65例老年糖尿病合并低血糖症临床疗效观察

目的 探讨和分析老年糖尿病患者合并低血糖症的发病原因和临床治疗效果.方法 选取该院自2012年10月-2013年9月所收治的老年糖尿病合并低血糖症患者共65例,在分析病因的基础上给予对症的治疗.结果 全部患者经过紧急治疗以后,在8h内的血糖水平恢复到正常标准,患者的病情得到明显的好转,低血糖症状和体征随即消失.全部患者也没有1例误诊或者死亡发生,治疗的有效率为100％.结论 对于老年糖尿病合并低血糖患者,只要加强预防,在发现病情后给予科学及时的治疗,就一定能够明显缓解患者的低血糖状态,在临床应引起足够的重视.     

糖尿病低血糖昏迷急诊救治方法及其临床效果分析

目的分析糖尿病低血糖昏迷急诊救治方法及其应用效果。方法选取2017年1月—2019年6月于该院急诊科收治的113例糖尿病低血糖昏迷患者作为研究对象,将其随机分为观察组(56例)与对照组(57例)。对照组采取常规急救方案,观察组则采取综合急救方案。观察两组患者急救有效率、急救总时间、急救后空腹血糖水平以及急救期间的风险事件发生率。结果观察组在急救有效率、急救总时间明显优于对照组(P<0.05),且在急救后空腹血糖水平以及急救期间的风险事件发生率方面明显优于对照组(P<0.05)。结论通过综合急救方案的应用有助于提高患者的急救有效率,从而改善患者的血糖水平,有助于降低风险事件的发生率,值得在临床中推广应用。     

三叶因子家族在胃癌发生中的作用机制

三叶因子家族（trefoil factor family，TFF）是一群主要由胃肠道黏液细胞分泌的小分子多肽，在黏膜修复和重建以及肿瘤的发生、发展过程中发挥重要作用，对其结构功能、遗传学改变等分子机制的研究一直是近20余年的研究热点。TFF在肠型胃癌中表达降低甚至缺失，在弥漫型胃癌中高表达。其在胃癌发生、发展过程中的机制涉及肿瘤抑制、促进肿瘤侵袭浸润以及促癌与抑癌的双重机制。通过对TFF在胃癌发生、发展中机制的深入研究，有望在胃癌防治方面开辟新途径。     

Nurse Practitioners,Physician Assistants,and Physicians Are Comparable in Managing the First Five Years of Diabetes

Background

Increasing use of nurse practitioners and physician assistants is a possible solution to the shortage of primary care providers in the United States, but the quality of care they provide is not well understood.

纠正低血糖生活食物卡夹在低血糖处置的效果观察

目的观察使用“纠正低血糖的生活食物卡夹”(已获国家实用新型专利,专利号ZL 201720756805.8)对发生低血糖的糖尿病患者的影响,指导患者在日常生活中选择标准的纠正低血糖的食物种类和量,及时纠正低血糖。方法选择2017年10月—12月住院的糖尿病患者90例,通过自制问卷,了解患者对低血糖反应的知识掌握情况,通过使用“纠正低血糖的生活食物卡夹”进行健康指导,观察使用卡夹后,患者在发生低血糖时对生活食物种类和量的选择正确率。结果通过该卡夹的使用及健康指导,糖尿病患者在发生低血糖时,能够准确、及时的选择生活中食物的种类和量,差异有统计学意义(P<0.001)。结论“纠正低血糖的生活食物卡夹”可作为临床护理教育工具使用,针对患者或家属,具有直观、具体、形象,实用性强的特点,能够更规范地帮助糖尿病患者在发生低血糖时,及时、准确地选择含糖食物和进食量,纠正低血糖,减少对机体的损害。另外还可作为日常健康保健资料推广使用,提高群众健康管理知识。     

Physician and Patient Characteristics Associated With Clinical Inertia in Blood Pressure Control

Clinical inertia, the failure to adjust antihypertensive medications during patient visits with uncontrolled hypertension, is thought to be a common problem. This retrospective study used 5 years of electronic medical records from a multispecialty group practice to examine the association between physician and patient characteristics and clinical inertia. Hierarchical linear models (HLMs) were used to examine (1) differences in physician and patient characteristics among patients with and without clinical inertia, and (2) the association between clinical inertia and future uncontrolled hypertension. Overall, 66% of patients experienced clinical inertia. Clinical inertia was associated with one physician characteristic, patient volume (odds ratio [OR]=0.998). However, clinical inertia was associated with multiple patient characteristics, including patient age (OR=1.021), commercial insurance (OR=0.804), and obesity (OR=1.805). Finally, patients with clinical inertia had 2.9 times the odds of uncontrolled hypertension at their final visit in the study period. These findings may aid the design of interventions to reduce clinical inertia.     

Hypoglycemia in Diabetic Patients Undergoing Chronic Hemodialysis

The aim of our study was to determine if different hypoglycemic therapies are associated with more frequent episodes of hypoglycemia in diabetes patients undergoing long-term hemodialysis. We conducted a prospective cohort study that included 102 diabetes patients who were undergoing long-term hemodialysis. The frequency of symptomatic hypoglycemic episodes, intradialytic hypotension, antihypertension medication, hypoglycemic therapy regimens, dialysate contents, and laboratory data were reviewed. The duration of follow-up was three months. Fifty-four (52.9%) patients were categorized as hypoglycemic and 48 (47.1%) patients as non-hypoglycemic. The serum albumin levels of the hypoglycemic and non-hypoglycemic patients were 3.18 ± 0.34 g/dL and 3.44 ± 0.33 g/dL respectively (P < 0.001). The prevalence of intradialytic hypotension is significantly higher in the hypoglycemic patients (44.4%) than in the non-hypoglycemic patients (20.8%) (P = 0.012). The risk of hypoglycemia differed significantly between the patients taking oral hypoglycemic agents (OHAs) and those receiving purely insulin therapy (P = 0.035). Multivariate analysis revealed that the serum albumin (odds ratio [OR] 0.093, 95% confidence interval [CI] 0.021–0.409), intradialytic hypotension (OR 2.755, 95% CI 1.048–7.228), and OHA therapy (OR 0.337, 95% CI 0.128–0.888) were independent factors of hypoglycemia. The patients treated only with meglitinides as hypoglycemic therapy had a significantly lower risk of hypoglycemia than those receiving mixed insulin therapy (P = 0.016). Frequent episodes of intradialytic hypotension and hypoalbuminemia are powerful clinical predictors of hypoglycemia in diabetes patients undergoing hemodialysis. It was also found that OHAs do not pose a higher risk of hypoglycemia than insulin in diabetic patients undergoing hemodialysis.     

Hypoglycemia and cognitive function in diabetic patients

Aims

Hypoglycemia can be considered the most common complication of Diabetes Mellitus treatment. So far, controversial studies have been carried out to examine the impacts of hypoglycemia on the cognitive function.

Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article

Hypoglycemia is an essential issue for diabetic patients and considered a limiting factor in the glycemic management. Heterogeneity of the diseases in Type 2 Diabetes Mellitus can affect the frequency of hypoglycemia, especially when the patient has cardiovascular diseases. There are several factors that lead to hypoglycemia including sulfonylurea therapy, insulin therapy, delaying or missing a meal, physical exercise, or alcohol consumption. Long-term studies reported that repeated hypoglycemia could increase the risk of cardiovascular diseases. During Ramadan fasting, diabetic patients have high incidence of hypoglycemia. Therefore, focused education about hypoglycemia in routine life of diabetic patients and during fasting in Ramadan is important to reduce the complications.     

Assessing Pediatric Clinical Asthma Practices and Perceptions: A New Instrument

Over the past 20 years, the most substantial increases in prevalence, morbidity, and mortality of asthma have been observed among children aged 5-14 years. A survey instrument designed to measure clinical asthma management practices of primary care physicians was developed and evaluated. Study participants included 127 practitioners providing pediatric asthma care in inner-city communities in Baltimore, MD and Washington, DC. Study results found that the instrument assessed four separate dimensions of clinical assessments and five dimensions of physician perceptions. These dimensions should be considered in future research protocols and may be used to design tailored interventions to improve asthma care.     

Family Interactions of Alcoholics as Related to Alcoholism Type and Drinking Condition

BACKGROUND: Several studies have reported that the marital interactions of antisocial and aggressive, versus nonantisocial and nonaggressive, alcoholics exhibit higher rates of aversive-defensive communications and higher levels of negative reciprocity. To extend these findings, we examined the effect of alcoholism type (high- versus low-antisocial alcoholics: HAS, LAS) and drinking condition on family communication patterns. METHODS: Marital and parent-child dyads from 100 alcoholic families were videotaped while they discussed personally relevant issues during drinking and no-drinking sessions (no children were offered any alcohol). All interactions were coded with the Marital Interaction Coding System, and the data were assessed for differences in rate of positive, negative, and problem-solving behaviors, as well as sequential structures. RESULTS: HAS couples were more negative during the drink versus no-drink condition, whereas drinking did not affect negativity for LAS couples. In addition, the negative communications of HAS versus LAS alcoholics were more likely to increase spouse negativity during the drink versus no-drink condition. Group differences for parent-child interactions were few. CONCLUSIONS: The nature of family interactions was related to both alcoholism type and alcohol consumption, and the marital interactions of alcoholism types could be differentiated on the basis of the frequency and sequential structure of negative exchanges. It is most important to note that it is the interactions of the HAS alcoholic that undergo the most change as a function of drinking condition, with little support for the "adaptive consequences" hypothesis that alcohol consumption leads to more effective problem-solving for couples in which the alcoholic exhibits fewer antisocial and more internalizing characteristics. Study limitations and directions for future research are discussed.     

急诊糖尿病低血糖昏迷原因与护理措施分析

目的 探讨急诊糖尿病低血糖昏迷原因与护理措施.方法 回顾性分析2018年1月—2019年12月该院急诊101例急诊糖尿病低血糖昏迷患者的资料,将其作为研究组.回顾性分析同期该院98例糖尿病未合并低血糖昏迷患者资料,将其作为对照组.通过比较两组资料,对糖尿病低血糖昏迷的发生原因进行单因素分析与多因素Logistic回归分...     

基础胰岛素治疗的临床惰性与治疗优化

随着T2DM病情进展,胰岛β细胞功能减退,需要起始Ins治疗使血糖有效控制。基础胰岛素是T2DM治疗的重要药物之一。目前我国基础胰岛素治疗现状并不理想,较多起始晚、剂量调整不充分和血糖达标率低的情况。基础胰岛素治疗惰性,即根据循证临床指南未能及时起始或强化胰岛素治疗,主要涉及医生和患者两方面因素。担心低血糖风险是导致医生和患者基础胰岛素治疗惰性的共同原因。担心低血糖严重制约基础胰岛素的起始、调量及患者依从性。要克服基础胰岛素治疗惰性,需降糖疗效确切、低血糖风险更低的治疗方案。循证医学证据表明,新型甘精胰岛素300 U/ml药代动力学和药效动力学更平稳,可有效减少低血糖发生,为改善基础胰岛素治疗惰性带来新的手段。     

Review of insulin‐associated hypoglycemia and its impact on the management of diabetes in Southeast Asian countries

Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin‐associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin‐associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations.     

Hypoglycemia does not affect gonadotroph responsiveness to gonadotropin-releasing hormone in rhesus monkeys

Hypoglycemia inhibits gonadotropin secretion in primates by an undefined mechanism. Some evidence suggests that hypoglycemia inhibits gonadotropin secretion independent of gonadotropin-releasing hormone (GnRH) inhibition. To this end, the effect of insulin-induced hypoglycemia on the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) response to graded doses of GnRH (25, 75, and 250 ng/kg) administered at 120-min intervals was determined in rhesus monkeys. A crossover design was employed such that each animal received GnRH under both hypoglycemic and euglycemic conditions. Experiments were performed in the follicular phase. Gonadotroph responsiveness to GnRH was quantified by determining the change in area under the LH (ΔAULHC) and FSH (ΔAUFSHC) curves that occurred in the first 60 min following each GnRH pulse. There was no statistical difference in ΔAULHC between euglycemic and hypoglycemic animals at any GnRH dose (25 ng/kg: p=0.19; 75 ng/kg: p=0.41; 250 ng/kg: p=0.46). Similarly, changes in AUFSHC following GnRH administration were comparable in euglycemic and hypoglycemic animals (25 ng/kg: p=0.59; 75 ng/kg: p=0.90; 250 ng/kg: p=0.33). We conclude that hypoglycemia had no effect on gonadotroph responsiveness to GnRH. These results are consistent with the conclusion that hypoglycemia inhibits gonadotropin secretion by acting primarily at the level of the hypothalamus to reduce GnRH secretion rather than affecting pituitary responsiveness to GnRH.     

老年糖尿病患者无症状低血糖诱发异常心电图分析研究

目的探讨老年糖尿病患者无症状低血糖反应的心电图改变特征。方法分析57例老年糖尿病患者无症状低血糖反应的心电图资料。结果 57例老年糖尿病患者在发生无症状低血糖反应过程中,心电图有异常改变者37例,占65%,其中以冠脉供血不足最多,共22例,占39%;心律失常15例,占26%。结论老年糖尿病发生无症状低血糖反应时,心电图可能出现异常改变,应及时治疗,治疗后心电图可以恢复。     

Comparison of Direct Interview and Family History Diagnoses of Alcohol Dependence

Using data from The Collaborative Study on the Genetics of Alcoholism, we compare direct interview diagnoses of alcohol dependence to those obtained by history from family members. Using a requirement of three or more positive implications by history, the specificity, sensitivity, and positive predictive values are 98%, 39%, and 45%, respectively.
A logistic analysis found the gender of the relative and alcoholism in the informant to be significant, but not the gender of the informant. The partial odds ratio of a diagnosis at interview associated with a positive family history diagnosis was 13.6. The relationship between the informant and relative was significant, with negative reports from an offspring or mate more influential than a negative report from a parent or second-degree relative.
We derived a recursive equation to combine a variable number of family history reports, wherein the probabilities associated with a single report are computed from the logistic analysis. This permits the use of family history information both as a proxy for an uninterviewed relative, as well as a second source of information to be used in the analysis of genetic family data.