糖尿病并发症的临床进展(六)

糖尿病肾病是糖尿病重要的微血管病变之一，也是糖尿病的主要死亡原因，糖尿病病人中20%～40%会发生糖尿病肾病，水平在30～299mg/24h的持续蛋白尿（微量蛋白尿）是糖尿病肾病的最早期阶段，也是CVD（心血管病）的显著标志之一，合并微量蛋白尿的病人常常会发展为临床蛋白尿（≥300mg/24h），并在数年内陆不出现肾小球滤过率（GFR）持续下降，一旦出现临床蛋白尿，发生终末期肾病（ESRD）的风险就很高。     

冠心病介入治疗的过去、现在和未来

冠心病是致死率与致残率极高的心血管疾病，严重威胁人类健康。目前，药物治疗、冠状动脉搭桥术和介入治疗是冠心病治疗的三架“马车”，其中又以介入治疗发展最为迅速，成为缓解心绞痛和降低急性心肌梗死死亡率的重要治疗手段。冠状动脉造影和介入治疗技术源于外周动脉疾病介入治疗，经过无数冠状动脉介入治疗先行者的不懈努力，使介入器械得到巨大进步和发展，先后经历单纯球囊扩张、金属裸支架和药物洗脱支架时代，同时介入治疗适应症亦不断扩大，几乎囊括所有的冠心病患者。展望未来，伴随着光学相干断层扫描、血管内超声和血流储备分数测定等新技术广泛应用，生物可降解支架成为下一代支架治疗的新希望和发展方向。     

The physician, the media, and the 'spectacular' case

Drawing on his experiences as a pioneer in performing artificial heart transplants for illustration, DeVries considers the dilemmas that the physician-researcher working on a "spectacular" medical case confronts in dealing with the news media. He discusses five major concerns: the patient's privacy; the effects of the media on the treatment of the patient; the integrity of the experiment; hospital disruptions; and the negative reactions of peers who perceive physician-researchers as self-aggrandizing. DeVries concludes that physician cooperation with the press is necessary and desirable, but that it should be based on the following principles: (1) concern for the patient and family is paramount, taking precedence over the public's right to know; (2) any information released must be accurate; and (3) advance preparation regarding the logistics of reporting the news quickly and accurately is essential.     

Order, 19 May 1982, in the matter of the American Medical Association, the Connecticut State Medical Society, the New Haven County Medical Association, Inc

The text of a Federal Trade Commission cease-and-desist order against the American Medical Association (AMA) is reprinted. The order prohibits the AMA from restricting or declaring unethical the advertising of physician services or the participation of physicians in health maintenance organizations.     

Confidentiality, ethics, and the law

This brief report discusses the British Medical Association's reservations concerning two bills pending in the House of Commons. Clauses in the Data Protection Bill pertaining to accessing and transferring computerized information could affect physicians' ability to protect the confidentiality of patients' records. A code of guidance proposed by the government would apply only within the National Health Service and not to outside data users. The Police and Criminal Evidence Bill is the second piece of legislation being monitored by the BMA. Its provision for intimate body searches of prisoners without consent has prompted the Home Office to request guidance from the BMA and the General Medical Council.