Impact of glucose in peritoneal dialysis: saint or sinner?

Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.     

Atomoxetine treatment of attention-deficit/hyperactivity disorder

OBJECTIVE: To review the literature of the first nonstimulant approved for treatment of attention-deficit/hyperactivity disorder (ADHD). DATA SOURCES: Primary literature and review articles were obtained through PubMed/MEDLINE (1966-February 2003). STUDY SELECTION AND DATA EXTRACTION: Literature evaluating atomoxetine in ADHD was selected. Animal data were excluded. DATA SYNTHESIS: Stimulants are currently first-line therapy for ADHD. However, their use raises several concerns including the potential for abuse and adverse effects. Atomoxetine introduces a new therapeutic drug class, selective norepinephrine-reuptake inhibitors, for ADHD management. This additional treatment option offers potential advantages over current therapies. CONCLUSIONS: Clinical trials demonstrate that atomoxetine is a safe and effective alternative for ADHD treatment in children and adults; however, its disadvantages may hinder it from becoming a first-line agent.     

SGLT1 inhibition boon or bane for diabetes-associated cardiomyopathy

Chronic hyperglycaemia is a peculiar feature of diabetes mellitus (DM). Sequential metabolic abnormalities accompanying glucotoxicity are some of its implications. Glucotoxicity most likely corresponds to the vascular intricacy and metabolic alterations, such as increased oxidation of free fatty acids and reduced glucose oxidation. More than half of those with diabetes also develop cardiac abnormalities due to unknown causes, posing a major threat to the currently available marketed preparations which are being used for treating these cardiac complications. Even though impairment in cardiac functioning is the principal cause of death in individuals with type 2 diabetes (T2D), reducing plasma glucose levels has little effect on cardiovascular disease (CVD) risk. In vitro and in vivo studies have demonstrated that inhibitors of sodium glucose transporter (SGLT) represent a putative therapeutic intervention for these pathological conditions. Several clinical trials have reported the efficacy of SGLT inhibitors as a novel and potent antidiabetic agent which along with its antihyperglycaemic activity possesses the potential of effectively treating its associated cardiac abnormalities. Thus, hereby, the present review highlights the role of SGLT inhibitors as a successful drug candidate for correcting the shifts in deregulation of cardiac energy substrate metabolism together with its role in treating diabetes-related cardiac perturbations.     

Management of chronic noncancer pain in depressed patients

Many patients with chronic noncancer pain present with comorbid depression, which can greatly complicate the treatment of pain. Chronic pain and depression each increase the risk of licit and illicit substance abuse, including the abuse of opioids, and of suicide. Patients attempting suicide may overdose on opioids, which are commonly perceived as potentially harmful, or acetaminophen, an agent that is believed to be safe but is actually the leading cause of liver failure in the United States. Opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to interact with antidepressants, and their adverse effects may be exacerbated by alcohol use, which is also common in patients with depression. Topical NSAIDs, capsaicin, and lidocaine provide effective analgesia for several pain conditions. These agents limit systemic drug exposure, reducing the risk of systemic adverse events without risk of accidental or deliberate overdose. However, use of topical agents is generally limited to localized pain syndromes and therefore does not substantially eliminate the need for systemic analgesics in those patients with diffuse persistent pain, central sensitization, and opioid-responsive pain. This review will discuss the challenges associated with treating chronic pain in depressed patients and will provide recommendations for optimizing treatment.     

Safe handling of hazardous drugs

Recommendations for the safe handling of hazardous drugs have been available for more than twenty years. Evidence for continued risk of occupational exposure is abundant; however, nurses' use of the recommended precautions is not universal. This may be related to a lack of information or to a lack of serious concern for the potential hazards. This article includes a discussion of current issues related to handling hazardous drugs in the workplace and a review of the history of safe handling guidelines, current recommendations, and barriers to implementing guidelines in health care settings.     

妊娠期糖尿病一日门诊管理实践与效果

目的:调查分析妊娠期糖尿病(Gestational Diabetes Mellitus,GDM)孕妇通过一日门诊前、后对孕期血糖控制标准、食物交换份的使用以及自我血糖监测方法等知识的了解和掌握情况,制定出更易于被妊娠期糖尿病孕妇接受、掌握和执行的孕期膳食指导方案。方法:使用统一的调查表对214名参加妊娠期糖尿病一日门诊培训与学习的孕妇进行调查,比较其参加培训前、后对妊娠期糖尿病相关知识的知晓度情况。结果:参加一日门诊前97.2%的孕妇对妊娠期糖尿病控制标准不了解,97.3%的孕妇对如何运用食物交换份的方法制定每日食谱以及自我监测的方法不了解,通过一日门诊的学习与实践,95.2%的孕妇对以上知识和方法有所了解和掌握。结论:大多数孕妇对妊娠期糖尿病相关知识、有效控制方法及监测方法不了解;一日门诊的体验和学习,是促使妊娠期糖尿病孕妇尽快掌握自我管理方法的有效尝试,也是对妊娠期糖尿病孕妇进行综合管理的一种新的模式。     

孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值

目的 分析孕前甘油三酯葡萄糖(TyG)指数及孕期增重与妊娠期糖尿病(GDM)患者分娩巨大儿的关系。方法 以2020年06月1日-2022年01月31日就诊于河北省人民医院产科住院分娩且确诊为GDM的孕产妇共476例为研究对象,统计患者各项临床资料。根据新生儿体重,分为巨大儿组(124例)和非巨大儿组(352例)。分析GDM患者分娩巨大儿的独立影响因素,绘制受试者工作特征(ROC)曲线以分析孕前TyG指数及孕期增重对GDM患者分娩巨大儿的预测价值。结果 巨大儿组年龄、孕期增重及孕前TyG指数均高于非巨大儿组(P<0.05)。巨大儿组初孕及初产比例均低于非巨大儿组(P<0.05)。多因素Logistic回归分析结果显示,孕期增重、孕前TyG指数是GDM患者分娩巨大儿的独立影响因素(P<0.05)。ROC曲线结果显示：孕期增重(AUC:0.613, 95%CI:0.554～0.672,P<0.01)、孕前TyG指数(AUC:0.720,95%CI:0.672～0.768,P<0.01)对GDM患者分娩巨大儿有一定预测能力,但二者联合预测能力更高(AUC:0.74...     

Probiotics for preventing gestational diabetes in overweight or obese pregnant women: A review

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit to the host. Specific probiotics or probiotic foods can be used to reduce the risk of diseases associated with aberrant gut microbiota composition. The incidence of gestational diabetes mellitus (GDM) has increased annually with the proportion of overweight and obese people. Overweight or obese pregnant women are at high risk of GDM and have obvious changes in gut microbiota compared with normal-weight pregnant women. Specific probiotics or probiotic foods may alter gut microbiota in overweight or obese pregnant women and inhibit the expression of inflammatory factors, consequently resulting in weight loss and reduced insulin resistance. This review discusses the mechanism of probiotics on GDM, as well as the dose, method and duration of probiotics use, and summarizes current evidence on probiotics in improving glucose metabolism and other maternal and infant outcomes in overweight/obese pregnant women.     

The bath environment, the bathing task, and the older adult: a review and future directions for bathing disability research

Purpose. To review existing research studies to identify optimal intervention strategies for remediation and prevention of bathing disability and future directions for bathing disability research.

Method. Bathing disability, defined as problems in the interaction between the person and the environment during bathing performance, is examined through a comprehensive, narrative literature review.

Results. Most studies focus on the relationship between the person and the environment (such as assistive device use and environmental hazards) while fewer studies focus on analysis of the bathing task or the interaction of the person, environment, and bathing task. Of intervention studies, most do not focus solely on remediation of bathing disability and outcomes vary widely.

Conclusions. In order to help remediate and prevent bathing disability, it will be necessary to better understand and measure the person-environment-occupation interaction involved in bathing as it relates to specific groups of older adults.     

妊娠中晚期孕妇血清Gremlin1水平变化及其对妊娠期糖尿病的影响

目的 了解妊娠中晚期孕妇血清Gremlin1水平变化,探究Gremlin1对妊娠期糖尿病(gestational diabetes mellitus,GDM)的影响.方法 选取2020年9-11月就诊于安徽医科大学第一附属医院行孕期体检的妊娠24～28周并完善口服葡萄糖耐量试验(oral glucose toleran...     

妊娠期糖尿病产妇分娩的新生儿出生后24小时内血糖变化规律与护理对策

目的 探讨妊娠期糖尿病（gestation diabetes mellitus,GDM）产妇分娩的新生儿出生后24 h内母婴同室期间血糖变化规律及影响因素,并提出护理对策。方法 回顾性收集2017年12月—2018年9月入住杭州市某三级甲等妇产科医院的884对GDM产妇的一般资料及分娩新生儿的一般资料和出生后3 h、6 h、12 h、24 h的血糖值,并对其影响因素进行相关性分析。结果 新生儿出生后3 h、6 h发生低血糖各4例（0.45%）,12 h、24 h无低血糖发生;3 h、6 h、12 h、24 h发生临界低血糖（不包含重复发生者）各30例（3.39%）、19例（2.17%）、7例（0.81%）和7例（0.81%）。产妇分娩方式（OR=3.834）、泌乳量（OR=7.006）及新生儿性别（OR=4.014）是新生儿出生后3 h发生临界低血糖的影响因素（P<0.05）;产妇泌乳量是各时点发生临界低血糖的影响因素（P<0.05）。 结论 GDM产妇分娩的新生儿出生后24 h低血糖、临界低血糖的发生率随时间的延长逐渐降低。多种因素影响新生儿各时间点血糖的变化,择期剖宫产、母乳不足和男性新生儿是新生儿出生后3 h发生临界低血糖的独立影响因素。在临床护理工作中,对GDM产妇分娩的新生儿出生后24 h内母婴同室期间应进行分层、针对性的血糖观察和管理。     

妊娠期糖尿病患者阴道分娩的安全性分析及护理

目的探讨妊娠期糖尿病患者阴道分娩的安全性及护理经验。方法总结2004年1月-2005年6月自愿选择阴道分娩的85例妊娠期糖尿病(GDM)产妇作为GDM组,同期选择阴道分娩的非GDM产妇4 506例作为非GDM组,对两组母婴的安全性进行分析。结果妊娠期糖尿病产妇选择阴道分娩,其剖宫产率、胎儿宫内窘迫发生率、新生儿窒息率、死产及新生儿病率与非GDM组相比无显著性差异(P>0.05)。而≥41周分娩胎儿宫内窘迫发生率增加,差异有显著性(P<0.01)。结论妊娠期糖尿病积极控制血糖,加强产时护理监测,阴道分娩是安全的,≥41周者应终止妊娠。     

妊娠期糖尿病孕妇妊娠相关焦虑的潜在类别分析

目的 探索妊娠期糖尿病孕妇妊娠相关焦虑的潜在类别,分析不同类别孕妇的特征差异。方法 于2018年12月—2019年5月便利选取郑州市某三级甲等医院门诊的172例妊娠期糖尿病孕妇为研究对象,采用一般资料调查表、妊娠相关焦虑量表、易感性人格类型问卷和心理弹性量表进行调查。结果 妊娠期糖尿病孕妇妊娠相关焦虑分为2个潜在类别：焦虑高发组（59.0%）和低焦虑-担心胎儿组（41%）;Logistic回归分析结果显示,大专及以上学历（OR=6.799）、既往有不良妊娠史（OR=4.276）、易感性人格（OR=5.999）是妊娠相关焦虑高发的危险因素（均P<0.05）,心理弹性得分是妊娠相关焦虑高发的保护因素（OR=0.940,P<0.05）。结论 妊娠期糖尿病孕妇妊娠相关焦虑有明显的分类特征,高学历、不良妊娠史及易感性人格的孕妇焦虑高发,应多关注该类别孕妇;高心理弹性是妊娠相关焦虑的保护因素,应注重挖掘孕妇的心理弹性,减轻其心理应激,缓解孕妇妊娠相关焦虑。     

24h动态血糖监测妊娠期糖尿病患者的效果观察

目的 观察24h动态血糖监测系统用于妊娠期糖尿病(gestational diabetes mellitus,GDM)患者的效果。 方法 选取2013年1月-2015年1月入院治疗的GDM患者186例,按随机数字表法分为对照组99例、观察组87例。对照组采用传统方法人工测量血糖值(7次/d),观察组采用24h动态血糖监测系统(continuous glycose monitoring system,CGMS)监测血糖,共观察3d。比较2组患者低血糖的发生率。 结果 观察组发生低血糖37例,发生率为42.5%,高于对照组的25.3%(χ²=6.219,P=0.013);观察组发生低血糖的时间主要集中在夜间0∶00-3∶00,有症状低血糖发生率为29.7%,明显低于对照组的56.2%(χ²=7.789,P=0.005)。 结论 24h动态血糖监测系统比传统方法能够更早识别低血糖反应,降低低血糖的发生率,指导GDM的个体化治疗,降低母婴并发症。     

多学科协作管理模式对妊娠期糖尿病患者的应用效果

目的 探讨多学科协作管理模式对糖尿病患者的应用效果。方法 采用方便抽样和历史对照研究方法,以我院2016年1-12月诊断为GDM的108例孕妇为对照组,以2017年1-12月诊断为GDM的94例孕妇为干预组。对照组接受常规诊疗护理,干预组采用多学科协作管理模式进行护理,比较2组妊娠结局的差异。结果 2组孕妇分娩孕周、体质量增长及新生儿Apgar评分、新生儿黄疸发生率比较,差异均无统计学意义。干预组产妇使用胰岛素情况、空腹血糖和餐后2 h血糖均好于对照组(χ²=4.739,P=0.029; t=-5.124,P<0.001; t=-3.190,P=0.001),巨大儿及新生儿低血糖发生率低于对照组(χ²=3.940,P=0.047;χ²=3.949,P=0.047),2组新生儿Apgar评分及新生儿黄疸发生率比较,差异无统计学意义(P>0.05)。结论 多学科协作管理模式可有效降低GDM患者胰岛素使用率,降低血糖水平,减少巨大儿及新生儿低血糖发生,在GDM患者管理中发挥着重要作用。     

Ruscus aculeatus (butcher's broom) as a potential treatment for orthostatic hypotension, with a case report

CONTEXT: Chronic orthostatic hypotension (OH) is frequently a severely debilitating disease that affects large groups of the population with autonomic insufficiency--the elderly; patients with diabetes, Parkinson's disease, and chronic fatigue syndrome; and anyone on drugs that affect the autonomic nervous system. Unfortunately, even though more than 60 medications are currently being used to treat OH, none of them is particularly or consistently effective. Ruscus aculeatus, a phytotherapeutic agent that is well known in Europe, may, however, change this. Its vasoconstrictive and venotonic properties make it ideally suited to treat the pooling of blood in the limbs, lack of venous tone, and lack of neurally mediated vasoconstriction that frequently characterize OH. Although it has never been suggested as a treatment for OH, it already has a long, proven record of use in Europe for treating a variety of circulatory disorders. OBJECTIVE: To provide evidence for what appears to be an effective, safe, inexpensive botanical therapy for OH and encourage further studies on the efficacy of Ruscus for OH patients. DESIGN: Review of OH and therapies currently available for OH and evaluation of the properties of Ruscus aculeatus, its mechanism of action, and its suitability as a therapeutic agent for treatment of OH. RESULTS: A review of the many pharmacologic and nonpharmacologic agents for treating OH reveals that all of the drug therapies are disappointing and marginally useful. Although nonpharmacologic management is preferred, in the many cases in which OH becomes debilitating, pharmacologic intervention becomes a last resort. But drug therapy may not always be necessary, because Ruscus aculeatus, a phytotherapeutic agent containing ruscogenins and flavonoids, may prove useful for the treatment of OH if denervation is not so advanced that it has compromised receptor activity at the venous wall. Ruscus aculeatus is an alpha-adrenergic agonist that causes venous constriction by directly activating postjunctional alpha1- and alpha2-receptors, in turn stimulating the release of noradrenaline at the level of the vascular wall. It also possesses venotonic properties: it reduces venous capacity and pooling of blood in the legs and exerts protective effects on capillaries, the vascular endothelium, and smooth muscle. Its flavonoid content strengthens blood vessels, reduces capillary fragility, and helps maintain healthy circulation. Unlike most of the drug therapies used to treat OH, Ruscus aculeatus does not cause supine hypertension. It also appears to do something no other therapy can offer--alleviate the worsening effects of OH in environmentally hot conditions. Finally, it is an extremely safe, inexpensive, over-the-counter botanical medicine. CONCLUSION: With proven phlebotherapeutic properties, including vasoconstrictive action and venotonic properties, Ruscus aculeatus shows great promise for ameliorating the symptoms of OH and improving the quality of life for large groups in the population. It clearly deserves to be the object of wider research and study as a treatment for OH.     

246例妊娠期糖尿病孕妇产后6周血糖监测状况分析

目的分析妊娠期糖尿病(GDM)孕妇产后6周行口服葡萄糖耐量试验(OGTT)状况及影响因素,探索提高产后血糖管理对策。方法回顾性分析对确诊的GDM孕妇产后行75g OGTT复查和访谈。结果2015~2019年共计孕妇建卡数2533例,2532例行OGTT确诊GDM 246例,其中170例孕妇产后6周行OGTT,51例拒绝检查,25例失访。170例中发现25例糖调节受损,2例糖尿病。51例GDM孕妇拒绝OGTT的因素分别是自测空腹血糖正常、坚信自己不会得糖尿病、害怕多次抽血、没时间、喝糖水不适及家人不支持或反对。结论GDM孕妇产后6周行OGTT是必要的,但依从性不高。建议扩大健康宣教对象,加强宣教力度,利用信息技术完善动态管理机制,妇保医生联合全科医生对GDM孕妇产后血糖管理。     

妊娠期糖尿病糖耐量试验的数据特点及临床意义

目的探讨妊娠期糖尿病糖耐量试验的特点。方法选择2009年1月至2009年10月在我院行产前检查并常规行50g GCT的孕妇682例,对筛查结果阳性者219例再行75g葡萄糖耐量试验（OGTT）,诊断妊娠期糖尿病（GDM）31例,糖耐量减低（GIGT）47例,分析GDM和GIGT的OGTF四点血糖值特点。结果GDM组平均年龄30．6岁;GIGT组平均年龄28．8岁。两组年龄比较P〈0．05。GDM组0、1、2、3h点血糖异常率分别是：0％、80．6％、90．3％和48．4％,以1h和2h点异常为主,占GDM诊断依据的71％;GIGT组0、1、2、3h点血糖异常率分别是：0％、21．3％、42．6％和36．1％,以2h和3h点异常为主,占GDM诊断依据的78．7％。结论GDM和GIGT发生与孕妇年龄有关,两种疾病可能有不同致病机理。GIGT可能主要是胰岛素储备功能不足,后续分泌下降引起,而GDM可能主要是胰岛素峰值分泌不足,部分兼具胰岛素储备功能不足后续分泌下降引起。     

Fetal gene transfer

Gene transfer early in development for the treatment of monogenetic and other diseases could overcome major obstacles of intervention in the mature individual. Early gene transfer may prevent the onset of irreversible pathological changes, predispose the individual to immunological tolerance to the introduced protein, take advantage of the high vector to cell ratio, and provide unique access to stem cell/progenitor compartments. The past few years have witnessed the publication of five studies showing long-term correction of monogenetic disorders by fetal gene transfer. Many others have examined the use of new vector systems with therapeutic transgenes, tested their potential for treating diseases in a wide range of organs (including the brain, lung and skin), and examined the hazards of fetal application. This review gives a comprehensive summary of the development of fetal gene transfer over the past few years.