BACKGROUND Transcutaneous oxygen pressure(TcpO2)is a precise method for determining oxygen perfusion in wounded tissues.The device uses either electrochemical or optical sensors.AIM To evaluate the usefulness of TcpO2...BACKGROUND Transcutaneous oxygen pressure(TcpO2)is a precise method for determining oxygen perfusion in wounded tissues.The device uses either electrochemical or optical sensors.AIM To evaluate the usefulness of TcpO2 measurements on free flaps(FFs)in diabetic foot ulcers(DFUs).METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh(ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.RESULTS Significant differences were observed in the ankle-brachial index;duration of diabetes;and haemoglobin,creatinine,and C-reactive protein levels between the two groups.TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained<30 mmHg and did not increase>50 mmHg.CONCLUSION Even if the flap is clinically stable,sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues,which is supported by the slow recovery of the sympathetic tone following FF.Therefore,TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.展开更多
OBJECTIVE: To evaluate the effects of qi-promoting and phlegm-resolving approach in treatment of diabetic microvascular complications. METHODOLOGY: Clinical observation of cases given modified Wen Dan Tang ([symbol: s...OBJECTIVE: To evaluate the effects of qi-promoting and phlegm-resolving approach in treatment of diabetic microvascular complications. METHODOLOGY: Clinical observation of cases given modified Wen Dan Tang ([symbol: see text] Gallbladder-warming Decoction). RESULT: Favorable results obtained in cases of diabetic microvascular complications of the type of stagnancy of qi and phlegm (diabetic retinopathy, diabetic nephropathy and diabetic foot). CONCLUSION: Wen Dan Tang is effective for diabetic microvascular complications of the type of stagnancy of qi and phlegm.展开更多
Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and u...Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.展开更多
Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the...Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the advent of new drugs, SUs are being relegated and denigrated by some authorities contrary to present recommendations by various organizations e.g. American Diabetes Association, European Association for the Study of Diabetes and International Diabetes Federation. In this article, the advantages of SUs over the new agents in terms of their well established and proven better efficacy as well as their short term and long term (over 50 years) safety based on extensive literature data are documented. Moreover, lower costs of SUs render them to be far more cost effective when compared to new agents and therefore make them affordable in many regions of the world. Additionally, SUs are probably the initial drugs of choice in lean subjects with prediabetes and type 2 diabetes because they are the most effective secretogogues and major pathophysiologic mechanism of altered glucose metabolism in lean subjects is the decline in insulin secretion and not rising insulin resistance. Furthermore, SUs are also the most cost effective 2nd line agents in obese subjects with type 2 diabetes on lapse of glycemic control while receiving metformin. Finally, with progression of the disorder, the most cost effective combination of 2 oral agents in conjunction with basal insulin remains to be metformin and SUs. Many studies have documented a significantly greater extra pancreatic effect of glimepiride in comparison to other SUs probably because of its unique property in enhancing insulin sensitivity in conjunction with its ability to stimulate both 1st and 2nd phase insulin secretion. These characteristics may contribute to its greater efficacy with lesser hypoglycemia when compared with other SUs. Lack of hypoglycemic effect of metabolites of glimepiride may also be responsible for lesser hypoglycaemia. Moreover, metabolism of glimepiride performed partially by the liver and partially by the kidneys may render it suitable and adaptable to be administered safely in subjects with hepatic or renal dysfunctional as well as elderly. Finally, the documentation of its pleiotropic effects in lowering of cardiovascular surrogate markers, improving thrombotic milleau by reducing platelet aggregation factors along with improvement in glycemic control and its preferential binding to SU receptors on the pancreatic beta cells rather than myocardium may be responsible for providing better cardiovascular outcomes in comparison to other SUS and thus make it a better choice amongst SUs in subjects with or without presence of cardiovascular disease. Additionally, once daily administration because of lasting efficacy for 24 hours based on its half life is likely to enhance compliance on the part of patients and assist in attaining and maintaining desirable glycemic control. Therefore, SUs still deserve to be major players in management of hyperglycemia in subjects with type 2 diabetes mellitus and glimepiride may be the best choice amongst SUs because of its long term record regarding efficacy and safety in diverge population of subjects with type 2 diabetes mellitus.展开更多
【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎...【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎患者的临床资料,计算手术前后PTS的变化值(△PTS),根据△PTS分为PTS减小组(△PTS<-2.5°,n=36)和PTS微减组(-2.5°≤△PTS<0°,n=42)及PTS增大组(△PTS≥0°,n=18)。所有患者术后均至少随访12个月,比较各组患者术后膝关节活动度(range of motion,ROM)、膝关节主动活动时所能达到的最大屈曲角度(max flexion degree,MFD)、膝关节协会临床评分(Knee Society Clinical Score,KSS-C)、膝关节协会功能评分(Knee Society Functional Score,KSS-F),并记录术后并发症的发生情况;采用Pearson相关性分析△PTS与术后ROM、MFD、KSS-C、KSS-F的相关性。【结果】PTS减小组患者术后ROM、MFD、KSS-C、KSS-F均高于PTS微减组及PTS增大组(P<0.05)。△PTS与ROM、MFD、KSS-C、KSS-F呈负相关(P<0.05)。各组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。【结论】对于老年糖尿病合并膝关节骨性关节炎患者,UKA术后PTS适当减小可显著改善患者膝关节功能,提高患者生活质量。展开更多
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 t...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.展开更多
基金the National Research Foundation of Korea Grant funded by the Korean government(MSIT)(2020R1A2C1100891 and 2021R1G1A1008337)the Soonchunhyang University Research Fund.
文摘BACKGROUND Transcutaneous oxygen pressure(TcpO2)is a precise method for determining oxygen perfusion in wounded tissues.The device uses either electrochemical or optical sensors.AIM To evaluate the usefulness of TcpO2 measurements on free flaps(FFs)in diabetic foot ulcers(DFUs).METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh(ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.RESULTS Significant differences were observed in the ankle-brachial index;duration of diabetes;and haemoglobin,creatinine,and C-reactive protein levels between the two groups.TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained<30 mmHg and did not increase>50 mmHg.CONCLUSION Even if the flap is clinically stable,sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues,which is supported by the slow recovery of the sympathetic tone following FF.Therefore,TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
文摘OBJECTIVE: To evaluate the effects of qi-promoting and phlegm-resolving approach in treatment of diabetic microvascular complications. METHODOLOGY: Clinical observation of cases given modified Wen Dan Tang ([symbol: see text] Gallbladder-warming Decoction). RESULT: Favorable results obtained in cases of diabetic microvascular complications of the type of stagnancy of qi and phlegm (diabetic retinopathy, diabetic nephropathy and diabetic foot). CONCLUSION: Wen Dan Tang is effective for diabetic microvascular complications of the type of stagnancy of qi and phlegm.
基金funded by Shanghai Municipal Commission of Health and Family Planning,Key Developing Disciplines(2015ZB0501)Project of Shanghai Science and Technology Commission(16411971300).
文摘Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.
文摘Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the advent of new drugs, SUs are being relegated and denigrated by some authorities contrary to present recommendations by various organizations e.g. American Diabetes Association, European Association for the Study of Diabetes and International Diabetes Federation. In this article, the advantages of SUs over the new agents in terms of their well established and proven better efficacy as well as their short term and long term (over 50 years) safety based on extensive literature data are documented. Moreover, lower costs of SUs render them to be far more cost effective when compared to new agents and therefore make them affordable in many regions of the world. Additionally, SUs are probably the initial drugs of choice in lean subjects with prediabetes and type 2 diabetes because they are the most effective secretogogues and major pathophysiologic mechanism of altered glucose metabolism in lean subjects is the decline in insulin secretion and not rising insulin resistance. Furthermore, SUs are also the most cost effective 2nd line agents in obese subjects with type 2 diabetes on lapse of glycemic control while receiving metformin. Finally, with progression of the disorder, the most cost effective combination of 2 oral agents in conjunction with basal insulin remains to be metformin and SUs. Many studies have documented a significantly greater extra pancreatic effect of glimepiride in comparison to other SUs probably because of its unique property in enhancing insulin sensitivity in conjunction with its ability to stimulate both 1st and 2nd phase insulin secretion. These characteristics may contribute to its greater efficacy with lesser hypoglycemia when compared with other SUs. Lack of hypoglycemic effect of metabolites of glimepiride may also be responsible for lesser hypoglycaemia. Moreover, metabolism of glimepiride performed partially by the liver and partially by the kidneys may render it suitable and adaptable to be administered safely in subjects with hepatic or renal dysfunctional as well as elderly. Finally, the documentation of its pleiotropic effects in lowering of cardiovascular surrogate markers, improving thrombotic milleau by reducing platelet aggregation factors along with improvement in glycemic control and its preferential binding to SU receptors on the pancreatic beta cells rather than myocardium may be responsible for providing better cardiovascular outcomes in comparison to other SUS and thus make it a better choice amongst SUs in subjects with or without presence of cardiovascular disease. Additionally, once daily administration because of lasting efficacy for 24 hours based on its half life is likely to enhance compliance on the part of patients and assist in attaining and maintaining desirable glycemic control. Therefore, SUs still deserve to be major players in management of hyperglycemia in subjects with type 2 diabetes mellitus and glimepiride may be the best choice amongst SUs because of its long term record regarding efficacy and safety in diverge population of subjects with type 2 diabetes mellitus.
文摘【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎患者的临床资料,计算手术前后PTS的变化值(△PTS),根据△PTS分为PTS减小组(△PTS<-2.5°,n=36)和PTS微减组(-2.5°≤△PTS<0°,n=42)及PTS增大组(△PTS≥0°,n=18)。所有患者术后均至少随访12个月,比较各组患者术后膝关节活动度(range of motion,ROM)、膝关节主动活动时所能达到的最大屈曲角度(max flexion degree,MFD)、膝关节协会临床评分(Knee Society Clinical Score,KSS-C)、膝关节协会功能评分(Knee Society Functional Score,KSS-F),并记录术后并发症的发生情况;采用Pearson相关性分析△PTS与术后ROM、MFD、KSS-C、KSS-F的相关性。【结果】PTS减小组患者术后ROM、MFD、KSS-C、KSS-F均高于PTS微减组及PTS增大组(P<0.05)。△PTS与ROM、MFD、KSS-C、KSS-F呈负相关(P<0.05)。各组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。【结论】对于老年糖尿病合并膝关节骨性关节炎患者,UKA术后PTS适当减小可显著改善患者膝关节功能,提高患者生活质量。
文摘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.
