高敏C反应蛋白对新诊2型糖尿病患者亚临床动脉粥样硬化的预测探讨

目的探讨高敏C反应蛋白（hsC—RP）对新诊2型糖尿病（T2DM）患者亚临床动脉粥样硬化（AS）发生的预测作用。方法前瞻性观察新诊T2DM患者（n=161）接受抗血小板聚集，强化血糖、血压及血脂等多因素干预1年后hsC-RP（免疫比浊法检测）的变化。结果亚临床AS组基线hsC-RP高于无AS组[1．34（O、09～6、43）mg／Lus0．56（0．04～7．84）mg／L，P〈0．05]；干预1年无AS组hsC—RP较基础值降低（P〈0.01），亚临床As组无此改变。hsC—RP处于上四分位数区间组亚临床AS发生率高于其余三组（30．0％vs10．0％、11．1％及9．8％，P=0．029）。结论轻度升高的hsC-RP能在多因素干预条件下预测新诊T2DM亚临床AS发生的风险。     

2型糖尿病患者血清可溶性细胞间黏附分子与大血管病变的相关性研究

本研究显示2型糖尿病（T2DM）大血管病变组血清可溶性细胞间黏附分子（sICAM-1）显著高于非大血管病变组和对照组，sICAM-1与hsC—RP、Fib、TG、TC以及LDL—C呈显著正相关，且SBP、hsC—RP和sICAM-1对T2DM大血管病变呈独立正相关影响。     

罗格列酮对非糖尿病代谢综合征患者糖脂代谢、胰岛素抵抗及炎症指标的影响

157名伴有低HDL-C和代谢综合征（MS）的非糖尿病患者随机分为两组,分别给予马来酸罗格列酮4mg或8mg／d治疗12周之后,两组FPG、2hPG、HbA1C、Fins、HOMA—IR、TG、hsC—RP、纤维蛋白原（FIB）和WBC均下降,HDL-C升高（P均＜0．05）,8mg组变化尤著;两组TC和LDL-C均无明显变化（P〉0．05）。对伴有低HDL—C和MS的非糖尿病患者予罗格列酮治疗能有效改善血糖和血脂,减轻IR和炎症状态。     

感染耐甲氧西林金黄色葡萄球菌的糖尿病足溃疡患者的临床特点及分析

目的研究感染耐甲氧西林金黄色葡萄球菌（MRSA）的糖尿病足（DF）溃疡患者的临床特点,探讨MRSA对DF溃疡预后的影响。方法分析2005年6月-2008年5月102例DF感染（DFI）患者入院48h内及抗感染治疗后创面棉拭子和组织细菌培养结果,将其分为4组：A组16例,入院后48h内MRSA阳性;B组25例,入院后48h内甲氧西林敏感金黄色葡萄球菌（MSSA）阳性;C组27例,入院后48h内革兰氏阴性菌阳性,经抗感染治疗后MRSA阳性;D组34例,入院后48h内革兰氏阴性菌阳性,住院期间始终未分离出MRSA菌株。将A组与B组、C组与D组分别进行比较,研究感染MRSA的高危因素以及其对患者住院时间、住院费用及预后的影响。结果A、B组间WBC、RBC、白蛋白（ALB）和DF溃疡面积差异均有统计学意义（P均〈0．05）,而DM病程、DF溃疡病程、住院时间、日住院费、高敏C-反应蛋白（hsC—RP）差异均无统计学意义;C、D组间DM病程差异有统计学意义（P〈0．05）,而其余指标差异均无统计学意义。43株MRSA对庆大霉素／环丙沙星／红霉素／四环素耐药率均为100％。结论与MSSA阳性DFI患者比较,MRSA阳性DFI患者全身炎症反应更明显。骨髓炎、复发性溃疡、频繁住院、交叉感染及溃疡面积〉4cm^2可能是DFI患者感染MRSA的高危因素,而DF溃疡病程与其无关。DFI分离的MRSA多重耐药现象普遍存在。对DF患者及时发现MRSA菌株并清创处理,将不影响患者住院时间、住院费用及预后,避免盲目应用万古霉素等新一代抗生素,以延缓新型耐药菌的产生。     

葛根素治疗糖尿病合并颈动脉硬化患者细胞黏附分子和炎症因子的改变及临床意义

目的探讨葛根素治疗2型糖尿病（T2DM）合并颈动脉硬化的作用机制。方法将80例T2DM合并颈动脉硬化患者分为葛根素治疗组和对照组，比较两组患者治疗前后血液流变学、可溶性细胞间黏附分子1（siCAM-1）、可溶性血管细胞黏附分子1（sVCAM1）及高敏C反应蛋白（hsC—RP）的变化。结果葛根素治疗组经治疗后血液流变学各项指标均有下降（P〈0．05）；sICAM-1、sVCAM-1、hsC-RP水平明显下降（P〈0．01），且明显优于对照组（P〈0．05）；而对照组治疗前后各项指标差别均无显著性意义（P〉0．05）。结论葛根素能改善T2DM合并颈动脉硬化患者的血液流变学，调节改善免疫细胞黏附分子和炎症因子表达，对血管有保护作用。     

单纯胰岛素强化治疗及联合双胍类药物的疗效比较

49例短病程2型糖尿病住院患者随机分为胰岛素强化治疗组（23例）,胰岛素联合二甲双胍组（26例）,测定强化治疗2周前后各组患者FPG、Ins、C—P、hsC—RP及75g葡萄糖负荷后2hPG、Ins、C—P。应用稳态模型计算13细胞功能（HOMA—β）和胰岛素抵抗指数（HOMA—IR）,同时比较两组治疗前后各指标的变化级治疗费用。结果强化治疗后胰岛素＋二甲双胍组相比胰岛素组HOMA—β水平显著升高（P〈0．05）,HOMA—IR水平显著下降（P〈0．05）;血糖达标时间显著缩短,胰岛素及治疗费用显著下降（P〈0．05）。结论胰岛素联合二甲双胍较单纯胰岛素治疗更能有效改善型糖尿病患者的胰岛β细胞功能,减轻胰岛素抵抗,能明显减少胰岛素用量及治疗费用。     

高敏C反应蛋白与糖尿病肾病的相关性研究

研究105例2型糖尿病患者和34例健康对照，发现血清高敏C反应蛋白（hsC-RP）平与肌酐呈正相关，且为糖尿病。肾病的发病危险因素之一，随着糖尿病。肾病病程的进展，hsC—RP水平逐渐升高。     

养胃冲剂治疗慢性浅表性胃炎的临床研究

目的：研究养胃冲剂治疗慢性浅表性胃炎的临床疗效。方法：将１６０例慢性浅表性胃炎患者随机分为两组。治疗组（１２０例）用养胃冲剂，对照组（４０例）用胃炎康治疗，对照组观察两组疗效，结果：治疗组对慢性浅表性胃炎患者胃粘膜水肿、斑点状充血或糜烂炎症程度、肠化及非典型增生均有较好的防治作用，对胃脘痞满、纳呆、胃痛、嗳气等症状具有较好疗效。两组总有效率分别为９２．５％、７５．０％，两组比较有显著性差异（Ｐ〈０     

非典型哮喘183例临床表现与诊断

目的探讨总结非典型哮喘的临床表现，提高对非典型哮喘的认识，防止误诊与漏诊并为其防治提供理论依据。方法根据患者临床症状表现及气道反应性测定。结果通过气道反应性测定确诊非典型哮喘183例患者，其临床表现呈多样性，大致分5类：（1）以咳嗽为主要的原发症状；（2）以胸部不适感为主要的原发症状；（3）以喘憋为主要的原发症状；（4）以咽部不适感为主要的原发症状；（5）以对闻及异味过敏为主要的原发症状。结论非典型哮喘的临床表现具有多样性，开展气道反应性测定有利于此类哮喘诊断及治疗。     

益肝调脂饮治疗高脂血症37例分析

目的观察中药益肝调脂饮治疗高脂血症的疗效及安全性。方法将68例高脂血症患者随机分成中药组（n=37）、对照组（n=31）两组，分别观察两组患者中医临床症状、血脂指标及肝功能等。结果中药组与对照组在中医临床症状、血脂指标中的TG、HDL—C及保肝降酶等方面差异有显著性（P〈0．05）。结论中药益肝调脂饮能有效改善高脂血症患者的中医临床症状及有较好的调脂降酶作用，并且安全可靠。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.