Renal Replacement Therapy in Patients with Diabetic Nephropathy, 1980-1985: Report from the European Dialysis and Transplant Association Registry

Diabetic nephropathy, a rarely listed cause of end-stage renalfailure (ESRF) among patients starting renal replacement therapy(RRT) in the early seventies, has progressively gained in importanceand become one of the major reasons for the continuous growthof the patient population on RRT in most European countries.Amongst new patients commencing RRT in 1985, the acceptancerate varied between 3 and 12 per million population for typeI diabetes mellitus and between one and four per million populationfor type II diabetes mellitus. Nordic countries, particularlySweden and Finland, had the highest acceptance rate of youngpatients with type I diabetes mellitus whose median ages were38–42 years. In most central and southern European countriesthe median age of patients with type I diabetes mellitus variedbetween 50 and 58 years. The high number of young patients withtype I diabetes mellitus and ESRF in Nordic countries pointto a different natural history of this disease. It cannot beexcluded, however, that the higher median age in other countriesmight result from doctors mistakenly diagnosing type I diseasein patients with type II disease who need insulin treatment.Patients with type II diabetes mellitus had a similar age distributionat start of RRT throughout Europe and their median ages clusteredaround 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renaltransplantation was analysed for diabetic compared to non-diabeticESRF. Despite large geographical differences in the proportionaluse of methods of treatment, a general trend to apply CAPD morefrequently in diabetic as compared to non-diabetic patientswas observed, and this was true for countries with both predominanthaemodialysis and predominant transplant programmes. Transplantationwithout prior dialysis was performed in 17% of Swedish and 30%of Norwegian patients with type I diabetes mellitus. In order to better explain the high mortality of patients withdiabetic ESRF, the proportional distribution of causes of deathwas analysed. Myocardial ischaemia and infarction was confirmedto be the leading cause of death in patients with diabetes mellituson RRT. The coronary death rate was estimated to be 10 timesgreater in young patients with type I diabetes mellitus as comparedto their non-diabetic counterparts. Other cardiovascular aswell as infectious causes were recorded in a similar proportionof deaths in diabetics as in non-diabetics. Cancer deaths, however,appeared to be definitely less frequent in patients on RRT dueto diabetic nephropathy.     

《诸病源候论》对宣导术的发挥

《诸病源候论》是一部中医临床病理学和证候学方面的不朽专著,在记述诸证之后多附养生法和宣导术以防治疾病。书中所载不仅保存早已失传的很多内容,并对宣导术有诸多发挥,如解释行功的具体做法,对宣导术理论阐发,对宣导基本术语进行通俗易懂的解释,宣导后附有医嘱,强调调气伴咽津,宣导结合存思,导引饮食忌宜,最早明确“六字决”与脏腑配对及“辨证施功”。     

影响洗胃效果的原因分析

对口服药物中毒的１８例患者，进行经口插管洗胃，并分别留取洗出液进行毒物检测，目测洗出液澄清无味时留取最终标本检测毒物含量。结果最终标本毒物残留量最少０．４％，最多７６．７％，说明操作者用目测洗胃液澄清度或闻及气味来判断洗胃是否彻底的方法是影响洗胃效果的重要因素。另外，对影响洗胃效果的其它因素（如药物的理化性质、洗胃液及患者的体位等）进行了分析。     

西藏尼木县孕产期活跃期停滞产妇病例临床分析

目的对活跃期停滞的95例临床资料进行分析,探讨其发生的原因、产程特点和对母儿的影响。方法选择2007年7月至2010年6月在本院单胎头位分娩被诊断为活跃期停滞的95例产妇为观察组,另选同期住院分娩产程正常的单胎头位初产妇95例为对照组,比较两组产妇的产程、产力、胎方位、胎儿及并发症情况,总结引起活跃期停滞的原因。结果两组产妇潜伏期、产力、新生儿体重、新生儿窒息的发生率及产后出血率比较,差异均有统计学意义（P〈0.05）。结论活跃期停滞的原因有潜伏期延长、胎方位异常、官缩乏力等,出现活跃期停滞时及时行内诊检查分析其原因,针对性地给予及时处理,可有效降低剖宫产率及母儿并发症。     

54例腹部切口疝病因分析

目的探讨腹壁切口疝的发病原因。方法从切口类型、切口感染、腹内压增高、年龄、营养状况、发生时间等方面对54例切1：3疝进行回顾性分析。结果腹壁纵行切口、切口感染、腹内压增高及高龄、肥胖、代谢性疾病等因素的存在易诱发切口疝。54例切口疝患者中,6例小切口疝及5例中切口疝采用传统方法直接缝合修补,余病例均采用材料修补,随访0．5～3年,1例复发,经材料修补后痊愈。结论（1）围手术期应积极预防感染;（2）在不影响手术操作及安全的前提下,采用横向切口;（3）术后半年内注意防护,尽量避免一切诱发因素;（4）围手术期加强营养,控制血糖,治疗可引起腹内压增高的合并症。     

口服有机磷农药中毒合并上消化道出血58例临床分析

目的：探讨口服有机磷农药中毒合并上消化道出血的原因及治疗。方法：回顾分析本院58例急性有机磷农药口服中毒合并上消化道出血的原因及治疗效果。结果：58例患者中,治愈51例（87.9%）,死亡7例（12.1%）,出血原因主要为急性胃黏膜病变和应激性溃疡。结论：有机磷农药中毒合并上消化道出血,早发现、早预防、早治疗,效果良好。     

Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway

Aims/hypothesis We examined long-term total and cause-specific mortality in a nationwide, population-based Norwegian cohort of patients with childhood-onset type 1 diabetes. Materials and methods All Norwegian type 1 diabetic patients who were diagnosed between 1973 and 1982 and were under 15 years of age at diagnosis were included (n=1,906). Mortality was recorded from diabetes onset until 31 December 2002 and represented 46,147 person-years. The greatest age attained among deceased subjects was 40 years and the maximum diabetes duration was 30 years. Cause of death was ascertained by reviews of death certificates, autopsy protocols and medical records. The standardised mortality ratio (SMR) was based on national background statistics. Results During follow-up 103 individuals died. The mortality rate was 2.2/1000 person-years. The overall SMR was 4.0 (95% CI 3.2–4.8) and was similar for males and females. For ischaemic heart disease the SMR was 20.2 (7.3–39.8) for men and 20.6 (1.8–54.1) for women. Acute metabolic complications of diabetes were the most common cause of death under 30 years of age (32%). Cardiovascular disease was responsible for the largest proportion of deaths from the age of 30 years onwards (30%). Violent death accounted for 28% of the deaths in the total cohort (35% among men and 11% among women). Conclusions/interpretation Childhood-onset type 1 diabetes still carries an increased mortality risk when compared with the general population, particularly for cardiovascular disease. To reduce these deaths, attention should be directed to the prevention of acute metabolic complications, the identification of psychiatric vulnerability and the early detection and treatment of cardiovascular disease and associated risk factors. Electronic Supplementary Materials Supplementary material is available in the online version of this article at . T. Skrivarhaug et al.: Mortality of type 1 diabetes in Norway     

我院门诊药房退药原因分析及对策探讨

目的:减少和规范退药,保证患者用药的安全、有效、经济、合理。方法:对我院2009年3月～2009年11月门诊西药房449份退药登记单进行统计,分析退药原因,探讨应对策略。结果:退药原因主要由医师(如医患缺少沟通,计算机操作错误)、患者(如医药知识不足而拒绝用药,入院、转院、死亡)、药房供应短缺、收费错误、其他(如药品不良反应,医保费用问题)等几方面原因引起。结论:退药现象是客观存在的,应完善各项制度,提高医务人员诊疗水平,强化服务意识,加强对患者的用药指导,努力避免退药现象的发生。     

中药注射剂不良反应成因研究方法分析

目的:分析中药注射剂不良反应成因研究方法并总结研究成果。方法:查阅近几年公开发表的中药注射剂不良反应成因研究的文献,据此对中药注射剂不良反应成因研究方法进行分析。结果与结论:中药注射剂不良反应成因研究取得了一定的进展,但还存在一些局限,建议利用数理统计学方法、数据挖掘方法等对中药注射剂ADR文献所含成因研究的信息进行系统整合和深入挖掘,从而为现有研究提供新的参考。