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Hypoglycaemia in diabetes 糖尿病中的低血糖
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-10-01 Epub Date: 2026-08-31 DOI: 10.1016/j.mpmed.2026.07.001
Simon Heller, Peter Novodvorsky
{"title":"Hypoglycaemia in diabetes","authors":"Simon Heller,&nbsp;Peter Novodvorsky","doi":"10.1016/j.mpmed.2026.07.001","DOIUrl":"10.1016/j.mpmed.2026.07.001","url":null,"abstract":"<div><div>Hypoglycaemia is a much-feared complication of diabetes treated with insulin or sulfonylureas. Hypoglycaemia prevents people with diabetes from achieving their glycaemic targets. Normal brain function depends on a continuous supply of glucose. Diminished glucose supply to the brain leads to cerebral dysfunction and, if not corrected, confusion and coma. Hypoglycaemia is a direct consequence of the inability of current glucose-lowering therapies to reproduce pancreatic β-cell physiology. This leads to inappropriately high insulin concentrations between meals and at night. Glucagon and adrenaline oppose the glucose-lowering effect of insulin through hepatic glycogenolysis and inhibition of peripheral glucose uptake. In addition, activation of the sympatho-adrenal system provokes symptoms that patients learn to recognize and treat by taking carbohydrates. With an increasing duration of diabetes, and after episodes of hypoglycaemia, these defence mechanisms become impaired. Individuals are increasingly at risk of severe episodes, particularly if they develop ‘impaired awareness of hypoglycaemia’. Structured patient education remains the cornerstone in managing hypoglycaemia. Individualized blood glucose targets prevent recurrent hypoglycaemia. Novel insulin formulations and diabetes technologies such as continuous glucose monitoring and automated insulin delivery systems significantly reduce the burden of hypoglycaemia, but the importance of patient education cannot be overemphasized.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 10","pages":"Pages 749-755"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exercise and safe sport participation in cardiac conditions 心脏病患者的运动和安全参与
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-07-29 DOI: 10.1016/j.mpmed.2026.06.013
Dimitra Maritsa, Michael Papadakis
{"title":"Exercise and safe sport participation in cardiac conditions","authors":"Dimitra Maritsa,&nbsp;Michael Papadakis","doi":"10.1016/j.mpmed.2026.06.013","DOIUrl":"10.1016/j.mpmed.2026.06.013","url":null,"abstract":"<div><div>Exercise is increasingly recognized as a form of medicine in cardiovascular care. However, in individuals with cardiac disease, the transition from therapeutic physical activity to safe participation in higher intensity exercise and sport requires careful, phenotype-driven risk stratification. In most cardiac conditions, including stable coronary artery disease, heart failure and many valvular disorders, regular exercise is safe and confers substantial clinical benefit. High-intensity exercise can increase arrhythmic risk in selected conditions, including arrhythmogenic cardiomyopathy, active myocarditis and catecholamine-sensitive channelopathies. Risk is not uniform and is primarily determined by disease phenotype rather than diagnosis alone. Modern practice emphasizes accurate clinical phenotyping and shared decision-making rather than a blanket restriction from sport. Viewing exercise as medicine while applying proportionate, evidence-based risk assessment allows most individuals with cardiac disease to engage safely in physical activity and, where appropriate, progress to informed participation in sport.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 676-681"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148924913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Congenital heart disease in infancy and childhood 婴儿和儿童的先天性心脏病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-08-28 DOI: 10.1016/j.mpmed.2026.06.006
Maraisa Fachini Spada, Piers Daubeney
{"title":"Congenital heart disease in infancy and childhood","authors":"Maraisa Fachini Spada,&nbsp;Piers Daubeney","doi":"10.1016/j.mpmed.2026.06.006","DOIUrl":"10.1016/j.mpmed.2026.06.006","url":null,"abstract":"<div><div>Congenital heart disease (CHD) represents the most common group of congenital anomalies, ranging from asymptomatic simple shunt lesions to complex life-threatening malformations that require surgical repair or palliation. Advances in fetal echocardiography have enabled earlier detection, planned delivery and better neonatal outcomes. Postnatal diagnosis relies on a combination of clinical examination, cross-sectional imaging assessment and invasive haemodynamic studies. Management strategies in childhood are tailored to lesion complexity and feasibility of bi-ventricular surgical repair. Conservative management stabilizes the haemodynamics, treats heart failure and prevents complications while preparing the child for intervention. This review outlines the presentation of CHD at different stages of infancy and childhood, as well as the surgical separation of the pulmonary and systemic circulations.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 646-651"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mitral and tricuspid valve disease 二尖瓣和三尖瓣疾病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-08-26 DOI: 10.1016/j.mpmed.2026.06.011
Anna Reid, Serge Osula
{"title":"Mitral and tricuspid valve disease","authors":"Anna Reid,&nbsp;Serge Osula","doi":"10.1016/j.mpmed.2026.06.011","DOIUrl":"10.1016/j.mpmed.2026.06.011","url":null,"abstract":"<div><div>Mitral stenosis (MS) has become less common in developed countries with the declining incidence of rheumatic fever but remains a major health problem worldwide. Atrial fibrillation is a common accompaniment and can trigger the onset of pulmonary oedema. Medical treatment aims to control atrial fibrillation and prevent thromboembolism. Individuals with symptoms and a valve area &lt;1.5 cm<sup>2</sup> should be considered for balloon valvuloplasty or surgical valve replacement. Mitral regurgitation (MR) is common; it is usually caused by degenerative disease of the valve or is secondary to underlying left ventricular dysfunction. The management depends on the aetiology. Individuals with severe degenerative MR should be offered valve repair before the onset of limiting symptoms or left ventricular dysfunction. Surgery for secondary MR should be considered in patients with severe MR undergoing coronary artery bypass grafting, and in carefully selected patients with severe MR and symptoms of breathlessness despite optimal medical therapy. Percutaneous and minimally invasive approaches can be used in some patients. Tricuspid regurgitation is commonly seen on echocardiography and, if moderate to severe, is associated with a poor prognosis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 625-632"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Heart disease in pregnancy 妊娠期心脏病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-07-29 DOI: 10.1016/j.mpmed.2026.06.003
Abigail Masding, Dawn L. Adamson
{"title":"Heart disease in pregnancy","authors":"Abigail Masding,&nbsp;Dawn L. Adamson","doi":"10.1016/j.mpmed.2026.06.003","DOIUrl":"10.1016/j.mpmed.2026.06.003","url":null,"abstract":"<div><div>Cardiovascular disease remains a leading cause of maternal morbidity and mortality. Most women who die have no previous cardiac diagnosis (89%), highlighting the importance of recognizing new cardiovascular disease in pregnancy. This review provides a practical, clinically focused approach to the risk assessment, investigation and management of pre-existing and newly diagnosed heart disease in pregnancy.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 639-645"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erratum to “Systemic manifestations of sexually transmitted infections” [Medicine 2026; 54(5): 326–329] “性传播感染的全身表现”的勘误[医学2026；54 (5): 326 - 329)
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-08-26 DOI: 10.1016/j.mpmed.2026.08.006
Fiona Windebank, Michael Ewens
{"title":"Erratum to “Systemic manifestations of sexually transmitted infections” [Medicine 2026; 54(5): 326–329]","authors":"Fiona Windebank,&nbsp;Michael Ewens","doi":"10.1016/j.mpmed.2026.08.006","DOIUrl":"10.1016/j.mpmed.2026.08.006","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Page 690"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Congenital heart disease in adults 成人先天性心脏病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-07-29 DOI: 10.1016/j.mpmed.2026.06.008
Vanessa Kandoole, Priya H. Gaglani, Samantha Fitzsimmons
{"title":"Congenital heart disease in adults","authors":"Vanessa Kandoole,&nbsp;Priya H. Gaglani,&nbsp;Samantha Fitzsimmons","doi":"10.1016/j.mpmed.2026.06.008","DOIUrl":"10.1016/j.mpmed.2026.06.008","url":null,"abstract":"<div><div>Major advances in paediatric cardiac surgery over recent decades have resulted in an increased number of children with congenital heart disease (CHD) surviving into adulthood. In Europe, the adult CHD population is currently larger than the paediatric CHD population. This changing prevalence and ageing population with CHD have significant implications for the complexity of individuals with these conditions, given the number of co-morbidities that develop with age and the deteriorating physiological and anatomical substrate with time. It also has important implications for service provision, as most of these patients require long-term follow-up by a multidisciplinary team with expertise in the management of adult CHD. This article provides an introduction to the common conditions presenting acutely to general physicians, the long-term complications, the treatment options and the long-term considerations for end-of-life care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 652-658"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pericardial diseases 心包疾病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-07-29 DOI: 10.1016/j.mpmed.2026.06.005
Lucy Lawson, Natalia Briceno
{"title":"Pericardial diseases","authors":"Lucy Lawson,&nbsp;Natalia Briceno","doi":"10.1016/j.mpmed.2026.06.005","DOIUrl":"10.1016/j.mpmed.2026.06.005","url":null,"abstract":"<div><div>The pericardium is a membranous sac surrounding the heart that plays an important role in providing structural support and facilitating myocardial contractile function. It is, however, prone to diseases typically occurring as a result of inflammation or pericardial fluid accumulation. Pericardial diseases can be idiopathic or occur secondary to infective, neoplastic, autoimmune or iatrogenic causes. Although acute pericardial inflammation (pericarditis) is usually self-limiting, it can be complicated by the development of an effusion or persist/recur with the risk of developing pericardial constriction. Most pericardial effusions are small and resolve without intervention; however, they can cause life-threatening haemodynamic compromise – cardiac tamponade – which is a medical emergency requiring emergency pericardiocentesis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 659-663"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148924911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aortic valve disease 主动脉瓣疾病
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-08-08 DOI: 10.1016/j.mpmed.2026.06.010
Priya H. Gaglani, Eunice NC. Onwordi
{"title":"Aortic valve disease","authors":"Priya H. Gaglani,&nbsp;Eunice NC. Onwordi","doi":"10.1016/j.mpmed.2026.06.010","DOIUrl":"10.1016/j.mpmed.2026.06.010","url":null,"abstract":"<div><div>Heart valve disease is common and becomes increasingly prevalent with advancing age. Increasing life expectancy means an increased demand on healthcare services worldwide. Aortic valve disease includes aortic stenosis and aortic regurgitation. Aortic stenosis is the most prevalent valve disorder and in the geographical west is most commonly caused by degenerative calcification. Rheumatic heart disease is a common cause of aortic stenosis in developing countries. Once patients develop symptoms of angina, presyncope, syncope or dyspnoea, the prognosis is poor without treatment. Long-term sequelae in untreated patients include heart failure and death. Echocardiography is central to the assessment of valve morphology, severity and consequences for left ventricular function, and remains the gold standard investigative tool. Aortic valve replacement or transcatheter aortic valve implantation improves survival rates. The choice of valve intervention should be decided upon by the heart valve team on a case-by-case basis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 633-638"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
GLP-1 receptor agonists in obesity and musculoskeletal disease GLP-1受体激动剂在肥胖和肌肉骨骼疾病中的作用
Medicine (Abingdon, England : UK ed.) Pub Date : 2026-09-01 Epub Date: 2026-07-29 DOI: 10.1016/j.mpmed.2026.06.004
Kathryn Biddle, James Galloway, Katie Bechman
{"title":"GLP-1 receptor agonists in obesity and musculoskeletal disease","authors":"Kathryn Biddle,&nbsp;James Galloway,&nbsp;Katie Bechman","doi":"10.1016/j.mpmed.2026.06.004","DOIUrl":"10.1016/j.mpmed.2026.06.004","url":null,"abstract":"<div><div>Obesity is a major public health challenge and an important risk factor for musculoskeletal disease, contributing to poorer outcomes in osteoarthritis, inflammatory arthritis, gout and chronic pain conditions. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) and dual incretin agonists produce substantial weight loss and are now approved for obesity management, making their role in musculoskeletal health an important emerging clinical question. Weight loss, irrespective of modality, improves pain, physical function and disease activity across musculoskeletal conditions, and the mechanical and metabolic benefits of GLP-1RA-induced weight reduction are, in principle, predictable. This review examines the mechanistic and clinical evidence linking obesity, metabolic inflammation and musculoskeletal disease, focusing on whether GLP-1RAs exert effects beyond weight loss. More complex questions arise in inflammatory arthritis, where obesity and autoimmune disease are linked through bidirectional inflammatory pathways. The STEP 9 trial demonstrated significant symptomatic benefit in knee osteoarthritis, and the TOGETHER-PsA trial provided the first controlled evidence of improved disease activity in psoriatic arthritis with combined incretin and biologic therapy. However, current evidence does not establish whether GLP-1RAs exert immunomodulatory effects independent of weight loss. Prospective studies are needed to clarify their effects on immune pathways, impact on autoimmune disease risk, and implications for clinical practice.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 9","pages":"Pages 682-685"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148924865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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