溃疡微环境稳态失衡与糖尿病足

糖尿病足是糖尿病常见并发症之一,是一个临床难治病,其病机复杂,病情缠绵难愈.基于以往认识基础上,本文侧重于对糖尿病足溃疡局部病理特点作一回顾性分析,了解溃疡局部因素在糖尿病足形成和发展中的作用.可能在理论上对既往认识糖尿病足血管病变、神经病变和感染三大影响因素基础上作一定延伸.由此引入的新疗法可能成为现行治疗糖尿痛足必要的补充.     

糖尿病足诊疗与预防进展

糖尿病足是糖尿病的严重并发症,血管狭窄闭塞、神经病变和感染是主要的临床表现,本文主要从糖尿病足的定义、病因、病理生理、临床表现、检测方法、分级及治疗和预防进展方面进行总结。糖尿病足的诊治是个系统工程,单一的方法难以治愈,且治疗效果欠佳,故我们在临床上以预防为主,早期诊断,早期治疗。     

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。     

胱抑素C水平与糖尿病足病病变发展的临床研究

为了探讨糖尿病足病(DF)患者胱抑素C(CYS-C)水平与病变发展的关系,对2型糖尿病(T2DM)、T2DM合并DF患者实验室指标进行回顾性研究,并用Logistic多元回归分析影响DF发展的危险因素。结果显示,DF较轻组、DF较重组与T2DM组相比,HDL-C、CYS-C、FIB的差异均有统计学意义,DF较重组与其余组比较UACR明显升高,差异且亦有显著性;Logistic多元回归分析结果显示CYS-C、FIB是DF病程进展的危险因素,CYS-C与FIB、UACR呈正相关,与HDL-C呈负相关。因此,T2DM中CYS-C是DF病程进展的独立危险因素,CYS-C水平的变化对DF病变发展及诊治具有一定的指导意义。     

健康教育及分层管理在糖尿病足病防治中的作用——3年随访观察

为探讨早期糖尿病足病健康教育及分层管理措施对糖尿病患者足病的防治作用,对初诊糖尿病患者进行了足部风险评估,分为正常、低危、中危、高危不同程度糖尿病足病风险人群,然后对不同风险人群组实施系统性、长期性兼个体化的糖尿病足病防治健康教育和分层管理3年.研究发现,糖尿病足病发生发展状况明显改善,与糖尿病足病相关的溃疡复发率相对风险降低52.30％,再住院率相对风险降低43.28％,溃疡发生率降低61.99％.因此,早期糖尿病足病健康教育和分层管理的防治策略可提高患者对足部的自我管理和护理能力,对糖尿病足病的发生发展起到了有效的防治作用.     

健康教育及分层管理在糖尿病足病防治中的作用——3年随访观察

为探讨早期糖尿病足病健康教育及分层管理措施对糖尿病患者足病的防治作用,对初诊糖尿病患者进行了足部风险评估,分为正常、低危、中危、高危不同程度糖尿病足病风险人群,然后对不同风险人群组实施系统性、长期性兼个体化的糖尿病足病防治健康教育和分层管理3年.研究发现,糖尿病足病发生发展状况明显改善,与糖尿病足病相关的溃疡复发率相对风险降低52.30％,再住院率相对风险降低43.28％,溃疡发生率降低61.99％.因此,早期糖尿病足病健康教育和分层管理的防治策略可提高患者对足部的自我管理和护理能力,对糖尿病足病的发生发展起到了有效的防治作用.     

系统论方法在糖尿病性视网膜病变危险因素及治疗研究中的应用

全球糖尿病患者人数在不断的增多,大约10％的Ⅰ型糖尿病患者在10年后可出现糖尿病性视网膜病变,而大约95％的Ⅱ型糖尿病患者在20年后可出现糖尿病性视网膜病变。目前,糖尿病性视网膜病的发病机制尚不明确,影响其发生发展的因素也很复杂,因此,对糖尿病性视网膜病的发病危险因素及其诊治的研究,具有相当重要的意义。系统论,研究各种物质运动形态所共有的系统联系和关系,具有普遍的方法论意义,为现代医学的进步提供了全新的思维方式和科学方法论原则。本文试用系统论的整体性、优化原理阐述糖尿病性视网膜病变发病的危险因素与治疗进展,为对其深入研究提供方法论依据。     

系统论方法在糖尿病性视网膜病变危险因素及治疗研究中的应用

全球糖尿病患者人数在不断的增多,大约10%的Ⅰ型糖尿病患者在10年后可出现糖尿病性视网膜病变,而大约95%的Ⅱ型糖尿病患者在20年后可出现糖尿病性视网膜病变.目前,糖尿病性视网膜病的发病机制尚不明确,影响其发生发展的因素也很复杂.因此,对糖尿病性视网膜病的发病危险因素及其诊治的研究,具有相当重要的意义.系统论,研究各种物质运动形态所共有的系统联系和关系,具有普遍的方法论意义,为现代医学的进步提供了全新的思维方式和科学方法论原则.本文试用系统论的整体性、优化原理阐述糖尿病性视网膜病变发病的危险因素与治疗进展,为对其深人研究提供方法论依据.     

治疗糖尿病创新药物研究

本论文从治疗2型糖尿病药物应用现状出发,通过对2型糖尿病病理的认识,新发现的主要受体和相关药靶等方面进行分析。指出随着对糖尿病认识的深入发展,治疗糖尿病创新药物研究的发展趋势也发生了相应的变化,就是从局部治疗到全身综合考虑,从药物外部直接地干预到增强自身调节功能。为治疗2-型糖尿病药物发展指明了方向。     

基于利益相关者视角的糖尿病视网膜监测服务探析

糖尿病性致盲已成为成年人首要致盲因素之一,通过早期糖尿病视网膜监测和系统治疗可以有效地降低糖尿病视网膜病变发生的几率,因此有效的监测手段对于科学规范管理糖尿病是十分有必要的。由于血糖的正常值和糖代谢异常的诊断切点主要依据血糖值与糖尿病视网膜病变和糖尿病发生风险的关系来确定,因此糖尿病视网膜监测可能会更加精确地监测糖尿病的变化。本文应用利益相关者分析对糖尿病视网膜监测服务开展过程中涉及的各主体利益及存在问题进行探讨,为进一步有效管理糖尿病提供相关建议。     

Foot and shoe responsible for majority of soft tissue work in early stance of walking

Soft tissues located throughout the human body are known to perform substantial mechanical work through wobbling and deforming, particularly following foot impacts with the ground. Yet, it is not known which specific tissues in the body are responsible for the majority of the soft tissue work. The purpose of this study was to quantify how much of the soft tissue work after foot contact was due to the foot and shoe, vs. from tissues elsewhere in the body, and how this distribution of work changed with walking speed and slope. We collected ground reaction forces and whole-body kinematics while ten subjects walked at five speeds (0.8–1.6 m/s) and on seven different slopes (9 degrees downhill to 9 degrees uphill). Using a previously-published Energy-Accounting analysis, we found that the majority of the soft tissue work during early stance was due to deformation of the foot and shoe. The percentage of work did not vary significantly with speed but did vary significantly with slope. The foot and shoe were responsible for ∼60–70% of the soft tissue work during level and uphill walking, and 80–90% during downhill walking.     

The Impact of Religious Connectedness on Health-Related Quality of Life in Patients with Diabetic Foot Ulcers

Religious connectedness is common phenomenon in Saudi Arabia and adjacent Gulf countries. An observational case control study was designed, enrolling 180 adult patients to report the association between religious connectedness and health-related quality of life (HRQL) in people with and without diabetes and foot ulcers. Sixty diabetic patients with foot ulcers (Group I) were compared with sixty diabetic patients without foot ulcer (Group II) and sixty healthy subjects (Group III) for assessment of their HRQL by using SF-36 questionnaire. The effect of religious connectedness was assessed using intrinsic/extrinsic religious connectedness scale. HRQL was found to be significantly lower in Group I compared with Group II and III as well as in group II compared with group III (P < 0.001). Group I patients showed a poorer HRQL with increased severity, duration and multiplicity of foot ulcers. There was a strong positive relationship between religious connectedness and HRQL as indicated by a positive correlation between religious connectedness scale and mental, physical component summary scores (r = 0.66 and 0.59 respectively and P < 0.001). While quality of life is generally poor in people with diabetic foot ulcers, there exists a strong positive relationship between religious connectedness and higher HRQL. These findings may have implications on improving outcomes.     

Hand–foot motor priming in the presence of temporary inability to use hands

To verify if the link between observed hand actions and executed foot actions found in aplasics is essentially induced by the constant use of foot substituting the hand, we investigated if the vision of a grasping hand is able to prime a foot response in normals. Participants were required to detect the time-to-contact of a hand grasping an object either with a suitable or a less suitable movement, an experimental paradigm known to induce a priming effect. Participants responded either with the hand or the foot, while having free or bound hands. Results showed that for hand responses motor priming effect was stronger when the hands were free, whereas for foot responses it was stronger when the hands were bound. These data are interpreted as a further evidence that a difficulty to move affects specific cognitive functions and that the vision of a grasping hand may prime a foot response.     

Hand-foot motor priming in the presence of temporary inability to use hands

To verify if the link between observed hand actions and executed foot actions found in aplasics is essentially induced by the constant use of foot substituting the hand, we investigated if the vision of a grasping hand is able to prime a foot response in normals. Participants were required to detect the time-to-contact of a hand grasping an object either with a suitable or a less suitable movement, an experimental paradigm known to induce a priming effect. Participants responded either with the hand or the foot, while having free or bound hands. Results showed that for hand responses motor priming effect was stronger when the hands were free, whereas for foot responses it was stronger when the hands were bound. These data are interpreted as a further evidence that a difficulty to move affects specific cognitive functions and that the vision of a grasping hand may prime a foot response.     

情绪性记忆的定向遗忘效应

刺激的情绪性具有增强记忆的效果,那么,带有情绪信息的刺激对遗忘又会产生怎样的影响？已有研究从行为及认知神经机制层面探讨了情绪性刺激对定向遗忘效应的影响,但结果并不一致。总结已有文献发现,以情绪性刺激的材料类型、情绪效价、唤醒度和熟悉度为主的客观因素和以被试的情绪状态为主的主观因素均为影响定向遗忘效应产生及其稳定性的重要原因。这类研究是对有意遗忘研究领域的重要补充,也加深了人们对有意遗忘机制的理解。     

Neurotoxic lesion of the rostral perirhinal cortex blocks stress-induced exploratory behavioral changes in male rats

Exposure to stress leads to adaptive responses including both behavioral and physiological changes. This process is induced by the activation of multiple brain regions. The present study examined the role of the rostral perirhinal cortex (rPRh) in behavioral changes following electrical foot shock-induced stress. The rPRh of rats was lesioned bilaterally by local microinjections of 10 microg N-methyl-D-aspartic acid (NMDA) before foot shocks (0.7 mA, 1 s). The effects of these lesions on foot shock-induced changes in exploratory behaviors were tested in the open field (4 h, 48 h, 72 h, and 14 days after foot shocks) and the light-dark box (7 days after foot shocks). Foot-shocked and sham-lesioned rats showed several well known behavioral changes in the open field (e.g., immobility, reduction of exploratory activity) most marked at 48 h after foot shocks, and the light-dark box (e.g., reduction of time spent and activity in the lit compartment). All these stress-induced behavioral changes were blocked by neurotoxic lesions of the rPRh. Furthermore, rPRh lesions did not affect behavior in the open field and the light-dark box in unstressed rats. Taken together, these data indicate that the rPRh is involved in neurophysiological mechanisms that mediate changes induced by foot-shock stress in exploratory behaviors which indicate unconditioned fear or anxiety.     

Intentionally remembering or forgetting own- and other-race faces: Evidence from directed forgetting

People are better at remembering faces of their own relative to another ethnic group. This so-called own-race bias (ORB) has been explained in terms of differential perceptual expertise for own- and other-race faces or, alternatively, as resulting from socio-cognitive factors. To test predictions derived from the latter account, we examined item-method directed forgetting (DF), a paradigm sensitive to an intentional modulation of memory, for faces belonging to different ethnic and social groups. In a series of five experiments, participants during learning received cues following each face to either remember or forget the item, but at test were required to recognize all items irrespective of instruction. In Experiments 1 and 5, Caucasian participants showed DF for own-race faces only while, in Experiment 2, East Asian participants with considerable expertise for Caucasian faces demonstrated DF for own- and other-race faces. Experiments 3 and 4 found clear DF for social in- and outgroup faces. These results suggest that a modulation of face memory by motivational processes is limited to faces with which we have acquired perceptual expertise. Thus, motivation alone is not sufficient to modulate memory for other-race faces and cannot fully explain the ORB.