• 【花生对患有高2型糖尿病风险的肥胖女性的血糖反应和食欲的急性和第二餐作用:一项随机交叉临床试验。】 复制标题 收藏 收藏
    DOI:10.1017/S0007114512004217 复制DOI
    作者列表:Reis CE,Ribeiro DN,Costa NM,Bressan J,Alfenas RC,Mattes RD
    BACKGROUND & AIMS: :Nut consumption is associated with a reduced risk of type 2 diabetes mellitus (T2DM). The aim of the present study was to assess the effects of adding peanuts (whole or peanut butter) on first (0-240 min)- and second (240-490 min)-meal glucose metabolism and selected gut satiety hormone responses, appetite ratings and food intake in obese women with high T2DM risk. A group of fifteen women participated in a randomised cross-over clinical trial in which 42·5 g of whole peanuts without skins (WP), peanut butter (PB) or no peanuts (control) were added to a 75 g available carbohydrate-matched breakfast meal. Postprandial concentrations (0-490 min) of glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), appetitive sensations and food intake were assessed after breakfast treatments and a standard lunch. Postprandial NEFA incremental AUC (IAUC) (0-240 min) and glucose IAUC (240-490 min) responses were lower for the PB breakfast compared with the control breakfast. Insulin concentrations were higher at 120 and 370 min after the PB consumption than after the control consumption. Desire-to-eat ratings were lower, while PYY, GLP-1 and CCK concentrations were higher after the PB intake compared with the control intake. WP led to similar but non-significant effects. The addition of PB to breakfast moderated postprandial glucose and NEFA concentrations, enhanced gut satiety hormone secretion and reduced the desire to eat. The greater bioaccessibility of the lipid component in PB is probably responsible for the observed incremental post-ingestive responses between the nut forms. Inclusion of PB, and probably WP, to breakfast may help to moderate glucose concentrations and appetite in obese women.
    背景与目标: :食用坚果与降低2型糖尿病(T2DM)的风险有关。本研究的目的是评估添加花生(全脂或花生酱)对第一次(0-240分钟)和第二次(240-490分钟)膳食葡萄糖代谢的影响,以及选择的肠饱腹感激素反应,食欲等级患有T2DM风险较高的肥胖女性的饮食和食物摄入量。一组15名妇女参加了一项随机交叉临床试验,在该试验中,将75.g可用碳水化合物匹配的42·5克无皮的全花生(WP),花生酱(PB)或无花生(对照)添加早餐餐。早餐后评估餐后血糖,胰岛素,NEFA,胰高血糖素样肽1(GLP-1),肽YY(PYY),胆囊收缩素(CCK),食欲感觉和食物摄入的浓度(0-490分钟)。标准午餐。与对照早餐相比,PB早餐的餐后NEFA增量AUC(IAUC)(0-240分钟)和葡萄糖IAUC(240-490分钟)响应较低。 PB摄入后120和370分钟时的胰岛素浓度高于对照组摄入后的胰岛素浓度。与对照组相比,PB摄入后的按需饮食评分较低,而PYY,GLP-1和CCK浓度较高。 WP产生了相似但不重要的影响。早餐中添加PB可减轻餐后血糖和NEFA的浓度,增强肠饱腹感激素的分泌并减少进食的欲望。 PB中脂质成分的更大生物可及性可能是观察到的坚果形式之间渐增的消味后反应的原因。在早餐中加入PB和可能的WP可能有助于减轻肥胖女性的葡萄糖浓度和食欲。
  • 【糖尿病和胰腺癌的风险:来自胰腺癌队列财团的汇总分析。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-012-0078-8 复制DOI
    作者列表:
    BACKGROUND & AIMS: PURPOSE:Diabetes is a suspected risk factor for pancreatic cancer, but questions remain about whether it is a risk factor or a result of the disease. This study prospectively examined the association between diabetes and the risk of pancreatic adenocarcinoma in pooled data from the NCI pancreatic cancer cohort consortium (PanScan). METHODS:The pooled data included 1,621 pancreatic adenocarcinoma cases and 1,719 matched controls from twelve cohorts using a nested case-control study design. Subjects who were diagnosed with diabetes near the time (<2 years) of pancreatic cancer diagnosis were excluded from all analyses. All analyses were adjusted for age, race, gender, study, alcohol use, smoking, BMI, and family history of pancreatic cancer. RESULTS:Self-reported diabetes was associated with a forty percent increased risk of pancreatic cancer (OR = 1.40, 95 % CI: 1.07, 1.84). The association differed by duration of diabetes; risk was highest for those with a duration of 2-8 years (OR = 1.79, 95 % CI: 1.25, 2.55); there was no association for those with 9+ years of diabetes (OR = 1.02, 95 % CI: 0.68, 1.52). CONCLUSIONS:These findings provide support for a relationship between diabetes and pancreatic cancer risk. The absence of association in those with the longest duration of diabetes may reflect hypoinsulinemia and warrants further investigation.
    背景与目标: 目的:糖尿病是怀疑为胰腺癌的危险因素,但有关它是该疾病的危险因素还是结果仍存在疑问。这项研究从NCI胰腺癌队列联合会(PanScan)收集的数据中前瞻性地检查了糖尿病与胰腺腺癌风险之间的关联。
    方法:汇集的数据包括使用嵌套病例对照研究设计的来自十二个队列的1,621例胰腺腺癌病例和1,719例匹配的对照。所有分析均排除在胰腺癌诊断时间(<2年)内被诊断出患有糖尿病的受试者。所有分析均根据年龄,种族,性别,研究,饮酒,吸烟,BMI和胰腺癌家族史进行了调整。
    结果:自我报告的糖尿病与胰腺癌风险增加40%相关(OR = 1.40,95%CI:1.07,1.84)。该关联因糖尿病持续时间而异;持续时间为2-8年的患者风险最高(OR = 1.79,95%CI:1.25,2.55);糖尿病9年没有相关性(OR = 1.02,95%CI:0.68,1.52)。
    结论:这些发现为糖尿病与胰腺癌风险之间的关系提供了支持。糖尿病持续时间最长的患者缺乏相关性可能反映了低胰岛素血症,需要进一步研究。
  • 【HMGA2基因的常见变异会增加2型糖尿病患者对肾病的易感性。】 复制标题 收藏 收藏
    DOI:10.1007/s00125-012-2760-5 复制DOI
    作者列表:Alkayyali S,Lajer M,Deshmukh H,Ahlqvist E,Colhoun H,Isomaa B,Rossing P,Groop L,Lyssenko V
    BACKGROUND & AIMS: AIMS/HYPOTHESIS:Type 2 diabetes is a chronic metabolic disorder associated with devastating microvascular complications. Genome-wide association studies have identified more than 60 genetic variants associated with type 2 diabetes and/or glucose and insulin traits, but their role in the progression of diabetes is not established. The aim of this study was to explore whether these variants were also associated with the development of nephropathy in patients with type 2 diabetes. METHODS:We studied 28 genetic variants in 2,229 patients with type 2 diabetes from the local Malmö Scania Diabetes Registry (SDR) published during 2007-2010. Diabetic nephropathy (DN) was defined as micro- or macroalbuminuria and/or end-stage renal disease. Estimated glomerular filtration rate (eGFR) was assessed using the MDRD-4 formula. Replication genotyping of rs1531343 was performed in diabetic (Steno type 2 diabetes [n = 345], Genetics of Diabetes Audit and Research in Tayside Scotland [Go-DARTS] [n = 784]) and non-diabetic (Malmö Preventive Project [n = 2,523], Botnia study [n = 2,247]) cohorts. RESULTS:In the SDR, HMGA2 single-nucleotide polymorphism rs1531343 was associated with DN (OR 1.50, 95% CI 1.20, 1.87, p = 0.00035). In the combined analysis totalling 3,358 patients with type 2 diabetes (n = 1,233 cases, n = 2,125 controls), carriers of the C-allele had a 1.45-fold increased risk of developing nephropathy (95% CI 1.20, 1.75, p = 0.00010). Furthermore, the risk C-allele was associated with lower eGFR in patients with type 2 diabetes (n = 2,499, β ± SEM, -3.7 ± 1.2 ml/min, p = 0.002) and also in non-diabetic individuals (n = 17,602, β ± SEM, -0.008 ± 0.003 ml/min (log( e )), p = 0.006). CONCLUSIONS/INTERPRETATION:These data demonstrate that the HMGA2 variant seems to be associated with increased risk of developing nephropathy in patients with type 2 diabetes and lower eGFR in both diabetic and non-diabetic individuals and could thus be a common denominator in the pathogenesis of type 2 diabetes and kidney complications.
    背景与目标: 目的/假设:2型糖尿病是与破坏性微血管并发症相关的慢性代谢性疾病。全基因组关联研究已鉴定出与2型糖尿病和/或葡萄糖和胰岛素性状相关的60多种遗传变异,但尚未确定它们在糖尿病进展中的作用。这项研究的目的是探讨这些变异是否也与2型糖尿病患者的肾病发展有关。
    方法:我们研究了2007年至2010年间发表的2 229例2型糖尿病患者的28种遗传变异,这些变异来自当地的马尔默斯堪尼亚糖尿病登记处(SDR)。糖尿病性肾病(DN)被定义为微蛋白尿或巨蛋白尿和/或晚期肾病。使用MDRD-4公式评估估计的肾小球滤过率(eGFR)。 rs1531343的复制基因分型是在糖尿病(Steno 2型糖尿病[n = 345],Tayside Scotland糖尿病的遗传学研究和研究[Go-DARTS] [n = 784])和非糖尿病(Malmö预防项目[n == 2,523],Botnia研究[n = 2,247]队列。
    结果:在SDR中,HMGA2单核苷酸多态性rs1531343与DN相关(OR 1.50,95%CI 1.20,1.87,p = 0.00035)。在总共3358名2型糖尿病患者的综合分析中(n = 1,233例,n = 2,125对照),C-等位基因携带者患肾病的风险增加了1.45倍(95%CI 1.20,1.75,p = 0.00010 )。此外,高风险C等位基因与2型糖尿病患者的eGFR较低有关(n = 2,499,β±SEM,-3.7±1.2 ml / min,p = 0.002),在非糖尿病患者中(n = 17,602) ,β±SEM,-0.008±0.003 ml / min(log(e)),p = 0.006)。
    结论/解释:这些数据表明,HMGA2变异似乎与2型糖尿病患者发生肾病的风险增加以及糖尿病和非糖尿病患者的eGFR降低有关,因此可能是2型糖尿病发病机制的共同指标2糖尿病和肾脏并发症。
  • 【回复:Bayomi等人的“ Plasminogen Activator Inhibitor-1和2型糖尿病患者的心包脂肪”。 (Metab Syndr Relat Disord 2017; 15:269-275)。】 复制标题 收藏 收藏
    DOI:10.1089/met.2017.0070 复制DOI
    作者列表:Avogaro A
    BACKGROUND & AIMS: :Plasminogen activator inhibitor-1 (PAI-1) is a member of the serine protease inhibitor (serpin) superfamily, which inactivates tissue plasminogen activator (tPA); therefore, increased level of PAI-1 antigen counteracts the anticoagulant effect of tPA and facilitates the fibrin clot formation. Plasma PAI-1 antigen and activity levels are associated with increased body mass index and with features of the insulin resistance syndrome like obesity and diabetes. Visceral adipose tissue produces more PAI-1 than subcutaneous adipose tissue: This increased production of PAI-1 from the visceral adipose tissue is one important link between visceral obesity and cardiovascular disease. Besides visceral adipose tissue, there is mounting evidence that epicardial adipose tissue may be an important source of PAI-1, especially in patients with type 2 diabetes.
    背景与目标: :Plasminogen activator inhibitor-1(PAI-1)是丝氨酸蛋白酶抑制剂(serpin)超家族的一员,它可以使组织纤溶酶原激活物(tPA)失活。因此,PAI-1抗原水平的增加抵消了tPA的抗凝作用,并促进了纤维蛋白凝块的形成。血浆PAI-1抗原和活性水平与体重指数增加以及胰岛素抵抗综合征(如肥胖症和糖尿病)的特征有关。内脏脂肪组织比皮下脂肪组织产生更多的PAI-1:内脏脂肪组织增加的PAI-1产生是内脏肥胖与心血管疾病之间的重要联系。除内脏脂肪组织外,越来越多的证据表明心外膜脂肪组织可能是PAI-1的重要来源,尤其是在2型糖尿病患者中。
  • 【加纳人口的一般和中枢肥胖和2型糖尿病风险的度量。】 复制标题 收藏 收藏
    DOI:10.1111/tmi.12024 复制DOI
    作者列表:Frank LK,Heraclides A,Danquah I,Bedu-Addo G,Mockenhaupt FP,Schulze MB
    BACKGROUND & AIMS: OBJECTIVE:The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS:A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS:The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION:Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.
    背景与目标: 目的:肥胖症和2型糖尿病的流行在撒哈拉以南非洲(SSA)中很明显。但是,在该地区几乎没有检查过它们的关联。
    方法:一项基于医院病例对照研究,由加纳市区的1221名成年人(542例和679名对照)组成,研究了人体测量学参数在糖尿病中的作用。 Logistic回归用于分析。糖尿病的鉴别力和特定人群的临界点通过接受者的操作特征曲线来确定。
    结果:腰臀比与糖尿病的关系最大:女性每1个标准差的年龄校正比值比为1.95(95%置信区间[CI]:1.64-2.31),而女性为1.40 [1.01-1.94] ]的男人。另外,在女性中,糖尿病的几率随着腰围(1.35 [1.17-1.57])和腰高比(1.29 [1.12-1.50])的增加而增加。在男人中,这是不明显的。相反,髋围呈负相关(0.69 [0.50-0.95])。体重指数与女性(1.01 [0.88-1.15])和男性(0.74 [0.52-1.04])均与糖尿病无关。在这两个性别中,腰臀比在该人群中表现出对糖尿病的最佳判别能力,并且最佳的临界点是女性≥0.88,男性≥0.90。推荐的体重指数和腰围临界点的预测能力较差。
    结论:我们的研究结果表明,中枢性肥胖而非一般性肥胖与SSA中的2型糖尿病有关。 SSA中预防肥胖症的人体测量指标是否与发达国家不同,尚需从更大的基于人群的流行病学研究中得到验证。
  • 【链脲佐菌素诱发的糖尿病易感性的菌株差异:对高甘油三酯血症和心肌病的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0008-6363(97)00045-x 复制DOI
    作者列表:Rodrigues B,Cam MC,Kong J,Goyal RK,McNeill JH
    BACKGROUND & AIMS: OBJECTIVE:Streptozotocin (STZ)-induced diabetes in Wistar rats results in severe hyperlipidemia and a characteristic cardiomyopathy. However, Wistar-Kyoto (WKY) rats made diabetic with a similar dose of STZ did not develop heart dysfunction or hypertriglyceridemia at 12 weeks post-STZ. We investigated whether an apparent resistance of the WKY strain to develop diabetic cardiomyopathy and hypertriglyceridemia following chronic diabetes could be due to a reduced susceptibility to the diabetogenic effects of STZ.

    METHODS:Adult male WKY and Wistar rats were made diabetic with a moderate (55 mg/kg) or high (75 mg/kg) dose of STZ. At 6 weeks of diabetes, glucose tolerance, cardiac function, pancreatic insulin content and basal and post-heparin plasma lipolytic activity were determined.

    RESULTS:Administration of a moderate dose of STZ produced cardiac dysfunction in Wistar but not WKY rats at 6 weeks after diabetes induction. The same dose of STZ in WKY rats also resulted in a lesser degree of hyperglycemia and glucose intolerance, and significantly higher pancreatic insulin content relative to Wistar rats. Following a high dose of STZ, the apparent resistance to developing cardiomyopathy was lost in the WKY rats. As well, the WKY rats demonstrated an equal degree of hyperglycemia and glucose intolerance as Wistar rats. However, unlike the Wistar strain, WKY rats did not demonstrate either hypertriglyceridemia or a reduced heparin-releasable plasma lipoprotein lipase (LPL) activity following a high dose of STZ.

    CONCLUSIONS:These results suggest that the incidence of diabetes-related cardiomyopathy and hypertriglyceridemia in rats may be independently influenced by strain-dependent susceptibilities to the beta-cytotoxic effects of STZ. The absence of hypertriglyceridemia in severely diabetic WKY rats may be linked to the maintenance of a critical level of plasma LPL activity.

    背景与目标: 目标:链脲佐菌素(STZ)诱导的Wistar大鼠糖尿病会导致严重的高脂血症和典型的心肌病。但是,在STZ后12周,使用相似剂量的STZ患糖尿病的Wistar-Kyoto(WKY)大鼠并未出现心脏功能障碍或高甘油三酯血症。我们调查了WKY菌株对慢性糖尿病后糖尿病性心肌病和高甘油三酯血症的明显抵抗是否可能是由于对STZ的致糖尿病作用的敏感性降低所致。

    方法:成年男性用中度(55 mg / kg)或高(75 mg / kg)剂量的STZ使WKY和Wistar大鼠患糖尿病。在糖尿病的6周时,测定了葡萄糖耐量,心脏功能,胰腺胰岛素含量以及肝素基础和血浆中的脂解活性。

    结果:服用中等剂量的STZ诱导糖尿病后6周,Wistar大鼠出现心脏功能障碍,但WKY大鼠没有。与Wistar大鼠相比,WKY大鼠中相同剂量的STZ还导致较低的高血糖和葡萄糖耐受不良,以及显着较高的胰腺胰岛素含量。服用高剂量的STZ后,WKY大鼠失去了明显的对发展性心肌病的抵抗力。同样,WKY大鼠表现出与Wistar大鼠相同程度的高血糖和葡萄糖耐受不良。但是,与Wistar菌株不同,WKY大鼠在高剂量的STZ后既未表现出高甘油三酸酯血症或肝素释放性血浆脂蛋白脂肪酶(LPL)活性降低。

    结论:这些结果表明,大鼠与糖尿病有关的心肌病和高甘油三酯血症的发生可能受到STZ的β细胞毒性作用的应变依赖性敏感性的独立影响。严重糖尿病WKY大鼠缺乏高甘油三酸酯血症可能与维持血浆LPL活性临界水平有关。

  • 【调整i.v.继续手术前接受血液透析的患者服用铁和EPO剂量:我们能否保护我们的患者接受铁缺乏性贫血的教育?】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Deaver K,Bennington L
    BACKGROUND & AIMS: :Ongoing blood loss and iron-deficiency anemia are common problems in patients on hemodialysis; therefore, nephrology clinicians are particularly concerned with their patients who are scheduled for surgery Surgery can cause significant blood and iron losses, thereby worsening their preexisting anemia. However, patients on hemodialysis can be effectively treated preoperatively by adjusting their continued doses of intravenous (i.v.) iron and recombinant human erythropoietin (EPO) therapy, based on expected blood and iron losses. This valuable strategy can help improve surgical and anemia outcomes as well as decrease EPO requirements and the need for transfusions. This article examines the use of IV iron and EPO therapy as preventive therapy for anemia in patients on hemodialysis prior to invasive surgical procedures, illustrated with an experience from a dialysis unit and patient case studies.
    背景与目标: :持续的失血和缺铁性贫血是血液透析患者的常见问题;因此,肾脏病临床医生特别关心计划进行手术的患者。手术可能会导致大量的血液和铁丢失,从而加剧他们先前的贫血。但是,可以根据预期的血液和铁损失,通过调整静脉注射铁和重组人促红细胞生成素(EPO)治疗的持续剂量,对接受血液透析的患者进行术前有效治疗。这种有价值的策略可以帮助改善手术和贫血结果,并降低EPO需求和输血需求。本文探讨了在进行侵入性外科手术之前,静脉铁剂和EPO疗法作为血液透析患者贫血的预防性疗法的用途,并结合透析部门和患者案例研究的经验进行了说明。
  • 【艾塞那肽:治疗2型糖尿病的新选择。】 复制标题 收藏 收藏
    DOI:10.1345/aph.1H060 复制DOI
    作者列表:Yoo BK,Triller DM,Yoo DJ
    BACKGROUND & AIMS: OBJECTIVE:To evaluate available literature characterizing the pharmacology, pharmacokinetics, drug interactions, efficacy, and safety of exenatide in patients with type 2 diabetes. DATA SOURCES:A PubMed database search (1966-May 2006) was conducted, using exenatide as the search term. The manufacturer's prescribing information was also used. STUDY SELECTION AND DATA EXTRACTION:English-language articles were selected and data were extracted with a focus on clinical outcomes associated with the treatment of patients with type 2 diabetes. DATA SYNTHESIS:Exenatide exerts a glucoregulatory effect by various mechanisms including secretion of glucose-dependent insulin, suppression of inappropriately high glucagon levels in patients with type 2 diabetes, delayed gastric emptying, and reduction of food intake. In placebo-controlled clinical studies, plasma exenatide concentrations appeared to exhibit dose-proportional kinetics, reaching peak plasma levels between 2 and 3 hours after a single subcutaneous injection. Exenatide's elimination half-life ranged from 3.3 to 4.0 hours, and the time to reach maximum concentration was about 2 hours. Interactions between exenatide and agents such as digoxin and lisinopril were not considered significant. In Phase III trials, exenatide demonstrated significant reduction of hemoglobin A1c levels from baseline and compared with placebo after 30 weeks of treatment in patients unable to achieve optimal glycemic control with metformin, a sulfonylurea, or oral combination therapy (0.4-0.9%). Patients' weight decreased with exenatide (0.9-2.8 kg), but adverse gastrointestinal (GI) events were common. Exenatide combined with thiazolidonediones, D-phenylalanine derivatives, meglitinides, or alpha glucosidase inhibitors has not been studied. CONCLUSIONS:Clinical trials have demonstrated that exenatide improves glycemic control when added to sulfonylureas and metformin, and it may be an alternative to insulin glargine in patients requiring additional therapy. Hypoglycemia has been encountered in clinical trials of exenatide, especially upon initiation of therapy with sulfonylureas (not with metformin); close patient monitoring is therefore recommended. Further studies should assess the impact of exenatide on clinical outcomes such as micro- and macrovascular disease.
    背景与目标: 目的:评估现有文献中艾塞那肽在2型糖尿病患者中的药理学,药代动力学,药物相互作用,疗效和安全性。
    数据来源:使用艾塞那肽作为搜索词,进行了PubMed数据库搜索(1966年-2006年5月)。还使用了制造商的处方信息。
    研究选择和数据提取:选择英语文章并提取数据,重点是与2型糖尿病患者治疗相关的临床结局。
    数据合成:艾塞那肽通过多种机制发挥糖调节作用,包括分泌葡萄糖依赖性胰岛素,抑制2型糖尿病患者中不适当的高胰高血糖素水平,延迟胃排空和减少食物摄入。在安慰剂对照的临床研究中,血浆艾塞那肽的浓度似乎呈剂量比例动力学,在单次皮下注射后2至3小时内达到峰值血浆水平。艾塞那肽的消除半衰期为3.3到4.0小时,达到最大浓度的时间约为2小时。艾塞那肽与地高辛和赖诺普利等药物之间的相互作用不被认为是重要的。在III期试验中,对于无法用二甲双胍,磺酰脲或口服联合疗法实现最佳血糖控制的患者,艾塞那肽在治疗30周后显示出血红蛋白A1c水平较基线显着降低,并且与安慰剂相比有所降低(0.4-0.9%)。艾塞那肽(0.9-2.8 kg)使患者体重减轻,但胃肠道不良(GI)事件很常见。尚未研究将艾塞那肽与噻唑烷二酮,D-苯丙氨酸衍生物,美格替尼或α葡萄糖苷酶抑制剂合用。
    结论:临床试验表明,艾塞那肽加到磺酰脲类和二甲双胍中可以改善血糖控制,在需要额外治疗的患者中,艾塞那肽可以代替甘精胰岛素。在艾塞那肽的临床试验中遇到了低血糖症,尤其是在开始使用磺酰脲类药物(非二甲双胍)治疗时;因此,建议对患者进行密切监测。进一步的研究应评估艾塞那肽对临床结果如微血管和大血管疾病的影响。
  • 【糖尿病引起的脑血管功能障碍:聚(ADP-核糖)聚合酶的作用。】 复制标题 收藏 收藏
    DOI:10.1016/j.mvr.2006.08.001 复制DOI
    作者列表:Arrick DM,Sharpe GM,Sun H,Mayhan WG
    BACKGROUND & AIMS: :Our goal was to identify the role of poly(ADP-ribose) polymerase (PARP) in cerebrovascular dysfunction in Type 1 diabetes mellitus (T1D). In a first series of studies, rats were assigned to nondiabetic and diabetic (streptozotocin; 50 mg/kg IP) groups. Two to three months after injection of streptozotocin, we examine in vivo responses of pial arterioles to nitric oxide synthase (NOS)-dependent (adenosine diphosphate (ADP), acetylcholine and histamine) and -independent (nitroglycerin) agonists. After the initial examination of reactivity to the agonists, we treated pial arterioles acutely with an inhibitor of PARP (PJ-34; 1 microM), and then we again examined responses to the agonists. In a second series of studies, we examine superoxide production (lucigenin chemiluminescence) by parietal cortex tissue in nondiabetic and diabetic rats. We found that dilation of pial arterioles in response to ADP, acetylcholine and histamine, but not to nitroglycerin, was impaired in diabetic compared to nondiabetic rats. In addition, although PJ-34 did not alter responses in nondiabetic rats, PJ-34 alleviated T1D-induced impairment of NOS-dependent vasodilation. We also found that basal production of superoxide was increased in diabetic compared to nondiabetic rats and that PJ-34 decreased this basal production of superoxide. Our findings suggest that T1D impairs NOS-dependent reactivity of cerebral arterioles by a mechanism that appears to be related to the formation of superoxide via activation of PARP.
    背景与目标: :我们的目标是确定聚(ADP-核糖)聚合酶(PARP)在1型糖尿病(T1D)的脑血管功能障碍中的作用。在第一个系列研究中,将大鼠分为非糖尿病和糖尿病(链脲佐菌素; 50 mg / kg IP)组。注射链脲佐菌素后两到三个月,我们检查了小动脉对一氧化氮合酶(NOS)依赖性(二磷酸腺苷(ADP),乙酰胆碱和组胺)和非依赖性(硝酸甘油)激动剂的体内反应。初步检查与激动剂的反应性后,我们用PARP抑制剂(PJ-34; 1 microM)急性治疗了小动脉,然后再次检查了对激动剂的反应。在第二系列研究中,我们检查了非糖尿病和糖尿病大鼠顶叶皮质组织的超氧化物生成(荧光素化学发光)。我们发现,与非糖尿病大鼠相比,糖尿病患者对ADP,乙酰胆碱和组胺(而非对硝酸甘油)响应的小动脉小动脉扩张受到损害。此外,尽管PJ-34不会改变非糖尿病大鼠的反应,但PJ-34减轻了T1D诱导的NOS依赖性血管舒张功能受损。我们还发现,与非糖尿病大鼠相比,糖尿病患者的基础过氧化物含量增加,而PJ-34降低了基础过氧化物含量。我们的发现表明,T1D通过一种机制似乎削弱了NOS依赖性的脑小动脉反应性,该机制似乎与通过激活PARP形成超氧化物有关。
  • 【放射肿瘤科医生(RO)临床实践的综合持续医学教育(CME)和质量改进(QI)计划的功效。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijrobp.2006.07.018 复制DOI
    作者列表:Leong CN,Shakespeare TP,Mukherjee RK,Back MF,Lee KM,Lu JJ,Wynne CJ,Lim K,Tang J,Zhang X
    BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.
    背景与目标: 目的:在继续医学教育(CME)或质量改善(QI)计划功效方面,几乎没有针对放射肿瘤学家(RO)的研究。我们的目的是评估一个CME / QI计划,以了解该计划的前12个月RO行为,绩效以及对部门规约/研究的遵守情况的变化。
    方法和材料:CME / QI程序将图表审核与反馈(C-AWF),模拟审阅AWF(SR-AWF),提醒清单和目标CME教程相结合。在2003年4月至2004年3月之间,使用经过验证的工具,通过带有反馈的图表审计(C-AWF)评估了75名患者的管理,通过模拟审查审计(SR-AWF)评估了178名患者的管理。提出分数,并通过个性化的教育反馈讨论案例管理。在该计划的第一年,对RO的行为和性能进行了比较。
    结果:与前六个月和第二个六个月相比,平均行为(14.12.7-13.6,p = 0.0005)和反渗透表现(7.6-7.9,8,p = 0.018)有显着改善。方案/研究依从性从90.3%显着提高到96.6%(p = 0.005)。总共产生了50项行动,包括确定直接进行CME指导的学习需求,对次优RO实践的系统性改变以及在该计划中审核的3%的患者管理不善的变更。
    结论:结合了C-AWF,SR-AWF,QI提示和目标CME教程的集成的CME / QI程序可以在12个月内有效改善目标RO的行为和性能。部门规程和研究依从性相应增加。
  • 【注意缺陷/多动症患者的药物使用与高等教育入学考试成绩之间的关联。】 复制标题 收藏 收藏
    DOI:10.1001/jamapsychiatry.2017.1472 复制DOI
    作者列表:Lu Y,Sjölander A,Cederlöf M,D'Onofrio BM,Almqvist C,Larsson H,Lichtenstein P
    BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.
    背景与目标: 重要性:患有注意力缺陷/多动症(ADHD)的人更容易出现学术问题。药物治疗可有效减轻多动症的核心症状,但尚不清楚它是否有助于改善学业成果。
    目的:探讨多动症患者使用多动症药物与高等教育入学考试成绩之间的关系。
    设计,背景和参与者:该队列研究从2006年1月1日到2013年12月31日观察了61640名患有ADHD的患者。他们的药物治疗记录与瑞典的学历能力数据一起被提取。测试。使用患者内设计,将患者服用ADHD药物时的测试得分与未服用ADHD药物时的得分进行比较。数据分析时间为2015年11月24日至2016年11月4日。
    暴露:有或没有使用ADHD药物的时期。
    主要成果和措施:高等教育入学考试分数(分数范围:1-200分)。
    结果:在930名个体(平均年龄[SD],22.2 [3.2]岁)中,参加多次入院测试(n = 2524)并间歇性使用ADHD药物,测试得分平均为4.80分在调整年龄和实践影响后,他们在服药期间与非服药期间相比更高(95%CI,2.26-7.34; P <.001)。在敏感性分析中,ADHD药物使用与测试评分之间存在相似的关联。
    结论与相关性:ADHD患者在接受ADHD药物治疗期间与非药物治疗期间在高等教育入学考试中得分较高。这些发现表明,多动症药物可能有助于改善多动症患者的教育相关成果。
  • 【血清视黄醇结合蛋白:肥胖,胰岛素抵抗和2型糖尿病之间的联系。】 复制标题 收藏 收藏
    DOI:10.1111/j.1753-4887.2007.tb00302.x 复制DOI
    作者列表:Wolf G
    BACKGROUND & AIMS: :Insulin resistance occurs under conditions of obesity, metabolic syndrome, and type 2 diabetes. It was found to be accompanied by down-regulation of the insulin-responsive glucose transporter GLUT4. Decreased adipocyte GLUT4 caused secretion by adipocytes of the serum retinol-binding protein RBP4. Enhanced levels of serum RBP4 appeared to be the signal for the development of systemic insulin resistance both in experimental animals and in humans. In mice, increased levels of serum RBP4 led to impaired glucose uptake into skeletal muscle and increased glucose production by liver, whereas lowered serum RBP4 levels greatly enhanced insulin sensitivity. Thus, a link has been established between obesity and insulin resistance: RBP4, the vitamin A-transport protein secreted into the circulation by adipocytes.
    背景与目标: 胰岛素抵抗在肥胖,代谢综合症和2型糖尿病的情况下发生。发现伴随着胰岛素反应性葡萄糖转运蛋白GLUT4的下调。脂肪细胞GLUT4减少导致脂肪细胞分泌视黄醇结合蛋白RBP4。血清RBP4水平升高似乎是实验动物和人类体内系统性胰岛素抵抗发展的信号。在小鼠中,血清RBP4水平升高会导致葡萄糖吸收到骨骼肌中,并增加肝脏产生的葡萄糖,而降低血清RBP4水平会大大增强胰岛素敏感性。因此,在肥胖与胰岛素抵抗之间建立了联系:RBP4,脂肪细胞分泌到循环中的维生素A转运蛋白。
  • 【年轻女性的肥胖,骨密度和微结构之间的关系得以维持,而与糖尿病的状况无关。】 复制标题 收藏 收藏
    DOI:10.1111/cen.13410 复制DOI
    作者列表:Abdalrahaman N,McComb C,Foster JE,Lindsay RS,Drummond R,McKay GA,Perry CG,Ahmed SF
    BACKGROUND & AIMS: BACKGROUND:The relationship between bone health and adiposity and how it may be affected in people with chronic metabolic conditions is complex. METHODS:Seventeen women with type 1 diabetes mellitus (T1DM) and nine age-matched healthy women with a median age of 22.6 years (range, 17.4, 23.8) were studied by 3T MRI and MR spectroscopy to assess abdominal adiposity, tibial bone microarchitecture and vertebral bone marrow adiposity (BMA). Additional measures included DXA-based assessments of total body (TB), femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) and fat mass (FM). RESULTS:Although women with T1DM had similar BMI and BMA to the controls, they had higher visceral and subcutaneous adiposity on MRI (P<.05) and total body FM by DXA (P=.03). Overall, in the whole cohort, a clear inverse association was evident between BMA and BMD at all sites (P<.05). These associations remained significant after adjusting for age, BMI, FM and abdominal adiposity. In addition, visceral adiposity, but not subcutaneous adiposity, showed a positive association with BMA (r, .4, P=.03), and a negative association with total body BMD (r, .5, P=.02). Apparent trabecular separation as assessed by MRI showed an inverse association to total body BMD by DXA (r, -.4, P=.04). CONCLUSION:Irrespective of the presence of an underlying metabolic condition, young women display a negative relationship between MRI-measured BMA and DXA-based assessment of BMD. Furthermore, an association between BMA and visceral adiposity supports the notion of a common origin of these two fat depots.
    背景与目标: 背景:在慢性代谢疾病患者中,骨骼健康与肥胖之间的关系及其可能受到的影响是复杂的。
    方法:通过3T MRI和MR光谱法研究了17位1型糖尿病(T1DM)妇女和9位年龄相匹配的健康女性(中位年龄为22.6岁,范围分别为17.4、23.8),以评估腹部肥胖,胫骨微结构和椎骨肥胖症(BMA)。其他措施包括基于DXA的全身(TB),股骨颈(FN)和腰椎(LS)骨矿物质密度(BMD)和脂肪量(FM)评估。
    结果:尽管患有T1DM的女性的BMI和BMA与对照组相似,但其MRI的内脏和皮下脂肪率较高(P <.05),而DXA显示的全身FM较高(P = .03)。总体而言,在整个队列中,BMA和BMD在所有位点之间均存在明显的逆相关性(P <.05)。在调整了年龄,BMI,FM和腹部肥胖后,这些关联仍然很显着。此外,内脏脂肪而不是皮下脂肪与BMA呈正相关(r,.4,P = .03),与全身BMD呈负相关(r,.5,P = .02)。 MRI评估的表观小梁分离显示,DXA与全身BMD呈负相关(r,-。4,P = .04)。
    结论:无论是否存在潜在的代谢状况,年轻女性在MRI测量的BMA与基于DXA的BMD评估之间均显示负相关。此外,BMA和内脏肥胖之间的联系支持了这两个脂肪库的共同起源这一概念。
  • 【电子教育档案袋的开发:医学教育专业人员的大纲。】 复制标题 收藏 收藏
    DOI:10.1080/10401330701332219 复制DOI
    作者列表:Lewis KO,Baker RC
    BACKGROUND & AIMS: BACKGROUND:A growing body of literature shows that many universities and colleges are making educational portfolios part of their faculty assessment and student's learning plan for both undergraduate and graduate programs. We provide an outline for the development of a medical educator's portfolio, including an electronic version. DESCRIPTION:Guidelines for the development of an educational portfolio focusing on medical education are provided, including design, format, and content. An electronic version of the portfolio, which combines flexibility and ease of revision, is also described, including formats for publication and distribution. Student reflections on the e-portfolio are presented, and potential applications of the e-portfolio in medical education are described. CONCLUSION:We believe that portfolio development is a valuable application that provides rich documentation of participants' educational history, accomplishments, and intellectual property as related to their professional learning and growth.
    背景与目标: 背景:越来越多的文献表明,许多大学和学院正在将教育档案袋作为其本科和研究生课程教师评估和学生学习计划的一部分。我们为医学教育者的档案袋的发展提供了一个大纲,包括电子版本。
    描述:提供了针对医学教育的教育档案袋的开发指南,包括设计,格式和内容。还介绍了组合的灵活性和易于修改的电子版本,包括发布和分发的格式。介绍了学生对电子档案夹的思考,并描述了电子档案夹在医学教育中的潜在应用。
    结论:我们认为,档案袋开发是一个有价值的应用程序,它为参与者的教育历史,成就和与他们的专业学习和成长有关的知识产权提供了丰富的文档。
  • 【澳大利亚护理实践,护士教育和护理人员国际化面临的挑战。】 复制标题 收藏 收藏
    DOI:10.5172/conu.2007.24.2.128 复制DOI
    作者列表:Parker V,McMillan M
    BACKGROUND & AIMS: :This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context.
    背景与目标: :本文探讨了导致护理人员队伍和护理教育国际化的因素,并认为需要对护士管理者和护士学者进行教育和支持,以使他们更好地为即将面临的挑战做好准备。护理国际化将带来许多好处,其中最重要的是在各国之间提高对跨文化的了解和改进工作场所的实践。但是,护理和护士为国际议程做出贡献的方式对于维持澳大利亚以及与澳大利亚人合作的国家的教育和护理标准至关重要。国际化提出了许多挑战,需要仔细考虑。本文旨在探讨和审查护理国际化中的一些重要问题,特别是在澳大利亚的情况下。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录