Clinical cornerstone最新文献

{"title":"Endocrine Functions of Adipose Tissue: Focus on Adiponectin","authors":"James R Sowers MD","doi":"10.1016/S1098-3597(08)60026-5","DOIUrl":"10.1016/S1098-3597(08)60026-5","url":null,"abstract":"<div><p><span><span><span>Accumulating evidence indicates that obesity and overweight are associated with, and contribute to, the development of type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease<span> (CKD). The adipocyte-derived cytokine, adiponectin, has been shown to improve </span></span>insulin sensitivity, increase rates of </span>fatty acid oxidation<span><span>, decrease muscle lipid content, and reduce inflammation and vascular injury. However, adiponectin levels have been found to be reduced in persons with obesity and type 2 DM. Furthermore, adiponectin levels are inversely associated with those of tumor necrosis factor-α and C-reactive protein—markers of </span>endothelial dysfunction and systemic inflammation. The 2 receptors for adiponectin—Adipo R</span></span>₁ and Adipo R₂<span><span>, which are expressed in muscle and liver tissue and in human fat cells—are hormonally regulated, with increased insulin levels causing a reduction in their abundance. The hyperinsulinemia<span> observed in obesity, therefore, may be partially responsible for the reduction in the numbers of adiponectin receptors. Adiponectin aggregates range from a hexamer of low molecular weight to larger multimeric structures of high molecular weight. A smaller proteolytic fragment—the globular head domain of adiponectin, or gAd—interacts specifically with </span></span>skeletal muscle. The relation of circulating adiponectin to its biologic actions is more complex than originally believed; therefore, it is the multimeric forms of the adiponectin molecule that need to be measured and evaluated in relation to associated metabolic, cardiovascular, and renal functions. Furthermore, strategies to measure the numbers of adiponectin receptors on available tissue need to be developed to fully assess the clinical role of adiponectin in type 2 DM, CVD, and CKD.</span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 1","pages":"Pages 32-40"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)60026-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27871250","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}

{"title":"Diabetic Dyslipidemia and Atherosclerosis","authors":"Stephen N. Davis MD, FRCP","doi":"10.1016/S1098-3597(09)60022-3","DOIUrl":"10.1016/S1098-3597(09)60022-3","url":null,"abstract":"<div><p><span><span>Atherosclerosis is the primary cause of death </span>in patients<span><span> with type 2 diabetes mellitus (DM) and it seems to be closely related to a specific cluster of lipid abnormalities, including low levels of high-density lipoprotein cholesterol, increased numbers of small dense low-density lipoprotein particles, and elevated triglyceride levels. Each of these abnormalities is associated with an increased risk for cardiovascular morbidity and mortality. This review describes the atherogenic </span>dyslipidemia that characterizes type 2 DM, the causes of this so-called </span></span><em>diabetic dyslipidemia</em><span><span>, and pharmacologic approaches to normalizing the lipid profile in these patients. The management of patients with type 2 DM usually centers on glycemic and blood pressure control. Most of the commonly used </span>antidiabetic agents<span><span> have neutral or only mildly beneficial effects on diabetic dyslipidemia; thus, achieving better glycemic control<span> may only slightly improve the lipid profile. Treatment of dyslipidemia usually requires pharmacotherapy to achieve major improvements in lipid profiles, yet current management of diabetic dyslipidemia generally is not optimal. Even when treated with statins, patients with type 2 DM frequently exhibit a residual risk for cardiovascular disease; therefore, additional treatment options that use mechanisms of action that differ from those of statins are needed. New agents such as </span></span>ezetimibe<span>, along with the more traditional treatments of statins, fibrates, and nicotinic acid, may potentially improve the lipid profiles of patients with diabetic dyslipidemia.</span></span></span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S17-S27"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60022-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56553800","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}

{"title":"Harnessing endocrine physiology for better clinical outcomes","authors":"Stephen N. Davis MD, FRCP,&nbsp;Gary A. Manko MD,&nbsp;Susan Renda CRNP, CDE","doi":"10.1016/S1098-3597(08)80005-1","DOIUrl":"10.1016/S1098-3597(08)80005-1","url":null,"abstract":"<div><p>Diabetes is a highly prevalent and costly disease with debilitating vascular and metabolic complications. The effects of both fasting plasma glucose (FPG) and postprandial glucose (PPG) excursions independently lead to an increased risk of morbidity and mortality. In patients with glucose levels that are fairly well controlled (ie, glycosylated hemoglobin [HbA1c] &lt;7.3%), PPG excursions are the predominant form of hyperglycemia. In patients with poor HbA1c values (&gt;8.5%), the pattern is one of both elevated FPG and PPG levels, with the predominant contribution resulting from an increase in fasting hyperglycemia. These data point to the need for a physiologically based basal-bolus insulin replacement strategy, with administration of basal insulin working to restore interprandial glucose levels and bolus insulin to simulate mealtime actions of the pancreas. Insulin also may offer beneficial anti-inflammatory, vasodilatory, antithrombotic, and antiapoptotic effects. Reductions in cardiometabolic risk factors and other parameters, therefore, focus attention on the early use of a basal-bolus insulin strategy. Challenges faced in the treatment of diabetes, including barriers and myths associated with the use of insulin, represent an area that urgently needs to be addressed. Patients and their caregivers need to be educated about the progressive nature of diabetes and the benefits of insulin to help them make informed decisions to ensure optimal diabetes care.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S28-S40"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80005-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56553767","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}

{"title":"ABCs of Asthma","authors":"David I. Bernstein MD","doi":"10.1016/S1098-3597(08)80010-5","DOIUrl":"10.1016/S1098-3597(08)80010-5","url":null,"abstract":"<div><p>Asthma results from chronic airway inflammation involving a diversity of activated cells including mast cells, eosinophils, T-lymphocytes, neutrophils, macrophages, and epithelial cells. These cells release proinflammatory cytokine mediators that augment and regulate airway inflammation, leading to airway hyperresponsiveness responsible for the chronic asthma symptoms of dyspnea, wheezing, and chest tightness. It is hypothesized, but unproven, that inflammatory effects can lead to irreversible structural and functional airway changes. Early intervention with anti-inflammatory agents mitigates inflammatory changes, reverses airway obstruction, and may possibly prevent progression of airway remodeling. Current asthma guidelines recommend that initial management should be based on pretreatment assessments of asthma severity as determined by measures of clinical and spirometric impairment in individual patients; subsequent adjustments of pharmacotherapy and avoidance recommendations should be performed at regular follow-up visits and guided by frequent assessments of asthma control. Physicians and providers should continually educate asthmatic patients about proper use of asthma controller medications, avoidance of asthma triggers, and self-management of asthma exacerbations.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"8 4","pages":"Pages 9-25"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80010-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27605673","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}

{"title":"Asthma in Infants and Children","authors":"Bradley E. Chipps MD","doi":"10.1016/S1098-3597(08)80012-9","DOIUrl":"10.1016/S1098-3597(08)80012-9","url":null,"abstract":"<div><p>Asthma is the most common chronic illness in childhood and represents a significant burden to health care and educational systems. Between one quarter and two thirds of childhood asthma cases persist into adulthood. Childhood asthma may be particularly difficult to diagnose because of the high prevalence of episodic wheezing and cough in childhood illnesses such as upper respiratory tract infections.</p><p>National and worldwide guidelines for the management of asthma in children are continually being updated. These guidelines recommend first establishing a diagnosis and assessing the severity of disease, initiating pharmacologic therapy based on symptoms and lung function, and adjusting doses and agents as required based on the level of asthma control. Inhaled corticosteroids are the cornerstone of long-term asthma management in children of all ages. Recent research efforts have focused on ways to improve inhalant drug delivery to the lungs and minimize oral and systemic bioavailability so as to improve the therapeutic benefit:risk ratio.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"8 4","pages":"Pages 44-61"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80012-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27605675","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}

{"title":"Advances in therapy for adult asthma","authors":"Erwin W. Gelfand MD","doi":"10.1016/S1098-3597(08)80013-0","DOIUrl":"10.1016/S1098-3597(08)80013-0","url":null,"abstract":"<div><p>There are &gt;22 million Americans with asthma. Chronic asthma is a worldwide problem with an increasing socioeconomic burden on individuals and on society. Recent advances have been made in diagnostic lung imaging, defining control of asthma, as well as in the education of patients with asthma. Accurate diagnosis of the cause of chronic cough in adults and of asthma in elderly individuals will help affected individuals receive appropriate treatment. Inhaled corticosteroids are the recommended first-line therapy for persistent asthma and can help prevent exacerbations in patients with asthma that are not well controlled. Early intervention and improved management can significantly reduce the socioeconomic burden of asthma. Patient education is an essential part of asthma management.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"8 4","pages":"Pages 62-75"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80013-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27605676","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}

{"title":"CME Test Questions","authors":"","doi":"10.1016/S1098-3597(09)60024-7","DOIUrl":"https://doi.org/10.1016/S1098-3597(09)60024-7","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S39-S40"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60024-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137161279","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}

{"title":"Asthma Management and Prevention: Current Perspectives","authors":"Stuart W. Stoloff MD","doi":"10.1016/S1098-3597(09)62036-6","DOIUrl":"10.1016/S1098-3597(09)62036-6","url":null,"abstract":"<div><p><span><span>The continuing evolution of asthma treatment and prevention are reflected in updated guidelines from the National </span>Asthma Education and Prevention Program and Global Initiative for Asthma as well as other recent publications. The </span><em>2007 Expert Panel Report 3</em><span><span> guidelines designate severity and control, mediated by considerations of current impairment and future risk, as the primary concepts in assessing and monitoring asthma. Severity should ideally be determined at the time of diagnosis, after which control becomes the central focus of asthma management. In the area of treatment, inhaled corticosteroids (ICSs) remain first-line therapy for long-term asthma management in children and adults. For patients whose severity of asthma requires more than low-dose ICSs, or whose asthma cannot be well controlled on </span>monotherapy with low-dose ICSs, evidence supports the efficacy of combination therapy consisting of an ICS plus an inhaled long-acting β</span>₂<span>-agonist (LABA) or an increase to medium-dose ICSs. For children &gt;5 years of age and adults not controlled on low-dose ICSs, the combination of a low-dose ICS plus an inhaled LABA is equivalent in terms of outcomes to the use of medium-dose ICS. For children &lt;5 years of age not controlled on low-dose ICSs, increasing the dose of ICSs is preferred to the addition of a LABA to low-dose ICS therapy<span> as no studies using combination therapy have been conducted for patients in this age group. With regard to asthma prevention, approaches to primary prevention (to avoid allergen sensitization) and secondary prevention (to avoid disease progression) are still very much in the developmental stage, while tertiary prevention (to avoid asthmatic stimuli) has been more successful particularly in pediatric patients. Written action plans as part of self-management processes appear to improve physician-patient communication and disease status tracking. Other considerations in successful asthma management include patient education and monitoring of adherence to treatment regimens.</span></span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 2","pages":"Pages 6-23"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)62036-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28147505","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}

{"title":"Commentary on Current Literature","authors":"Richard A. Johnson MD","doi":"10.1016/S1098-3597(08)60030-7","DOIUrl":"https://doi.org/10.1016/S1098-3597(08)60030-7","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 1","pages":"Page 69"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)60030-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137353116","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}

{"title":"CME Information","authors":"","doi":"10.1016/S1098-3597(08)60022-8","DOIUrl":"https://doi.org/10.1016/S1098-3597(08)60022-8","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 1","pages":"Pages 3-5"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)60022-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137353118","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}