Preventing microalbuminuria in patients with type 2 diabetes

The public health burden of type 2 diabetes mellitus has been dramatically increasing world-wide. The chronic complications of type 2 diabetes play an important role in decreasing life expectancy and adversely affecting quality of life. Diabetic nephropathy, which is originally microvascular in nature, is widely considered an important complication of diabetes. In prospective clinical investigations, increased urinary albumin excretion proved to be associated not only with subsequent renal outcomes but also with cardiovascular morbidity/mortality independently of other risk factors. Therefore, microalbuminuria as an early sign of increased urinary albumin excretion should be considered important for both treatment and even for prevention. Preventing microalbuminuria might diminish progression to overt nephropathy and, hopefully, might limit cardiovascular events. Regarding primary prevention of diabetic nephropathy, therapeutic intervention should optimally be initiated at the stage of normoalbuminuria. Although additional factors such as smoking cessation, reduction of protein intake, and treatment of lipid abnormalities are important, providing optimal diabetic control as well as targeting optimal blood pressure are the key elements of a prevention strategy in diabetic patients. Recently, the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) documented that a significant decrease of the development of persistent microalbuminuria could be achieved by using an ACE-inhibitor, trandolapril alone or in combination with verapamil SR, a non-dihydropyridine calcium-channel blocker in hypertensive type 2 diabetic patients with normoalbuminuria. The results of this primary-prevention strategy should be corroborated by further investigations to determine whether these beneficial changes could later result in improvement of renal clinical outcomes, macrovascular complications, or both.     

女性原位尿流改道控尿机制的基础研究及临床应用

目的探讨女性控尿解剖形态机制,并与女性原位尿流改道临床应用相结合,以进一步指导女性原位尿流改道的研究和临床推广工作。方法（1）对20具成人女性尸体进行盆丛及其分支,主要是尿道支、阴部神经及其尿道支的解剖。（2）解剖出完整的尿道及周围的肌肉等进行病理学HE染色、肌肉染色、结缔组织染色、银染等。（3）对20例正常控尿女性的下尿路、盆底的MRI矢状位、冠状位及横截位扫描,观察控尿有关的组织形态及其变化。（4）结合上述基础研究的结果,总结、分析40例女性原位尿流改道患者的控尿情况、并发症等临床问题。结果（1）盆丛分支有直肠丛、阴道丛、膀胱尿道丛,阴道丛分支到膀胱颈、尿道,在阴道、膀胱颈两侧走行,约在尿道的5、7点进入尿道;膀胱尿道丛量较少,紧帖盆侧壁几乎与尿道上缘平行走向尿道,距膀胱尿道连接部外约0．5—0．7cm,约在10～11、1～2点处进入尿道。阴部神经尿道支主要由其终末支发出,在耻骨联合下缘正对处的11、2点位置进入尿道。（2）病理结果表明,横纹肌主要位于尿道远端2／3,与盆底肌肉并不相连,主要包饶尿道,部分肌肉在远端还同时包饶阴道。对完整下尿路的大块组织切片HE染色、肌肉染色、结缔组织染色、银染等显示：神经分布在尿道的肌肉之间,横纹肌分布于尿道中外2／3的尿道,内中1／3交界处与平滑肌混杂存在,在外1／3有横纹肌包饶阴道。（3）MRI可清楚显示与控尿有关的盆底肌肉;正常控尿女性膀胱颈子宫口位于齿尾线以上。（4）上述基础研究与40例临床应用相结合表明,女性控尿主要由横纹括约肌完成,此肌肉主要由阴部神经支配,术中注意该肌肉的保护,女性同样可以获得理想的控尿效果。结论女性控尿的主要因素是受阴部神经尿道支和盆丛分支?     

泌尿系结石体外震波碎石术600例临床护理体会

目的探讨体外震波碎石术的护理方法。方法对600例泌尿系结石行体外震波碎石术治疗的患者,给予术前、术中、术后细致的心理护理及健康指导。结果全部患者无碎石恐惧感,顺利接受碎石治疗,并逐渐排出结石。结论对泌尿系结石体外震波碎石术患者进行细致的护理及健康指导,可使患者积极主动配合治疗及调整饮食结构,促进排石及预防再次发生结石。     

脉压及夜间血压下降异常与2型糖尿病肾病的关系研究

目的评估脉压（pulse pressure,PP）及夜间血压下降异常（Impaired nocturnal BP decline）对2型糖尿病肾病的影响。方法对该院2004年1月-2008年12月收治的154例2型糖尿病患者作回顾性分析,根据尿白蛋白/血肌酐比值大小将糖尿病患者分为无肾病组37例（A组）和肾病组117例（B组）,其中肾病组（B组）又分为早期肾病65例（B1组）和临床肾病52例（B2组）两个亚组,通过24h动态血压监测（ambulatory blood pressure monitoring,ABPM）,收集相关数据进行分析。结果性别、年龄、糖尿病病程、BMI、HbA1C与2型糖尿病肾病的相关性不显著（P〉0.05）,而脉压及夜间血压下降异常与2型糖尿病肾病的进展呈显著相关（95%CI,1.248～3.262;1.468～3.682）。结论脉压及夜间血压下降异常是2型糖尿病患者肾病强有力的预测因素,临床上应及早进行干预,降低收缩压的同时防止舒张压过度降低,平稳降压,减小血压波动,对降低肾损害可起到积极作用。     

浅表性膀胱癌术后复发和进展影响因素分析

目的探讨影响浅表性膀胱移行细胞癌术后复发和进展的主要因素。方法初次收治浅表性膀胱移行细胞癌患者共150例,获得随访120例,对可能影响肿瘤复发和进展的因素（如病理特点、治疗方案等）进行Cox回归分析。结果平均随访84．7个月。3、5年的复发率分别为27．5％和36．7％,影响复发的主要因素是肿瘤病理分级、TNM分期、肿瘤数量、肿瘤复发情况,而肿瘤病理分级、TNM分期和肿瘤复发情况是肿瘤复发的独立危险因素。3、5年的进展率分别为9．2％和17．5％,影响进展的主要因素是肿瘤病理分级、TNM分期、肿瘤数量、肿瘤复发情况,而肿瘤病理分级是肿瘤进展的独立危险因素。结论肿瘤病理分级、TNM分期、肿瘤数量、肿瘤复发情况均是影响浅表性膀胱移行细胞癌术后复发和进展的独立危险因素。     

尿激酶治疗急性脑梗死临床观察

目的：评价尿激酶（UK）治疗急性脑梗死（ACI）的临床疗效。方法：68例ACI患者随机分成治疗组和对照组。治疗组用UK15万U静脉推注,续以UK135万U60min内静脉滴注,对照组采用通常的治疗方案,评价治疗前和治疗后神经功能缺损评分。结果：治疗后神经功能缺损评分改善显著（P〈0.01）。结论：早期ACI采用UK治疗比常规治疗起效快、作用强、疗效好,并且安全、可靠。     

Comparison of D-Xylose Hydrogen Breath Test With Urinary D-Xylose Test in Indian Children With Celiac Disease

D-xylose hydrogen breath test (H₂BT) may be better parameter in screening for intestinal malabsorption in patients with celiac disease. This study sought to compare D-xylose H₂BT with urinary D-xylose tests in screening for intestinal malabsorption in patients with celiac disease. A total of 68 children with confirmed celiac disease were enrolled for this study. Five-gram urine D-xylose test and D-xylose H₂BT were performed simultaneously according to standard methods. Institute ethical clearance and informed consent was taken before starting this study. Of 68 children, 41 were boys and 27 girls of age range 5–14 years; 5-g urine D-xylose test was abnormal in 50% of cases and 5-g D-xylose H₂BT in 69.9% of cases. D-xylose H₂BT was able to pick up 19.9% more cases of malabsorption in Indian children with celiac disease. This study indicates that performance of 5-g D-xylose H₂BT is a better test than 5-g urinary D-xylose test in screening for intestinal malabsorption in patients with celiac disease.     

Morbid Obesity Adversely Impacts Pelvic Floor Function in Females Seeking Attention for Weight Loss Surgery

Purpose This study was designed to determine the impact of excess body mass on the prevalence of pelvic floor disorders in morbidly obese females. Methods A total of 358 morbidly obese females (body mass index (BMI) ≥ 35 kg/m²) completed two validated, condition-specific, quality of life questionnaires of pelvic floor dysfunction, which assessed stress/impact in three main domains of pelvic floor disorders: pelvic organ prolapse, colorectal-anal, and urogenital incontinence. Prevalence and severity scores in the study population were compared with data from 37 age-matched nonobese controls (BMI ≤ 35 kg/m²). Results Mean age was 43 ± 11 years vs. 42 ± 12 years, and mean BMI was 50 ± 10 kg/m² vs. 26 ± 4 kg/m² (p = 0.02) in the study and control groups, respectively. Parity and past obstetric history were similar between the groups. Pelvic floor disorders were prevalent in 91 percent of the morbidly obese females compared with 22 percent in the control group (p < 0.001). Scores were statistically significantly higher in the study group for all studied stress/impact domains (p < 0.001 and p = 0.001, respectively). Further stratifications in the study group revealed a significant impact on pelvic floor disorders with increased age (p < 0.003 and p < 0.009 for stress/impact mean scores, respectively) and the presence of other comorbidities (p< 0.008, p < 0.03 for stress/impact prevalence, respectively). Additional increases in BMI > 35 kg/m² did not show increased adverse impacts on pelvic floor disorders symptoms. Conclusion More than 90 percent of morbidly obese females experience some degree of pelvic floor disorders, and 50 percent of these females report that symptoms adversely impact quality of life. In morbidly obese females, obesity is as important as obstetric history in predicting pelvic floor dysfunction. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.     

Effect of telmisartan-amlodipine combination at different doses on urinary albumin excretion in hypertensive diabetic patients with microalbuminuria

BACKGROUND: Aim of this study was to evaluate the effect of the telmisartan-amlodipine combination at different doses on urinary albumin excretion rate (UAER) in hypertensive diabetic patients with microalbuminuria. METHODS: After a 2-week placebo period, 300 hypertensive patients with type 2 diabetes and microalbuminuria were treated with the 40 mg of telmisartan and 2.5 mg of amlodipine combination. After 4 weeks 210 patients whose blood pressure (BP) was not controlled (BP >130/80 mm Hg) were randomized to two-dose titration regimens, one based on increasing doses of telmisartan (up to 160 mg daily) and fixed 2.5-mg dose of amlodipine, the other based on increasing doses of amlodipine (up to 10 mg daily) and fixed 40-mg dose of telmisartan. After 12 weeks the nonresponder patients were given transdermic clonidine (0.1mg/d). After 16 weeks the patients yet not controlled were discontinued, the others were followed for 48 weeks. Office BP, UAER, creatinine clearance, plasma potassium, fasting glycemia, and glycosylated hemoglobin were assessed at the end of the telmisartan (40 mg)/amlodipine (2.5 mg) treatment period and after 48 weeks of treatment. RESULTS: Similar decrease in systolic/diastolic BP values were obtained with both regimens (-24/-21, -23/-21, and -24/-21 mm Hg, all P < .001 v baseline, with increasing telmisartan; -25/-22, -25/-21, and -25/-22 mm Hg, all P < .001 v baseline with increasing amlodipine). Reductions of UAER were 47.5% (P < .01), 65.3% (P < .001), and 77% (P < .0001) for telmisartan 80, 120, and 160 mg/amlodipine 2.5 mg daily, respectively, whereas reductions of UAER were 34% (P < .03), 37% (P < .03), and 33% (P < .03) for amlodipine 5, 7.5, and 10 mg/telmisartan 40 mg daily, respectively, The difference between the two regimens was statistically significant (P < .05, P < .01, and P < .001, respectively). CONCLUSIONS: These findings indicate that, at comparable levels of BP reduction, UAE decreased more in subjects treated with escalating doses of telmisartan.     

Mild hyperuricemia and subclinical renal damage in untreated primary hypertension

BACKGROUND: Subclinical renal damage and hyperuricemia are not uncommon in patients with primary hypertension. Whether mild hyperuricemia reflects a subclinical impairment of renal function or contributes to its development is currently debated. We investigated the relationship between serum uric-acid levels and the occurrence of early signs of kidney damage. METHODS: Four hundred eighteen patients with primary hypertension were studied. Albuminuria was measured as the albumin-to-creatinine ratio, and creatinine clearance was estimated by the formula of Cockcroft and Gault. Interlobar resistive index and renal abnormalities, ie, the renal volume-to-resistive index ratio, were evaluated by renal Doppler and ultrasound. RESULTS: Uric acid was directly related to resistive index (P = .007) in women and to albuminuria (P = .04) in men, and was inversely related to the renal volume-to-resistive index ratio in both men (P = .005) and women (P = .02). Patients with uric-acid levels above the median showed a higher prevalence of microalbuminuria (14% v 7%, P = .012) and of renal abnormalities (41% v 33%, P = .007). Moreover, when creatinine clearance was taken as a covariate, patients with increased uric-acid levels showed higher albuminuria and resistive indices, and a lower renal volume-to-resistive index ratio. Even after adjustment for several risk factors, each standard deviation increase in serum uric acid entailed a 69% higher risk of microalbuminuria, and a 39% greater risk of ultrasound detectable renal abnormalities. CONCLUSIONS: Mild hyperuricemia is associated with early signs of renal damage, ie, microalbuminuria and ultrasound-detectable abnormalities, regardless of the glomerular filtration rate in primary hypertension.