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ABSTRACT Objective: to develop a mid-range theory for nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. Method: the theory construction was carried out in six stages: approach definition; theoretical-conceptual model definition; definition of the main concepts; pictogram development; construction of propositions and establishment of causal relationships evidence for practice. Results: twelve etiological factors and 22 clinical indicators were included in the theory, some of which were not listed in NANDA International (Inc.) and others were adapted to better characterize patients with diabetic foot. A pictogram was constructed and eight propositions were established to verify causal relationships and evidence for practice. Conclusion: medium-range theory made it possible to broaden the concepts and demonstrate the causal relationships between the elements of ineffective peripheral tissue perfusion, providing subsidies to minimize gaps in knowledge and assist clinical nursing practice.
RESUMEN Objetivo: desarrollar una teoría de rango medio para el diagnóstico de enfermería de la perfusión tisular periférica ineficaz en pacientes con pie diabético. Método: la construcción de la teoría se realizó en seis etapas: definición del enfoque; definición del modelo teórico-conceptual; definición de los principales conceptos; desarrollo de pictogramas; construcción de proposiciones y establecimiento de relaciones causales basadas en evidencia para la práctica. Resultados: se incluyeron en la teoría 12 factores etiológicos y 22 indicadores clínicos, algunos de los cuales no estaban incluidos en NANDA International (Inc.) y otros se adaptaron para caracterizar mejor a los pacientes con pie diabético. Se construyó un pictograma y se establecieron ocho proposiciones para verificar las relaciones causales y la evidencia de la práctica. Conclusión: la teoría de rango medio permitió ampliar los conceptos y demostrar las relaciones causales entre los elementos del diagnóstico de perfusión tisular periférica ineficaz, brindando subsidios para minimizar las brechas en el conocimiento y ayudar a la práctica clínica de la enfermería.
RESUMO Objetivo: desenvolver uma teoria de médio alcance para o diagnóstico de enfermagem perfusão tissular periférica ineficaz em pacientes com pé diabético. Método: a construção da teoria foi realizada em seis etapas: definição da abordagem; definição do modelo teórico-conceitual; definição dos conceitos principais; desenvolvimento de pictograma; construção das proposições e estabelecimento das relações de causalidade evidências para a prática. Resultados: foram incluídos na teoria 12 fatores etiológicos e 22 indicadores clínicos, alguns destes não estavam listados na NANDA Internacional (Inc.) e outros foram adaptados para melhor caracterização dos pacientes com pé diabético. Construiu-se um pictograma e foram estabelecidas oito proposições para verificar as relações causais e evidências para a prática. Conclusão: a teoria de médio alcance possibilitou ampliar os conceitos e demonstrar as relações causais entre os elementos do diagnóstico perfusão tissular periférica ineficaz, fornecendo subsídios para minimizar as lacunas no conhecimento e auxiliar a prática clínica da enfermagem.
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Objective·To verify the indicating value of the simple screening of lower extremity atherosclerosis artery disease (LEAD) by lower extremity arterial ultrasound examination for coronary atherosclerotic heart disease (CAD) in patients with type 2 diabetes. Methods·A total of 606 type 2 diabetes patients were enrolled. Their clinical data and biochemical parameters (hepatorenal function, glycometabolism, tumor markers) were collected. All patients were undertaken lower extremity vascular ultrasound and CT angiography (CTA) scan for coronary artery disease. According to the results of lower extremity ultrasound, patients were divided into two groups, patients with LEAD group (n=318) and patients without LEAD group (n=288). According to the history of coronary CTA or percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), the patients were divided into CAD group (n=280) and non-combined CAD group (n=326). The prevalence of CAD in different LEAD groups was compared and their relationship was analyzed. Results·The degree of LEAD was proportional to the prevalence of CAD. Both of the prevalences of CAD in group with arterial stenosis >50% (81%) and group with plaque and stenosis<50% (63%) were significantly higher than that in group without plaque (29%) (P=0.021,P=0.015, respectively). Spearman analysis found that age, sex, duration of diabetes, systolic blood pressure, total cholesterol, LEAD, femoral artery intima-media thickness were positively correlated with CAD. However, high density lipoprotein cholesterol and glomerular filtration rate were negatively associated with CAD. Logistic regression analysis revealed that duration of diabetes, existence of LEAD were independent associated factors of CAD. After adjusting the confounding factors, odds ratio risk analysis showed the risk increased 4.818 times in patients with LEAD (OR=5.818, 95% CI 2.627-12.888, P=0.000). Conclusion·The evaluation of LEAD by ultrasound has an indicating value for CAD in type 2 diabetes patients.
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Objective·To verify the indicating value of the simple screening of lower extremity atherosclerosis artery disease (LEAD) by lower extremity arterial ultrasound examination for coronary atherosclerotic heart disease (CAD) in patients with type 2 diabetes. Methods·A total of 606 type 2 diabetes patients were enrolled. Their clinical data and biochemical parameters (hepatorenal function, glycometabolism, tumor markers) were collected. All patients were undertaken lower extremity vascular ultrasound and CT angiography (CTA) scan for coronary artery disease. According to the results of lower extremity ultrasound, patients were divided into two groups, patients with LEAD group (n=318) and patients without LEAD group (n=288). According to the history of coronary CTA or percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA), the patients were divided into CAD group (n=280) and non-combined CAD group (n=326). The prevalence of CAD in different LEAD groups was compared and their relationship was analyzed. Results·The degree of LEAD was proportional to the prevalence of CAD. Both of the prevalences of CAD in group with arterial stenosis >50% (81%) and group with plaque and stenosis<50% (63%) were significantly higher than that in group without plaque (29%) (P=0.021,P=0.015, respectively). Spearman analysis found that age, sex, duration of diabetes, systolic blood pressure, total cholesterol, LEAD, femoral artery intima-media thickness were positively correlated with CAD. However, high density lipoprotein cholesterol and glomerular filtration rate were negatively associated with CAD. Logistic regression analysis revealed that duration of diabetes, existence of LEAD were independent associated factors of CAD. After adjusting the confounding factors, odds ratio risk analysis showed the risk increased 4.818 times in patients with LEAD (OR=5.818, 95% CI 2.627-12.888, P=0.000). Conclusion·The evaluation of LEAD by ultrasound has an indicating value for CAD in type 2 diabetes patients.
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Diabetic vascular complications are among the leading causes of morbidity and mortality in diabetic patients. In the past, many studies have focused on the mechanisms of hyperglycemia-induced chronic vascular complications via the formation of toxic metabolites such as oxidative stress, advanced glycosylated end products, persistent activation of protein kinase C, and increased sorbitol concentrations. However, vascular complications result from imbalances caused by increases in systemic toxic metabolites, such as those that occur under conditions of hyperglycemia and dyslipidemia, and by reductions in endogenous protective factors such as insulin, vascular endothelial growth factor, and platelet derived growth factor. This review outlines some of the evidence supporting the importance of enhancing endogenous regenerative factors.
Subject(s)
Humans , Diabetic Angiopathies , Dyslipidemias , Hyperglycemia , Insulin , Oxidative Stress , Platelet-Derived Growth Factor , Protein Kinase C , Sorbitol , Vascular Endothelial Growth Factor AABSTRACT
Protein kinase C(PKC) is a serine/threonine kinase groups including a series of isoenzyme.Hyperglycemia and elevated free fatty acid can affect signal transduction pathway function,in particular activation of diacylglycerol (DG) and PKC,which occurs in the diabetic state. Activation of PKC lead to insulin resistance and diabetic vascular complications. PKC ? isoform selective inhibitor(LY 333531) and vitamin E have shown potential effect as therapies for diabetic vascular complication.
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AIM: To study the effect of crocetin on the formation of advanced glycation end products(AGEs) and receptor for AGEs(RAGE) protein expression in diabetic rats induced by streptozotocin(STZ).METHODS: Rats were injected STZ in tail vessel with a dose of 45(mg?kg~(-1)).3 d later,the rats whose blood glucose were over(11.1)(mmol?L~(-1)) were regarded as diabetic rats,and were divided randomly into two groups: diabetic mellitus(DM) group,crocetin(50(mg?kg~(-1)),po) group.At the same time,8 normal rats were regarded as control group.After 21 d treatment,The levels of fasting blood glucose(FBG),serum fructosamine(FMN) and glycosylated hemoglobin(GHb) were measured.The contents of AGEs in aorta and mesenteric vessel were detected by fluorospectrophotometry.HE staining for mesenteric aorta was performed,and RAGE protein expression was studies with immunohistochemical method.RESULTS: Compared with DM group,crocetin did not decrease the level of FBG.However,it could decrease the levels of FMN and GHb in blood and AGEs in aorta and mesenteric vessel(P