中国老年2型糖尿病诊疗措施专家共识(2018年版)

According to the national survey data over the past five years,there are about 50.16 million elderly diabetic patients (≥60 years old) in China.With the increase in the total number of the elderly,this number will be expected to increase.Among the elderly patients,most of them are newly diagnosed,and are associated with a number of risk factors for cardiovascular diseases at the time of initial diagnosis.Those who were with young-onset have a long-term clinical course,and often complicated with diabetic chronic complications and potential organ dysfunctions.Most of the elderly diabetic patients in China are with poor glycemic control.The diabetes-related complications have become one of the major reasons for the senile death.It is well accepted that early diagnosis and reasonable treatment could reduce the occurrence of diabetic complications,and the disability and fatal cardiovascular and cerebrovascular events.Thus,it is recommended,in the consensus,to conduct a comprehensive assessment of the glycemic control,metabolic cardiovascular risk factors,diabetes complications,multiple organ functions of the elderly patients,as well as their intelligence and physical fitness.Personalized control targets on blood glucose,pressure,lipids,uric acid and body weight would be established based on the assessment of each patient and consideration of the balance between benefits and risks in order to achieve the goal of early detection,early diagnosis,early treatment and early target reaching.Moreover,it is also recommended,in the consensus,to focus on the basic treatments (diets,exercises,self-monitoring and management),initiate suitable hypoglycemic drugs with complementary mechanisms when needed,and take into consideration of management of multiple cardiovascular risk factors and drug usage together with the caution of mutual interactions of multiple drugs.

Mitochondria play an important role in neuronal apoptosis caused by cerebral ischemia, and the role is mediated by the expression of mitochondrial proteins. This study investigated the involvement of mitochondrial proteins in hippocampal cell apoptosis after transient cerebral ischemia-reperfusion injury in aged rats using a comparative proteomics strategy. Our exper-imental results show that the aged rat brain is sensitive to ischemia-reperfusion injury and that transient ischemia led to cell apoptosis in the hippocampus and changes in memory and cognition of aged rats. Differential proteomics analysis suggested that this phenomenon may be mediated by mitochondrial proteins associated with energy metabolism and apoptosis in aged rats. This study provides potential drug targets for the treatment of transient cerebral isch-emia-reperfusion injury.

Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a deifned interface. Virtual real-ity interface devices such as the Nintendo? Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addi-tion, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients’ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

Objective: To observe the therapeutic efficacy of fire-needle therapy plus tuina in treating primary knee osteoarthritis (KOA) in the elderly.
Methods: Twenty-three patients with KOA were intervened by pricking with fire-needle therapy plus tuina, and evaluated by using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) before and after intervention.
Results: After intervention, the total score, scores of pain, rigidity, and activities of daily living of WOMAC dropped significantly (P<0.05).
Conclusion: Pricking with fire needle plus tuina can produce a significant therapeutic efficacy in treating KOA in the elderly, thus worth application in clinic.