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钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南 被引量:10
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作者 Sheyu Li Per Olav Vandvik +27 位作者 Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer Rene Rodriguez-Gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David J Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand Jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren Emma Jane Cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 郭鹤鸣(译) 《英国医学杂志中文版》 2021年第9期523-531,共9页
临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病... 临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生� 展开更多
关键词 胰高血糖素样肽1 终末期肾病 临床研究结果 心血管风险 meta分析 临床试验结果 临床证据 控制血糖
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Development of Mathematical Model for Control Wear in Backup Roll for Hot Strip Mill 被引量:5
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作者 R.Servin-Castaeda A.M.Garcia-Lara +1 位作者 R.D.Mercado-Solís C.A.Vega-Lebrun 《Journal of Iron and Steel Research International》 SCIE EI CAS CSCD 2014年第1期46-51,共6页
The precision of strip flatness depends on several factors; wear of rolls is one of the main variables that have influence on the surface quality of the strip. The wear of the roils represents a complex friction condi... The precision of strip flatness depends on several factors; wear of rolls is one of the main variables that have influence on the surface quality of the strip. The wear of the roils represents a complex friction condition, sometimes the wear in the backup roll is not analyzed because the strip is not in contact with the backup roll; however, after several campaigns of rolling, the wear in the backup roll becomes dangerous because the pressure distribution is not uniform. Investigation of mechanism of the surface deterioration of the backup roll for the hot strip rolling is very important for the development of the automatic strip shape control system used in hot strip mills. A mathematical model is developed considering the Hertzian pressure distribution between two cylinders with parallel axes. It is used in real time for calculating the wear in the backup roll and in this manner take deci- sions for preventing finished product reworking or damage of equipments, which result in accidents caused by excessive wear in the backup rolls. 展开更多
关键词 strip flatness backup roll DRESS CROWN rolling campaign
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Health Status of Urban Medium-Low-Income Elderly at the Community
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作者 Lilia Cárdenas-Ibarra Jesús Z. Villarreal-Pérez +5 位作者 Raúl Fernando Gutiérrez Herrera Perla Alejandra Mellado-Urbina Ana Laura Turner-Llaguno Adolfo Montemayor-Alatorre José Carlos Lira-Castillo Fernando J. Lavalle González 《Open Journal of Endocrine and Metabolic Diseases》 2018年第3期105-116,共12页
Background: Nonagenarians are uncommon in our population. The study aim was to profile physical mobility, declared health problems, hypertension and diabetes frequency, awareness, treated and good control in urban low... Background: Nonagenarians are uncommon in our population. The study aim was to profile physical mobility, declared health problems, hypertension and diabetes frequency, awareness, treated and good control in urban low-income elders. Method: The study had cross-sectional design in population sample. Subjects were urban men and women older than 59 years at the medium low income stratum at a developing country. Survey was carried out from October 2008 to October 2009. All elder dwellers in randomly selected houses were surveyed;clinical exam after consent. Good Control: Systolic/Diastolic Results: There were 162 elders, 53 (32.7%) were male, 99 (61.1%) were younger than 70 years. Forty nine (30.2%) had impaired mobility;among them 20 (55.6%) were bed or home restricted, and 29 (44.4%) needed help to go out. Unstable health condition was found in 36 (22.2%), with significantly more men 19 (52.8%) vs 34 (27.0%), X2 = 8.5, df1, P 0.05. The frequency, proportions for: known diagnosis, on treatment, and good control were 75 (69.4%), 55 (73.3%), 45 (60.0%) and 12 of 45 (26.7%) for hypertension;53 (49.1%), 47 (88.7%), 42 (79.2%) and 9 of 42 (21.4%) for diabetes. The most frequent unstable conditions were cardiovascular. Conclusions: Data suggest unstable health no association with the oldest old. The small proportion in good control of Diabetes and/or hypertension could explain the large frequency of elders with unstable health and prevention of reaching nonagenarian age. 展开更多
关键词 COMMUNITY Health ELDERLY AWARENESS Treatment and Control of HYPERTENSION and Diabetes MELLITUS Type 2
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Judgment Formation towards Health Risk Behaviors Concerning Obesity: An Integration Information Theory Approach
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作者 Aida A. Jimenez-Martinez Perla Lizeth Hernandez-Cortes +1 位作者 Guadalupe E. Morales-Martinez Ernesto O. Lopez-Ramirez 《Health》 2017年第7期1047-1053,共7页
A sample of 80 secondary students was required to take an information integration theory study to explore judgment formation toward health risk behavior regarding obesity. Here, twelve social scenarios containing a si... A sample of 80 secondary students was required to take an information integration theory study to explore judgment formation toward health risk behavior regarding obesity. Here, twelve social scenarios containing a simulated actor were implemented (vignettes) having in mind a three factor experimental factor design (diet, weight and physical activity). Subjects had to read each vignette and provide an answer by marking ten points anchored scale to provide judgment on actors’ possible health risk outcome. Results showed that study participants valuated diet as the most relevant factor, followed by the description of weight and finally followed by the factor of physical activity. They impose systematic thinking to integrate different sources of information provided by factor manipulation in the vignettes by using a cognitive summative rule. Implications of this study result to clinical intervention in obesity as well as for theoretical considerations of cognitive models of health risk behavior are discussed in the present article. 展开更多
关键词 OBESITY COGNITIVE Specification JUDGMENT FORMATION Information INTEGRATION Theory COGNITIVE ALGEBRA
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2型糖尿病患者强化血糖控制的利与弊 被引量:1
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作者 Rene Rodriguez-Gutierrez Jose Gerardo Gonzalez-Gonzalez +3 位作者 Jorge A Zuniga-Hernandez- Rozalina G McCoy 吴量(译) 潘洁敏(校) 《英国医学杂志中文版》 2020年第9期505-521,共17页
糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性... 糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性心肌梗死的发生率外,强化(相对于适度)血糖控制对重要的微血管和大血管并发症预后没有显著获益。但是,严格的血糖控制却会增加严重低血糖的风险,并会增加药物种类、副作用和成本等额外负担。此外,来自心血管结局研究的数据表明,使用特定类别的降糖药可大大改善心血管、肾脏和死亡的结果,而这些效应在很大程度上不是由降糖作用带来的。因此,为2型糖尿病患者提供基于循证医学的、以患者为中心的诊疗,需要转变范式并脱离以血糖为中心的糖尿病管理观点。与其优先考虑加强血糖控制,不如将重点放在确保患者获得足够的糖尿病照护,使血糖目标和患者的目标与情况保持一致,最大程度地减少短期和长期并发症,减轻治疗负担以及改善生活质量上。 展开更多
关键词 严重低血糖 循证医学 糖尿病管理 血糖控制 大血管并发症 以患者为中心 2型糖尿病 降糖作用
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Gravity Field Variations Associated with the Buried Geological Structures: San Marcos Fault (NE Mexico) Case Study
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作者 Vsevolod Yutsis Yaneth Quintanilla-López +2 位作者 Konstantin Krivosheya Juan Carlos Montalvo-Arrieta Gabriel Chávez-Cabello 《Journal of Modern Physics》 2012年第9期1236-1246,共11页
Gravity data are sensitive to local vertical offsets across high-angle faults, where rocks with different densities are juxtaposed. Yet high densities in some Mesozoic sedimentary rocks just above the basement may sme... Gravity data are sensitive to local vertical offsets across high-angle faults, where rocks with different densities are juxtaposed. Yet high densities in some Mesozoic sedimentary rocks just above the basement may smear out the subtle gravity signatures of basement faults. At this study the gravity data processing tends to avoid ill-described “black-box” techniques. The study area is situated in the Palomas site, Cuatrociénegas region, Coahuila, NE Mexico. The San Marcos Fault is at least 300 km long and has WNW-ESE trend from the central part of Nuevo León State through Coahuila, and finally to the eastern part of Chihuahua State. Gravimetric data shows that the lowest values of free air and Bouguer anomalies are in the southern part of the area, and the highest values are in the western and central part of the area. Between these parts exists a zone of high horizontal gravity gradient. Configuration of linear elements of gravity field (gradient zones) delimited the San Marcos Fault in the San Marcos valley below thickness of recent sedimentary cover. Two density models were carried out, which showed that the Cretaceous rocks are in discordant contact with the Paleo- zoic rocks that can be related to the San Marcos Fault. The density was determinate using to Nettleton’s method, which results highlight the presence of the San Marcos Fault. Density models showed that the Quaternary sediments are in direct contact with the San Marcos Fault. 展开更多
关键词 Earth GRAVITY Newton Potential GEOPHYSICAL PROSPECTING Density Models Free Air Anomaly GRAVITY Field VARIATIONS
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Explosions and seismic phenomena based on exciting of acoustic-electromagnetic waves
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作者 S. Koshevaya V. Grimalsky +4 位作者 G. Urquiza M. Tecpoyotl A. Kotsarenko V. Yutsis N. Makarets 《Natural Science》 2012年第8期652-658,共7页
During earthquakes and strong underground explosions it is possible to observe two different effects. The first one is connected with the destruction of media, and this causes acoustic and later hybrid acoustic-electr... During earthquakes and strong underground explosions it is possible to observe two different effects. The first one is connected with the destruction of media, and this causes acoustic and later hybrid acoustic-electromagnetic waves in an epicenter in the atmosphere and in the ionosphere. Another one is connected with cracks in crystals of rocks, which seems more interesting, because it is possible to recognize the natural earthquakes and industrial explosions. In the first effects due to nonlinear elastic modules the acoustic waves move through the lithosphere and transform their spectra from VLF (very low frequencies ~ 1 - 10 kHz) at the depth of about 30 km into the lower part of ELF (extremely low frequencies, ~ 3 Hz - 1 kHz) on the Earth’s surface, then they pass the atmosphere and penetrate into the ionosphere. During the nonlinear acoustic passage through the atmosphere and the ionosphere, the spectrum transforms from ELF into ULF (ultra low frequencies, < 1 Hz) range. In this review article the classification of spectrum and analysis of two cases of the destruction of rocks in the lithosphere is presented. The rocks possess piezoelectric and piezomagnetic properties. In this case the electromagnetic emission is excited by the fracturing in plates of crystals. The difference of emission from piezoelectric and magnetic plates in cases of industrial explosions and natural seismic events including volcanic phenomena gives a possibility to analyze the method of its identification. The consideration is based on the model of the plate of a finite size with an uniformly moving crack. 展开更多
关键词 UNDERGROUND Explosion Nonlinear PASSING of ACOUSTIC Waves Piezoelectric and Magnetic Plates Difference Between Natural SEISMIC VOLCANIC and Industrial Events
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Optimized Filling of a Given Cuboid with Spherical Powders for Additive Manufacturing
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作者 Zoya Duriagina Igor Lemishka +4 位作者 Igor Litvinchev Jose Antonio Marmolejo Alexander Pankratov Tatiana Romanova Georgy Yaskov 《Journal of the Operations Research Society of China》 EI CSCD 2021年第4期853-868,共16页
In additive manufacturing(also known as 3D printing),a layer-by-layer buildup process is used for manufacturing parts.Modern laser 3D printers can work with various materials including metal powders.In particular,mixi... In additive manufacturing(also known as 3D printing),a layer-by-layer buildup process is used for manufacturing parts.Modern laser 3D printers can work with various materials including metal powders.In particular,mixing various-sized spherical powders of titanium alloys is considered most promising for the aerospace industry.To achieve desired mechanical properties of the final product,it is necessary to maintain a certain proportional ratio between different powder fractions.In this paper,a modeling approach for filling up a rectangular 3D volume by unequal spheres in a layer-by-layer manner is proposed.A relative number of spheres of a given radius(relative frequency)are known and have to be fulfilled in the final packing.A fast heuristic has been developed to solve this special packing problem.Numerical results are compared with experimental findings for titanium alloy spherical powders.The relative frequencies obtained by using the imposed algorithm are very close to those obtained by the experiment.This provides an opportunity for using a cheap numerical modeling instead of expensive experimental study. 展开更多
关键词 Sphere packing Heuristic algorithm Titanium alloy spherical powders 3D printing
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Mexican Guidelines for the Diagnosis and Treatment of Chronic Myeloid Leukaemia
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作者 Eduardo Cervera Federico Godínez +21 位作者 Rosa Sosa Ramón Rivas Carlos Best Juan Hernández Adrián Morales Hugo Zurita Ivette Carrasco Jorge Cruz álvaro Aguayo José Espinoza Juan Labardini Luis Valero Judith Cruz Diana Arcos Diego Limón Omar López-Navarro Daniela Gordillo-Bastidas Myrna Candelaria Francisco Torres Juan Kassack Oscar de Jesús Pérez Ramírez Jorge Aqui 《Journal of Cancer Therapy》 2013年第3期747-764,共18页
Background: This document includes recommendations and guidelines issued by a group of Mexican researchers and specialists gathered in the First National Colloquium for the Diagnosis and Management of Chronic Myeloid ... Background: This document includes recommendations and guidelines issued by a group of Mexican researchers and specialists gathered in the First National Colloquium for the Diagnosis and Management of Chronic Myeloid Leukaemia (CML) by initiative of Instituto Nacional de Cancerología and with the support of the Leukaemia Department of the MD Anderson Cancer Center. Mexico lacks of updated information taken from its own reality on the diagnosis and treatment of CML and other haematological disorders;besides, there are no national guidelines. Aim: To publish a consensus document with guidelines for the management of CML adjusted to the national environment and overall characteristics. Method: The participants answered a DELPHI questionnaire about the overall aspects of the disease, aiming to target controversial topics, discuss them in the colloquium, and to agree on the best ones. After those meetings, a final document was drawn up. Results: The group presents recommendations for definition, diagnosis, prognosis, monitoring, and treatment of CML in Mexico. Conclusions: Having consensus guidelines for the clinical management of CML in our country will enable the consensual practice of Mexican specialists regarding the clinical approach to CML, as well as optimize the resources which allow the rational planning of the medical care strategies. 展开更多
关键词 CHRONIC MYELOID LEUKAEMIA Management GUIDELINES DIAGNOSIS Treatment.
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