Category: Health

The prevalence of type 2 diabetes mellitus (T2DM) in the world continues to rise, leading to a continuous increase in diabetes treatment needs and medical burden. With the progress of science and technology, social needs, hypoglycemic drugs continue to change, hypoglycemic programs become more diverse.
"Classic" traditional hypoglycemic drugs, such as sulfonylureas, metformin α- Glucosidase inhibitors and insulin still occupy half of the hypoglycemic world; However, the rise of new hypoglycemic drugs, such as dipeptidyl peptidase IV inhibitor (dpp-4i), glucagon like peptide-1 receptor agonist (glp-1ra), sodium glucose transporter 2 inhibitor (sglt2i), set off a new trend of hypoglycemic "popularity"“ How to treat and choose "classic" and "popular"?
Break the inherent impression and understand the characteristics of drugs from multiple dimensions
Compared with traditional oral hypoglycemic drugs, new hypoglycemic drugs have different hypoglycemic mechanisms and sites. At present, most people think that the new hypoglycemic drugs have good hypoglycemic safety and low risk of hypoglycemia. Besides hypoglycemia, they can also obtain multiple benefits such as heart and kidney, blood pressure control and weight control. However, the hypoglycemic effect is not strong enough and it is not suitable for patients with poor islet function. So far, insulin therapy is still an important means to control blood glucose.
The majority of diabetic patients' understanding of insulin is that they are suitable for patients with long course of T2DM and poor function of islets. They have strong hypoglycemic effect and wide indications, but insulin can increase body weight and increase side effects such as low blood sugar risk. At the same time, insulin needs to be refrigerated and stored. Before injection, it needs to be disinfected and the needle needs to be replaced, which brings inconvenience to life. The research on insulin and new hypoglycemic drugs is constantly in-depth exploration and progress, in order to meet the needs of patients with good curative effect, convenient use and high safety.
Popularity ≠ flash in the pan
Representatives of new hypoglycemic drugs include dpp-4i, glp-1ra and sglt2i. Dpp-4i reduces the inactivation of endogenous GLP-1 by inhibiting DPP-4; Glp-1ra can reduce blood glucose by activating GLP-1 receptor. Sglt2i can reduce renal glucose threshold and promote urine glucose excretion by inhibiting SGLT2, which is responsible for reabsorption of sodium and glucose from urine. Some new drugs can reduce blood glucose, maintain or reduce weight, control blood pressure, protect heart and kidney, etc.
Because cardiovascular disease (CVD) is easily associated with diabetes mellitus, which seriously affects the quality of life and life expectancy of patients, cardiovascular benefits of new drugs have attracted much attention and favor. Cardiovascular outcome trails (cvot) of new drugs have emerged one after another. Table 1 shows the completed cvot outcomes.
Table 1 cvot outcomes of completed dpp-4i, glp-1ra and sglt2i
In terms of cardiovascular outcome, the main evaluation criteria were composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke (3p-mace), which was the combination of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. Renal outcomes, including proteinuria progression, end-point events. Some sglt2i and glp-1ra have significant cardiovascular protection and renal endpoint benefit. This suggests that some new drugs have multiple benefits while lowering blood glucose, and can delay the occurrence of cardiovascular, cerebrovascular and vascular complications in diabetic patients.
Classic ≠ invariable
The development of insulin has experienced a long time, and constantly updated. In early twentieth Century, Banting and his assistant successfully extracted animal insulin from the pancreas of dogs and used it for the treatment of diabetes. In the 1980s, with the breakthrough of genetic engineering / recombinant DNA technology, human insulin began to be widely used in clinic because of its high homology, less adverse reactions such as allergy and less daily insulin consumption.
In the 1990s, insulin analogues came out, which are highly homologous with physiological insulin secretion, with rapid onset and metabolism, higher safety, flexible administration mode, and better simulation of physiological insulin secretion mode. After the 21st century, a new generation of insulin analogues was born. The use of fast acting insulin (such as insulin aspart and insulin lispro) during meals makes the injection time more free and convenient, and can be injected before or during meals; The drug release of super long acting insulin (specific hexamer structure, such as degulin, etc.) is slower, which can further reduce the risk of hypoglycemia.
At present, there are three kinds of insulin, which are basal insulin, postprandial insulin and premixed insulin. Basic insulin is injected once a day to control basic blood glucose. Insulin was injected before meals to control postprandial blood glucose. Premixed insulin can give attention to both basic blood glucose and postprandial blood glucose. In addition to the innovative structure of insulin, the current technological innovation is also reflected in the dosage form and administration mode.
The innovative dosage form has to be insulin tigro / insulin aspart, which is a combination of 70% insulin tigro and 30% insulin aspart. After one injection, it works independently and complements each other. It is injected once or twice a day with the main meal, while taking into account the basic blood glucose and postprandial blood glucose. Compared with the traditional basic postprandial scheme, the injection times and dose are improved. The current research direction focuses on insulin weekly preparation, intelligent insulin patch, oral insulin capsule, etc., which are all in the clinical research stage. The progress of these studies is bound to bring more convenient, safe and efficient treatment experience to diabetic patients.
On the premise of "reaching the standard of blood glucose", hypoglycemia is the last word
With the changes of the times, the concept of hypoglycemia is also evolving, but blood glucose control is still the core of many ideas. The guidelines for type 2 diabetes published by the Chinese Medical Association Diabetes Association in 2020 suggested that Glycated hemoglobin (HbA1c) determined by standardized testing can be used as a supplementary diagnostic standard for diabetes in laboratories with strict quality control. This is the first time that HbA1c has been included in the diagnosis of diabetes in China. At the same time, it is also proposed that controlling HbA1c is the first goal.
Figure 1 no matter how the guidelines change, controlling blood sugar is always the core
Among all kinds of drugs, insulin decreased HbA1c by 1.5-3.5%, with the most obvious effect, while dpp-4i, glp-1ra and sglt2i decreased HbA1c by 0.4-0.9%, 1.0-1.5% and 0.5-1.5%, respectively (Table 2). No matter which hypoglycemic regimen is chosen, blood glucose should be considered.
Table 2 Comparison of characteristics of various hypoglycemic drugs
Insulin can be combined with some new hypoglycemic drugs, and the combination of drugs with complementary mechanisms is more effective for blood glucose. Basic insulin and premixed insulin can be used in combination with the three new drugs. Adding dpp-4i, glp-1ra or sglt2i to hypoglycemic regimen can reduce insulin resistance, reduce insulin dosage, offset weight gain to a certain extent, and increase patient compliance. At present, there are compound preparations of glp-1ra and basic insulin, such as glargine insulin, lisnatide compound preparation, degu insulin, liraglutide injection, etc. when the dosage of insulin is the same or lower, the hypoglycemic effect is better than that of basic insulin, reducing the risk of hypoglycemia and weight gain.
Looking for a hypoglycemic method suitable for Chinese people
What kind of hypoglycemic method is suitable for Chinese people? The choice of treatment for diabetes patients will be considered in many ways. The efficacy, safety and convenience are essential. Patients' willingness and economic cost are also important.
Figure 2 diabetes treatment options need multiple considerations.
According to the recommendation of the 2020 edition of China 2 diabetes guideline, when patients' blood sugar is not well controlled or HbA1c is not up to standard, drug therapy can be started on the basis of lifestyle intervention. The first choice is oral metformin, if it is still not up to the standard, it can be combined according to the specific situation: glp-1ra or sglt2i is preferred for patients with atherosclerotic cardiovascular disease (ASCVD); Combined with chronic kidney disease, sglt2i is the first choice, glp-1ra is the second choice; Combined with heart failure, the first choice is combined with sglt2i, if not combined with the above diseases, other different types of hypoglycemic drugs can be selected for combination [1].
Insulin treatment can be divided into 2 cases, one is short-term intensive insulin treatment, usually for newly diagnosed type 2 diabetes patients, HbA1c or more than 9% or fasting blood glucose is more than 11.1 mmol/L, can be 2 weeks to 3 months of short-term intensive insulin treatment. The second is that HbA1c ≥ 7.0% after 3 months of conventional oral hypoglycemic drug treatment. If the oral hypoglycemic drug has poor blood glucose control, the first step is to start subcutaneous injection of basal insulin or premixed insulin for 1-2 times. If the blood glucose is still not up to the standard, the second step is to start multiple injections of basal + intraprandial insulin or premixed insulin [2].
Figure 3 hypoglycemic therapy in China's type 2 diabetes
Insulin and new drugs can also be combined or combined. Studies have shown that insulin combined with dpp-4i can significantly reduce HbA1c and insulin dosage compared with insulin alone [3]. The mechanism of basal insulin combined with glp-1ra is complementary, which can control the blood glucose level of patients more comprehensively, significantly reduce HbA1c and weight, and reduce the incidence of hypoglycemia [5, 6]. In theory, the hypoglycemic mechanism of sglt2i is independent of insulin, and the combination of sglt2i and basal insulin is ideal, with less hypoglycemic events [7].
In terms of composition of compound preparation, degu insulin / liraglutide mixture is the first mixture product of basic insulin and glp-1ra. The latest research in Chinese population has confirmed that the mixture has more decrease in HbA1c, higher compliance rate and lower risk of hypoglycemia compared with insulin degu alone or liraglutide alone. Compared with the insulin degu group, the body weight gain was less and the daily insulin dose was less [8]. Premixed insulin, such as insulin aspart 30, can also be combined with new hypoglycemic drugs with definite curative effect. It can be used as both initial insulin therapy and intensive insulin therapy, with lower medical cost and better safety.
Summary
The incidence rate of type 2 diabetes is increasing, science and technology are progressively improving, and market and technology have been promoting the continuous updating of hypoglycemic drugs. Whether for insulin or new hypoglycemic drugs, we should understand it from multiple dimensions. In the selection of hypoglycemic program, we should consider the needs of Chinese people, take HbA1c standard as the core, make the program according to different people, and appropriately integrate the classic and popular.

It is very important to people's liver organ, the liver inflammation the health effects of very large, acute hepatitis and viral hepatitis are two different diseases, but high risk because of the same is often confused and some inexperienced doctors for some patients, but in fact these two diseases are much different, if you can't distinguish good, treatment is not correct, Will bring a lot of unnecessary pain to patients, then today by the director of Wang Yuan to take you to understand what is the difference between acute hepatitis and viral hepatitis?

What is viral hepatitis

Viral hepatitis is by the virus and liver disease, which is formed by the infection of this disease has two kinds of classification, a for acute, a for chronic and acute viral hepatitis of obvious symptoms, patients often have nausea and vomiting, loss of appetite, skin and iris has the possibility of yellow, it is also because of a kind of expression of liver disease cause jaundice. Chronic viral hepatitis, on the other hand, is relatively mild and easy to detect, showing signs of fatigue, bloating and bloating.

What is acute hepatitis

Acute hepatitis is actually a kind of classification of viral hepatitis, indicating that the onset is more rapid, the disease spread faster, and the symptoms will be very obvious, if acute viral hepatitis can not be treated in time and effectively, it will be transformed into chronic viral hepatitis, and chronic disease is more difficult to treat than acute attack period.

After acute hepatitis is being cured, also need to make check to the hospital regularly, because of liver disease repeatedly break out sex is taller, if very good ego cannot be done after treatment recuperate, can turn chronic toxic hepatitis below the circumstance that breaks out repeatedly.

Everybody knew what distinction to have after all acute hepatitis and viral hepatitis now, actually acute hepatitis and viral hepatitis are same kind of disease, just this kind of disease has acute and chronic cent normally. The cure method of method of cure of common viral hepatitis and acute viral hepatitis nevertheless still have certain distinction, should check clear redecide cure plan so.

Guide language: chronic cor pulmonale is clinically common heart and respiratory system disease, is closely related to smoking, is mainly due to the lung, pulmonary vascular or thoracic chronic disease, their illnesses out painless, harm is bigger, the case fatality rate is high, the impact on the quality of life in patients with late, some patients complicated with respiratory, heart failure and death.

01
The course of chronic pulmonary heart disease is slow, the harm is great, and the pathogenesis is complex

1, an overview of the

Chronic cor pulmonale, referred to as "cor pulmonale, clinical disease is the main pathophysiological basis of hypoxic pulmonary hypertension, the resulting pulmonary vasoconstriction and the change of the structure, lead to the right ventricle hypertrophy of expansion and, to induce chronic cor pulmonale, illnesses out slowly, harmfulness is large, some patients complicated with heart failure and even death.

The prevalence of the disease in the northern and central regions of the country is 15 percent of the population aged over 15 years, with an estimated 25 million people affected nationwide.
There was no "pulmonary heart disease" in ancient Chinese medicine, but it belongs to the category of "lung distension" and "asthma syndrome" in modern Chinese medicine.
At present, the focus of research on chronic cor pulmonale is on the classification of syndromes and the effectiveness and mechanism of TCM treatment.

Different treatment schemes have been reported by different doctors. The research on the syndrome elements and the correlation between the syndromes is not very in-depth, and there is no TCM treatment scheme that has been widely recognized and can be promoted.
In clinical syndrome differentiation, there is a lack of syndrome specification of chronic cor pulmonale.
The differences in the understanding of TCM syndromes and characteristics of TCM syndromes are not conducive to the prevention and treatment of TCM, as well as the promotion and application of TCM, and greatly limit the in-depth and development of related research.

2. Pathogenesis

Chronic pulmonary heart disease is mainly caused by chronic obstructive pulmonary disease (COPD), primary pulmonary hypertension, severe retrospinal process and sleep apnea hypopnea syndrome and other diseases, which are delayed, mistreated and eventually developed.

Pulmonary hypertension is the main pathological basis, the formation of pulmonary hypertension factors include: 1, functional factors, mainly chronic hypoxia, acid accumulation, causing pulmonary vasoconstriction, increased pressure, forming manifestations of pulmonary hypertension.
II. Anatomic factors: the alveolar structure is destroyed, which further leads to vascular bed damage, inflammation involving small vessels leads to vasculitis, and chronic hypoxia leads to the destruction of pulmonary vascular institutions and pulmonary vascular remodeling.

Among them, functional factors are the main factors of the disease. Persistent pulmonary hypertension, which exceeds the load of the right heart, leads to compensatory right heart hypertrophy, which can then develop into right heart failure. In addition, repeated pulmonary infection, acid-base balance disorder, and chronic hypoxia can further damage the myocardium and aggravate heart failure.
Chronic cor pulmonale is the terminal stage of lung disease. The pathological process is related to the abnormal inflammatory response of the lungs to harmful gases, particles and pathogenic microorganisms.

Smoking is a kind of potential risk factors, long-term smoke exposure causes pulmonary vascular reconstruction of rsa, the smoke stimulated repeatedly respiratory tract mucous membrane can cause mucus gland hyperplasia, mucus secretion increased, ciliary motion is abate, trypsin activity, lysozyme level, elevated levels of circulating immune complex, result in pulmonary arterial endothelial cells, epithelial cells such as PKC activation, vascular smooth muscle cell proliferation, migration, pulmonary vascular remodeling, and the formation of pulmonary hypertension.

Exposure to chemical raw materials and occupational dust can directly cause damage to bronchial mucosa and lung tissue. The main pathological changes are inflammatory infiltration and obvious lymphocyte reaction.
Among the air pollutants, the ones that have the greatest impact on human beings are carbon dioxide, carbon monoxide, nitrogen dioxide, chlorine gas, sulfur dioxide and total suspended matter.
Atmospheric particles are inhaled and deposited in the alveoli, causing the increase of interleukin-6 and TNF-a in the body cells, mediating the immune inflammatory response, and finally causing the damage to the structure and function of airway mucosal epithelium and respiratory system.

3. Clinical manifestations

Chronic pulmonary heart disease (CPH) is a chronic disease of lung deficiency, lung gas loss or lung gas loss, airway obstruction, lung fullness, and failure to condense and drop. Few people have no cough or sputum, and seek medical treatment simply with slight shortness of breath, chest tightness, shortness of breath, fatigue, and palpitation.
According to the severity of the syndromes of chronic cor pulmonale, clinical syndrome differentiation can be guided.

The patient only saw chest swelling and fullness, slight cough and asthma, fatigue, relatively mild syndrome, stable condition.
Where see agitated, phlegm more difficult to be, can not supine, nasal alar incitement mouth and shoulder, prompt critical condition.
If you see signs of delirium and panting, your condition is critical and you need urgent treatment.

02
To understand the syndromes and syndromes of chronic pulmonary heart disease, Chinese medicine has a unique insight into the disease

1. General situation

According to the epidemiological survey, women have a slightly higher prevalence rate of chronic cor pulmonale in rural areas than men. The reason may be that the living standard in rural areas is relatively poor, resulting in poor room environment, more smoke and dust in the air, combined with the influence of dietary habits, women are more affected by the environment.

However, with the improvement of living standards in recent years, the incidence of chronic cor pulmonale in women is significantly lower than that in men, while the incidence of chronic cor pulmonale in men is significantly higher than that in women due to risk factors such as smoking.
For patients with chronic pulmonary history, it is recommended to quit smoking clinically. Long-term smoke exposure leads to pulmonary vascular reconstruction and multiple inflammatory reactions of airway mucosa, thus aggravating the development of the disease.

Chronic pulmonary heart disease is mainly composed of a variety of chronic lung diseases, repeated attacks, prolonged and difficult to heal the development, combined with such patients have a history of chronic pulmonary diseases, the elderly healthy qi is relatively weak, the function of the viscera decreased, the lungs and kidney deficiency, the healthy qi weakness can not protect outside, evil gas is easy to penetrate the viscera, susceptible to evil disease.
Therefore, age is one of the main factors affecting chronic cor pulmonale, and the incidence of disease increases with age.

Therefore, for patients with cor pulmonale in remission period because of the attention to health to enhance the healthy qi, pay attention to regulating the spleen and stomach, prevent the deterioration of pathogenic feelings, vigilance from becoming.
The incidence of chronic cor pulmonale is mostly concentrated in the Qingming Festival, Grain Rain, Winter Solstice, Minor Cold, Snow, that is, spring and winter festival, followed by autumn, the least in summer.
It is mainly concentrated in winter and spring. In this season, the climate changes are more intense, and the disease is mainly caused by cold pathogenic factors. The human body is relatively deficient in Yang Qi.

2. Distribution of syndromes

According to the comprehensive literature and clinical studies, the common empirical syndromes of chronic pulmonary heart disease include: phlegm heat obstructing the lung and phlegm turbidity obstructing the lung; deficiency syndromes include deficiency of qi and Yin in lung and kidney and deficiency of qi in lung and kidney, and deficiency and deficiency of qi in lung and kidney are more common; deficiency and deficiency are mainly: deficiency of Yang and flooding in water, deficiency of lung and kidney and qi and phlegm stasis obstructing the lung.
Chronic pulmonary heart disease, lung qi stagnation, spleen dysfunction, body fluid is not normalized.

Lung heart disease with phlegm turbidities obstructs the lung, and the disease is long and deep. The lung deficiency cannot be treated, regulate the operation of blood vessels, and the blood is unable to promote blood vessels. Then the blood becomes astringent and stagnant, forming the syndrome of lung and kidney qi deficiency, phlegm stasis and lung obstruction.
In the early stage, chronic cor pulmonale originated from the lungs and extended to the spleen and kidney, mostly belonging to deficiency of Qi and deficiency of Qi and Yin.

In the late stage, the main diseases are lung, kidney and heart, deficiency of qi and Yang, or deficiency of Yin and Yang. Clinically, deficiency of qi and Yin and deficiency of lung and kidney are more common.
In clinical treatment, due to the two aspects of treating the root cause and treating symptoms, dispelling pathogenic factors and strengthening positive factors are applied together, which is standard and solid. The treatment principle is mainly to dispelling pathogenic factors and promoting lung, lowering qi and resolving phlegm, warming Yang and promoting water, etc.

3. Distribution of syndrome elements

According to the literature and clinical study results, the main disease location elements of chronic cor pulmonale are lung, kidney, spleen, heart, mind, surface, meridians and so on.
Chronic cor pulmonale disease is first in the lung, then affect the spleen and kidney, later can reach the heart, the heavy involvement of the mind.
A variety of chronic pulmonary diseases lead to lung deficiency and loss, the lung does not host qi, then the lung main qigong disorder, the lung is not declared healthy, it is difficult to turbidity qi out, and difficult to clear qi in.

If the qi machine is blocked between the lungs, the lung is not declared to be reduced, the water function is abnormal, and the phlegm and turbidities are endogenous, and the airway is blocked, the lung distention disease such as chest swelling, cough and asthma appears.
Spleen is the main transport and source of phlegm. Spleen is the mother of lung. Lung disease affects kidney, lung qi deficiency is damaged, and son disease affects mother.

The syndromes of disease are: phlegm, qi deficiency, heat, Yin deficiency, blood stasis, Yang deficiency, water drinking, water stagnation, dampness, external wind, cold, closed and so on.
The basic pathogenesis of chronic cor pulmonale is always the original deficiency and standard solid. The lesion is in the lung in the early stage, then affects the spleen and stomach, and in the late stage, affects the heart, xinshen, meridians and collaterals.
In general, Qi deficiency and Qi Yin deficiency are the main ones, with the combination of phlegm and turbidities, water drinking and blood stasis as the marks. The original deficiency and evil solid are each other's cause and effect.

Conclusion: The disease location elements of chronic cor pulmonale are mainly concentrated in lung, kidney, spleen, heart, etc.
The main symptoms are phlegm, qi deficiency, heat and so on.
The general characteristics of the disease are: deficiency and solid mixed, the acute phase is mainly solid, the remission phase is mainly deficiency.
At present, there are many diagnosis and treatment methods for this disease, but there is no ideal drug for effective targeted treatment. Therefore, research on the pathogenesis of pulmonary heart disease and early intervention treatment can delay the development of the disease and improve its prognosis, which has important benefits for patients.

Doctor, I checked on baidu, asthma is likely self-healing, then my child's asthma can not be treated?

Before we can answer that question, we need to understand what asthma really is.

Asthma is a disease of chronic airway inflammation and hyperresponsiveness.

Chronic airway inflammation refers to the swelling of airway wall, increased mucus secretion and contraction of airway smooth muscle in children with asthma, which leads to lumen narrowing.

Airway hyperresponsiveness refers to airway sensitivity and vulnerability, especially after exposure to cold air, physical and chemical stimuli, allergens, hyperventilation and exercise, a series of reactive symptoms will appear.

Asthma can be compared to a huge iceberg. The wheezing symptoms are just the tip of the iceberg at sea level, and there is a huge ice body under the sea. This is the chronic inflammation of asthma, so we need to treat not only the wheezing symptoms, but also the chronic airway inflammation of the huge ice body below the sea level.

Why treat asthma, and what risks does it pose to children?

Asthma mainly affects lung function.
Impairment of lung function will lead to decreased exercise endurance, affect the children's collective living and athletic ability, and continue to have persistent impairment of lung function in adulthood, especially in old age. Daily life will also be affected, such as walking, climbing, climbing stairs, and chronic obstructive pulmonary disease and emphysema.
In China, when the cognition of asthma is insufficient, the death caused by the acute attack of asthma is the main harm of asthma.
And asthma caused by growth retardation especially short height is also more common.
It also causes children's inferiority, a variety of psychological problems, a variety of family problems and parents' anxiety, increasing the family's medical costs and so on.
Our beloved Chairman Mao died of emphysema, and the famous singer Teresa Teng did not escape an acute attack of asthma.

So can asthma heal itself?

Infants and young children with the growth of age, the growth and development of the lung and immune function gradually mature, indeed, some infants and young children wheezing gradually relieved, after 6 years of age, wheezing attacks reduced, or even no attack.
Studies have now shown that 80 percent of adults with asthma have impaired lung function, with their first wheezing episode occurring within the age of 3.
And some children with asthma who seem to heal on their own suddenly have an asthma attack, a relapse, later in life.
Asthma in outpatient service, there is a child's mother, talk to the doctor says she is breathing frequently, in elementary school before the parents did not seriously, junior high school of time don't breathe heavily, suddenly thought of asthma have self-healing, result in again breathing again and again, since the birth of her baby, now is also a long-term drug use, drug withdrawal.

So if a child already has impaired lung function, don't try to heal itself years later, which may or may not occur.
If a child is normal lung function, the number of breath is not a lot, allergen detection basic normal, no asthma or repeated wheezing family members in the family, is that you can consider to clinical observation, if there are still breathing frequently attack, review or breath nitric oxide have abnormal lung function, to start the treatment of asthma.

Rheumatoid arthritis patients to adhere to the treatment, but also to eat!
A growing body of evidence suggests that changing diet can improve symptoms and reduce the number of inflammatory markers in patients with rheumatoid arthritis.
Nutritional treatment plays an important role in this autoimmune disease.
Remove and add some food or nutrition supplements, is often thought of as a potential method for effect of rheumatoid arthritis, but researchers at the university of California, San Diego school of medicine in the United States, recently at the American rheumatism association annual meeting in Atlanta, a study has shown that in just two weeks, anti-inflammatory diet can improve the symptom such as rheumatoid arthritis patients with tenderness and swelling.
The sample size of the pilot study was small, with only 22 women with rheumatoid arthritis (all seropositive) with an average age of 55 taking part in the two-week trial.
These patients had at least three tender and three swollen joints on physical examination.
They were given diets that increased the ratio of omega-3 fatty acids to omega-6 fatty acids, added anti-inflammatory spices (such as turmeric), antioxidants, probiotics and prebiotics, and removed inflammation-boosting foods such as lactose, gluten and red meat.
What are omega-3 fatty acids and omega-6 fatty acids?
Among the essential unsaturated fatty acids, omega-3 fatty acids and omega-6 fatty acids are a love-killing couple.
The balance between the two is vital to human health.
Omega-3 fatty acids soothe and suppress inflammation, preventing a variety of chronic diseases;
Its main sources are deep-sea fish and fish oils.
Omega-6 fatty acids promote inflammation, which can lead to health problems.
Its main sources are corn, soybeans and processed products, such as various vegetable oils, fried foods and pork, beef and mutton.
Modern people tend to consume far more omega-6 fatty acids than the body needs to metabolize, which often has the side effect of inflammation.
In fact, the most reasonable ratio of omega-3 fatty acids to omega-6 fatty acids is 4:1.
How is disease activity in rheumatoid arthritis assessed?
Two weeks before the start of the study, the researchers collected clinical and biological characteristics of each participant at baseline, and measured their symptoms and disease activity using two standard measures (DAS28 and CDAI).
In DAS28, DAS stands for "disease activity score" and 28 is the number of joints examined.
The score was calculated from a range of measures, including joint swelling and tenderness, an overall score of pain, blood markers of inflammation, a questionnaire assessing physical function, and an ultrasound or MRI image.
CDAI is a composite score that takes into account the number of joints with tenderness, the number of joints with swelling, the patient's assessment of disease activity (0 to 10) and the physician's assessment of disease activity (0 to 10).
The day before the start of the study, the researchers again measured the patients' clinical parameters and instructed each on how to follow the diet and keep a daily food journal.
After 14 days, the subjects were evaluated based on measures of blood samples, clinical indicators, and dietary adherence.
Serum levels of oxolipids, a by-product of fatty acid metabolism, were measured by mass spectrometry.
A total of 17 women took part in the full trial.
■ Number of swollen joints and other arthritis symptoms before and after changing diet
After two weeks, patients had significantly improved DAS28 and CDAI scores.
The number of tender and swollen joints observed by doctors and felt by patients decreased, as did their fatigue, stress and joint stiffness.
Some pro-inflammatory and anti-inflammatory linoleic acid-derived oxolipids were significantly altered before and after dietary changes and correlated with DAS28 and CDAI scores.
■ Research defects
The study's drawback is that it wasn't a randomized, double-blind trial, so it's hard to determine how much placebo helps.
But there is no denying that the anti-inflammatory diet has played a complementary role in improving the quality of life of patients with rheumatoid arthritis.
These herbs and spices can relieve the symptoms of rheumatoid arthritis
1
ginger
Ginger has been widely used in Asian medicine and cooking for centuries for its anti-inflammatory properties.
A study by researchers at the University of Dhaka in Bangladesh, published in the Journal of Arthritis, showed that ginger inhibits the production of inflammatory molecules known as leukotrienes, as well as prostaglandins, hormone-like substances that cause pain and inflammation.
People with rheumatoid arthritis can try stir-frying chicken or vegetables with chopped ginger, eating fresh pickled ginger, or adding grated ginger to soups.
2
thyme
Thyme is an aromatic herb with strong antioxidant capacity and has a long history as a flavoring.
In a study published in Pharmacognosy Letters, researchers at Griffith University in Australia showed that thyme has anti-inflammatory effects in patients with rheumatoid arthritis.
Patients can add a small handful of thyme or fresh leaves to meat, poultry, beans, tomatoes or scrambled eggs, or add it to soups and stews.
3
turmeric
In Indian and traditional Chinese medicine, turmeric is used to treat a variety of conditions, including arthritis and musculoskeletal disorders.
In addition to having anti-inflammatory properties, turmeric and curcumin (the active ingredient in turmeric) also have analgesic effects, according to a study by researchers at Husai University in South Korea published in the Journal of Medicinal Foods.
Patients can add turmeric to soups, stews and curries.
Mix turmeric with black pepper to help your body absorb the yellow spice better.
4
Green tea
Green tea is rich in antioxidants called polyphenols, which help reduce inflammation and protect joints, thus reducing the severity of arthritis.
Researchers at Egypt's Ain Shams University reported in the International Journal of Rheumatology that green tea extract has stronger anti-inflammatory effects than black tea.
Patients can drink hot green tea, iced green tea, or matcha (made from the powder of ground green tea leaves) daily.
5
cinnamon
Iran, watts university school of medicine researchers published in the journal of the American dietetic association, according to research results on 36 female patients with rheumatoid arthritis (ra) ate four a day, each contains 500 mg of cinnamon powder) capsule, for eight weeks, the number of C - reactive protein in their blood decreases obviously, the activity of disease is reduced, the decrease in the number of tenderness and swelling of the joints.
Patients can add cinnamon sticks (or powder) to oatmeal, smoothies, soups, stews, or teas.
It is important to note that consuming large amounts of this spice can interfere with blood clotting and the effectiveness of blood-thinning drugs.
6
garlic
Like leeks and Onions, garlic contains diallyldisulfide, an organic sulfur compound found in Allium, which is an anti-inflammatory compound that reduces the action of pro-inflammatory cytokines.
Researchers from Yangzhou University Hospital published their findings in the Journal of Environmental Pathology, Toxicology and Oncology. They found that garlic reduced inflammation and reduced disease activity in rats with arthritis, which prevented their cartilage from being damaged.
Sufferers can slice or chop fresh garlic and add it to any dish to relieve pain.
7
Black pepper
Black pepper has antioxidant, antimicrobial, anti-inflammatory, and stomach-protecting properties thanks to its active ingredient (piperine).
In a study published in the Journal of Arthritis Research and Treatment, researchers at Kyung Hee University in South Korea showed that taking piperine helped reduce symptoms of inflammation and pain in animals with arthritis.
Patients can use black pepper to taste any dish, including salads, soups and eggs.

preface

Human nature is both divine and beastly -- The Wealth of Nations

As for education, I believe all of you are familiar with it. In modern times, education is the most common and important thing. If the ultimate goal of education is anything, some people will answer that it is to have a bright and beautiful future.
In fact, this is not the real purpose of education.
If we look at the excellent classics of the past dynasties and our Chinese nation, we will find that education has a purpose, which is to standardize people's humanity.

As early as a long time ago, people said that people at the beginning of life, nature is good, but Xunzi is completely different, he put forward that people at the beginning of life, nature is evil, human nature is not good, good, just people's good wishes.
Xunzi said that "human nature is inherently evil and hypocritical", and the ultimate purpose of education is to enable people to regulate the dark side of their hearts.

For a person, you can hardly really know her inner thoughts, as an old Chinese saying goes, you know the person, you know the face, you don't know the heart.
In the performance art of the last century called "Rhythm 0", others in the world finally learned how dark human nature really is.
A European artist drugged his body for six hours, only to get all kinds of destruction.

A: pollution-free appearance

This society is a society of "people".
Everyone is dealing with different people every day.
Every day we see a different face. For people, the face they show to others is a symbol of themselves.
People can only know what she looks like and if it fits their aesthetic, but we know nothing about her heart.

Although there is an old saying in China called Xiangyou Xinsheng, which holds that people who are very kind don't have bad intentions, this is only a rare case. People's appearance is determined by genes, not by psychology. Therefore, we really can't correctly judge whether a person is a good person or a bad person only by her appearance.
Man is a very good camouflage animal, life is like a play, all by acting.

A person can flexibly switch their roles between different people, so that everyone's impression of her is almost different. In this world, the only person who knows her heart may be herself, and some people even have no way to know how dark her heart is.
Artists and philosophers in almost every period of human history have debated over and over again in order to find out what it is like to be human, but these debates have almost always ended in failure in the end.
It wasn't until the last century that a body artist named Marina Abramovic really showed the world the other side of human nature.

Two: the artist who is not understood

Marina Abramovic was born in 1946, and the first half of her life, we can say, was very sad.
When she was a child, she should have a happy childhood, but Marina grew up in the family education with abnormal oppressive environment.
It was as if she had been born the one to blame.
Under high pressure, she hovered on the verge of breaking down for a long time.

This situation does not ease until after college, because away from one's parents the oppression of education no longer exists.
Being suppressed for a long time, she yearned for freedom in her heart. In college, she showed extreme boldness and freedom.
It can also be said that this high-pressure education is the foundation for her to become the mother of performance art.

In the eyes of most people, some famous artists are considered to have some mental diseases, because what they do is not understood by ordinary people, and what they do is mostly meaningless, seemingly insisting on, but in fact, it is just a stunt.
But a lot of artists, what they do has a strong practical significance.
Art comes from life, and she is higher than life, it comes from every little bit of life.

Through a peculiar way of expression, the problems found in life are infinitely amplified to make people as widely known as possible. After amplification, people begin to understand some things.
In the end, I understand some truths, which may be the original intention of the artists. They hope to bring people deeper thinking through their influence.

Three: Prosody 0

Marina at university of the arts in Belgrade her grades have been very good, after graduation, she again to Zagreb art academy, and received a master's degree, after that, she began her artistic performance career, because childhood experiences, she always thought that only extreme suffering and pain, to inspire the heart of things, can the real power.
After that, she launched an art show that shocked the world.
She was "Rhythm 0," an art performance that became a huge hit.

This performance art performance is very cruel, in order to be able to achieve a more real effect, Marina released a disclaimer to the outside world.
During this performance art, she took full responsibility for herself, not for the person who shot her, and then she sat in her room drugged for six hours.

In this process, Marina's mind is completely awake, she knows what is happening in the outside world, but because of the anesthetic effect, she does not have a little sensation, also can't move.
Marina put a lot of things in front of them, these things have a lot of beautiful meaning, such as roses, honey.
On top of that, she has a lot of murder weapons in front of her.

At the beginning of the performance art show, people stood by to watch her.
No one did anything to her. Later, a viewer, who wanted to see if she was really under anesthesia, came forward and touched her twice, but Marina did not respond at all. Finally, people really knew that she was under anesthesia.
Like drawing lipstick on Marina's face.
Someone else took Marina's coat off and threw a shower of cold water over her.

This is the end of the show.
Nothing particularly dangerous happened, nor did it reflect another cover of human nature.
Later, people were even bolder.
Someone walked up to Marina's body, picked up scissors and cut all her clothes into pieces, thus exposing Marina's whole person to people. When everyone thought that no one would take those things symbolizing good meaning, there was a person.
The rose that takes up before on Marina, but she scratched Marina's skin with the thorn of rose however, blood is direct.

At the end of the show, one of the audience members took up a weapon.
Loaded the bullet.
Aimed at Malina's head, the scene at this time makes the staff very flurried, although Marina has signed a disclaimer, but after all this is a human life.
The staff immediately stepped forward to stop.
Finally, after six hours, Marina regained consciousness and the show was declared over.

Wild wrote "all corners of the lake around" there is such a sentence "life is like a play, everything is reasonable, everything is unexpected".
To Marina's performance, look like everything is very unexpected, but actually they are in reason.
When a person is not responsible for what she does, she will show her darkest side, because no one will hold you to account.
Marina's performance also proves that when people try to test human nature, they will constantly refresh their cognition of human nature

Diabetes need to seriously deal with, because diabetes affects obviously, a lot of people body a variety of complications related to diabetes development, therefore, to understand what are the specific signal diabetes strikes, with the right treatment for the effects of diabetes, or blood glucose control, may shorten the service life.
So, is prediabetes painless or not?

In the early stage of diabetes, the elevation of blood sugar is not obvious. Some people do not have obvious adverse symptoms, but this situation should not be taken lightly. If the stable control of blood sugar is still not paid attention to, the disease may worsen.

What are the symptoms of diabetes?

1. Weight loss

During the onset of diabetes, the body sends signals that people who lose weight may have overblood sugar.
In the development of diabetes, the function of the pancreas islet is reduced, insulin secretion is insufficient, and sugar in the blood cannot be converted into energy supply, which will consume too much fat and protein in the body. Obese diabetes patients will become thin after a period of time.

2. Dry mouth

Dry mouth is a signal of excessive blood sugar. Because the body is in a state of high blood sugar for a long time, the oral mucosa is prone to stimulation, and then the feeling of dryness can not be alleviated by drinking water often.
This situation calls for caution and is likely a signal of elevated blood sugar.

3, limb numbness

People with high blood sugar will have numbness in the limbs. Under normal circumstances, the blood circulation in the limbs is good, which can provide blood to the parts needed by the body in time and keep the limbs in a relaxed state.
However, after the occurrence of diabetes, the high glucose environment accelerates vascular and neuropathy, and the normal blood circulation of the body cannot be maintained. The limbs are more prone to lack of blood, and local numbness will occur after the influence. In these cases, we should be vigilant against disease.

4. Itchy skin

Diabetes is a chronic disease that should not be underestimated. Under the threat of diabetes, patients will feel itchy skin.
Itchy skin doesn't have to be a skin disease. It can also be a chronic condition that threatens your health.
During the development of diabetes, the rise in blood sugar can irritate the skin, which often becomes itchy when affected.
People with this condition need to distinguish it from the common skin disease and make their itchy skin feel less through proper control of blood sugar.

5. Hunger easily

Being prone to hunger is a signal of high blood sugar. The body should keep healthy and have regular diet with three meals. Obtaining nutrients in the diet process can increase the sense of satiety, meet the needs of the body and maintain life activities.
However, those who develop diabetes in the food of sugar can not be obtained by the body, coupled with the fast digestion of food, more prone to frequent hunger this situation, there are these signs should be vigilant diabetes.

In recent years, the field of artificial intelligence technology has been receiving much attention. On the one hand, it is indeed that artificial intelligence technology has unique advantages. Its powerful learning ability and intelligent reaction ability are quite welcome. For example, the famous Go event-AlphaGo defeated the world’s Go game. One person, Ke Jie; on the other hand, artificial intelligence technology is maturing, and has made great breakthroughs in many aspects. Artificial intelligence technology has blossomed in services, finance, manufacturing and other industries, and the field of biomedicine has also ushered in artificial intelligence. The east wind awakens the green life.

Artificial intelligence biotechnology, covering the entire field of biomedicine

The application of artificial intelligence technology in the field of biomedicine covers everything from the development of new drugs at the source to biopharmaceuticals to clinical trials. In the past, many examinations and diagnosis were based on microscope observation and doctors’ clinical experience. In the face of artificial intelligence, all doctors are likely to be “newcomers”. According to reports, at a meeting in Changsha, artificial intelligence technology and 200 top domestic doctors conducted a PK. As a result, the judgment accuracy of artificial intelligence reached 100%. What is even more amazing is that it takes less than 5 seconds. It is impossible for any famous doctor. In fact, an artificial intelligence system once learned 80 million cases, such a "full stomach economy", and this is a doctor can't do it all his life.

Artificial intelligence biotechnology revolutionizes the face of biomedicine

Clinical trials are the foothold of biomedicine, and new drug development is the leader in biomedicine. The development of new drugs is a top priority in the field of biomedicine, but in addition to the relatively closed nature of the new drugs, they also lack a lot of learning resources to support the use of artificial intelligence biotechnology. It is true that artificial intelligence biotechnology still needs to go a long way to revolutionize the face of biomedicine, but there are already companies at home and abroad that have taken steps forward.

Since 2017, international pharmaceutical giants have deployed their own AI systems to improve the research and development efficiency of new drugs, such as Merck, Novatis, Roche, Pfizer, Johnson & Johnsone, etc. Dawan Bio's Klone4.0 and other technical service platforms combine artificial intelligence with biomedicine to make cell line development easier and more efficient.

As we all know, the development of new drugs has always been a long-term work. The spring breeze of artificial intelligence and biotechnology has transformed the development of new drugs from traditional labor-intensive to intelligent technology. In a limited cycle, unlimited possibilities can be created.

Technology is the first productive force. As the application of artificial intelligence technology matures, the biomedical field is not just about the air vent, it is likely to be an ecological innovation in the entire industry. From a macro perspective, it can be applied to almost all links of the entire industrial chain from new drug development, drug production, and clinical trials; from a micro perspective, artificial intelligence technology is used in a certain step of a new drug development, The entire new drug development efficiency is likely to increase exponentially.

As the weather heats up, for many parents, whether their children sleep well also determines whether they can get rest.
You know what?
If your child is sweating and waking up all the time, it may not be the heat or the sleep, but vitamin D deficiency.

Vitamin D deficiency leads to type O legs

The boy Dou Dou is two years old this year. Recently, his mother found that he always sweats at night and often wakes up with a start.
Examination of the body found that the legs of Doudou a little outward bend, came to the children's hospital examination found that Doudou was actually due to vitamin D deficiency caused by O leg.
What's going on here?

Vitamin D is a good helper to maintain the balance of calcium and phosphorus metabolism, promote calcium absorption and bone development, and can also participate in a variety of cell proliferation, differentiation and immune function regulation, said Ding Yuan, a doctor from the Children's Medical Examination Department of the Children's Hospital.
Studies have shown that the occurrence of malignant tumors may also be related to vitamin D deficiency in the body.

▲ Pictures from the Internet

More than 6,000 children were tested for serum vitamin D in 2019, according to the Ministry of Child Health.
The results showed that many children were deficient in vitamin D, and the proportion of vitamin D decrease gradually increased with age.
There were also differences in the rate at which serum vitamin D levels were reached in children who came for a physical examination at different seasons.
Children also have suggestive signs and symptoms, such as hyperperspiration, night terrors, irritability, and skeletal changes (symptoms of developmental abnormalities such as type X or O legs due to vitamin D deficiency).
Vitamin D levels can be checked by regular health checks and venous blood draws.

Except for children, there are four groups of people who are prone to vitamin D deficiency:

1. Inactive, not the sun, always stay at home.

People who wear sunscreen year-round, because makeup and sunscreen block out a lot of UV rays, leaving the sun's UV rays in no way to make vitamin D from the skin's 7-hydroxycholesterol.

Vegetarians who don't like meat in order to lose weight.

4. The elderly.

A word of caution: Don't take too much vitamin D

The maximum tolerable intake of vitamin D in China is 20 g. Excessive intake of vitamin D can cause vitamin D toxicity, Ding said.
Vitamin D intoxication can be manifested as anorexia, constipation, vomiting, headache, excessive urine, decreased muscle tone, heart rate is fast and abnormal, and can even cause soft tissue softening.
If taken in excess, vitamin D can cause hypercalcemia, nephrocalcinosis, and even kidney failure if taken in large doses.
Therefore, vitamin D supplements should be taken under the guidance of a doctor.

Doctor Ding yuan said, for pregnant mothers, every day must be guaranteed to eat 1,500 to 2,000 IU of vitamin D to meet the needs of the fetus.

Children under the age of 1 should get at least 400 IUS a day.
Newborn babies should receive vitamin D supplements as soon as possible under the guidance of a doctor.
Premature, twin and low weight babies must ensure 800-1000IU per day, and then reduce to 400-800IU/ day after 3 months as appropriate;
Children after the age of one should aim for 600IU of vitamin D a day.

Vitamin D supplements are simple. You can use cod liver oil and some vitamin D supplements.
In addition, the baby needs a balanced diet, more outdoor activities during the day;
Nevertheless the small baby of 6 months of less than please do not illuminate directly under the sun, lest injure delicate skin, teenager is in when undertaking outdoor activity, also want to protect the skin to prevent sunburn.

Ms. Li, who is in her 40s, has been in good health.
In 3 years ago, when Ms. Li is checked accidentally, discover transaminase is exalted, go to local hospital to do an examination to exclude hepatitis virus infection.

But, did not check clear transaminase raises specific pathogeny, opened a few to protect liver medicaments to go back accordingly eat.
Since Ms. Li did not feel any obvious discomfort, she slowly forgot about it.

Six months ago, Ms. Li began to feel weak in body, unable to do things in spirit, not wanting to eat too much, and often felt itchy on her body. Her family also felt that she looked pale.

Miss Li comes to a hospital to examine just discovery, at this moment the liver function assay of her is transaminase is raised not only, still appeared bilirubin rise obviously (jaundice) with a lot of index appear abnormal.

After a series of tests, including liver biopsy and serum antibody screening, Li was diagnosed with "autoimmune hepatitis".

Fortunately, the discovery is still timely, after active treatment, Ms. Li's condition is well under control, the color is also slowly better, gradually restored to the former health.

So, you might be wondering:

What is autoimmune hepatitis?
Abnormal liver function turns out to be more than viral hepatitis?
Below, introduce the relevant knowledge of autoimmune hepatitis to everybody!

01
What is autoimmune hepatitis?
Why 'prefer' women?

Autoimmune hepatitis (AIH) is an inflammation of the liver parenchyma mediated by an autoimmune response to liver cells.

It is caused by the destruction of the patient's autoimmune tolerance, the specific etiology and pathogenesis has not been fully defined.

Women themselves are prone to various autoimmune diseases, so AIH is more common in female patients.

The proportion of male and female patients is about 1:4, and most of them are over 40 years old.

02
Is autoimmune hepatitis hepatitis?
Is it contagious?

Mention hepatitis, everybody thinks of first is infectious disease.

Actually, besides the virus hepatitis that has infectivity, other a lot of diseases that cause liver function abnormality also call it hepatitis collectively, but without infectivity, resemble alcoholic sex hepatitis, medicaments sex hepatitis, fat sex hepatitis and autoimmune hepatitis (AIH) to wait.

What other hepatitis differs somewhat is, the main pathogenic factor of autoimmune hepatitis does not come from outside, originate from oneself however.

AIH is an inflammatory liver injury mediated by abnormal autoimmunity, which is generally believed to be triggered by environmental and other factors in genetically susceptible individuals. This abnormal autoimmunity is the main cause of liver dysfunction.

If rely solely on transaminase to rise this one index, it is impossible to carry on differential diagnosis with other hepatitis, this also is why Miss Li fails to diagnose in time at the beginning.

03
How to detect autoimmune hepatitis early?

Autoimmune hepatitis often comes on more insidious, what symptom can do not have or show only for certain non-specific symptom, for example anore inappeasement, lack of power, weight reduces, right upper abdomen is unwell, skin pruritus.

If have other immunological disease besides liver, can concomitant concerned knot is painful, goiter, blood sugar is raised wait, nevertheless a lot of circumstances are found only when examination liver function is abnormal.

So, want to diagnose autoimmunity hepatitis in time, rely on symptom only cannot early diagnose.

For female friends, if no hepatitis virus infection, no history of alcohol consumption, no significant fatty liver, no long-term medication.

Once appear liver function is abnormal, be about to think of the likelihood is autoimmune hepatitis place is brought about, suggest arrive as soon as possible hospital further examination.

04
How is autoimmune hepatitis treated and checked regularly?

Autoimmune hepatitis is also a type of chronic liver disease, and the overall objectives of its treatment are:

To obtain hepatic histological relief, prevent the progression of hepatitis to liver fibrosis, prevent cirrhosis, liver failure, as far as possible to prolong the survival time and improve the quality of life.

The standard treatment for autoimmune hepatitis is immunosuppressive therapy, but drug-related side effects should be avoided as much as possible.

Many patients require long-term low-dose hormone maintenance therapy and need to be aware of the risk of osteoporosis and fractures.

Most of the patients after receiving standard treatment, the transaminase can be rapidly decreased until it returns to normal, a small number of people will have repeated.

In addition, patients with autoimmune hepatitis should review liver function and immunoglobulin every 3-6 months, still need to do regular imaging examination, including B ultrasound, CT or MRI, aggravation of the disease can be considered to repeat liver biopsy.

05
conclusion

Autoimmune hepatitis is not as common as viral hepatitis, but it is easily misdiagnosed.

Therefore, early detection, correct diagnosis and standardized treatment are the keys to control the development of the disease.

For patients with recurrent abnormal liver function for unknown reasons, especially female friends, it is recommended to have autoantibodies and IgG globulin detected in major hospitals as soon as possible, and to conduct pathological examination through liver biopsy if necessary.

Once diagnosed, should receive regular treatment, strengthen regular examination, most cases of treatment effect is very good.