测定尿红细胞平均细胞容积值以鉴别血尿的来源

作者应用ＣｏｕｌｔｅｒＪＴ型血细胞分析仪对临床上血尿标本的尿红细胞平均细胞容积（ＭＣＶ）值进行了检测，以区别肾小球性或非肾小球性血尿，现报道如下。材料与方法一、对象血尿患者４０例，均根据临床表现，实验室检查，器械检查（Ｂ超、膀胱镜、Ｘ线、ＣＴ）和肾活...

先确定来源,再做进一步检查血尿的标准化全科诊疗路径

血尿包括肉眼血尿和镜下血尿。许多疾病都可以引起血尿,这些疾病中有些可能会危及生命,有些是可以治疗的,也有一部分一过性的血尿患者可能难以明确病因且能自愈。全科医生通过详细询问病史和体格检查可以初步确定血尿的来源和选择进一步的检查。血尿患者的标准化全科诊疗路径建议如下.

Depression is associated with increased C-reactive protein levels in patients with heart failure and hyperuricemia

Psychological depression is considered a major determinant of health status in patients with heart failure （HF）. The incidence of depression in HF is four to five times higher than that in the general population.

Glycemic and blood pressure control in older patients with hypertension and diabetes： association with carotid atherosclerosis

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure （Bp） control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness （CIMT） in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic w＇. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects （508 males and 162 females） aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure： tight control, 〈 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, 〉 140 mmHg, and by their hemoglobin Alc （HbAlc） level： tight control, 〈 6.5%; usual control, 6.5%-7.5%; or uncontrolled, 〉 7.5%, respectively. Results The mean CIMT was 8.20 ±0.11 mm, and carotid plaque was found in 52.5% （352/670） subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT （≥ 1.1 ram）. The mean CIMT was significantly different between Bp control categories （7.60 ± 0.09 mm, 7.90 ±0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03） but not between glycemic control categories （8.20± 0.10 mm, 8.1 ±0.08 mm, and 8.40 ± 0.14 ram, respectively, P = 0.13） using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque （OR = 1.08 and OR=1.42, respectively）, or elevated CIMT [Odd ratio （OR） = 1.17, 95% confidence interval （CI） 1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.

Correlations Between Serum Uric Acid Level and Disease Activity,Intrathecal Inflammation Reactivity in Patients with Multiple Sclerosis

Objective To explore the correlations between serum uric acid （HA） levels and the clinical and cerebrospinal fluid （CSF） parameters of multiple sclerosis （MS）. Methods The medical reports of 47 MS patients admitted to Peking Union Medical College Hospi- tal during 2008 and 2010 were reviewed. And 49 age- and gender-matched cerebral infarction patients were enrolled as control. The mean serum HA level of the MS patients was compared with that of the control group. The correlations between the HA levels and the clinical parameters including gender, disease duration, relapse rate, and disease disabilities as assessed by the Expanded Disability Status Scale score, were explored. Forty-one patients had CSF examinations. The correlations between the IdA levels and the CSF parameters reflecting inflammation and tissue damage, including CSF protein, white blood cell count, oligoclonal band, 24-hour IgG index, and myelin basic protein, were also investigated. Results The mean serum HA level in the MS patients was lower than that in the control group （247.75 ± 52.59 jamol/L vs. 277.94 ± 74.33 pmol/L, P=0.025） and inversely correlated with the relapse rate （P=0.049）. MS patients with lower serum UA levels tended to have higher white blood cell counts and myelin basic protein level. But there was no correlation between CSF protein levels （r=0.165, P=0.273）, white blood cell counts （r=-0.051, P=0.732）, IgG index （r =0. 045, P=0.802）, or myelin basic protein level （r =-0.248, P=0.145） and the serum UA level, respectively. Conclusion In MS patients, UA levels might partly reflect the extent of disability and inflammation.

Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

Several studies have shown that coronary artery bypass graft surgery （CABG） is superior to percutaneous coronary intervention （PCI） in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality （Relative risk （RR）： 0.78, 95% confidence interval （CI）： 0.62-0.99）, and for major adverse cardiac and cerebrovascular events （MACCE, RR： 0.59, 95% CI： 0.47-0.75） for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI （RR： 0.87, 95% CI： 0.54-1.42）. Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies （P 〉 0.05 for all）. The pre- sented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies.

Drug Therapy Monitoring in Patients with Type 2 Diabetes and Hypertension

The aim of this paper is to detect, prevent and resolve DRP （drug-related problems） and NOM （negative outcomes associated with medication） in hospitalized patients with DM2 （type 2 diabetes） with HTN （hypertension） in a tertiary care clinic. Descriptive cross-sectional interventional study is used. DTM （drug therapy monitoring） was conducted in 73 patients using data obtained from clinical histories and interviews. NOM were detected based on symptoms and laboratory test results. The statistical significance was 0.05. It can be found that 23 DRP were detected, primarily in the category ＂likelihood of adverse effects＂ （30.43%） causing NOM in the ＂non-quantitative safety problem＂ category. The NOM detected were related to safety （62%）, effectiveness （24.5%） and necessity （13.5%）. Of the 68.57% of pharmacist interventions accepted, 48.57% were resolved and 20% were not resolved. A simple linear correlation （r = -0.34） analysis indicated a weak association between patient age and severity ofNOM. DTM made it＇possible to detect suspected DRP and NOM, which were then prevented or resolved, improving the control of HTN and DM2 and helping ensure better drug therapy outcomes for patients.

Technology and Inequity in Health： The Geographical Distribution of Glucometers for the Control of Diabetes

Technological innovation plays an important role in the dynamics of economic growth and in promoting the welfare of the general population. In support of this hypothesis, an empirical study was carried out to assess the spatial distribution of insulin and supplies （glucometers） for the control of diabetes in patients registered in the Public Healthcare System in Salvador, Bahia, from 1998 to 2012. In order to achieve this objective, we applied a combination of data collection strategies, including spatial analysis and discrete choice model estimation. The study proposed to answer the following question： What factors affect access to the supplies required to control diabetes in insulin-dependent patients？ To this end, we assessed the spatial distribution of diabetic patients in Salvador who had received glucometers. The hypothesis asserted that social, economic and geographical factors determine access to the supplies （glucometers） used to control diabetes. Exploratory Spatial Data Analysis （ESDA） was therefore performed using the Global Spatial Autocorrelation Index in order to analyze the spatial distribution of glucometers. We then performed econometric estimations and analyzed the results. The final results initially demonstrated that there were major inconsistencies in the distribution of glucometers; i.e. purely random factors largely determined the probability of obtaining this device. Individual characteristics were not decisive factors in the probability of obtaining a glucometer, which were insteadrelated to type of diabetes and recommended treatment.

Effects of the Modified Linggui Zhugan Decoction(加味苓桂术甘汤) Combined with Short-term Very Low Calorie Diets on Glycemic Control in Newly Diagnosed Type 2 Diabetics

Objective:To evaluate the effects of the modified Linggui Zhugan Decoction(加味苓桂术甘汤) combined with short-term very low calorie diets(VLCDs) on glycemic control in newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods:A total of 20 subjects with newly diagnosed T2DM were treated with the modified Linggui Zhugan Decoction(one-month administration) combined with short-term VLCDs(5 days),and 3-months follow-up.A standard 75-g oral-glucose-tolerance test(OGTT) indexes fasting plasma glucose(FPG),post-prandial 0.5 h and 2 h plasma glucose(P0.5hPG,P2hPG),glycated hemoglobin A1C(GHbA1C),body weight,body mass index(BMI),insulin function,insulin resistance index,incidence of hypoglycemia,and the liver and renal functions were evaluated before and after treatment.Correlations of BMI with insulin function and insulin resistance were also assessed.Results:After the treatment,the patients' plasma glucose decreased steadily,FPG decreased from 5.8±0.9 mmol/L at pre-treatment to 5.0±0.6 mmol/L at 3-months follow-up(P<0.05),and P2hPG decreased from 11.7±3.8 mmol/L at pre-treatment to 6.9±0.9 mmol/L at 3-months follow-up(P<0.01).The level of GHbA1C declined from(6.47±1.24)% at pre-treatment to(6.14±0.99)% at 3-months follow-up(P<0.01).Body weight and BMI also declined significantly.Insulin resistance index was improved obviously and no event of hypoglycemia occurred.Part of the patients companied with fatty liver had a transient increase in hepatic transaminase during the treatment,but it turned to normal after the treatment.Conclusions:The modified Linggui Zhugan Decoction combined with short-term VLCDs can be safely implemented for steady glycemic control in newly diagnosed T2DM patients.

Characteristics of blood glucose excursions in type 2 diabetes mellitus patients with three different Traditional Chinese Medicine syndromes

OBJECTIVE:To explore the characteristics of blood glucose excursions of type 2 diabetes mellitus patients with three different Traditional Chinese Medicine(TCM) syndromes.METHODS:One hundred and nine patients with type 2 diabetes mellitus were recruited from the Department of Endocrinology and the Department of TCM of the Sixth People's Hospital affiliated to Shanghai Jiao Tong University.Subjects were divided into three groups according to TCM syndrome:intrinsic Damp(n- 42),Yin deficiency and internal Heat(n = 25),and Qi and Yin deficiency(n- 42).Subcutaneous interstitial glucose was monitored with a continuous glucose monitoring system for 3consecutive days to investigate the glycemic profile in each group.Plasma C-peptide levels were measured,and an arginine test was taken in 10 patients randomly selected from each group.Glucose data and glycemic variability were analyzed to investigate the differences among the groups.The change in C-peptide levels and the results from arginine trial were used to evaluate β cell function.RESULTS:Indicators reflecting blood glucose level were the highest in subjects with Yin deficiency and internal Heat syndrome,and parameters reflecting glycemic variability were the lowest in those with Qi and Yin deficiency syndrome.The change in C-peptide levels showed that subjects with Qi and Yin deficiency syndrome had the best βcell function among the three groups;this was confirmed by the arginine trial.CONCLUSION:Patients with Qi and Yin deficiency syndrome had a more stable blood glucose profile,as glycemic variability was higher in those with intrinsic Damp syndrome and those with Yin deficiency and internal Heat syndrome.

COMPARISON OF TWO-STEP DILATION VERSUS STEP BY STEP DILATION IN MINIMAL PERCUTANEOUS NEPHROLITHOTOMY

Objective To investigate minimizing dilation times of percutaneous nephrolithotomy （PCNL） in treating large renal stones. Methods A total of 105 consecutive patients undergoing minimal PCNL by using the two-step dilation protocol （ Group I ） and step by step dilation protocol （ Group 1I ） were reviewed. Two groups were compared in terms of stone size, dilating time, operation time, and blood loss. Results In all patients, the dilating of channel was finished and the success rate was 100%. The stone-free rate was 88. 7% （47/53） in Group [ and84.6% （44/52） in Group O . There were significant differences in the time of dilating and the blood loss in dilating channel （P = O. 000）. But there was no significant difference in the operation time of PCNL. Conclusion PCNL of the urinary calculi is safe in Chinese patients. Two-step dilation in PCNL has advantages of shorter dilating time and lower blood loss in different types of calculi during dilating.