Diabetes distress,but not depressive symptoms,is associated with glycaemic control among Japanese patients with Type 2 diabetes: Diabetes Distress and Care Registry at Tenri (DDCRT 1)

Aims To investigate the association between glycaemic control, diabetes distress and depressive symptoms among Japanese patients with Type 2 diabetes. Methods Cross‐sectional data from 3305 patients with Type 2 diabetes were obtained from a baseline assessment of a diabetes registry at a general hospital in Japan. The Centre for Epidemiologic Studies Depression scale and Problem Areas in Diabetes scale were used to measure depressive symptoms and diabetes‐related distress, respectively. Modified Poisson regression analysis was used to estimate the relative risks for poor glycaemic control across the quartiles of Centre for Epidemiologic Studies Depression scale and Problem Areas in Diabetes scale scores. Results The average age of the participants was 64.9 years and the average HbA_1c level was 58.1 mmol/mol (7.5%). Clinically significant levels of depressive symptoms (Centre for Epidemiologic Studies Depression scale scores ≥ 16) were reported by 27.8% of participants. These scores significantly correlated with Problem Areas in Diabetes scale scores (r = 0.4354, P < 0.0001). Diabetes distress, but not depressive symptoms, was significantly associated with higher HbA_1c levels. The relative risks for poor glycaemic control (HbA_1c≥ 64 mmol/mol; 8.0%), when adjusted for age, sex, BMI, type of diabetes therapy and duration of diabetes, was 67% higher among patients with Problem Areas in Diabetes scale scores in the highest quartile (≥ 26.25) compared with those in the lowest quartile (0–3.75). Conclusion A significant association between glycaemic control and diabetes‐related distress, but not depressive symptoms, was observed in Japanese patients with Type 2 diabetes.     

纳洛酮对缺氧诱导大鼠神经元损伤的抑制作用及其机制

目的探讨纳洛酮对缺氧诱导大鼠神经元损伤的作用及其可能的机制。方法体外培养大鼠神经元，将其分为正常对照组、缺氧诱导组、缺氧诱导＋纳洛酮干预组。应用流式细胞术测定大鼠神经元损伤；应用荧光探针2，7-二氯二氢荧光素乙酰乙酸（DCFDA）检测细胞内活性氧的变化；应用比色法检测超氧化物歧化酶（SOD）的活性；应用Westernblot检测NF—KB的活化。结果（1）纳洛酮抑制缺氧诱导的大鼠神经元凋亡，缺氧组大鼠神经元细胞凋亡明显增加，为对照组的3．54倍，纳洛酮干预组为对照组的1．35倍（均P〈0．05）。（2）纳洛酮抑制缺氧诱导的活性氧生成，缺氧诱导大鼠神经元活性氧生成，为对照组的2．66倍，纳洛酮干预组为对照组的1．24倍（均P〈0．05）。（3）纳洛酮抑制缺氧诱导的NF—KB活化（P〈0．05）。（4）抗氧化剂NAC抑制缺氧诱导的NF—KB活化，抑制率达49％（P〈0．05）。结论纳洛酮抑制缺氧诱导的活性氧生成，进而抑制NF—KB活化，从而抑制缺氧诱导的大鼠神经元凋亡。     

Glycaemic management during the inpatient enteral feeding of people with stroke and diabetes

This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group . Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area.     

遗传代谢病所致贫血的诊疗专家共识

遗传代谢病是一大类复杂的单基因病,由于代谢通路异常导致物质代谢紊乱,可以引起单系统或多系统损害.血液系统疾病涉及红细胞、白细胞和血小板功能和数量的异常,其中贫血最常见,新生儿到老年均可发病.现有研究发现,多种遗传代谢病可导致贫血,致病机制不同,一些疾病引起铁、维生素B12、叶酸代谢异常,另一些造成红细胞膜、代谢相关酶或血红蛋白合成异常,引起不同类型不同程度的贫血.为了提高临床医生对遗传代谢病所致贫血及血液系统疾病的认识,早期诊断、精准治疗、改善预后,国内多学科专家共同讨论,结合国内外经验及指南,以巨幼细胞性贫血、溶血性贫血、铁粒幼细胞性贫血和小细胞低色素性贫血四类贫血相关的遗传代谢病的病因、发病机制、临床表现和治疗为重点,制定了本共识,以期指导优化临床诊治实践.     

Association of rs1568885, rs1813443 and rs4411591 polymorphisms with anti-TNF medication response in Greek patients with Crohn’s disease

AIM:To investigate the correlation between rs1568885,rs1813443 and rs4411591 polymorphisms and response to infliximab in a cohort of Greek patients with Crohn’s disease(CD).METHODS:One hundred and twenty-six patients diagnosed with CD based on standard clinical,endoscopic,radiological,and pathological criteria were enrolled in this study at the Gastroenterology Unit of the 2nd Department of Surgery and at the Colorectal Unit of the1st Department of Propaedeutic Surgery.Infliximab at a dose of 5 mg/kg was administered intravenously at weeks 0,2,6 and then every 8 wk.Clinical and serological responses were assessed using the HarveyBradshaw Index and serum C-reactive protein(CRP)levels,respectively,and the endoscopic response was evaluated by ileocolonoscopy performed at baseline and after 12-20 wk of therapy.The changes in endoscopic appearance compared to baseline were classified into four categories,and patients were classified as responders and non-responders.Genomic DNA from whole peripheral blood was extracted and genotyping was performed by allele-specific polymerase chain reactions.χ2test with Yate’s correction based on the S-Plus was used to compare the genotype frequencies.RESULTS:Eighty patients(63.49%)were classified as complete and 32(25.39%)as partial responders to infliximab,while 14(11.11%)were primary non-responders.No correlation was found between response to infliximab and patients’characteristics such as age,gender and disease duration.There was consistency between Harvey-Bradshaw index scores and serum CRP levels.The TT genotype of the rs1568885 polymorphism was significantly related to partial response(P=0.024)and resistance to infliximab(P=0.007)while the AT genotype was more frequent in partial responders(P=0.035)and in primary non-responders(P=0.032).Regarding rs1813443,the CC genotype was found to be associated with partial response(P=0.005)and primary resistance(P=0.002)to infliximab while no association was found between the rs4411591 polymorphism and the clinical response to infliximab.CONCLUSION:Based on our results,the rs1568885and rs1813443 polymorphisms are associated with clinical and biochemical response to infliximab in Greek patients with Crohn’s disease.     

Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome

Irritable bowel syndrome(IBS)is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role.The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors,interacting with peripheral/central neuroendocrine and immune changes,may induce symptoms of IBS,modulate symptom severity,influence illness experience and quality of life,and affect outcome.The present review focuses on the role of negative affects,including depression,anxiety,and anger,on pathogenesis and clinical expression of IBS.The potential role of the autonomic nervous system,stress-hormone system,and immune system in the pathophysiology of both negative affects and IBS are taken into account.Psychiatric comorbidity and subclinical variations in levels of depression,anxiety,and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS,such as sensorimotor functions,gut microbiota,inflammation/immunity,and symptom reporting.     

Bronchiolitis: Recommendations for diagnosis,monitoring and management of children one to 24 months of age

Bronchiolitis is the most common reason for admission to hospital in the first year of life. There is tremendous variation in the clinical management of this condition across Canada and around the world, including significant use of unnecessary tests and ineffective therapies. This statement pertains to generally healthy children ≤2 years of age with bronchiolitis. The diagnosis of bronchiolitis is based primarily on the history of illness and physical examination findings. Laboratory investigations are generally unhelpful. Bronchiolitis is a self-limiting disease, usually managed with supportive care at home. Groups at high risk for severe disease are described and guidelines for admission to hospital are presented. Evidence for the efficacy of various therapies is discussed and recommendations are made for management. Monitoring requirements and discharge readiness from hospital are also discussed.