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981.
The renin angiotensin system as a therapeutic target to prevent diabetes and its complications 总被引:4,自引:0,他引:4
The role of the RAAS in development and maintenance of blood pressure is well established.In addition, the deleterious effects of angiotensin II on the heart, vasculature, and kidneys have been clearly defined. There seems to be a close relationship between endothelial dysfunction, insulin resistance (a precursor to diabetes and coronary artery disease) and angiotensin II. The signaling pathways for insulin in the vascular wall interacts with the angiotensin signaling, giving rise to potential mechanisms for development of diabetes and resulting harmful effects. A large number of clinical trials using ACE inhibitors or ARBs have shown significant reduction in secondary endpoints in the development of new onset of diabetes. Ongoing prospective studies involving ARBs (eg, the Nateglinide and Valsartan Impaired Glucose Tolerance Outcomes Research trial) and ACE inhibitors (eg, the Diabetes Re-duction Assessment with Ramipril and Rosiglita-zone Medication trial) are testing the ability of certain agents to prevent type 2 diabetes. In the meantime, it is important to recognize insulin resistance and metabolic syndrome as entities that increase the risk for cardiovascular disease. In addition to lifestyle modifications, managing endothelial dysfunction and protecting the vasculature will help prevent diabetes and cardiovascular disease. 相似文献
982.
OBJECTIVES: To describe a new 3-dimensional technique for medial canthal repositioning, precaruncular medial canthopexy (PMC), and to present an outcome study demonstrating its efficacy. METHODS: Data (age, sex, cause, and initial symptoms) were collected prospectively on patients with malposition of the lower eyelid. All patients were photographed before and after surgery in a set protocol. The type and severity of eyelid malposition were documented using the Ectropion Grading Scale (EGS) before and after each procedure. Surgical outcome was evaluated by objective improvement of ectropion grading and subjective resolution of symptoms. RESULTS: Precaruncular medial canthopexy was performed on 30 eyelids of 27 consecutive patients (10 were revisions) for correction of medial eyelid laxity or malposition. Twenty-six patients had ectropion, and 1 had bilateral entropion. The most common cause of eyelid malposition was facial paralysis (n = 21). Ancillary procedures, most commonly lateral transorbital canthopexy (for correction of lateral ectropion), were performed on 60% of the eyelids at the time of PMC. Twenty-eight procedures resulted in complete restoration of the medial canthus to a normal position (EGS grade I). Two patients had minimal residual medial scleral show after surgery (EGS grade II) but experienced symptom relief. There were no wound infections or perioperative complications. CONCLUSIONS: Precaruncular medial canthopexy rapidly and safely restores support in all 3 dimensions without blocking the visual field or damaging the lacrimal system, with minimal morbidity and excellent wound healing. In addition to being a primary technique for correcting medial eyelid malposition, PMC should be routinely considered as an adjunct procedure when correcting lateral eyelid malposition. 相似文献
983.
This investigation used a multivariate survival model, which allowed for dependent caries data with possible censoring, to analyse the impact of timing of tooth emergence, gender and several reported oral hygiene and dietary habits on the incidence of cavity formation in permanent first molars (PFM) in young children. A 6-yr prospective oral health screening project in Flanders, Belgium, provided clinical and questionnaire data on 4,468 children. The results revealed that PFM in children who reported frequent brushing, who had no visible caries experience in the primary dentition, and who presented without occlusal plaque on the PFM had the best survival estimates. Girls had a higher incidence than boys of cavity formation in mandibular molars. The multiple survival analysis confirmed the major impact of the caries status of the deciduous dentition and self-reported oral hygiene habits on the incidence of cavities in permanent first molars. 相似文献
984.
985.
We report a case of the development of Zoon's balanitis in an African-American man with human immunodeficiency virus. Photographs of the clinical and pathological lesion are presented. To our knowledge, this has not been recently reported in urologic studies. The clinicopathologic correlation is discussed. 相似文献
986.
OBJECTIVE: Reduce false-positive results and loss to follow-up through systematic modifications in Universal Newborn Hearing Screening at a large public hospital. STUDY DESIGN: During a pilot program, neonates who failed technician-performed automated auditory brain stem response were scheduled for diagnostic evaluation. In year 1, audiologists rescreened neonates who failed, and those who did not pass were screened as outpatients. For years 2 through 4, neonates who failed were rescreened by technicians before inpatient audiology rescreening. RESULTS: For the pilot, 3759 neonates were screened; 1% (n = 43) failed and 44% (n = 19) were lost to follow-up. In year 1, 15,297 neonates were screened and 2% (n = 365) failed; audiology rescreening reduced this to <1% (n = 129). Outpatient rescreening yielded 0.5% (n = 70) who failed; 17% (n = 12) were lost to follow-up. In year 2, 16,384 neonates were screened, 3% (n = 456) failed, and 1% (n = 167) failed after technician rescreen; audiology rescreening reduced inpatient fails to 0.6% (n = 108), and 0.4% (n = 61) failed outpatient rescreening; 11% (n = 7) were lost to follow-up. Results for years 3 and 4 were similar to year 2, with further reduction in loss to follow-up to 11% (n = 6) and 1.7% (n = 1). CONCLUSIONS: Successful Universal Newborn Hearing Screening with reduced false-positive results and loss to follow-up can be accomplished with a planned schedule of inpatient rescreens and outpatient rescreening at the birthing facility. 相似文献
987.
Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? 总被引:6,自引:0,他引:6
Salvatore S Hauser B Vandemaele K Novario R Vandenplas Y 《Journal of pediatric gastroenterology and nutrition》2005,40(2):210-215
Symptoms of gastroesophageal reflux disease (GERD) are common in infants. It is often difficult to discriminate between physiological and pathologic gastroesophageal reflux, although this discrimination is essential to determine which infants to evaluate and treat. OBJECTIVES: To identify the prevalence of reflux symptoms in infants and to evaluate the predictive value of a questionnaire and the correlation between pH study, histology and clinical score. METHODS: Parents of 100 unselected infants visiting the well-baby clinic and 100 infants suspected of having gastroesophageal reflux disease were asked to fill in a 35-item questionnaire. A validated score, the Orenstein I-GERQ, was applied for selected questions. All infants suspected of having gastroesophageal reflux disease underwent prolonged esophageal pH monitoring and 44 or 100 underwent upper gastrointestinal tract endoscopy with esophageal biopsy. RESULTS: Parents of infants with suspected gastroesophageal reflux disease reported significantly more regurgitation (68% versus 45%, P < 0.05) and crying (51% versus 20%, P < 0.01) compared with the parents of healthy infants. A pathologic pH study (reflux index > 10%) was found in 21 of 100 (21%) infants and was significantly associated only with pneumonia, apnea with fussing (P = 0.013 for both), defecation less than once a day (P = 0.033) and constipation (P = 0.05). Esophagitis was present in 17 of 44 (39%) and no one question was found to be significantly predictive. 38% of infants with a pathologic pH study had a normal esophageal biopsy and 53% of infants with histologic esophagitis had a normal pH study. Discordance between pH study and biopsies occurred in 14 of 44 (32%) patients. The Orenstein I-GERQ cut-off score failed to identify eight of 31 (26%) infants with gastroesophageal reflux disease. Conversely, the score was positive in 17 of 22 (81%) infants with normal biopsy and pH study and in 14 of 47 (30%) infants with normal pH study. CONCLUSIONS: Clinical symptoms, histology and pH study show poor correlation in infants. Clinical symptoms such as regurgitation and crying are less frequent in unselected infants than in infants suspected of gastroesophageal reflux disease. However, questionnaires are poorly predictive for the severity of gastroesophageal reflux disease, as they do not correlate with esophageal acid exposure as measured by pH-metry and with esophagitis as evaluated by histology of esophageal biopsies. 相似文献
988.
Evans IV Belle SH Wei Y Penovich C Ruppert K Detre KM;National Institute of Diabetes Digestive Kidney Diseases Liver Transplantation Database Team 《Pediatric transplantation》2005,9(4):480-485
Improving a patient's quality-of-life (QOL) post-liver transplantation is of great importance. An aspect of improved QOL is the restoration of normal growth patterns in pediatric patients. To describe the post-transplantation growth patterns of 72 children included in the National Institute of Diabetes and Digestive and Kidney Diseases - Liver Transplantation Database (NIDDK-LTD), multilevel models were used, according to which children who waited more than a year for transplantation were smaller, compared with age and sex matched peers, at transplantation than children who waited less than a year while children who were growth retarded at transplantation experienced a larger yearly comparison height increase than children who were not growth retarded. The analysis also showed that boys older than 2 yr and younger than 13 yr at transplantation and girls older than 2 yr and younger than 11 yr at transplantation were significantly less growth retarded at transplantation than boys and girls under the age of 2 yr at transplantation. 相似文献
989.
Jimenez X Lu D Brennan L Persaud K Liu M Miao H Witte L Zhu Z 《Molecular cancer therapeutics》2005,4(3):427-434
Vascular endothelial growth factors (VEGF) and their receptors (VEGFR) have been implicated to play important roles in tumor-associated angiogenesis and lymphangiogenesis, and hence in tumor growth and metastasis. We previously produced a number of fully human antibodies directed against VEGF receptor 2 (VEGFR2) and VEGF receptor 3 (VEGFR3) and showed that these antibodies are capable of inhibiting growth factor (VEGF and VEGF-C)-induced receptor activation, migration, and proliferation of human endothelial cells. In this report, we constructed and produced a bispecific antibody, a diabody, using the variable domain genes of two neutralizing antibodies, IMC-1121 to VEGFR2 and hF4-3C5 to VEGFR3. The diabody binds to both VEGFR2 and VEGFR3 in a dose-dependent manner, and blocks interaction between VEGF/VEGFR2, VEGF-C/VEGFR2, and VEGF-C/VEGFR3. In cell-based assays, the diabody neutralized both VEGF and VEGF-C-stimulated activation of VEGFR2, VEGFR3, and p44/p42 mitogen-activated protein kinase in endothelial cells. Furthermore, the diabody was able to inhibit both VEGF and VEGF-C-induced migration of endothelial cells. Taken together, our results suggest that a dual blockade of both VEGFR2 and VEGFR3 simultaneously may represent a more potent approach to effective cancer therapy. 相似文献
990.