【正文】 Importantly, these changes depend at least in part on hyperglycemia, as they are diminished by intensive diabetes treatment.hyperglycemia 高血糖 intensive 加強的，密集的重要的是，這些變化至少部分是依靠高血糖，因為通過有力的糖尿病治療它們會消失。The period immediately following diagnosis is best characterized by glomerular hyperfiltration.glomerular 腎小球的 hyperfiltration 超過濾緊接診斷后的一段時期以腎小球超濾最具有特征。Overall, diabetes is the leading cause of ESRD in the United states, accounting for more than one third of cases.overall 總體來說 accounting for 說明、證明、對…負責總的來說，糖尿病是美國晚期腎病的首要病因，占三分之一以上。Chapter 23 Diabetic Nephropathy Page 67第二十三章 糖尿病腎病 第67頁Endstage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and mortality, particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States.nephropathy 腎病由糖尿病性腎病所發(fā)展的晚期腎?。‥ARD）是人類患病和死亡的一個主要原因，特別是患有1型糖尿病的病人，在美國涉及30~35%的病人。The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible.potentially 潛在的、可能的 inaccessible 達不到的、難接近的膠囊小腸鏡的診斷效率現(xiàn)在還不清楚，但是，這種方法可能顯示出以前難以接近的小腸腸管。In some clinical situations, the site of bleeding cannot be identified, and the patient requires longterm transfusion therapy.longterm 長期的 transfusion 輸血某些臨床病例，出血部位無法找到，病人而要長期輸血治療。As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment.內(nèi)鏡退出時，內(nèi)鏡的發(fā)現(xiàn)可以決定是外科切除或保守治療。During the procedure, the surgeon plicates the bowel over the endoscope.plicate 有褶的。Provocative angiography using heparin or thrombolytic agents has been suggested by some authorities, but this approach has the potential risk of precipitating major bleeding.provocative 刺激的、挑拔的、氣人的 precipitating 使突然發(fā)生、促使雖然使用肝素或溶栓藥的刺激性血管造影被某些專家推薦，但這種方法有促發(fā)大出血的潛在風險。Traditional videoendoscopes can evaluate only the proximal small bowel (≤150cm), whereas longer scopes, which are passed though the entire small bowel and then withdrawn while visualizing the mucosa (sonde enteroscopy), are limited in their ability to visualize the entire mucosa and cannot be used to perform diagnostic or therapeutic maneuvers.proximal 最接近的、近側(cè)的 visualize 使看得見，想像 sonde 探空火箭、探子、探針傳統(tǒng)的電視內(nèi)窺鏡只能檢查近端小腸(≤150cm)，然而能通過整個小腸邊退邊看腸粘膜的更長內(nèi)鏡，也不能看到整個腸粘膜，不能作為常規(guī)的診斷或治療手段。Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a less than 6% yield from small bowel followthrough and a 10 to 21% yield from enteroclysis.insensitive 感覺遲鈍的 followthrough 持久的貫徹，持續(xù) enteroclysis 小腸造影小腸X線檢查是非侵入性的，但相對不靈敏，小腸全片不到6%有發(fā)現(xiàn)，小腸造影10～21％有結(jié)果。A repeat endoscopic evaluation may be appropriate, because approximately one third of cases reveal a cause of bleeding overlooked during the initial endoscopy.內(nèi)窺鏡重復檢查可能是需要的，因為接近三分之一病例查出了首次內(nèi)窺鏡漏掉的出血病原灶。Potential causative agents, such as NSAIDs and aspirin, should be discontinued. causative 成為原因的NSAIDs 非甾體類抗炎鎮(zhèn)痛藥nonsteroidal antiinflammatory drugs 能成為潛在病因的藥物，如非甾體類抗炎鎮(zhèn)痛藥和阿斯匹林，都應該停用。Angiodysplasia is the most mon cause in most recent series.Angiodysplasia 血管發(fā)育畸形血管發(fā)育畸形是最近病例統(tǒng)計中最常見的病因。Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that are identified.utility 實用、效用、通用隱匿性出血時，上、下消化道的鋇劑造影應用有限，因為它們不能活檢或治療發(fā)現(xiàn)的病損。Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have both upper and lower endoscopy because the plementary endoscopic examination has a yield of 6% even if the first one was positive.plementary 補充的、互補的 positive 確定的、絕對的、真實的無論首次上消化道或下消化道內(nèi)窺鏡檢查會有何發(fā)現(xiàn)，所有病人兩個檢查都應該做，因為互補的內(nèi)窺鏡檢查有6%的再發(fā)現(xiàn)，即使第一個檢查是陽性的。The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one or more colonic polyps.yield 產(chǎn)出、結(jié)出、產(chǎn)生這些病人結(jié)腸鏡的結(jié)果大約2%是癌癥，30%是單發(fā)或多發(fā)的結(jié)腸息肉。The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic evaluation.對隱匿性胃腸道出血，應該使用內(nèi)窺鏡進行早期檢查。Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts.initial 開始的、最初的 evaluation 評價來源不明性胃腸出血是指首次上、下消化管內(nèi)窺鏡檢查都陰性、原發(fā)部位不明的持續(xù)性或反復性出血。 one trial showed improvements in functioning with resistance and aerobic exercise in older adults with osteoarthritis of the knee.aerobic exercise 有氧運動 osteoarthritis 骨關(guān)節(jié)炎許多干預試驗揭示能力喪失可預防或減輕；一個試驗顯示膝骨關(guān)節(jié)炎老年人用對抗運動和有氧運動改善了功能。 Although physical disability is primarily a result of chronic diseases and geriatric conditions, its onset and severity are modified by other factors, including treatments that control the underlying diseases, physical activity, nutrition, and smoking. primarily 首先、起初、主要、根本 onset 進攻、有力的開始、發(fā)作雖然身體能力喪失是慢性疾病和年老狀態(tài)的一個主要結(jié)果，它的發(fā)生和嚴重程度被其它因素影響著，包括基礎(chǔ)疾病的治療和控制、身體鍛煉、營養(yǎng)和吸煙。 Of persons older than age 65, 5% reside in nursing homes, largely as a result of dependency in IADL and/or ADL secondary to severe disease. reside 居住 nursing home 療養(yǎng)院大于65歲的老人中，5%住在療養(yǎng)院里，大多數(shù)是嚴重疾病后依賴IADL和ADL的結(jié)果。 for both, the prevalence increases with age.prevalence 流行大于65歲的老人或其它人，IADL困難報導為20%，ADL困難報導為11%；隨年齡增加兩個都困難成為普遍現(xiàn)象。 basic selfcare tasks). 在老年人中， 40%對需要運動的任務有困難，運動困難提示將來開展日常工具鍛煉（IADL；家務自理項目）和目常鍛煉（ADL；基本自理項目）的困難。Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL。 Cognitive impairment plicates diagnosis and requires additional care giving to ensure safety.認知損害使診斷復雜，為保證安全需要更多的照料。 Fourth, cognitive impairment increases in prominence as people age. prominence 突出、顯著第四，人們變老時認知損害顯著增加。Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritional supplements, and homebased physical therap