维生素D与糖尿病肾病的研究进展

糖尿病肾病是糖尿病常见的并发症之一,流行病学研究显示维生素D缺乏与糖尿病肾病的发生有关,维生素D可能是影响糖尿病肾病的重要因素。目前,维生素D缺乏与糖尿病肾病发病的关系及补充维生素D改善糖尿病肾病患者的状态成为研究的热点。此文总结近年国内外的相关研究,系统全面地从维生素D与糖尿病肾病关系、维生素D对糖尿病肾病保护作用机制以及维生素D在糖尿病肾病患者中的应用等方面介绍维生素D与糖尿病肾病之间关系的研究进展,重点介绍维生素D与糖尿病肾病相互关系的生理学机制,并从维生素D受体信号通路及基因多态性方面解释人群实验中补充维生素D对糖尿病肾病防治效果差异性产生的原因。未来,随着维生素D在糖尿病肾病发病机制中作用的进一步揭示,将为糖尿病肾病患者的治疗及并发症的预防提供更好的指导。     

2型糖尿病慢性并发症与维生素A、C、E缺乏关系的研究

本研究通过对糖尿病不同类型慢性并发症及慢性并发症不同病程的200例2型糖尿病患者体内维生素A、C、E的变化探讨糖尿病慢性并发症与维生素A、C、E代谢的关系，为糖尿病的慢性并发症的治疗提供指导。     

维生素E对糖尿病胰岛素抵抗的影响及其相关机制分析

国内外的调查显示糖尿病患者体内维生素E水平低于正常人群,维生素E可通过降低机体的氧化应激水平、调节过氧化物增生活性受体α和γ的表达和改善脂质代谢来改善胰岛素抵抗,维生素E还有助于控制糖尿病患者并发症的发生发展。关于维生素E对糖尿病胰岛素抵抗的确切影响及机制有待进一步研究。     

胃麻痹与糖尿病

老年糖尿病的早期症状不典型．多以并发症为其首发症状，糖尿病性胃麻痹便是其中之一。糖尿病性胃麻痹的发生原因．主要为持续性高血糖造成迷走神经纤维水肿、变性，影响神经变性而使胃肠功能失调，导致胃动力减弱，胃排空阻滞。此外．糖尿病人体内血糖升高．糖代谢过程中会消耗过多的维生素B1，容易造成维生素B1在病人体内的缺乏．从而导致神经营养障碍，加重植物神经病变而影响胃动力。     

维生素和矿物质：帮助50岁以上中老年人预防糖尿病

糖尿病患者容易发生维生素、矿物质失衡 科学研究揭示，多种维生素、矿物质与糖尿病发生发展相关：维生素A缺乏可能与1型糖尿病的发生有关。也有研究表明，在预防和治疗上．许多维生素和矿物质起着积极的作用。例如，铬可协助或增强胰岛素的作用；钒有助于降低血糖。     

防治糖尿病补充哪维生素

在医院里,常有糖尿病病人询问医生有关补充维生素的问题,如"得糖尿病后,是否需要补充维生素","应该补充哪些维生素"等。事实上,糖尿病病人的病情比较复杂,单纯的Ⅱ型糖尿病如果没有并发症出现,全身状况相对简单;如果出现急性并发症(如酮症酸中毒)、慢性并发症,全身状况就比较复杂。因此,糖尿病病人需要根据病情来补充不同的维生素。     

防治糖尿病补充哪维生素

在医院里,常有糖尿病病人询问医生有关补充维生素的问题,如"得糖尿病后,是否需要补充维生素","应该补充哪些维生素"等.事实上,糖尿病病人的病情比较复杂,单纯的Ⅱ型糖尿病如果没有并发症出现,全身状况相对简单;如果出现急性并发症(如酮症酸中毒)、慢性并发症,全身状况就比较复杂.因此,糖尿病病人需要根据病情来补充不同的维生素.     

维生素D与糖尿病

维生素D缺乏与糖尿病的发生关系密切，而补充足量的维生素D可减少糖尿病的发生，并可改善血糖控制情况，其机制可能与维生素D抑制免疫炎症反应、减轻胰岛素抵抗、促进胰岛素的合成分泌等有关。     

维生素D缺乏与妊娠期疾病关系的研究进展

维生素D具有促进钙、磷吸收,促进皮肤细胞生长、分化及调节免疫功能等重要作用,是人体不可缺少的营养物质。维生素D对于成年女性具有重要意义,能提高其生育能力。而妊娠期妇女由于激素水平和代谢状况的改变,加之胎儿骨骼的生长和额外钙的需求,妊娠期妇女对于维生素D的需求量增高4～5倍,因此维生素D缺乏的发生率也明显增加。维生素D缺乏容易引起一系列妊娠期并发症,如妊娠期糖尿病、先兆早产、子痫前期、细菌性阴道病等,甚至导致新生儿罹患糖尿病、高血压等慢性疾病的风险明显增加。因此,及时了解和掌握妊娠期妇女维生素D水平对孕妇及胎儿具有重要意义,有助于对其开展针对性的临床干预,有效预防妊娠期并发症的发生。本文从妊娠期妇女维生素D缺乏与子痫前期、妊娠期糖尿病、先兆早产、妊娠期细菌性阴道病的关系等方面,对维生素D缺乏与妊娠期疾病关系的研究进展进行综述。     

维生素D与糖尿病周围神经病变关系的研究进展

维生素D作为维持人体正常生理状况必需的脂溶性维生素,在人体钙磷代谢过程中发挥着重要的作用。近年来大量的研究对于维生素D的作用有了全新的认知,发现维生素D在许多慢性疾病当中也发挥着重要的作用。糖尿病周围神经病变作为糖尿病并发症当中最常见的慢性并发症,大量研究显示维生素D与糖尿病周围神经病变之间存在显著相关。因此,本文简要综述维生素D与糖尿病周围神经病变的相关进展。     

Chronic complications in diabetes mellitus

Diabetes mellitus is one of the most prevalent diseases among adult population in Japan. The persistent hyperglycemia is responsible for the appearance of various organ and tissue damage in diabetic subjects. Eyes, kidneys and peripheral nerves are frequently damaged due to diabetes-specific alteration in microvessels. Furthermore, large vessels are also damaged causing severe diseases such as myocardial infarction, cerebral infarction and gangrene. The pathogenesis of these alterations in small and large vessels has been extensively studied and various metabolic abnormalities induced by hyperglycemia are proposed to play a major role in the development of these diabetic vascular complications. Among those metabolic abnormalities, the activation of the diacyl glycerol-protein kinase C pathway has been proposed to play a pivotal role in the pathogenesis of not only microvascular complications but also macrovascular complications. The beneficial effect of a protein kinase C inhibitor on renal, retinal and atherosclerotic lesions in diabetic animal models may support this notion. The results of several large-scale clinical trials have confirmed the efficacy of glycemic control as well as blood pressure control in the management of diabetic complications. It is a prerequisite, therefore, to obtain near-normal glycemic and blood pressure control in order to prevent the appearance of diabetic complications and also suppress their progression. In this aspect nutritional consideration may be an important way to improve the quality of these managements.     

400例腹腔镜胆囊切除围手术期护理

目的:探讨腹腔镜胆囊切除术(LC)围手术期护理的护理方式和特点.方法:对400例LC患者,根据腹腔镜手术的特点对症性实施术前检查、心理护理、全麻后护理以及并发症的观察及护理.结果:400例患者出现腹腔内出血、胆漏、急性水肿性胰腺炎共6例,经治疗及护理后痊愈出院,平均住院日6天.结论:根据腹腔镜手术的特点,对LC患者实施围手术期护理,可减少术后并发症,提高手术效果.     

侧脑室-腹腔分流术治疗交通性脑积水的临床分析

目的总结交通性脑积水患者经侧脑室-腹腔分流术治疗的经验及术后并发症的处理方法。方法回顾性分析100例交通性脑积水患者的临床表现、手术方法及治疗效果。结果100例交通性脑积水患者中,术后症状明显改善者86例,好转者9例,无改善者5例。6例术后发生并发症,其中分流管阻塞4例,术后感染2例,采取相应治疗措施后痊愈出院。结论侧脑室-腹腔分流术治疗交通性脑积水疗效显著,严格控制手术指征、严格无菌操作及减少术中创伤是减少手术并发症、提高手术成功率的关键。     

冠状动脉造影术病人术后护理体会(630例)

目的通过医务人员对冠状动脉造影术病人术后的精心合理高效的专业护理,降低病人的术后焦虑感,减少并发症的发生几率,使冠状动脉造影术最大限度的发挥作用。方法选择我院的630例冠状动脉造影术病人进行系统观察和护理,对结果进行分析评价。结果通过及时的症状观察和合理的护理措施,对患者早日康复起到了促进作用,护理效果满意。结论对冠状动脉造影术患者术后的合理有效的护理是提高冠脉造影术成功率的重要保证。     

肝硬化并发症与肠道菌群

肝硬化是我国的常见病,肝硬化患者常死于感染、上消化道大出血等并发症。近年来的研究表明,肠道细菌通过细菌移位等方式在肝硬化并发症的发生、发展过程中起重要的作用,同时研究也表明,调节肠道微生态在防治肝硬化并发症方面有较好的作用。文中就近年来有关肝硬化并发症与肠道菌群的关系研究作了综述。     

Influence of Age and Type of Underlying Disease on Complications Related to Home Enteral Nutrition

Background: No data about the influence of age and underlying diseases on home enteral nutrition (HEN)–related complications are reported in the literature. Herein, we retrospectively investigated this issue by analyzing HEN‐related complications in a cohort of consecutive patients grouped according to the underlying disease and age. Material and Methods: We reviewed the medical records of 101 patients referring to our team in 2007–2010 to obtain patients’ demographic data, age, nutrition status, duration of HEN treatment, and type of HEN‐related complications. They were divided in cancer and neurologic patients and subgrouped on the basis of their age. HEN‐related complications were expressed as complication rates. Results: Patients with neurological diseases suffered a significantly higher number of complications as compared with cancer patients (P = .04). Age did not significantly influence complication rates. The mechanical complications were the most frequent. The majority of HEN‐related complications were resolved at home. Conclusion: Our data strongly suggest that HEN‐related complications are influenced by underlying diseases and not by age. In neurologic patients, dementia, loss of autonomy, and the different therapies administered by PEG probably play an important role in increasing the number of HEN‐related complications as compared with cancer patients. The most frequent complications can be managed at home, reducing the costs of hospitalizations and discomfort for the patient.     

Lung transplant

A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient, are evident, above all with respect to quality of life.     

输尿管镜钬激光碎石45例急症的临床观察

[目的]研究输尿管镜钬激光碎石联合在输尿管结石急性嵌顿性梗阻中的疗效及并发症情况。[方法]收集2009年1月～2010年12月期间输尿管结石急性嵌顿性梗阻行输尿管镜钬激光碎石病例45例,分析其结石碎除疗效及并发症。[结果]本组患者行输尿管镜钬激光碎石手术时间(40±18.4)min,结石成功碎除率93.3%(42/45),总并发症率15.6%(7/45)。[结论]输尿管镜钬激光碎石术具有创伤小、效果明确、并发症少等特点,可与体外冲击波碎石术、开放手术等技术有机结合,充分发挥其腔镜与激光微创的优势。     

Potential complications of neonatal cephalhaematoma in the community: when to refer to the paediatric team?

Neonatal cephalhaematoma is commonly seen after a minor birth trauma, e.g. from vacuum-assisted deliveries. It is usually considered benign and resolves spontaneously without any treatment. Considerable parental anxiety may be associated with this condition and thus primary health care professionals play a significant role in providing reassurance to the new parents. Complications, although rare, are known to occur and can be potentially serious. A degree of uncertainty is often seen among primary health care professionals about whether to refer such cases to hospital. Recognition of the complications by primary health care professionals and early involvement of the paediatric services are essential to prevent serious complications such as meningitis and osteomyelitis. A case of bilateral cephalhaematoma is presented which was suspected to be infected and needed in-patient hospital care. The potential complications of a cephalhaematoma are discussed and guidelines provided for expediting early and appropriate referral of complicated cases to the paediatric services.     

Glycemic regulation and management of essential hypertension in diabetics with type 2 diabetes mellitus; the 'United Kingdom prospective diabetes study' of diabetic complications]

Patients with type 2 diabetes mellitus often develop micro- and macrovascular complications. In 25% of them, complications are already present at the time of diagnosis. The principal objective of the United Kingdom prospective diabetes study was to determine if good blood glucose control and adequate treatment of hypertension in patients with type 2 diabetes mellitus can prevent development of diabetes-related complications. The question was also studied if they way in which this blood glucose control was achieved and the way of treating the blood pressure affected the prognosis. Blood glucose control was found to reduce the incidence of--especially--microvascular complications. Oral hypoglycaemic agents and insulin both play an important part in achieving good control. Treatment with metformin reduced mortality due to cardiovascular disease in obese patients. Strict control of the blood pressure reduced development of micro- and macrovascular complications; the mortality from diabetes-related disorders and the numbers of patients suffering a stroke or heart failure. Non of the antihypertensive drugs used (an ACE inhibitor and a beta-blocking agent) offered any advantages over the other.