Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel

Background and objectiveThe aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture.MethodsThe study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories).ResultsOut of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%).ConclusionsPatients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.     

Animal models of diabetic retinopathy: doors to investigate pathogenesis and potential therapeutics

Effective and validated animal models are valuable to investigate the pathogenesis and potential therapeutics for human diseases. There is much concern for diabetic retinopathy (DR) in that it affects substantial number of working population all around the world, resulting in visual deterioration and social deprivation. In this review, we discuss animal models of DR based on different species of animals from zebrafish to monkeys and prerequisites for animal models. Despite criticisms on imprudent use of laboratory animals, we hope that animal models of DR will be appropriately utilized to deepen our understanding on the pathogenesis of DR and to support our struggle to find novel therapeutics against catastrophic visual loss from DR.     

Synthesis,anti-diabetic evaluation and molecular docking studies of 4-(1-aryl-1H-1, 2, 3-triazol-4-yl)-1,4-dihydropyridine derivatives as novel 11-β hydroxysteroid dehydrogenase-1 (11β-HSD1) inhibitors

11-Beta-Hydroxysteroid dehydrogenase-1(11β-HSD1) inhibitors are one of the emerging classes of molecules to fight against diabetic complications. A novel series of 4-(1-substituted-1H-1,2,3-triazol-4-yl)-1,4-dihydropyridine derivatives were synthesized and evaluated for their anti-diabetic activity. Two compounds showed anti-diabetic activity very effectively. To clarify the mechanism of action of these compounds, the most potent compounds (5g and 5h) of the synthesized analogs were further studied by testing its 11-Beta Hydroxysteroid dehydrogenase-1 inhibitory activity through in vitro enzymatic experiments. The results showed that the 11β-HSD1 inhibitory activity of compounds 5g and 5h was stable and efficient. Molecular docking studies revealed compounds 5g (−9.758) and 5h (−8.495) to have a stable binding patterns to the human 11-Beta-Hydroxysteroid dehydrogenase-1.     

Cutaneous trichosporosis

Of 269 patients with cutaneous trichosporosis a majority of 170 (63.2%) showed the infection as intertrigo in the genitocrural and perianal areas. The predominant symptoms were itching and burning. Trichosporosis has been found to be less common in the other sites. Trichosporosis due to Trichosporon beigelii should be kept in mind as one of the differential diagnosis in cases of genitocrural intertrigo and other cutaneous infections by fungi and bacteria in the tropics.     

Influence of surface anesthesia on the pressure pain threshold measured with different-sized probes

Transcutaneous pressure with pressure probes of arbitrary diameters have been commonly used for measuring the threshold and magnitude of muscle pain, yet this procedure lacks scientific validation. To examine the valid probe dimensions, we conducted physiological experiments using 34 human subjects. Pin-prick pain, pressure pain threshold (PPT) to pressure probes of various diameters, heat pain threshold, and electrical pain threshold of deep tissues were measured before and after application of surface lidocaine anesthesia to the skin surface over the brachioradial muscle in a double-blinded manner. The anesthesia neither affected PPT with larger probes (diameters: 1.6 and 15?mm) nor increased electric pain threshold of deep structures, whereas it diminished pain count in pin-prick test and PPT with a 1.0?mm diameter probe, suggesting that mechanical pain thresholds measured with 1.6 and 15?mm probes reflect the pain threshold of deep tissues, possibly muscle. Pain thresholds to heat did not change after application of the anesthesia. These results suggest that larger pressure probes can give a better estimation of muscular pain threshold.     

口服降糖药和胰岛素对不同临床分期糖尿病视网膜病变病情进程的影响

目的:探讨降糖药物和胰岛素控制血糖对不同临床分期糖尿病视网膜病变进程的影响。方法:收集糖尿病伴有视网膜病变的患者78例。采用随机表法,将糖尿病视网膜病变患者分为药物控制血糖组和胰岛素控制组,药物治疗组38例,胰岛素治疗组40例,使血糖达到控制标准。评价干预前后患者血清C肽、糖化血红蛋白、胰岛素抵抗指数,以及糖尿病视网膜病变分级。结果:药物控制组治疗前后2 h CP、以及糖化血红蛋白测定差异无统计学意义(p0.05)。胰岛素组治疗前后,血清空腹C肽、2 h CP差异有统计学意义(p0.05);而糖化血红蛋白、胰岛素抵抗指数差异无统计学意义(p0.05)。药物组治疗前Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期、Ⅴ期、Ⅵ期病例数和治疗后相比,差异有统计学意义(p0.05),视网膜病变分级程度明显增高。胰岛素组治疗前Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期、Ⅴ期、Ⅵ期病例数和治疗后相比,差异有统计学意义(p0.05)。药物组和胰岛素组间视网膜病变分级差异无统计学意义(p0.05);治疗后差异有统计学意义(p0.05)。结论:胰岛素能够提高糖尿病患者血清C肽,降低胰岛素抵抗,和药物控制血糖相比,能够延缓糖尿病视网膜病变的进展。     

Monoamine oxidase-A is an important source of oxidative stress and promotes cardiac dysfunction,apoptosis, and fibrosis in diabetic cardiomyopathy

Oxidative stress is closely associated with the pathophysiology of diabetic cardiomyopathy (DCM). The mitochondrial flavoenzyme monoamine oxidase A (MAO-A) is an important source of oxidative stress in the myocardium. We sought to determine whether MAO-A plays a major role in modulating DCM. Diabetes was induced in Wistar rats by single intraperitoneal injection of streptozotocin (STZ). To investigate the role of MAO-A in the development of pathophysiological features of DCM, hyperglycemic and age-matched control rats were treated with or without the MAO-A-specific inhibitor clorgyline (CLG) at 1 mg/kg/day for 8 weeks. Diabetes upregulated MAO-A activity; elevated markers of oxidative stress such as cardiac lipid peroxidation, superoxide dismutase activity, and UCP3 protein expression; enhanced apoptotic cell death; and increased fibrosis. All these parameters were significantly attenuated by CLG treatment. In addition, treatment with CLG substantially prevented diabetes-induced cardiac contractile dysfunction as evidenced by decreased QRS, QT, and corrected QT intervals, measured by ECG, and LV systolic and LV end-diastolic pressure measured by microtip pressure transducer. These beneficial effects of CLG were seen despite the persistent hyperglycemic and hyperlipidemic environments in STZ-induced experimental diabetes. In summary, this study provides strong evidence that MAO-A is an important source of oxidative stress in the heart and that MAO-A-derived reactive oxygen species contribute to DCM.     

前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响

目的:分析前列地尔联合益肾化湿颗粒对糖尿病肾病患者血糖、血脂、肾功能以及尿足细胞相关蛋白的影响。方法:98例糖尿病肾病患者按抽签法分为对照组与实验组,各49例,对照组予以前列地尔治疗,实验组基于对照组加用益肾化湿颗粒治疗,比较两组疗效,糖化血红蛋白(Hb A1c)、血糖(FPG)、餐后2 h血糖低(2h PG),甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),血尿素氮(BUN)、肌酐(Cr)、β2微球蛋白(β2-MG)、胱抑素(Cys-C),尿足细胞标志蛋白(PCX)nephrin,安全性。结果:实验组总有效率高于对照组(P0.05)。治疗后,两组Hb Alc、FPG、2h PG比较无差异(P0.05)。实验组TG、TC、LDL-C、BUN、Cr、β2-MG、Cys-c、PCX、尿nephrin/尿Cr低于对照组(P0.05)。实验组HDL-C高于对照组(P0.05)。结论:前列地尔联合益肾化湿颗粒治疗对糖尿病肾病的疗效确切,可利于血糖、血脂、肾功能的改善,降低尿足细胞相关蛋白的浓度。     

Adenosine mediates transforming growth factor-beta 1 release in kidney glomeruli of diabetic rats

Up regulation of the transforming growth factor-beta 1 (TGF-β1) axis has been recognized as a pathogenic event for progression of glomerulosclerosis in diabetic nephropathy. We demonstrate that glomeruli isolated from diabetic rats accumulate up to sixfold more extracellular adenosine than normal rats. Both decreased nucleoside uptake activity by the equilibrative nucleoside transporter 1 and increased AMP hydrolysis contribute to raise extracellular adenosine. Ex vivo assays indicate that activation of the low affinity adenosine A_2B receptor subtype (A_2BAR) mediates TGF-β1 release from glomeruli of diabetic rats, a pathogenic event that could support progression of glomerulopathy when the bioavailability of adenosine is increased.     

苯那普利对糖尿病大鼠肾小球MMP-9影响的实验研究

目的探讨苯那普利对糖尿病大鼠肾小球基质金属蛋白酶-9（MMP-9）表达的影响。方法将雄性SD大鼠30只，随机抽出10只动物作为正常对照组（C组），其余20只采用腹腔注射STZ制备糖尿病大鼠模型。将这20只造模成功的糖尿病大鼠模型随机分为2组：糖尿病组（DM组）和药物处理组（DB组）。其中药物处理组即DB组大鼠每天应用苯那普利进行治疗性灌胃，C组和DM组用等量自来水灌胃。分别于治疗4、8周后，测定皿糖和内生肌苷清除率，用代谢笼收集24h尿量。利用免疫组织化学染色及图像分析方法，对MMP-9在肾组织不同时间点的含量变化进行定性分析。结果苯那普利治疗组血糖水平和内生肌苷清除率明显降低，与糖尿病模型组相比有显著性差异。免疫组织化学染色显示：MMP-9在正常肾小球有阳性表达；DM组大鼠病程第8周时，MMP-9在肾小球表达明显减弱；DB组大鼠病程第8周时，经苯那普利治疗后，与同期糖尿病组比较表达明显上调。图像分析方法定量分析免疫组织化学染色阳性面积百分比，苯那普利治疗后第4周和第8周糖尿病肾病的大鼠肾小球MMP-9的阳性面积百分比分别为25．55％±3．44％和20．10％±2．11％，与糖尿病组对比有明显的提高（P〈0．01）。结论MMP-9在糖尿病肾小球中的表达随病程进展逐渐减弱，苯那普利可能部分通过上调MMP-9在肾小球中的表达起到保护肾脏的作用。