1.Title：Diabetic painful neuropathy : current and future treatment options.Author：Chong MS， Hester J.Resource: Drugs. 2007;67(4):569-85.Abstract：Diabetic painful neuropathy (DPN) is one of the most common causes of neuropathic pain. The management of DPN consists of excluding other causes of painful peripheral neuropathy， maximising diabetic control and using medications to alleviate pain.The precise relationship between glycaemic control and the development and severity of DPN remains controversial. In this context， drugs such as aldose reductase inhibitors， ACE inhibitors， lipid-lowering agents and alpha-lipoic acid (thioctic acid) may have a useful role to play. There is also evidence that a successful pancreatic transplant may improve symptoms over time， but the mainstay of management continues to be symptomatic control of pain with drugs.Evidence from placebo-controlled studies has shown that opioids， antiepileptic and antidepressant drugs together with capsaicin are effective for alleviating DPN. Tramadol and oxycodone have been shown to be effective in studies of limited duration but their adverse effects， such as constipation and physical dependency， may limit their usefulness as a first-line treatment for DPN. Of the antidepressant drugs， the tricyclic antidepressants have been shown to be effective for alleviating DPN. These medications are widely used but their anticholinergic and sedative properties may not be well tolerated by patients. There is also good evidence that the serotonin-noradrenaline reuptake inhibitor antidepressant drugs venlafaxine and duloxetine are effective for treating DPN. However， venlafaxine may cause cardiac dysrhythmias， and patients using this medication require careful cardiac monitoring. Duloxetine appears to be less cardiotoxic and is licensed in the US and EU for alleviating DPN. The gabapentinoid group of drugs， gabapentin and pregabalin， appear to be the most evidence-based of the antiepileptic drugs for treating DPN. Large placebo-controlled studies have been performed with both of these agents. For many patients， it is still unclear what advantages pregabalin has over gabapentin for DPN. Until better evidence emerges， the potential availability of less expensive generic formulations of gabapentin， together with greater experience with its use， favour gabapentin as the main antiepileptic drug for alleviating DPN. Topiramate， lamotrigine， sodium valproate and oxcarbazepine have been shown to be effective in smaller studies but do not have the same evidence base as the gabapentinoid group of drugs. Of the newer antiepileptic drugs， lacosamide appears to be the most promising for alleviating DPN. Capsaicin has the best evidence base of all the topical agents， but local anaesthetic patches may also have a useful therapeutic role.It is not possible to nominate a single drug as the first-line treatment for DPN and there is evidence that a low-dose combination of two or more drugs rather than a single agent may provide better symptomatic relief with fewer adverse effects. Further studies are necessary to clarify the best combination of treatment for DPN.糖尿病悲凉性精神病变嫌理的近况与将来糖尿病悲凉性精神病变(DPN)是神经性悲凉最常见的原因之一。DPN的处置步调包括撤除其它悲凉性周围精神病变的病因、最大遏抑地遏抑血糖以及用药物缓解悲凉。血糖遏抑和DPN的进展以及严重经由之间的真确关系还有争议。如斯说来，醛糖还原酶遏抑剂，血管弥留素退换酶遏抑剂、降脂药物和α硫辛酸（硫辛酸）王人有用武之地。也有字据标明班师的胰腺移植跟着时候的推移能改善悲凉症状，然而DPN的主要调理仍然是用药物去遏抑悲凉症状。开头于劝慰剂对照说合的字据标明类罂粟碱、抗癫痫药、抗抑郁药物和辣椒碱可灵验地改善DPN。不雅察时候有限的说合骄气曲马多和氧可酮也有一定疗效，但反作用如便秘、体魄依赖性遏抑了其当作DPN的一线调理。抗抑郁药物中三环类抗抑郁药被证明可灵验地减轻DPN。这类药物利用相配无为，但其抗胆碱能和简约作用却很难被患者所耐受。也有充分的字据标明5-羟色胺-去甲肾上腺素再继承遏抑剂类抗抑郁药文拉法辛和度洛西汀灵验。然而，文拉法辛可导致心律失常，患者需要严实的腹黑监护。度洛西汀似乎腹黑毒性较小，已在好意思国和欧洲赢得使用许可用于调理DPN。 加巴喷丁类药物加巴喷丁和普瑞巴林看来是最有循证医学字据的调理DPN的抗癫痫剂。这两种药物王人曾被用于大范围劝慰剂对照的说合。对大量患者而言，普瑞巴林与加巴喷丁比较调理DPN有什么上风还不表示。除非有更充分的字据出现，加巴喷丁由于其价钱低廉，使用无为而应成为调理DPN的主要抗癫痫药。小样本说合证明托吡酯、拉莫三嗪、丙戊酸钠、奥卡西平灵验，但短缺与加巴喷丁类药物一样的字据。在新的抗癫痫药物中【SOE-125】ギリモザ ディープスロート Ami，lacosamide似乎最有但愿用于调理DPN。辣椒碱是扫数名义镇痛剂中字据最充分的药物【SOE-125】ギリモザ ディープスロート Ami，但局部麻醉贴片相同灵验。将单一药物当作DPN的一线调理是不可能的，有字据标明小剂量集中利用两种或两种以上药物比单用一种药物更能灵验地缓解症状且反作用较少。因此需要进一步的说合以发扬调理DPN的最好组合。 2.Title：CONTROVERSY IN CLINICAL ENDOCRINOLOGY: An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine Author：Scott A. Rivkees and Catherine Dinauer Resource: J Clin Endocrinol Metab 2007 92: 797-800 Abstract：Context: Antithyroid medications， surgery， and radioactive iodine have been used for more than five decades for the treatment of hyperthyroidism due to Graves’ disease in children， adolescents， and adults. Despite the widespread use of these different approaches， controversy still exists relative to the merits of each treatment， especially regarding the use of radioactive iodine. Objective: The objective of the study was to address the risk and benefits of 131I therapy， as compared with other treatment approaches. Position: Long-term， spontaneous remission of Graves’ disease occurs in less than 30% of children. Thus， the majority of children with Graves’ disease will need definitive， curative therapy. There is little evidence that use of antithyroid medications beyond 1 or 2 yr increases the likelihood of spontaneous， long-term remission. Although the use of antithyroid medications is standard practice， the use of antithyroid medications involves definite risks. When used at sufficient doses， radioactive iodine is an effective cure for Graves’ disease and is associated with few acute side effects. Potential long-term adverse side effects， including thyroid cancer and genetic damage， have yet to be observed in individuals treated as children or adolescents with 131I. Conclusion: Properly administered， radioactive iodine remains an ideal form of treatment for Graves’ disease in the pediatric population. Because of the increased risk of thyroid cancer associated with low-dose thyroid irradiation in children， larger， rather than smaller， doses of 131I should be given. 题目：临床内分泌学争议：儿科Graves病最好调理遴选是辐照性碘调理 作家： Scott A. Rivkees and Catherine Dinauer 出处： J Clin Endocrinol Metab 2007 92: 797-800 摘要：布景：抗甲状腺药物、手术、辐照性碘调理照旧用于儿童、青少年、成东说念主的Graves’病50多年了。尽管这些法子已无为利用，但对于多样法子的优点的争议依然存在，尤其是辐照性碘调理。见地：这次说合见地在于评价碘131调理与其他法子比较的优错误。定位：儿童Graves’病的始终自愿缓解率不及30%。是以，大大量儿童患者仍需要详情的调理步调。莫得字据阐述用一两年以上的抗甲药物不错增多儿童患者的始终当然缓解率。尽管利用抗甲药物是一种尺度法子，但仍有一定的风险。当用量有余时，辐照性碘调理是一种灵验的法子，且急性期反作用较少。儿童或青少年患者调理后，始终潜在的反作用，包括成年后甲状腺癌和对遗传的影响还有待不雅察。论断：赐与得当的辐照性碘调理仍然是儿科Graves’病调理的一种设念念。由于小剂量辐照性碘导致甲状腺癌的危急性增多，应该赐与更大剂量而不是更小剂量辐照性碘进行调理。3.Title：Relationship of Traditional and Nontraditional Cardiovascular Risk Factors to Coronary Artery Calcium in Type 2 Diabetes Author：Theodore Mazzone， Peter M. Meyer， George T. Kondos， Michael H. Davidson， Steven B. Feinstein， Ralph B. D’Agostino， Sr.， Alfonso Perez， and Steven M. Haffner Resource: Diabetes 2007 56: 849-855.Abstract：We evaluated correlates of coronary atherosclerosis， measured by coronary artery calcium， in a racially diverse group of male and female subjects with type 2 diabetes. Age， systolic blood pressure， sex， and race/ethnicity were significant determinants of coronary artery calcium. Among lipoproteins， cholesterol level contained in a particle excluded from direct measures of LDL and HDL cholesterol (designated triglyceride-rich lipoprotein cholesterol) was most strongly linked to coronary artery calcium. Neither inflammatory markers nor metabolic factors correlated with coronary artery calcium in models adjusted for age and sex， but measures of adipose distribution did. Waist-to-hip ratio and the ratio of visceral to total abdominal tissue were positively associated with coronary artery calcium. In fully adjusted multivariate models， the relationship of adiposity measures to coronary artery calcium was no longer significant after inclusion of apolipoprotein B or triglyceride-rich lipoprotein cholesterol. Traditional risk factors and race/ethnicity remain important correlates of coronary artery calcium in a cohort at elevated risk of cardiovascular disease because of type 2 diabetes. Adiposity measures are significantly associated with coronary artery calcium score， but their importance may be largely explained by apolipoprotein B or triglyceride-rich lipoprotein cholesterol. 咱们用冠状动脉钙化为缱绻评估了不同东说念主种/种族中男女2型糖尿病的冠状动脉硬化.在脂卵白中，除径直测量LDL与HDL胆固醇外，包含在A颗粒的胆固醇水平与冠状动脉钙化有最强的相关关系。经年齿和性别矫正后， 炎症绮丽物和代谢身分王人与冠状动脉钙化不相关，但与脂肪散布相关。腰臀比率和内脏/腹部器官组织的比率与钙化呈正相关。在根据各身分王人调整好的模子中，将apoB和胆固醇包括在内后，脂肪散布和钙化的相关不再显耀。经多变量模子矫正中，撤除载脂卵白B或富含甘油三酯的脂卵白胆固醇等混杂身分，臃肿评估与冠状动脉钙化进而不再呈显耀相关。在2型糖尿病引起患冠心病的升高危急身分中，传统的发病身分和东说念主种/种族身分仍与冠状动脉钙化有着迫切相关性。臃肿与钙化积分显耀相关，但很猛经由上可用apoB和富含甘油三酯的脂卵白胆固醇来解释。4.Glycated Albumin Is a Better Glycemic Indicator than Glycated Hemoglobin Values in Hemodialysis Patients with Diabetes: Effect of Anemia and Erythropoietin Injection.Inaba M， Okuno S， Kumeda Y， Yamada S， Imanishi Y， Tabata T， Okamura M， Okada S， Yamakawa T， Ishimura E， Nishizawa Y.Address correspondence to: Dr. Masaaki Inaba， Department of Metabolism， Endocrinology and Molecular Medicine， Internal Medicine， Osaka City University Graduate School of Medicine， 1-4-3， Asahi-machi， Abeno-ku， Osaka 545-8585， Japan. inaba-m@med.osaka-cu.ac.jp.The significance of glycated albumin (GA)， compared with casual plasma glucose (PG) and glycated hemoglobin (HbA(1c))， was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. The mean PG， GA， and HbA(1c) levels were 164.5 +/- 55.7 mg/dl， 22.5 +/- 7.5%， and 5.85 +/- 1.26%， respectively， in HD patients with diabetes (n = 538)， which were increased by 51.5， 31.6， and 17.7%， respectively， compared with HD patients without diabetes (n = 828). HbA(1c) levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the relationship among the three parameters in patients who had diabetes without renal dysfunction (n = 365)， as reflected by the significantly more shallow slope of regression line between HbA(1c) and PG or GA. A significant negative correlation was found between GA and serum albumin (r = -0.131， P = 0.002) in HD patients with diabetes， whereas HbA(1c) correlated positively and negatively with hemoglobin (r = 0.090， P = 0.036) and weekly dose of erythropoietin injection (r = -0.159， P < 0.001)， respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection， HbA(1c) levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartile by HbA(1c) level led to better glycemic control in a significantly higher proportions of HD patients with diabetes than those assessed by GA. Multiple regression analysis demonstrated that the weekly dose of erythropoietin， in addition to PG， emerged as an independent factor associated with HbA(1c) in HD patients with diabetes， although PG but not albumin was an independent factor associated with GA. In summary， it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA(1c) in these patients might lead to underestimation likely as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.J Am Soc Nephrol. 2007 Mar;18(3)糖尿病血液透析患者糖化白卵白是比糖化血红卵白更好的升血糖指数:贫血和打针促红素对其的影响.评估了GA与PG和HbA(1c)比较，当作糖尿病血液透析患者血糖遏抑现象缱绻的趣味趣味。 糖尿病血液透析患者的随即血糖， 糖化白卵白和糖化血红卵白水平区分是164.5 +/- 55.7 mg/dl， 22.5 +/- 7.5%， 和5.85 +/- 1.26%，与非糖尿病血液透析患者比较区分增多了51.5， 31.6， and 17.7%.与不伴有肾功能不全的糖尿病患者上述三项缱绻间互相关系比较，糖尿病血液透析患者HbA(1c)水平表示低于同期测得的PG 和 GA值。阐发为HbA(1c) 和 PG 或 GA之间转头弧线斜率表示趋缓。糖尿病血液透析患者糖化白卵白与血雪白卵白呈显耀负相关，而糖化血红卵白区分与血红卵白成正相关，和促红细胞生成素周剂量成负相关。尽管未打针促红素的糖尿病血液透析患者与打针者随即血糖和糖化白卵白莫得显耀的互异，但未打针患者糖化血红卵白水平表示升高. 将糖尿病血液透析患者血糖遏抑现象按HbA(1c)水平自便四分位分类，所得出的血糖遏抑率表示高于用GA评估所得。尽管PG （而不是血雪白卵白）是与GA相关的落寞身分，多元转头分析骄气，除PG外促红素周剂量亦然与糖尿病血液透析患者HbA(1c)相关的落寞身分。 总之，糖化白卵白为评价糖尿病血液透析患者血糖遏抑水平提供了一个更好的技艺。而要是用糖化血红卵白水平去评价这类患者的血糖遏抑现象则可能会导问候象不及，这是因为使用促红素后稚童红细胞比例增多的缘起。 5.Inhibiting albumin glycation attenuates dysregulation of VEGFR-1 and collagen IV subchain production and the development of renal insufficiency.Cohen MP， Lautenslager GT， Hud E， Shea E， Wang A， Chen S， Shearman CW. University City Science Center， Philadelphia， Pennsylvania， USA. drmpcohen@aol.comGlomerular cells in culture respond to albumin containing Amadori glucose adducts (the principal serum glycated protein)， with activation of protein kinase C-beta(1)， increased expression of transforming growth factor (TGF)-beta1， the TGF-beta type II signaling receptor， and the extracellular matrix proteins alpha(1)(IV) collagen and fibronectin and with decreased production of the podocyte protein nephrin. Decreasing the burden of glycated albumin in diabetic db/db mice significantly reduces glomerular overexpression of TGF-beta1 mRNA， restores glomerular nephrin immunofluorescence， and lessens proteinuria， mesangial expansion， renal extracellular matrix protein production， and increased glomerular vascular endothelial growth factor (VEGF) immunostaining. In the present study， db/db mice were treated with a small molecule， designated 23CPPA， that inhibits the nonenzymatic condensation of glucose with the albumin protein to evaluate whether increased glycated albumin influences the production of VEGF receptors (VEGFRs) and type IV collagen subchains and ameliorates the development of renal insufficiency. Renal levels of VEGF and VEGFR-1 proteins and serum creatinine concentrations were significantly higher and renal levels of alpha(3)(IV) collagen and nephrin proteins and endogenous creatinine clearance values were significantly lower in control diabetic than in age-matched nondiabetic (db/m) mice. These changes were significantly attenuated in db/db littermate mice treated from 9 to 18 wk of age with 23CPPA. The findings indicate that inhibiting excess nonenzymatic glycation of serum albumin improves renal molecular biology abnormalities and protects against the development of renal insufficiency in the db/db mouse.Am J Physiol Renal Physiol. 2007 Feb;292(2):F789-95. 遏抑白卵白糖化削弱了血管内皮滋长因子受体-1和IV型胶原子链抒发的失调，减速了肾功能不全的进展肾小球细胞在含有糖化血雪白卵白（主要的血清糖化卵白）的培养基中培养后，其卵白激酶C-β1活化、曲折滋长因子β1、TGF-βⅡ型信号受体、细胞外基质卵白α1IV型胶原和纤维畅通卵白抒发增多，而足细胞nephrin卵白抒发减少。镌汰糖尿病db/db鼠糖化白卵白水平能显耀减少肾小球曲折滋长因子β1 mRNA的过抒发，归附肾小球足细胞卵白nephrin的抒发，减少卵白尿，系膜彭胀及细胞外基质卵白产生，增多肾小球VEGF 抒发。 本说合中，赐与粗疏遏抑白卵白非酶糖化的小分子23CPPA处置db/db鼠，从而评价糖化白卵白的增多是否影响VEGF受体和IV型胶原各链抒发以及减速肾功能不全的进展。与年齿匹配的非糖尿病鼠比较，db/db鼠肾脏VEGF和VEGFR-1卵白水平，血肌酐浓度表示升高，而IV型胶原α，nephrin卵白与内生肌酐拔除率显耀镌汰。但在同窝出身的9至18周龄糖尿病鼠利用了23CPPA处置后这些改革表示削弱。这些效用标明遏抑血雪白卵白的过度非酶糖化粗疏改善肾脏分子生物学额外，保护肾功能。6、二肽基肽酶-4（DPP-4）遏抑剂： vildagliptin (Galvus[TM]; Novartis International AG， Basel， Switzerland) and sitagliptin (Januvia[TM]; Merck & Co， Inc， Whitehouse Station， NJ) Sitagliptin phosphate (Januvia) enhances the body’s ability to lower glucose levels without causing the weight gain associated with some other antidiabetic treatments. Indicated to treat type 2 diabetes， it can be used alone or combined with metformin or thiazolidinediones，such as rosiglitazone or pioglitazone， in patients who can’t control theirglucose levels with diet and exercise.The first in a new class called dipeptidyl peptidase-4 (DPP-4) inhibitors，Januvia works by prolonging the activity of proteins that increase the release of insulin after blood glucose rises. The most common adverse reactions are stuffy or runny nose， sore throat， upper respiratory tract infection， and headache.当今有：好意思国默克公司坐褥的Sitagliptin phosphate( 商品名Januvia)-----FDA已批准上市，瑞士巴塞尔诺化公司坐褥的vildagliptin(商品名Galvus)------待批，Sitagliptin phosphate (Januvia)可增强机体镌汰血糖水平的才能，同期与其他调理糖尿病的步调集中利用时不增多体重，可用来调理2型DM，在通过饮食和畅通不可遏抑血糖水平的患者中可单独、或集中二甲双胍、或集中噻唑脘二酮类（如罗格列酮或匹格列酮）利用。 当作二肽基肽酶-4（DPP-4）遏抑剂一类新药，Januvia通过延伸卵白质的活性，血糖升高后增多胰岛素的开释。最常见的反作用鼻塞、流鼻涕、咽痛、上呼吸说念感染、头痛。7、Metformin linked to vitamin B12 deficiency. New research has revealed an increased risk of vitamin B12 deficiency among patients taking metformin， a popular antidiabetic medication. A B12 deficiency can seriously damage the nervous system. Fortunately， it’s easily treated if detected early. In a study involving 465 patients， researchers found that each 1-gram daily increment in metformin dosage doubled the risk of vitamin B12 deficiency; taking metformin for 3 years or more also doubled the risk. The researchers say their findings are compelling enough to warrant screening for the deficiency，especially in patients on high metformin doses and those on prolonged courses of therapy.二甲双胍导致维生素B12的短缺新近说合提醒患者服用一种闲居的降糖药------二甲双胍增多维生素B12的短缺的风险。维生素B12的短缺严重毁伤神经系统，幸好，要是早期发现容易调理。在一项465例患者插足的说合中，说合者发现逐日增多1g二甲双胍，则维生素B12短缺的风险增多一倍。服用二甲双胍3年或以上，维生素B12的短缺的风险相同加倍。说合者以为这项说合效用令东说念主防护，足以证明必须检测维生素B12短缺，尤其是对那些服用高剂量和始终服用二甲双胍的患者。Januvia的扫数府上已发送到内分泌邮箱，去下载吧濑亚美莉番号