Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have transformed diabetes management by targeting renal glucose reabsorption. Designed initially as antidiabetic agents, their ability to lower blood gluco...Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have transformed diabetes management by targeting renal glucose reabsorption. Designed initially as antidiabetic agents, their ability to lower blood glucose levels independently of insulin is well-documented. Beyond glycemic control, emerging research has unveiled their profound cardiorenal benefits. By inhibiting SGLT-2 protein, these drugs enhance glucose excretion in urine, reducing blood glucose levels. This mechanism has translated into significant cardiovascular and renal protection, establishing SGLT-2 inhibitors as pivotal in managing not only diabetes but also cardiovascular and renal diseases. Recent studies have illuminated the broader therapeutic potential of SGLT-2 inhibitors beyond diabetes. Evidence indicates their efficacy in managing heart failure, chronic kidney disease (CKD), and cardiovascular complications in individuals with or without diabetes. This expanded therapeutic landscape has catalyzed a paradigm shift in SGLT-2 inhibitor use, positioning them as key agents in the cardiorenal metabolic continuum. Moreover, their role in the secondary prevention of cardiovascular events and slowing CKD progression in T2DM patients has garnered considerable attention. This consensus-based review aims to offer practical guidance in an algorithmic approach to primary care healthcare professionals to optimize SGLT-2 inhibitors utilization and maximize their benefits. The review seeks to empower clinicians to effectively manage patients who may benefit from SGLT-2 inhibitor therapy by addressing common initiation barriers and optimizing treatment strategies. Additionally, it aims to raise awareness among primary care physicians regarding the multifaceted benefits of these medications and overcome clinical inertia in their adoption into routine clinical practice.展开更多
Background：Enhanced recovery after surgery （ERAS） protocols or fast-track （FT） programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery （MIS） is associated with a lesser tr...Background：Enhanced recovery after surgery （ERAS） protocols or fast-track （FT） programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery （MIS） is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods：We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares （SC） or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups：open gastrectomies （OG） with SC （OG ＋ SC group,n =167）;OG with FT programs （OG ＋ FT group,n =277）;laparoscopic gastrectomies （LG） with FT programs （LG ＋ FT group,n =248）;and robot-assisted gastrectomies （RG） with FT programs （RG ＋ FT group,n =292）.Patients＆#39; data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results：The OG ＋ SC group showed the longest postoperative hospital stay （mean：12.3 days,median：11 days,interquartile range [IQR]：6-16 days）,while OG ＋ FT,LG ＋ FT,and RG ＋ FT groups recovered faster （mean：7.4,6.4,and 6.6 days,median：6,6,and 6 days,IQR：3-9,4-8,and 3-9 days,respectively,all P 〈 0.001）.The postoperative rehabilitation parameters such as flatus time after surgery （4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days） followed the same manner.After 30 postoperative days＆#39; follow-up,the total incidence of complications was 9.6% in OG ＋ SC group,10.1% in OG ＋ FT group,8.1% in LG ＋ FT group,and 10.3% in RG ＋ FT group.The complications showed no significant differences between the four groups （all P 〉 0.05）.Conclusions：ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique.MIS further reduces postoperative hospital stay.It is safe and effective to apply ERAS protocols combined with MIS for gastric cancer.展开更多
文摘Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have transformed diabetes management by targeting renal glucose reabsorption. Designed initially as antidiabetic agents, their ability to lower blood glucose levels independently of insulin is well-documented. Beyond glycemic control, emerging research has unveiled their profound cardiorenal benefits. By inhibiting SGLT-2 protein, these drugs enhance glucose excretion in urine, reducing blood glucose levels. This mechanism has translated into significant cardiovascular and renal protection, establishing SGLT-2 inhibitors as pivotal in managing not only diabetes but also cardiovascular and renal diseases. Recent studies have illuminated the broader therapeutic potential of SGLT-2 inhibitors beyond diabetes. Evidence indicates their efficacy in managing heart failure, chronic kidney disease (CKD), and cardiovascular complications in individuals with or without diabetes. This expanded therapeutic landscape has catalyzed a paradigm shift in SGLT-2 inhibitor use, positioning them as key agents in the cardiorenal metabolic continuum. Moreover, their role in the secondary prevention of cardiovascular events and slowing CKD progression in T2DM patients has garnered considerable attention. This consensus-based review aims to offer practical guidance in an algorithmic approach to primary care healthcare professionals to optimize SGLT-2 inhibitors utilization and maximize their benefits. The review seeks to empower clinicians to effectively manage patients who may benefit from SGLT-2 inhibitor therapy by addressing common initiation barriers and optimizing treatment strategies. Additionally, it aims to raise awareness among primary care physicians regarding the multifaceted benefits of these medications and overcome clinical inertia in their adoption into routine clinical practice.
文摘Background：Enhanced recovery after surgery （ERAS） protocols or fast-track （FT） programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery （MIS） is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods：We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares （SC） or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups：open gastrectomies （OG） with SC （OG ＋ SC group,n =167）;OG with FT programs （OG ＋ FT group,n =277）;laparoscopic gastrectomies （LG） with FT programs （LG ＋ FT group,n =248）;and robot-assisted gastrectomies （RG） with FT programs （RG ＋ FT group,n =292）.Patients＆#39; data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results：The OG ＋ SC group showed the longest postoperative hospital stay （mean：12.3 days,median：11 days,interquartile range [IQR]：6-16 days）,while OG ＋ FT,LG ＋ FT,and RG ＋ FT groups recovered faster （mean：7.4,6.4,and 6.6 days,median：6,6,and 6 days,IQR：3-9,4-8,and 3-9 days,respectively,all P 〈 0.001）.The postoperative rehabilitation parameters such as flatus time after surgery （4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days） followed the same manner.After 30 postoperative days＆#39; follow-up,the total incidence of complications was 9.6% in OG ＋ SC group,10.1% in OG ＋ FT group,8.1% in LG ＋ FT group,and 10.3% in RG ＋ FT group.The complications showed no significant differences between the four groups （all P 〉 0.05）.Conclusions：ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique.MIS further reduces postoperative hospital stay.It is safe and effective to apply ERAS protocols combined with MIS for gastric cancer.
