Hypertension and erectile dysfunction: The role of endovascular therapy in Asia

The prevalence of erectile dysfunction (ED) is above 40% in both Asian and non‐Asian male populations after the age of 40 years. The prevalence of ED among hypertensive patients is approximately double than that in normotensive population. Pelvic arterial insufficiency is the predominant cause of ED in men aged over 50 years. Stenosis in any segment of the iliac–pudendal–penile arterial system, which is considered an erectile‐related arterial axis, could lead to ED. Pharmacotherapy with lifestyle modification is effective in alleviating sexual dysfunction, yet a substantial number of patients still develop ED. Given the established applicability of angioplasty for the entire iliac–pudendal–penile arterial system, penile duplex ultrasound, and pelvic computed tomography angiography could be considered as the routine screening tools in ED patients with poor response to phosphodiesterase‐5 inhibitors. Endovascular therapy for pelvic arterial insufficiency‐related ED has been shown to be a safe and effective treatment option in patients who have anatomically suitable vessels and functionally significant stenoses. Clinical improvement was achieved in over 60% of patients at one year following pelvic angioplasty in the PERFECT registry from Taiwan. A 30%‐40% restenosis rate in distal internal pudendal and penile arteries remains a hurdle. Angioplasty for pelvic arterial occlusive disease could be considered as a viable approach to arteriogenic ED.     

综合护理在老年冠心病合并糖尿病住院患者中的应用效果探讨

目的探究在老年冠心病合并糖尿病住院患者中综合护理干预方法进行应用的临床效果。方法共选取2018年1月—2019年1月期间该院收治患者88例,将其随机分为实验组和对照组,每组44例,分别为给予常规护理的对照组和给予综合护理的实验组,对两组患者的干预效果进行分析比较。结果在给予护理干预后,实验组患者的入睡潜伏期、实际睡眠时间、睡眠效率与对照组患者进行比较时,实验组的改善效果更为显著,差异有统计学意义(P<0.05)。在给予护理干预后,实验组患者的空腹血糖浓度低于对照组,差异有统计学意义(P<0.05)。结论在老年冠心病合并糖尿病患者给予综合康复护理干预,其临床效果显著,可将患者血糖降低,可改善患者的睡眠时间,舒缓患者不良情绪,对临床发展具有积极意义。     

二甲双胍联合沙格列汀或格列美脲对初诊T2MD患者血糖波动影响的临床比较

目的探讨对初诊T2MD患者行二甲双胍+沙格列汀或者格列美脲联合治疗对于血糖波动情况的临床效果。方法抽取2018年5月—2019年5月该院接受治疗的初诊T2MD患者,共72例。将所有患者按照数字随机表的方法分为对照组和实验组,各为36例。对照组行二甲双胍+格列美脲联合治疗,实验组行二甲双胍+沙格列汀联合治疗,观察并对比两组患者接受治疗前后的血糖水平以及血糖波动情况。结果两组治疗前的血糖水平差异无统计学意义(P>0.05),实验组患者接受治疗后的空腹血糖、餐后2 h血糖以及糖化血红蛋白水平均低于对照组,差异有统计学意义(P<0.05)。实验组患者24 h平均血糖、血糖达标时间以及平均血糖波动幅度等指标均优于对照组,差异有统计学意义(P<0.05)。结论对初诊T2MD患者行二甲双胍+沙格列汀联合治疗的效果更加显著,血糖波动相对较小,患者的血糖控制状况良好。     

2型糖尿病老年患者降糖药物使用合理性分析

目的探讨2型糖尿病老年患者降糖药物临床使用的合理性。方法选取2019年3月—2020年3月期间的640例2型糖尿病老年患者作为研究对象。回顾性分析患者的临床资料,统计所有患者的降糖药物使用情况、用药频度、用药合理性、安全性。结果2型糖尿病老年患者的常用降糖药物,根据用药频度,分别为阿卡波糖、二甲双胍、瑞格列奈、格列美脲、格列齐特、格列吡嗪。640份处方中,合理598份,合理率93.44%;不合理42份,不合理率6.56%;不合理处方中,药物用法不合理23份3.59%,书写不规范10份1.56%、用药剂量不合理5份0.78%、药物数量不合理3份0.47%、药物联用不合理1份0.16%。640例2型糖尿病老年患者中,不良反应包括胃肠道反应85例13.28%、低血糖55例8.59%,便秘50例7.81%,头晕乏力23例3.59%,贫血3例0.47%,乳酸性酸中毒1例0.16%。结论2型糖尿病老年患者降糖药物的临床用药合理性较好,但存在药物用法不合理、处方书写不规范、用药剂量不合理等问题,需针对性地预防,提高临床用药合理性、安全性。     

SIRT1基因启动子DNA甲基化在老年钙化性心脏瓣膜病中的临床意义研究

[摘 要] 目的 探讨沉默信息调节因子1（SIRT1）基因启动子区域DNA甲基化修饰变化与老年钙化性心脏瓣膜病的相关性。方法 选取我院 2020年2月 ~ 2021年1月就诊的老年钙化性心脏瓣膜病患者60例,另纳入同期体检的健康老年40例作为对照。甲基化特异性PCR检测SIRT1基因启动子区域甲基化率,荧光定量PCR检测SIRT1 mRNA表达,ELISA检测SIRT1蛋白和NF-κB蛋白表达。结果 观察组SIRT1基因启动子区域甲基化率为63.3%（38/60）,显著高于对照组的37.5%（15/40）（P<0.01）。甲基化组SIRT1 mRNA的2-△△Ct值为0.22±0.05,显著低于非甲基化组的0.36±0.07（P<0.01）,甲基化组SIRT1 蛋白表达水平为82.34±11.56 μmol/L,显著低于非甲基化组的143.24±18.73 μmol/L（P<0.01）,甲基化组NF-κB蛋白表达水平为126.48±17.32 μmol/L,显著高于非甲基化组的41.53±7.26 μmol/L（P<0.01）。老年钙化性心脏瓣膜病SIRT1 mRNA与NF-κB蛋白表达呈显著负相关（P<0.05）,SIRT1蛋白表达与NF-κB蛋白表达呈显著负相关（P<0.05）。结论 老年钙化性心脏瓣膜病患者SIRT1基因启动子区域高甲基化变化,导致SIRT1表达减低,激活炎症反应,可能参与其致病过程。     

Responsiveness and Predictive Validity of the Participation Measure–3 Domains, 4 Dimensions in Survivors of Stroke

ObjectivesTo examine the responsiveness and predictive validity of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke.DesignProspective cohort observational study.SettingOutpatient rehabilitation settings.ParticipantsVolunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male).InterventionsNot applicable.Main Outcome MeasuresThe PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation.ResultsSignificant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57～0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation.ConclusionsThis study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.     

Nutritional Aspect of Cancer Care in Medical Oncology Patients

PurposeAwareness of advances in the nutritional aspects of cancer care and translation of this information into clinical practice are important for oncology practitioners to effectively couple oncologic and nutritional approaches throughout the cancer journey. The goal of this consensus statement by a panel of medical oncologists was to provide practical and implementable guidance addressing nutritional aspects of cancer care from the perspective of the medical oncologist.MethodsA panel of medical oncologists agreed on a series of statements supported by scientific evidence and expert clinical opinion.FindingsParticipating experts emphasized that both poor nutritional intake and metabolic alterations underlie cancer-related malnutrition. The use of liquid and high energy-dense oral nutritional supplements may enable better patient compliance, whereas higher efficacy is more likely with the use of pharmaconutrient-enriched oral nutritional supplements in terms of improved weight, lean body mass, functional status, and quality of life, as well as better tolerance to antineoplastic treatment. A multimodal approach is currently believed to be the best option to counteract the catabolism leading to cancer-related malnutrition; this treatment is scheduled in parallel with anticancer therapies and includes nutritional interventions, multitarget drug therapies, and exercise and rehabilitation programs. Participating experts emphasized the role of the oncologist as a reference professional figure in the coordination of nutritional care for patients with cancer within the context of complex and different clinical scenarios, particularly for permissive-adjunctive nutritional support.ImplicationsThis review article provides practical guidance addressing major nutritional aspects of cancer care from the medical oncologist's perspective. Thus, this document is expected to assist oncology practitioners in terms of awareness of advances in the nutritional aspects of cancer care and translation of this information into their clinical practice to effectively couple oncologic and nutritional approaches as part of the continuum of care for patients with cancer.     

What Do Medical Students Do and Want When Caring for “Difficult Patients”?

Phenomenon: Medical students, like physicians, experience negative emotions such as frustration when interacting with some patients, and many of these interactions occur for the first time during clinical clerkships. Students receive preclinical training in the social and behavioral sciences, often including learning about “difficult patient” interactions, yet little is known about their desire for training during clinical education. We explored students’ strategies in these difficult clinical interactions, whether they felt prepared by the curriculum, and what support they would have liked. These data inform proposed strategies for supporting clinical learning. Approach: We interviewed 4th-year students about interactions with patients toward whom they felt negative emotions and sought to identify strategies and supports needed in these interactions. Interviews ended when theoretical sufficiency was achieved. We used qualitative content analysis to organize strategies into themes about areas benefiting from curricular supports. We mapped students’ desired curricular support examples to cognitive apprenticeship teaching methods—modeling, coaching, reflection, scaffolding, exploration, and articulation—and aligned them with traditional pedagogical techniques. Findings: We interviewed 26 medical students (44 volunteered/180 invited). Their strategies formed five themes: finding empathy (with a subtheme of focusing on social determinants of health), using learned communication approaches, anticipating challenging interactions, seeking support, and considering it an opportunity for more responsibility. Students described ideal clinical teaching, including postinteraction debriefs with an emphasis on validating their emotional reactions and challenges. Students mentioned all cognitive apprenticeship teaching methods, most prominently modeling (observing supervisors in such interactions) and supported oral reflection. They also identified a need for faculty and resident development to enact these teaching methods. Insights: Although students use some learned strategies in interactions in which they feel negative emotions toward patients, they desire more preparation and support during their clinical rotations. Their desires map to traditional pedagogical techniques and to methods of cognitive apprenticeship. Our findings point to the need to use these techniques to enhance clinical learning for students who experience emotionally challenging patient interactions.     

品管圈在提高慢性精神分裂症患者生活自理能力中的应用

目的 探讨品管圈（QCC）活动在提高慢性精神分裂症患者生活自理能力的应用效果。方法 2016年1月至9月期间,纳入37名生活自理能力欠缺的慢性精神分裂症患者,科室开展品管圈活动,根据戴明环的程序：主题选定、拟定计划、现状把握、目标设定、解析、对策拟定实施与检讨、效果确认、标准化以及检讨与改进十大步骤来进行。结果 实施品管圈后,日常生活能力量表（ADL）总分在圈活动后（18.57±1.61）较圈活动前（27.86±2.21）明显降低（t=20.67,p＜0.05）,住院患者观察量表（NOSIE）的病情总估计在圈活动后（210.16±14.48）较较圈活动前（184.1±36.35）明显提高（t=3.94,p＜0.05）,具有统计学意义。结论 品管圈可以充分分析慢性精神分裂症患者生活自理能力低下的原因,有针对性的制定确实有效的护理措施,从而有效提高患者的生活自理能力。