压力接种训练对改善社区留守老年糖尿病患者低血糖恐惧的效果

目的 探讨压力接种训练在社区留守老年糖尿病患者低血糖恐惧中的应用效果。 方法 将长春市6个社区中存在低血糖恐惧的留守老年糖尿病患者126例随机分为对照组与观察组各63例,对照组给予常规心理干预,观察组在常规心理干预的基础上实施压力接种训练。比较两组干预前及干预8周后的低血糖恐惧评分及血糖水平。 结果 干预后观察组低血糖恐惧得分及空腹血糖、餐后2 h血糖、糖化血红蛋白显著低于对照组（均P＜0.01）。 结论 压力接种训练可降低社区留守老年糖尿病患者低血糖恐惧,改善患者血糖水平。     

护养中心老年人防跌倒保健操训练的效果

目的探讨防跌倒保健操对增强老年人身体柔韧性和平衡能力的作用。方法以重庆市某老年护养中心自理区招募的100名志愿老年人作为研究对象,随机分为干预组和对照组各50名。干预组进行为期1年的防跌倒保健操训练,对照组自愿参加护养中心组织的活动。结果干预组46名、对照组48名完成全程研究。两组功能伸展测试、坐位体前屈测试及平衡功能测试各项指标存在显著的组间效应;跌倒发生率干预组显著低于对照组(均P0.05)。结论应用防跌倒保健操长期训练,能提高老年人下肢肌力、身体的平衡功能和柔韧性,从而预防跌倒的发生。     

化疗诱导的周围神经病变患者多模式运动干预

目的 探讨多模式运动在化疗诱导的周围神经病变患者中的应用效果。方法 便利抽取82例结直肠癌化疗诱导的周围神经病变患者,按病区分为对照组和干预组各41例。对照组采用步行运动,每次30 min,每周至少3次;干预组采用多模式运动干预,每次30~40 min,每周至少3次。干预前及干预12周,采用化疗诱导的周围神经病变评估工具、Berg平衡量表、修正版跌倒效能量表、起立-行走计时测试 进行效果评价。结果 对照组38例、干预组36例完成研究。干预12周后,干预组患者化疗诱导的周围神经病变得分、Berg平衡得分<45分发生率、起立-行走计时测试结果显著低于对照组,跌倒自我效能得分显著高于对照组（均P＜0.05）。结论 多模式运动有利于改善结直肠癌患者化疗诱导的周围神经病变症状体验及对日常生活能力的影响,提高患者的平衡功能、跌倒自我效能和移动能力。     

社区老年糖尿病患者足部皮肤问题现状调查与分析

目的 了解老年糖尿病患者足部皮肤受损情况及其相关因素,为采取针对性预防措施提供参考。 方法 采用自行设计的足部皮肤评估表对上海地区5个社区的411例老年糖尿病患者足部皮肤情况进行现状调查。 结果 社区老年糖尿病患者足部皮肤受损的发生率为50.1%。良好的自我管理行为、及时就诊为保护因素;年龄、高血脂、糖尿病周围神经病变为危险因素（均P＜0.05）。 结论 老年糖尿病患者足部皮肤受损发生率高,且受多种因素影响。应提升患者的自我管理行为、及时就诊,定期进行高血脂、糖尿病周围神经病变筛查及干预,以预防糖尿病足的发生。     

糖尿病APP用于改善社区老年糖尿病患者自我管理行为研究

目的评价糖尿病管理APP对改善社区老年糖尿病患者自我管理行为的效果。方法将59例老年糖尿病患者随机分为干预组(30例)与对照组(29例)。对照组予以常规糖尿病管理,干预组采用糖尿病管理APP对患者进行治疗、运动、饮食、监测管理指导,连续3个月后评价效果。结果干预组患者糖尿病自我管理行为量表总分、各维度得分及血糖指标改善程度显著优于对照组(P0.05,P0.01);两组血脂、BMI、腰臀比比较,差异无统计学意义(均P0.05)。结论对社区老年糖尿病患者采用糖尿病管理APP进行规范指导,可有效改善自我管理行为,从而降低血糖水平,有利于糖尿病的控制。     

双重任务训练对养老院老年人步态与平衡功能的影响

目的 探讨双重任务训练对养老院老年人步态与平衡改善的效果。 方法 将养老院30例老年人按照随机数字表法分为观察组与对照组各15人。对照组按常规进行回春医疗保健操训练，观察组在常规训练基础上开展双重任务训练。于干预前和干预6周后进行步态参数测试及平衡测试。 结果 干预后，观察组步速、步长、双重任务步长、起立行走试验用时和双重任务起立行走试验用时、平衡功能评分显著优于对照组（P＜0.05，P＜0.01），两组双重任务步速及ABC平衡信心评分差异无统计学意义（均P＞0.05）。 结论 双重任务训练可改善养老院老年人的步态及综合平衡能力，但对其害怕跌倒心理的改善作用不显著。     

四方联动防跌护理在社区跌倒高危老年人中的应用

目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。     

毫米波联合甲钴胺治疗糖尿病周围神经病变的护理

目的 观察毫米波脉冲刺激联合甲钴胺治疗糖尿病周围神经病变患者的疗效.方法 将86例糖尿病周围神经病变患者随机分为观察组与对照组各43例.两组患者在饮食和降糖治疗不变的前提下进入治疗期.对照组应用甲钴胺0.5mg肌内注射,1次/d.观察组在对照组基础上采用糖尿病治疗仪进行治疗.两组均观察4周评价疗效.结果 观察组总有效率90.7%,对照组67.4%,观察组显著高于对照组(P＜0.01),且观察组神经传导速度显著优于对照组(均P＜0.05)).结论 毫米波脉冲刺激穴位可改善神经细胞的代谢,促进神经修复再生,联合甲钴胺治疗糖尿病周围神经病变疗效显著.治疗中需掌握糖尿病治疗仪的操作方法,密切观察治疗效果及不良反应,做好健康教育及心理护理.     

肢体运动训练对多发性骨髓瘤化疗致 周围神经病变患者的影响

目的 探讨基于周围神经病变的运动模式(Exercise for Peripheral Neuropathy, EPN)改良版肢体运动训练对多发性骨髓瘤化疗致周围神经病变患者生活质量及周围神经病变的改善效果。方法 将多发性骨髓瘤化疗致周围神经病变患者61例按随机数字表法分为对照组和干预组。对照组进行常规基础运动训练,干预组进行EPN改良版肢体运动训练,持续4周。干预前后对两组生活质量、神经病变严重程度进行比较。结果 共59例患者（干预组31例,对照组28例）完成研究。干预后,干预组生活质量得分(107.23±12.21)分,周围神经病变严重程度得分［7.00(7.00,9.00)］分,对照组分别为(95.04±15.11)分、［9.00(9.00,10.00)］分,两组比较,差异有统计学意义(均P<0.05)。结论 基于EPN改良版肢体运动训练能提高多发性骨髓瘤化疗致周围神经病变患者生活质量,有效改善其周围神经病变情况,且简便易行,安全有效。     

下肢肌力训练装置在老年糖尿病周围神经病变患者的应用

目的评价下肢肌力训练装置对老年糖尿病周围神经病变(DPN)患者下肢肌力的影响。方法采用自身前后对照设计,对34例老年DPN患者采用自行制作的下肢肌力训练装置进行3个月下肢肌力训练。结果训练后患者30s连续坐椅试验次数明显增加,睁眼、闭眼单足站立时间明显延长,起立-步行测试时间明显缩短(P0.05,P0.01)。结论应用下肢肌力训练装置进行下肢肌力训练,可以改善老年DPN患者下肢肌力、静态平衡功能和动态平衡功能。     

胰腺炎后糖尿病患者营养管理的研究进展

对胰腺炎后糖尿病患者流行病学现状、营养状况影响因素（糖代谢功能受损、胰腺外分泌功能不全、肠道菌群紊乱）及营养管理方案（日常饮食及精准营养管理、胰酶补充、健康宣教）进行综述，旨在为临床构建规范化、个体化的营养管理方案和进行针对性健康教育提供证据支持。     

Comparison of Perioperative Adverse Event Rates After Total Knee Arthroplasty in Patients With Diabetes: Insulin Dependence Makes a Difference

Background

Total knee arthroplasty (TKA) is an effective treatment option for patients with advanced osteoarthritis and has become one of the most frequently performed orthopedic procedures. With the increasing prevalence of diabetes mellitus (DM), the burden of its sequela and associated surgical complications has also increased. For these reasons, it is important to understand the association between DM and the rates of perioperative adverse events after TKA.

HNF1A mutation in a Thai patient with maturity-onset diabetes of the young: A case report

BACKGROUND Maturity-onset diabetes of the young(MODY) is the most common form of monogenic diabetes. The disease is transmitted in autosomal dominant mode and diabetes is usually diagnosed before age 25 year. MODY 3 is caused by mutation of hepatocyte nuclear factor(HNF) 1 A genes and is the most common MODY subtype. Diagnosis of MODY 3 is crucial since glycemic control can be accomplished by very low dose of sulfonylurea. In this report we described a Thai MODY 3 patient who had excellence plasma glucose control by treating with glicazide 20 mg per day and insulin therapy can be discontinued.CASE SUMMARY A 31-year-old woman was diagnosed diabetes mellitus at 14 years old. The disease was transmitted from her grandmother and mother compatible with autosomal dominant inheritance. Sanger sequencing of proband's DNA identified mutation of HNF1 A at codon 203 which changed amino acid from arginine to cysteine(R203 C). This mutation was carried only by family members who have diabetes. The patient has been treated effectively with a combination of oral hypoglycemic agents and must include a very low dose of glicazide(20 mg/d). Insulin therapy was successfully discontinued.CONCLUSION We demonstrated a first case of pharmacogenetics in Thai MODY 3 patient. Our findings underscore the essential role of molecular genetics in diagnosis and guidance of appropriate treatment of diabetes mellitus in particular patient.     

Trends in prevalence of diabetes in Asian countries

Diabetes is a major lifestyle disorder,the prevalence of which is increasing globally.Asian countries contribute to more than 60% of the world’s diabetic population as the prevalence of diabetes is increasing in these countries.Socio-economic growth and industrialization are rapidly occurring in many of these countries.The urban-rural divide in prevalence is narrowing as urbanization is spreading widely,adversely affecting the lifestyle of populations.Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors.As a result,they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population.The adverse effect of physical inactivity and fatty food are manifested as the increasing rate of overweightness and obesity,even among children.The health care budgets for the disease management are meager and the health care outcome is far from the optimum.As a result,complications of diabetes are common and the economic burden is very high,especially among the poor strata of the society.National endeavors are urgently needed for early diagnosis,effective management and for primary prevention of diabetes.This editorial aims to highlight the rising trend in prevalence of diabetes in Asia,its causative factors and the urgent need to implement national strategies for primary prevention of type 2 diabetes.     

Maturity onset diabetes of the young: clinical characteristics and outcome after kidney and pancreas transplantation in MODY3 and RCAD patients: a single center experience

The diabetes and renal phenotype of patients with maturity-onset diabetes of the young (MODY) on a transplantation waiting list is not known; neither is their outcome after pancreas (PT) and/or kidney transplantation (KT). Between 2002 and 2009, we screened 50 of 150 patients referred for kidney and pancreas transplantation to the Kremlin-Bicêtre center for HNF1B and HNF1A mutations if one or more of the following criteria was present (i) an atypical history of diabetes (ii) diabetes with at least one affected parent or two affected relatives, (iii) an absence of auto-antibodies at diagnosis (iv) a persistent secretion of fasting C peptide (v) a personal or a family history of renal cysts or dysplasia. Their phenotype and their outcome were analyzed. Four HNF1A (MODY3) and eight HNF1B mutations [renal cysts and diabetes (RCAD)] were identified. All MODY3 patients had diabetic nephropathy, but only 50% of RCAD patients. Four patients underwent a kidney and pancreas transplantation and two a kidney transplant alone. After 4.1 ± 1.1 years of follow-up, 83% of patients still have a functioning kidney and 75% a functioning pancreas. PT can be proposed with good results for MODY3 and RCAD patients.     

Diabetes mellitus: The epidemic of the century

The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults(10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes(37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development.     

Studies of the isolation, viability, and preservation of purified islets after surgical pancreatectomy in large pigs

Abstract: Previous studies have shown separation of mass quantities of islets from slaughterhouse pig pancreases. In these studies, we examined the isolation, viability, and preservation of pig islets obtained by surgical pancreatectomy. Pigs aged 6 to 30 months weighing 100 to 200 kg were subjected to laparotomy under general anesthesia. The splenic lobe of pancreas was mobilized without warm ischemia. Islets were immediately isolated by collagenase perfusion through the duct, automated dissociation, and Ficoll purification. Yields of islets (150 μm size) were 8500 to 9300/g for two different collagenases before purification. Purification yielded 90% pure islets, but yields decreased to 400 to 600/g. Perifusate insulin release was biphasic after glucose/theophylline with 3 to 5-fold stimulation. Following culture/cryopreservation marked islet losses occurred but viability was preserved. Quantities of 1,500 islet equivalents resulted in euglycemia in nude mice. These data show that mass quantities of viable islets can be isolated after pancreatectomy, but there is marked islet loss during purification and subsequent preservation due to inherent islet fragility.     

胰岛细胞移植的现状与进展

胰岛细胞移植是目前糖尿病治疗中的一个研究热点,也是有望从根本上治疗糖尿病的一种方法。自2000年加拿大Edmonton报到了对7例1型糖尿病患者成功施行胰岛细胞移植术以来,国内外掀起了胰岛细胞移植的研究热潮,在动物实验和临床研究方面取得了一定的突破。本文就胰岛细胞移植的现状与进展进行简要的综述。