初诊2型糖尿病合并脂肪肝与胰岛素抵抗和血脂异常及超敏C-反应蛋白的关系研究

目的 探讨2型糖尿病合并脂肪肝与胰岛素抵抗及脂代谢紊乱、超敏C-反应蛋白(hs-CRP)的关系.方法 108例初诊2型糖尿病患者,根据B超检查分为合并脂肪肝组58例和无脂肪肝组50例,分别测定身高、体重、腰围(WC)、臀围(HC)、腰臀比(WHR)、腰围/身高比(WHIR)、血压、TC、TG、HDL-C、LDL-C、FPG、FINS、ALT、hs-CRP.采用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR).结果 合并脂肪肝组和无脂肪肝组WC[(91.64±10.51)cm与(84.36±6.74)cm,t=4.341,P＜0.01]、HC[(99.14±8.45)cm与(93.58±6.04)cm,t=3.969,P＜0.01],WHR(0.92±0.05与0.90±0.04,t=2.390,P＜0.05)、WHtR(0.56±0.06与0.52±0.04,t=4.288,P＜0.01)、BMI[(27.02±3.18)kg/m~2与(24.50±2.65)ks/m~2,t=4.439,P＜0.01]、TC[(6.12±1.86)mmol/L与(5.02±0.88)mmol/L,t=4.013,P＜0.01]、TG[(4.62±4.80)mmoL/L与(1.62±0.79)mmol/L,t=4.676,P＜0.01]、ALT(48.09±33.47)U/L与(31.32±18.93)U/L,t=3.258,P＜0.01]、hs-CRP(2.32 mg/L与1.38 mg/L,t=1.078,P＜0.01)、HOMA-IR(1.37±0.63与1.01±0.57,t=3.121,P＜0.01]差异均有统计学意义.结论 初诊2型糖尿病合并脂肪肝患者,存在明显的胰岛素抵抗、血脂紊乱及高hs-CRP.     

炎症因子与2型糖尿病患者颈动脉内膜中层厚度的关系

目的 探讨炎症因子与2型糖尿病患者颈动脉内膜中层厚度(IMT)的关系.方法 50例2型糖尿病患者,根据胰岛素抵抗指数分为胰岛素抵抗组(IR组)26例及非胰岛素抵抗组(NIR组)24例,同时选取24名健康体检者为对照组.3组患者均行超声检查颈动脉IMT,测定空腹血糖(FPG)、空腹胰岛素(FINS)、血脂、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子(TNF-α)等指标,采用自我平衡模型分析法(HOMA)计算胰岛素抵抗指数(HOMA-IR).结果 对照组、NIR组及IR组患者的HOMA-IR、hs-CRP、TNF-α及IMT水平均逐渐增加,且3组间比较差异均有统计学意义[HOMA-IR:1.74±0.49、2.24±0.41、4.89±0.84(F=190.228,P＜0.01);hs-CRP:(1.75±0.83)、(3.08±1.04)、(5.89±1.17) mg/L(F=106.523,P＜0.01);TNF-α:(15.25±7.64)、(23.38±8.82)、(47.42±9.97) rng/L,(F=89.210,P＜0.01);IMT:(0.69 ±0.31)、(1.07 ±0.32)、(1.49±0.43) mm(F=30.942,P＜0.01)];相关性分析显示hs-CRP水平与HOMA-IR、IMT水平呈正相关(r值分别为0.453、0.395,P均＜0.05),TNF-α水平与HOMA-IR、IMT水平呈正相关(r值分别为0.428、0.376,P均＜0.05),HOMA-IR水平与IMT水平呈正相关(r =0.403,P＜0.05).结论 2型糖尿病患者存在炎症反应,并与胰岛素抵抗密切相关,炎症因子与胰岛素抵抗在2型糖尿病患者颈动脉粥样硬化的发生、发展过程中起着重要的作用.     

老年男性高尿酸血症与胰岛素抵抗及动脉粥样硬化相关性研究

目的 研究老年男性高尿酸血症与胰岛素抵抗及动脉粥样硬化的相关性.方法 对240例老年男性进行调查,按尿酸水平分为高尿酸组(HUA,n=58例)和正常尿酸组(对照组,n=182例),测量身高、体质量、收缩压、舒张压,并检测血尿酸、空腹血糖、甘油三酯(TG)、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇、空腹血浆胰岛素(FINS).测量颈动脉内膜中层厚度(IMT),同时计算胰岛素抵抗指数(HOMA-IR),分析临床资料及与IMT的相关性.结果 ①高尿酸血症检出率为24.2％;②高尿酸组TG、体质量指数(BMI)高于对照组,TG(2.28±1.41) mmol/L vs(1.49±0.87)mmol/L,BMI 25.98±2.58 vs 24.58±3.10,而HDL-C低于对照组(1.33±0.33)mmol/L vs(1.46±0.39)mmol/L(P ＜0.05或＜0.01);③高尿酸组FINS、HOMA-IR、IMT高于对照组(P＜0.05或＜0.01).结论 老年高尿酸血症人群的肥胖、代谢紊乱、胰岛素抵抗与IMT密切相关.     

血液透析患者脂质紊乱相关因素的研究

目的 研究血液透析患者脂质紊乱与胰岛素抵抗、瘦素、微炎症状态的相关关系.方法 测定102例血液透析患者(血液透析组)及26例健康者(健康对照组)体质量指数(BMI)、血脂、D二聚体(D-dimer)、空腹胰岛素(FINS)、空腹血糖(FBG)、瘦素、血C反应蛋白(C reactive protein,CRP)等指标,并计算胰岛素抵抗指数(HOMA-IR),分析脂代谢指标与HOMA-IR及CRP的相关性.结果 血液透析患者BMI、血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、瘦素、D-dimer、HOMA-IR、CRP明显升高,高密度脂蛋白胆固醇(HDL-C)明显减低(P＜0.05或＜0.01),血液透析组和健康对照组分别为BMI 24.20±12.20 vs 22.52±2.77,TG(2.76±0.65) mmol/L vs (2.33±0.72) mmol/L,LDL-C(3.01±0.71) mmol/L vs (2.51±0.75) mmol/L,瘦素(3.51±1.02)μg/L vs (2.96±0.89)μg/L,D-dimer(8.97±1.39) mg/L vs (4.99±1.61) mg/L,HOMA-IR 2.49±1.15 vs 1.89±0.85,CRP(45. 10±0.61) mg/L vs (17.60±0.54) mg/L,HDL-C( 1.09±0.41) mmol/L vs (1.32±0.36) mmol/L,血液透析患者BMI、TG、LDI-C、D-dimer和CRP与HOMA-IR呈正相关(r＝0.601、0.313、0.324、0.306、0.301,P＜0.05或＜0.01),HDL-C与HOMA-IR呈负相关(r＝-0.283,P＜0.05);其BM1与TG、LDL-C、D-dimer、FINS、HOMA-IR与CRP呈正相关(0.221,0.310,0.273,0.281,0.282,0.304,P＜0.05或＜0.01),HDL-C与CRP呈负相关(r=-0.342,P＜0.01).结论 血液透析患者脂代谢紊乱发生率高,与胰岛素抵抗及炎症反应相关,纠正脂代谢紊乱有助于降低此类患者心脑血管并发症的发病率.     

维持性血液透析患者血脂变化和胰岛素抵抗的相关分析

目的 了解维持性血液透析患者的血糖、血脂和胰岛素抵抗情况.方法 选取我科维持性血液透析患者(观察组)48例,同时选取30例健康体检者(对照组),测定两组的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、血脂指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI).结果 与对照组比较,观察组BUN、Cr、UA、FIns、FPG和HOMA-IR水平升高,总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)降低,BUN (24.9±5.8)mmol/Lvs (5.0±1.6)mmol/L(P＜0.05); Cr(820±222)μmol/L vs (73±17)μmol/L(P＜0.05); UA(397±96)μmol/L vs (298±79)μmol/L(P ＜0.05); FIns(16+11)mU/L vs (11±5)mU/L(P＜0.05);FPG(6.1±1.6)mmol/L vs (5.1±0.6)mmol/L(P ＜0.05);HOMA-IR 4.3±3.2 vs 2.4±1.2 (P＜0.05);TC(4.2±1.2)mmol/L vs(5.3±1.1)mmol/L(P＜0.05); HDL-C( 1.3±0.5)mmol/L vs (1.6±0.4)mmol/L(P＜0.01);LDI-C(3.0±1.0)mmol/L vs (4.1±1.1)mmol/L(P＜0.05).在观察组,TC与FPG呈负相关(r=-0.3482,P＜0.05);HDL-C与Fins呈负相关(r=-0.2603,P＜0.05);LDI-C与FPG呈负相关(r=-0.3289,P＜0.05),而对照组仅TG与FPG、HOMA-IR呈正相关(r =0.371,0.368,P＜0.05).结论 维持性血液透析患者中存在脂代谢紊乱,可能参与胰岛素抵抗.     

2型糖尿病合并非酒精性脂肪性肝病与胰岛素抵抗及血脂的关系

目的 探讨2型糖尿病合并非酒精性脂肪肝(NAFLD)与胰岛素抵抗及脂代谢紊乱的关系.方法 将92例初诊2型糖尿病患者,根据肝脏B超检查结果分为合并NAFLD组50例和无脂肪肝组42例,检测其体质量指数(BMI)、腰臀比(WHR)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(HBG)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR),并进行对照比较.结果 合并NAFLD组和无脂肪肝组比较,FINS、HOMA-IR、TG、LDL-C差异均有统计学意义[合并NAFLD组:FINS(11.9±5.14)μU/L、HOMA-IR(3.55±1.72)、TG(2.79±1.48)mmol/L、LDL-C(3.46±1.15)mmol/L,无脂肪肝组:FINS(7.29±3.61)μU/L、HOMA-IR(2.07±1.53)、TG(1.46±0.59)mmol/L、LDL-C(2.41±1.09)mmol/L;t值分别为2.738、3.121、3.182、4.321,P均＜0.01].结论 初诊2型糖尿病合并NAFLD患者,存在明显胰岛素抵抗、血脂紊乱.     

慢性肝病并发肝原性糖尿病的易患因素分析

目的探讨肝原性糖尿病的患病率及其相关因素。方法对230例慢性肝病患者进行肝功能、血糖、胰岛素及瘦素水平检测,稳态模型估算胰岛素抵抗指数(HOMA-IR)。结果肝原性糖尿病的患病率为15.22%,该组空腹胰岛素水平(FINS)及IR较无糖代谢异常的肝病组高,(20.76±8.95)mU/L vs(15.74±7.28)mU/L和0.60±0.33 vs 0.46±0.25,差异有统计学意义(均P<0.05);两组血清瘦素水平(2.96±0.38)μg/L vs(2.82±0.45)μg/L,差别无统计学意义(P>0.05);Logistic逐步回归分析显示FINS(r=0.125)、HOMA-IR(r=0.235)与肝原性糖尿病的发生呈正相关(P<0.05)。结论肝原性糖尿病的患病率较高,高胰岛素血症和胰岛素抵抗是其发生的重要因素。     

非酒精性脂肪肝病与胰岛素抵抗的相关性

目的:探讨不同程度非酒精性脂肪肝病(NAFLD)与胰岛素抵抗(IR)的相关性.方法:测定非NAFLD组(A组60例)、轻度NAFLD组(B组60例)、中重度NAFLD组(C组52例)的体质量指数(BMI)、腰围(WC)、血压、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FIns)等指标,采用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)并作统计分析.结果:B、C组的BMI、WC、SBP、DBP、TG、LDL-C、FPG、2hPG、HOMA-IR均高于A组(P＜0.05),B、C组HDL-C低于A组(P＜0.01);C组BMI、WC、TG、2hPG、HOMA-IR较B组明显升高(P＜0.01);相关分析显示,NAFLD的病变程度与BMI(r=0.212,P＜ 0.05)、WC(r=0.209,P＜0.05)、TG(r=0.547,P＜ 0.01)、2hPG(r=0.323,P＜ 0.01)、HOMA-IR(r=0.563,P＜ 0.01)呈正相关.多元逐步回归分析显示,BMI、2hPG、TG和有脂肪肝是胰岛素抵抗的主要危险因素.结论:NAFLD与胰岛素抵抗的发生发展密切相关,是胰岛素抵抗发生的独立危险因素之一.     

维持性血液透析患者血清vaspin水平与胰岛素抵抗的相关性研究

目的 探讨维持性血液透析患者血清vaspin的水平及其与胰岛素抵抗的关系.方法 选取我院透析中心终末期肾病维持性血液透析患者48例,测定血脂、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)等指标,并抽血测定血清vaspin、血清胰岛素(FIns)、血糖(FBG),计算胰岛素敏感指数(ISI),胰岛素抵抗指数(HOMA-IR)及腰臀比(WHR)、体质量指数(BMI),根据是否有糖尿病分为糖尿病组18例和非糖尿病组30例,同时选取30例健康体检者作为对照组,并对相关数据进行统计分析.结果 ①维持性血液透析患者血清vaspin水平较正常对照组降低,(0.91±0.36)μg/L vs (1.15±0.31) μg/L(P＜0.01).②糖尿病组和非糖尿病组两组患者的血清vaspin水平差异无统计学意义,(0.87±0.38) μg/L vs (0.97±0.34) μg/L(P＞0.05).③相关分析显示:vaspin除与BUN、Cr、UA、WHR相关外,尚与性别有关(r=-0.294、-0.284、一0.278、-0.375、0.244,P＜0.05),其中,女性vaspin水平高于男性(1.11±0.38) μg/L vs (0.93±0.33) μg/L(P＜0.05).vaspin与HOMA-IR、FIns、FBG、年龄、BMI则没有相关性(r=-0.098,-0.146,0.049,-0.095、-0.182,P＞0.05).结论 在维持性血液透析中存在有糖脂代谢紊乱和胰岛素抵抗,血清vaspin水平下降,与肾功能相关,但与胰岛素抵抗不相关.     

新诊断2型糖尿病合并非酒精性脂肪肝患者的代谢特点及相关危险因素分析

目的 探讨新诊断2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者的临床代谢特点,并分析影响NAFLD的危险因素.方法 选择新诊断的2型糖尿病患者142例,根据是否合并NAFLD分为A组(T2DM不合并NAFLD)(79例)、B组(T2DM合并NAFLD)(63例),所有受试者均测量身高、体质量及血压,检测空腹血糖(FPG)、血脂、尿酸(UA)、糖化血红蛋白(HbA1c)、空腹血清胰岛素(FINS),计算体质量指数(BMI)、胰岛素抵抗指数(HOMA-IR),比较两组间临床及生化指标的特点.结果 (1)A、B两组的年龄及血压比较差异无统计学意义(P均＞0.05).B组BMI(26.79±1.93)kg/m2、FINS(15.49 ±2.44) mU/L、HOMA-IR(6.74±1.32)、甘油三酯(TG) (2.94±0.65) mmol/L、低密度脂蛋白胆固醇(LDL-C)(3.46±0.73) mmol/L、UA(342.41 ±71.49) mmol/L均高于A组BMI(24.61±2.46) kg/m2、FINS(13.20±2.17) mU/L、HOMA-IR(5.65±1.10)、TG(1.74±0.46) mmol/L、LDL-C(2.78±0.86) mmol/L、UA(312.98 ±66.24) mmol/L,高密度酯蛋白胆固醇(HDL-C)(0.99±0.17)mmol/L低于A组(1.21±0.29) mm0l/L,两组比较差异均有统计学意义(t值分别为5.76、5.91、5.37、12.86、5.07、2.54、5.33,P均＜0.05).(2)以是否合并NAFLD为因变量,以BMI、FINS、HOMA-IR、TG、LDL-C、HDL-C、UA为自变量,经Logistic回归分析显示BMI、HOMA-IR、TG是NAFLD的主要危险因素(OR值分别为2.838、19.241、2.019,P均＜0.05).结论新诊断2型糖尿病合并NAFLD患者存在更明显的脂代谢紊乱及胰岛素抵抗.肥胖、胰岛素抵抗、高TG是新诊断2型糖尿病患者发生NAFLD的危险因素.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.