糖尿病性视网膜病变综合治疗的策略

糖尿病性视网膜病变（diabetic retinopathy,DRP）是糖尿病的常见并发症,其发病率和致盲率呈逐年上升趋势。半个多世纪以来,已经认识到DRP各种治疗手段都有一定的优势和局限性,单纯依靠一种治疗方法难以取得理想效果。因此,多种手段相结合的综合治疗措施成为糖尿病视网膜病变的一种科学合理的治疗模式。     

中国糖尿病教育者的重任

糖尿病教育是一种治疗性的干预措施,也是一项有计划的教育课程,糖尿病教育者是糖尿病管理队伍中的一个整合部分,一名专业糖尿病教育工作者对于促进糖尿病医疗护理、实践及服务等方面都将起到很大的贡献,其中,糖尿病专科护士扮演着重要角色.要促进我国糖尿病教育的快速发展,急需一支专业化的糖尿病教育者队伍来发挥主力军的作用.     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的剂量。结果,有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明,糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血,取得了不错的疗效,也证实糖尿病眼底病变是一种血管炎,与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿病,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在。为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红素升高,而也有一部分患者总胆红素不升高。     

中国糖尿病教育者的重任

糖尿病教育是一种治疗性的干预措施,也是一项有计划的教育课程,糖尿病教育者是糖尿病管理队伍中的一个整合部分,一名专业糖尿病教育工作者对于促进糖尿病医疗护理、实践及服务等方面都将起到很大的贡献,其中,糖尿病专科护士扮演着重要角色。要促进我国糖尿病教育的快速发展,急需一支专业化的糖尿病教育者队伍来发挥主力军的作用。     

糖尿病性视网膜病变综合治疗的策略

糖尿病性视网膜病变(diabetic retinopathy,DRP)是糖尿病的常见并发症,其发病率和致盲率呈逐年上升趋势.半个多世纪以来,已经认识到DRP各种治疗手段都有一定的优势和局限性,单纯依靠一种治疗方法难以取得理想效果.因此,多种手段相结合的综合治疗措施成为糖尿病视网膜病变的一种科学合理的治疗模式.     

关于胰岛移植治疗1型糖尿病的思考

糖尿病是一种严重影响人类健康的疾病,胰岛移植作为一项新兴技术,对于1型糖尿病而言是一种很有前景的治疗方法.通过总结和回顾该疗法的产生原因、研究现状及发展方向,揭示了认识论和系统论这些哲学基本原理在此过程中的指导作用,并以此为例阐述临床辩证思维对临床医学的促进作用.     

重视发挥糖尿病专科护士在糖尿病及其并发症防治中的作用

1 糖尿病教育是糖尿病及其并发症防治的基础 糖尿病是终身性的疾病,又是可控制、可预防的疾病.糖尿病致死致残的主要原因是糖尿病的各种并发症,而并发症的降低有赖于血糖的良好控制[1].UKPDS和DPP证明:血糖控制不良,可引起并发症提前出现,导致残疾和死亡.减少糖尿病并发症的发生、发展不仅是降低糖尿病病死率和致残率的关键,也是降低社会和糖尿病患者经济负担的关键,而最有效的推进糖尿病预防和治疗的方法是普及糖尿病知识即糖尿病教育[2].被称为美国糖尿病教育先驱的Dr Joslin就提出:"糖尿病教育不仅是治疗的一部分,它本身就是一种治疗".因此,对患者进行有效地糖尿病教育是必要的,也是其他治疗手段的基础.     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间.即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理.我们则采用小剂量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的荆量.结果,有部分患者完全摆脱了胰岛素.我们对糖尿病的再认识是建立在对多脏器活检的基础之上.我们的活检结果表明,糖尿病肾病存在着免疫损伤.糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果.我们尝试用小剂量的免疫抑制剂环孢茵素A(25 mg bid)治疗糖尿病眼底出血,取得了不错的疗效,也证实糖屎病眼底病变是一种血管炎,与自身免疫痛变有关.其他的器官还包括垂体、大脑的血管、糖尿痛足、冠心痛、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿痛,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积.这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在.为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病.应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效.唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红索升高,而也有一部分患者总胆红素不升高.     

导言:非内分泌科糖尿病患者的血糖管理

<正>糖尿病是一种严重危害人类健康的全身代谢性疾病。随着人民生活水平提高,糖尿病患病率呈逐年上升的趋势,2000年全球糖尿病患病率为2.8%,预计2030年将增至4.4%。到2025年全世界糖尿病患者将达到3亿,其中发展中国家为2.3亿,目前中国糖尿病患者达4千万之多,仅次于印度,居世界第2位。越来越多的糖尿病患者伴发其他疾病,如心脑     

社会及心理因素对胰岛素应用的影响

社会及心理因素对胰岛素应用的影响新疆石河子医学院第一附属医院内科（８３２００８）常向云目前,国际上推崇生物、心理、社会整体论和多因素综合观点解释糖尿病,并提出糖尿病是一种心身疾病。本文主要从社会心理因素对胰岛素应用的影响加以论述。第一,从糖尿病患者来...     

焦虑障碍的认知偏向矫正：应用与争议

认知偏向是焦虑障碍患者的重要认知特征, 是指患者或高焦虑个体对负性或威胁性信息存在认知加工方面的偏向。目前该领域的研究聚焦于注意偏向和解释偏向。近年来, 研究者致力于将认知偏向的矫正应用于焦虑障碍患者的临床治疗, 得到了不一致的结果。本文总结了将认知偏向矫正应用于临床实践的不同方式, 并从主观报告的疗效证据、行为及生理指标的疗效证据, 以及未发现疗效证据的研究三方面回顾了近年来的研究成果。对于结果的高度不一致, 本文从期望效应、干预对象、因变量和其它参数等方面探讨了可能的原因, 并讨论了未来可能的研究方向。     

西方心理学对禅定的功效研究

禅定是一种精神训练的方法。近年来,禅定越来越成为西方心理学中的热点课题,尤其是对禅定的功效研究。本文总结了近十年西方心理学对于禅定功效的研究成果。认为西方心理学对于禅定的功效研究,主要集中于对其心理功效、生理功效,以及临床功效的检验。大量的研究表明,禅定是一种有意义的科学现象,而不仅是一种简单的宗教现象。禅定在西方心理学的未来发展中将会占据越来越重要的位置,并成为心理治疗领域的未来发展趋势。     

The being a patient effect: negative expectations based on group labeling and corresponding treatment affect patient performance

Patient studies provide insights into mechanisms underlying diseases and thus represent a cornerstone of clinical research. In this study, we report evidence that differences between patients and controls might partly be based on expectations generated by the patients’ knowledge of being invited and treated as a patient: the Being a Patient effect (BP effect). This finding extends previous neuropsychological reports on diagnosis threat. Participants with mild allergies were addressed either as patients or control subjects in a clinical study. We measured the impact of this group labeling and corresponding instructions on pain perception and cognitive performance. Our results provide evidence that the BP effect can indeed affect physiological and cognitive measures in clinical settings. Importantly, these effects can lead to systematic overestimation of genuine disease effects and should be taken into account when disease effects are investigated. Finally, we propose strategies to avoid or minimize this critical confound.     

Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a “trial effect,” however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure—the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research—may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this “infrastructure effect” can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.     

Influence of clinical status in the relationship between alexithymia and emotional recognition: a dimensional study

The results of this study are part of an investigation to determine whether the cognitive-emotional process of emotional recognition is deficient as a function of the clinical condition and alexithymia in subjects with somatization. This investigation applied the self-assessment of emotion and used a procedure that minimizes the use of verbal skills and verbal comprehension. The specific goal of this study was to verify whether there were differences in the covariation between alexithymia and self-evaluation of the emotional reaction in clinical and nonclinical subjects. The results of this study highlight the significant differences between clinical and control subjects. There were inverse significant correlations with the affective valence in clinical subjects, whereas in the ratings of the TAS-20 in control subjects, there were direct correlations with activation. In the conclusions, we discuss whether the variability of the results of previous research of the relationship between alexithymia and emotional recognition is a characteristic feature of this relationship or an effect of the different sampling and procedures utilized.     

临床医生应具有很高的哲学修养

人体的复杂性和人命关天的特殊性决定了临床工作具有持久的挑战性.无论是病因的诊断,治疗方案的选择,还是治疗效果的判断都给临床医生的哲学思维提出很高的要求.因此,临床医生不仅要注重积累自己的专业知识和临床经验,而且要努力提高自己的哲学修养.     

中西医结合治疗儿童过敏性紫癜和预防相关肾损害的临床研究

过敏性紫癜是儿童常见的免疫系统疾病。西医治疗过敏性紫癜已形成常规模式,并有一定疗效,但也有一定局限性。本病易反复,易损伤肾脏,严重时可导致紫癜性肾炎。本文拟研究中西医结合方法治疗过敏性紫癜及预防肾脏损伤的临床效果。研究表明,中西医结合治疗该病存在一定优势,能有效治疗过敏性紫癜,并降低肾脏损害及紫癜性肾炎的发生率。但应看到本研究结论主要是通过临床经验取得,样本量小,未进行远期随访,缺乏系统深层次实验室论证,还有待进一步研究。     

Distraction for Pediatric Immunization Pain: A Critical Review

The paper provides a critical review of distraction for pediatric immunizations in order to determine clinical practicality and efficacy of this commonly employed intervention. The MEDLINE and PsycINFO databases were searched to identify papers that included an evaluation of a distraction intervention as a method of pediatric immunization pain management. Fifteen papers were included in this review. Effect sizes were calculated to estimate the clinical significance of findings. In order to examine possible differences in effect sizes related to distraction characteristics, chi square analyses were conducted. Results indicate that distraction is clinically effective in the reduction of pain during pediatric immunizations. Support is found for behavioral and cognitive explanations of distraction mechanisms. Further, various distraction stimulus characteristics were found to be associated with the clinical significance of findings. This article is based on the preliminary examination paper of the first author under the direction of the second, at West Virginia University.     

Learning and memory in conditioned fear extinction: effects of D-cycloserine

This review addresses the effects of the cognitive enhancer D-cycloserine (DCS) on the memory processes that occur in conditioned fear extinction, which is the experimental model for exposure techniques to reduce clinical anxiety. All reported rat studies show an enhanced fear extinction effect when DCS is administered acutely before or shortly after extinction training. DCS also promotes the generalization of this fear extinction effect. In addition, DCS reduces some forms of relapse (reduced reinstatement, reduced spontaneous recovery), but not others (contextual renewal, rapid reacquisition). It is argued that this pattern of results is best explained by assuming that DCS promotes extinction learning to the background context, resulting in enhanced contextual inhibition. Four human studies have produced mixed results, but some methodological issues complicate the reported failures. It is concluded that DCS is a promising tool as an adjunct to extinction techniques in exposure treatment, but that more pre-clinical and clinical research is needed to fully characterize its behavioral consequences.     

Social Support,Economic Hardship and Psychological Distress in Spanish and Portuguese At-Risk Families

Individuals with low socioeconomic status generally have worse mental health outcomes than their wealthier counterparts; a tendency that is exacerbated during financial crises. However, social support might buffer the effects of stress on mental health. In this study, we tested whether social support mitigated the effects of economic hardship on psychological distress on an at-risk sample from two of the European countries most affected by the 2008 economic downturn: Spain and Portugal. Participants were 249 caregivers enrolled in Child Welfare Services (73.0% women). Results showed that economic hardship and a negative indicator of social support (network dysfunctionality) were significant predictors of belonging to the psychological distress clinical group (OR: 2.35 and 1.80, respectively). However, no significant interaction effects were observed, thereby refuting the buffering effect hypothesis. When we conducted an in depth analysis of the clinical group, a significant moderation effect emerged. Our results suggest that, for at-risk populations, the detrimental effects of dysfunctional networks on mental health can outweigh the benefits of positive assistance and that social support is a potential stress buffer only for individuals in the clinical spectrum. These findings indicate that the protective effect of social support during circumstances of intense economic adversity is limited.