)

前言 LEAD（lower extremity atherosclerotic disease）是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞，使下肢组织出现慢性或急性缺血症状的疾病。提出本建议的目的是通过介绍LEAD的临床特点、诊断标准、治疗原则与方法，为临床医师提供诊断和防治LEAD的基本原则。     

Assessment of patient capacity to consent to treatment

OBJECTIVE: To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment. DESIGN: Cross-sectional study with independent comparison to expert capacity assessments. SETTING: Inpatient medical wards at an academic secondary and tertiary referral hospital. PARTICIPANTS: One hundred consecutive inpatients facing a decision about a major medical treatment or an invasive medical procedure. Participants either were refusing treatment, or were accepting treatment but were not clearly capable according to the treating clinician. MEASUREMENTS AND MAIN RESULTS: The treating clinician (medical resident or student) conducted a specific capacity assessment on each participant, using a decisional aid called the Aid to Capacity Evaluation. A specific capacity assessment is a semistructured evaluation of the participant’s ability to understand relevant information and appreciate reasonably foreseeable consequences with regard to the specific treatment decision. Participants also received a SMMSE administered by a research nurse. Participants then had two independent expert assessments of capacity. If the two expert assessments disagreed, then an independent adjudication panel resolved the disagreement after reviewing videotapes of both expert assessments. Using the two expert assessments and the adjudication panel as the reference standard, we calculated areas under the receiver-operating characteristic curves and likelihood ratios. The areas under the receiver-operating characteristic curves were 0.90 for specific capacity assessment by treating clinician and 0.93 for SMMSE score (2p=.48). For the treating clinician’s specific capacity assessment, likelihood ratios for detecting incapacity were as follows: definitely incapable, 20 (95% confidence interval [CI] 3.6, 120); probably incapable, 6.1 (95% CI 2.6, 15); probably capable, 0.39 (95% CI 0.18, 0.81); and definitely capable, 0.05 (95% CI 0.01, 0.29). For the SMMSE, a score of 0 to 16 had a likelihood ratio of 15 (95% CI 5.3, 44), a score of 17 to 23 had a likelihood ratio of 0.68 (95% CI 0.35, 1.2), and a score of 24 to 30 had a likelihood ratio of 0.05 (95% CI 0.01, 0.26). CONCLUSIONS: Specific capacity assessments by the treating clinician and SMMSE scores agree closely with results of expert assessments of capacity. Clinicians can use these practical, flexible, and evaluated measures as the initial step in the assessment of patient capacity to consent to treatment. This project was supported by the physicians of Ontario through a grant (94–28) from Physicians’ Services Incorporated Foundation of Ontario. Dr. Naglie is partially supported by an Arthur Bond Fellowship from the Physicians’ Services Incorporated Foundation.     

Mechanisms of damage to corals exposed to sedimentation

We investigated the mechanisms leading to rapid death of corals when exposed to runoff and resuspended sediments, postulating that the killing was microbially mediated. Microsensor measurements were conducted in mesocosm experiments and in naturally accumulated sediment on corals. In organic-rich, but not in organic-poor sediment, pH and oxygen started to decrease as soon as the sediment accumulated on the coral. Organic-rich sediments caused tissue degradation within 1 d, whereas organic-poor sediments had no effect after 6 d. In the harmful organic-rich sediment, hydrogen sulfide concentrations were low initially but increased progressively because of the degradation of coral mucus and dead tissue. Dark incubations of corals showed that separate exposures to darkness, anoxia, and low pH did not cause mortality within 4 d. However, the combination of anoxia and low pH led to colony death within 24 h. When hydrogen sulfide was added after 12 h of anoxia and low pH, colonies died after an additional 3 h. We suggest that sedimentation kills corals through microbial processes triggered by the organic matter in the sediments, namely respiration and presumably fermentation and desulfurylation of products from tissue degradation. First, increased microbial respiration results in reduced O(2) and pH, initiating tissue degradation. Subsequently, the hydrogen sulfide formed by bacterial decomposition of coral tissue and mucus diffuses to the neighboring tissues, accelerating the spread of colony mortality. Our data suggest that the organic enrichment of coastal sediments is a key process in the degradation of coral reefs exposed to terrestrial runoff.     

欢迎国内外广大糖尿病相关医务工作者踊跃向本刊投稿

《中华糖尿病杂志》(ISSN 1674-5809.CN 11-5791/R)由中华医学会主办并编辑出版,是中国科技论文统计源期刊、中国科学引文数据库(CSCD)来源期刊月刊海期64面,国内外公开发行.2020年25元/期,全年共300元主要栏目包括:述评、专题笔谈、专家共识、论著、短篇论著、指南解读、综述、病例报告,现向广大医务工作者及科研人员征集文稿,内容涉及:糖尿病人群流行病学调查及危险因素评估.糖尿病新型诊断技术和综合治疗的新理论、新策略与预防措施,糖尿病急、慢性并发症及重症监护,糖尿病发病机制的病理生理及免疫学、分子遗传学研究,患者教育与护理,社区管理和卫生经济学分析.糖尿病与其他疾病的关系等.     

Barriers to the use of medications to treat alcoholism

In 1994, naltrexone became the first medication approved by the Food and Drug Administration as an adjunct in alcoholism treatment in almost fifty years. Despite evidence of its efficacy, use of naltrexone is not widespread. Patient and physician focus groups were used to identify reasons naltrexone has not been prescribed more widely. Barriers to its widespread use include a lack of awareness, a lack of evidence of efficacy in practice, side effects, time for patient management, a reluctance to take medications, medication addiction concerns, Alcoholics Anonymous (AA) philosophy, and price. The study indicates that medications to treat alcoholism must overcome numerous barriers before becoming widely accepted.     

Failure to induce resistance of Schistosoma japonicum to praziquantel

In order to explore the possible occurrence of inducing resistance of Schistosoma japonicum to praziquantel (PZQ), a set of animal experiments were carried out. Outbred mice (NIH strain), Anhui isolates of S. japonicum and Oncomelania hupensis were used. In one protocol five weeks after being infected with 48-52 cercariae, mice were orally dosed with PZQ 300 mg/kg, and killed 82 days later to isolate eggs from the liver. Snails were exposed to miracidia released from egg-hatching. F1 progeny were thus obtained through cercarial inoculation. The same scheme was applied for the establishment of the F2 generation. In another protocol two weeks after infection, PZQ 50 mg/kg/day was given to mice for 5 days. Eggs were collected 26-27 days post treatment and the identical procedures were adopted for F1 and F2 generations successively. Analysis of total worm and female worm reduction rates indicated that there was no significant difference between the sensitivity to PZQ of F1 and F2 progenies of S. japonicum and the parent worms.     

不同HBV基因型感染慢性乙型肝炎患者对核苷(酸)类药物治疗的应答反应比较

目的研究与探讨HBV基因型与慢性乙型肝炎患者肝组织病理学变化及对核苷(酸)类抗病毒药物疗效的关系。方法随机将慢性HBV感染者541例分为4组:拉米夫定组136例、替比夫定组135例、恩替卡韦组135例和阿德福韦组135例,各治疗48周。治疗前应用聚合酶链反应法确定HBV基因型,并于治疗前和治疗48周时分别检测肝功能、HBV DNA和HBV M。其中109例行肝组织病理学检查。结果本组HBV B基因型94例(17.38%),C型410例(75.79%),B/C混合型37例(6.84%),未检出其他基因型;在B型感染者,肝组织G3占37.3%、S313.0%,C型感染者G3占8.7%、S3占22.7%,B基因型与C基因型之间比较,有统计学意义(P<0.05);在拉米夫定、恩替卡韦和替比夫定治疗患者,B型、C型和B/C混合型之间疗效的比较,有统计学差异(P<0.05),而在阿德福韦酯治疗患者,几种不同的基因型感染患者疗效无统计学差异(P>0.05)。结论 HBV基因型与患者肝组织病理学改变及对核苷类抗病毒治疗的疗效密切相关。