2型糖尿病合并急性脑梗死患者动态血糖变化及其与预后的关系

目的探讨2型糖尿病(T2DM)合并急性脑梗死(ACI)患者血糖水平与预后的关系。方法将122例T2DM合并ACI患者根据预后情况分为预后良好组(n=76)与预后不良组(n=46),对比2组患者空腹血糖(FPG)水平、平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、血糖波动频数,并分析上述指标与卒中量表(NIHSS)评分及预后改良Rankin量表(mRS)评分的关系。结果预后不良组患者平均血糖水平(MBG)、血糖标准差(SDBG)、LAGE、MAGE均显著高于预后良好组(P0.01),血糖波动频数无显著差异(P0.05)。患者MBG、SDBG、LAGE、MAGE均随着脑卒中病情严重程度的增加而显著增高(P0.05)。mRS评分与MBG、SDBG、LAGE、MAGE呈显著正相关(P0.05)。结论 T2DM合并ACI患者的血糖水平与血糖波动情况对患者预后具有重要影响,随着血糖水平的增高以及血糖波动的增大,患者预后也变差。     

2型糖尿病合并急性脑梗死患者血糖水平及血糖漂移对神经功能缺损的影响

目的:观察血糖水平及血糖漂移对2型糖尿病(type 2 diabetes mellitus,T2DM)合并急性脑梗死(acute cerebral infarction,ACI)患者神经功能缺损的影响。方法:选取2014年3月至2015年6月在我院治疗的ACI患者作为观察对象,根据其是否合并2型糖尿病史,将其分为2组:合并2型糖尿病组(DMCI组,42例)和不合并2型糖尿病组(NDMCI组,45例)。比较两组患者平均血糖水平(mean blood glucose,MBG)、血糖水平标准差(standard dev iation of blood glucose,SDBG)、血糖波动频数(number of effective glucose excursions,NEGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,L AGE)以及平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)的差异;观察两组患者神经功能缺损评分的差异,分析血糖水平及血糖漂移与神经功能缺损的相关性。结果:DMCI组患者神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)明显高于N D M CI组,差异具有统计学意义(P0.0 5);D M CI组患者M B G、SD B G、N EG E、L AG E和M AG E水平均明显高于NDMCI组,差异具有统计学意义(P0.05);NIHSS评分与MBG、SDBG、NEGE、L AGE和MAGE水平均明显正相关(r=0.356、0.412、0.389、0.435和0.397,P0.05)。结论:血糖及血糖漂移的高水平可加重T2DM合并ACI患者的神经功能缺损程度。     

非酒精性脂肪性肝病合并2型糖尿病患者血糖动态波动水平及其对预后的影响

目的探究非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血糖动态波动水平及其对预后的影响。方法回顾性分析2016年2月至2017年10月上海交通大学医学院附属第九人民医院就诊的NAFLD合并T2DM患者(NAFLD+T2DM组)和NAFLD患者(NAFLD组)各42例临床资料,并将同期体检的42名健康者纳入对照组。比较三组一般资料[体重质量指数(BMI)、空腹血糖(FBG)、空腹胰岛素(Fins)、糖化血红蛋白(Hb A1c)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]、血糖波动情况[平均血糖水平、平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)]差异;根据NAFLD+T2DM组就诊6个月后肝纤维化程度[非酒精性脂肪性肝病肝纤维化评分(NAFLDFS)]分为预后较好组(NAFLDFS评分0. 676)及预后较差组(NAFLDFS评分≥0. 676),比较其就诊时血糖动态波动情况,并使用Pearson相关分析法分析血糖动态波动水平与预后的相关性。结果 NAFLD+T2DM组、NAFLD组及对照组性别、年龄比较,差异无统计学意义(P 0. 05);而其他一般资料(BMI、FBG、Fins、Hb A1c、AST、ALT)、血糖波动(平均血糖、MAGE、LAGE)水平比较,均为NAFLD+T2DM组 NAFLD组对照组(P 0. 05)。就诊6个月后,42例NAFLD+T2DM患者中NAFLDFS评分0. 676有29例,纳入预后较好组; NAFLDFS评分≥0. 676有13例,纳入预后较差组;预后较好组就诊时MAGE、LAGE水平均低于预后较差组(P 0. 05)。经Pearson相关分析显示,NAFLD+T2DM组预后情况与MAGE、LAGE呈负相关(P 0. 05)。结论 NAFLD合并T2DM患者血糖波动幅度较大,且血糖波动水平较高者,预后情况越差,临床应对血糖波动幅度较大者予以干预措施,以改善患者预后。     

不同危险因素的急性脑梗死患者血清超敏C反应蛋白、神经元特异性烯醇化酶含量的变化及其临床意义

目的探讨不同危险因素的急性脑梗死(ACI)患者血清超敏C反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)含量的变化及临床意义。方法选取20例健康对照者与68例急性脑梗死患者,根据危险因素将脑梗死患者分为单纯脑梗死组、脑梗死合并高血压病组、脑梗死合并糖尿病组。采用酶联免疫吸附实验测定血清中hs-CRP、NSE的浓度,比较不同危险因素脑梗死患者hs-CRP及NSE含量变化。采用美国国立卫生院卒中量表(NIHSS)评估神经缺损程度。结果 ACI患者入院血清hs-CRP、NSE浓度显著高于健康对照组(P 0. 01)。ACI患者中,脑梗死合并高血压组、脑梗死合并糖尿病组患者血清hs-CRP、NSE浓度显著高于单纯脑梗死患者(P 0. 05)。ACI患者血清hs-CRP、NSE浓度与NIHSS评分呈线性正相关。Pearson相关分析显示,ACI患者血清hs-CRP水平与NSE水平呈显著线性正相关(P 0. 05)。结论急性脑梗死患者合并高血压病、糖尿病会加重血管炎性反应及神经功能损害。     

老年2型糖尿病患者血糖变异性与糖尿病肾病的关系

目的:研究老年2型糖尿病患者血糖变异性与糖尿病肾病的关系.方法:对114例老年2型糖尿病患者按照24 h尿微量白蛋白量分为:单纯糖尿病组(DM组)36例,早期糖尿病肾病组(EDN组)44例,临床糖尿病肾病组(DN组)34例.检测收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血肌酐(sCr)、半胱氨酸蛋白酶抑制剂C(Cys C),并采用动态血糖监测系统(CGMS)计算日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、全天血糖值标准差(SDBG)、曲线下面积(AUC)和日间血糖平均绝对差(MODD)来评价血糖变异性.结果:DN组SBP、DBP、HbA1C、sCr和Cys C显著高于EDN组和DM组(P＜0.05).EDN组Cys C显著高于DM组(P＜0.05).DN组SDBG、MAGE、LAGE、AUC、MODD显著高于EDN组和DM组(P＜0.05),日内及日间血糖波动幅度显著增加,EDN组的CGMS各项指标均显著高于DM组(P＜0.05).结论:老年2型糖尿病患者血糖变异性与DN的发生、发展及严重程度有着密切关系.     

2型糖尿病患者血糖波动与糖尿病视网膜病变的相关性研究

[目的]探讨2型糖尿病(T2DM)患者血糖波动与糖尿病视网膜病变(DR)的相关性.[方法]T2DM患者进行眼底照相或眼底荧光造影,根据DR程度分为无视网膜病变(NDR)组、糖尿病背景型视网膜病变(BDR)组、糖尿病增殖型视网膜病变(PDR)组,记录性别、年龄、病程,测量血压、体重指数、糖化血红蛋白、空腹及餐后2h胰岛素、空腹及餐后2h C肽及血脂指标.选取三组中上述基线指标具可比性的病例共106例(NDR组33例,BDR组38例,PDR组35例)纳入观察.采用动态血糖监测系统(CGMS)连续监测患者血糖72 h.[结果]各组间平均血糖水平(MBG)、血糖标准差(SDBG)、平均血糖波动幅度(MAGE)及血糖波动最大幅度(LAGE)相比较有统计学差异(P＜0.05).Spearman相关分析显示,DR与MBG、SDBG、MAGE及LAGE呈正相关(P＜0.05).校正MBG后,DR与SDBG、MAGE及LAGE的相关系数分别为0.297、0.396、0.284(P ＜0.01).[结论]血糖波动与DR的发生发展有关,应尽早干预.     

氯吡格雷联合阿司匹林治疗2型糖尿病并发急性脑梗死患者的临床疗效

【目的】探讨氯吡格雷联合阿司匹林治疗2型糖尿病(T2DM)并发急性脑梗死患者的临床疗效。【方法】回顾性2016年8月至2018年10月在本院诊治的82例T2DM并发急性脑梗死患者,按照治疗方法不同分为观察组和对照组。对照组采用常规阿司匹林治疗,观察组在对照组的基础上加用氣吡格雷治疗,分析两组患者临床疗效。【结果】两组患者治疗前空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、血管紧张素-Ⅱ(Ang-Ⅱ)、平均血小板体积(MPV)、大血小板比例(P-LCR)水平、颈动脉内膜-中层厚度(IMT)、斑块数量、斑块面积比较差异无统计学意义(P>0.05);治疗后,观察组患者FPG、2hPG、HbAlc、MMP-9、Ang-n、MPV、P-LCR水平、颈动脉IMT、斑块数量、斑块面积显著低于对照组,VEGF水平显著高于对照组(P<0.05)。两组患者治疗前美国国立卫生院神经功能缺损(NIHSS)评分比较差异无统计学意义(P>0.05);治疗后6 d、12 d,观察组患者NIHSS评分显著低于对照组(P<0.05)。【结论】氣吡格雷联合阿司匹林治疗T2DM并发急性脑梗死,可有效改善患者血糖和神经功能,值得临床推广应用。     

血清同型半胱氨酸、血糖三项水平与H型高血压患者发生急性脑梗死的关联性研究

目的探讨血清同型半胱氨酸(Hcy)、空腹血糖(FPG)、2 h口服葡萄糖耐量试验(2 h OGTT)、糖化血红蛋白(Hb A1c)水平与H型高血压患者发生急性脑梗死(ACI)的关联性。方法 120例H型高血压患者,其中34例发生ACI(ACI组),其余86例为对照组。测定血清Hcy、FBG、2 h OGTT、Hb A1c水平,分析与ACI发生的关联性及与ACI患者梗死灶大小、TOAST分型、美国国立卫生研究院卒中量表(NIHSS)评分的关系。结果 ACI组合并T2DM占比、收缩压(SBP)、舒张压(DBP)及血清Hcy、FBG、2 h OGTT、Hb A1c水平高于对照组(P0.05)。合并T2DM、SBP、DBP、血清Hcy、FBG、2 h OGTT、Hb A1c均为H型高血压患者发生ACI的独立危险因素(P0.05)。血清Hcy、FBG、2 h OGTT、Hb A1c水平比较,梗死灶直径4cm患者高于≤4 cm患者,大动脉粥样硬化(LAA)型患者高于小动脉闭塞(SAO)型患者,NIHSS评分1～4分患者低于5～15分及16～42分患者(P0.05)。结论血清Hcy、血糖三项水平升高均为H型高血压患者发生ACI的独立危险因素,ACI以LAA型为主,且Hcy、血糖三项水平与患者梗死灶大小、TOAST分型、神经功能缺损程度有关。     

血糖波动与老年2型糖尿病周围神经病变的相关性研究

目的探讨血糖波动与老年2型糖尿病周围神经病变的关系。方法应用动态血糖监测系统(CGMS)对24例老年2型糖尿病周围神经病变和28例单纯老年2型糖尿病患者进行连续3 d的血糖监测,比较CGMS监测中平均血糖(MBG)及其标准差(s)、日内最大血糖波动幅度(LAGE)、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD),并测HbA1c、血糖、血脂、血压等。结果 DPN组SD、MAGE、MODD均显著高于DM组(t=-4.31、-9.85、-10.45,均P<0.01),其中MAGE与s显著相关(r=0.82,P<0.01),与HbA1c、MBG均不相关(P>0.05)。结论血糖波动是老年2型糖尿病周围神经病变的危险因素,血糖控制同时应避免血糖波动。     

阻塞性睡眠呼吸暂停综合征对2型糖尿病患者夜间血糖漂移的影响

目的 观察阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)对2型糖尿病患者血糖水平及夜间血糖漂移的影响。 方法 选择2型糖尿病(Type 2 diabetes mellitus,T2DM)伴OSAHS患者31例及单纯T2DM患者18例,所有患者应用动态血糖监测系统(CGMS)连续进行动态血糖监测3 d,比较2组患者夜间血糖、空腹血糖、24 h血糖、夜间MAGE(Mean amplitude of plasma glucose excursion)、白天MAGE、24 h MAGE以及糖化血红蛋白(hemoglycoglobulin, GhBA1c)。 结果 单纯T2DM组及T2DM伴OSAHS组性别、年龄、病程差异无统计学意义,而体重指数、腰围、颈围差异有统计学意义(P0.05),体重指数、腰围、颈围校正后,T2DM伴OSAHS组患者夜间MAGE、24 h MAGE显著高于单纯T2DM组(P0.01),两组患者夜间血糖、空腹血糖、24 h血糖、白天MAGE及GhBA1c差异也有统计学意义(P0.05)。 结论 OSAHS引起T2DM夜间血糖、夜间MAGE增高,从而影响全天血糖及全天MAGE。     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001