甘舒霖30R联合二甲双胍治疗继发失效2型糖尿病疗效观察

目的 观察甘舒霖30R联合二甲双胍治疗口服磺脲类药物(SUs)继发失效2型糖尿病(T2DM)的疗效和不良反应.方法 将42例继发失效T2DM随机分成两组,分别给予甘舒霖30R联合二甲双胍治疗和单独甘舒霖30R治疗,治疗12周,分别测治疗前后两组空腹血糖(FPG),餐后2h血糖(2hPG),糖化血红蛋白(HbA1C),体重指数(BMI),甘舒霖30R用量,低血糖发生频率.结果 与结论两组患者FPG、2hPG、HbA1C均较治疗前明显下降,合用二甲双胍组甘舒霖30R用量,低血糖发生率,体重指数均较对照组低.     

不同浓度糖化血红蛋白及空腹血糖的2型糖尿病患者β-羟丁酸水平变化分析

目的:观察2型糖尿病(T2DM)患者不同糖化血红蛋白(HbA1c)及空腹血糖(FBG)水平时β-羟丁酸(β-HBA)血清水平的变化。方法:随机选择T2DM患者100例,男65例,女35例,年龄25～83岁,平均57±13岁。测定各患者血清β-HBA浓度,根据HbA1c水平将T2DM患者分为轻度组(HbA1c<7%)、中度组(7%≤HbA1c≤9%)、重度组(HbA1c>9%)。又根据FBG水平将T2DM患者分为轻度组(FBG<7mmol/L)、中度组(7mmol/L≤FBG≤mmol/L)、重度组(FBG>9mmol/L)。分析比较不同水平HbA1c和FBG组间β-HBA水平差异。结果:随着HbA1c水平的逐渐升高,β-HBA水平亦有逐渐升高的趋势,HbA1c重度组与轻度组和中度组比较差异有统计学意义(P<0.05)。不同FBG水平组间β-HBA没有统计学差异(P>0.05)。结论:在血浆HbA1c>9%的T2DM患者中,β-HBA显著升高,提示临床加强血糖控制,降低HbA1c,防止糖尿病酮症及酮症酸中毒。     

初诊2型糖尿病患者短期胰岛素强化治疗后胰岛β细胞功能的变化和疗效观察

观察胰岛素短期强化治疗对明显高血糖的初诊2型糖尿病(2DM)患者的胰岛β细胞功能的影响. 对空腹血糖＞12.0mmol/L的24例初诊DM患者进行胰岛素强化治疗,分析比较治疗前后和两次随访的空腹血糖、糖化血红蛋白(HbA1c)、口服75g葡萄糖后的胰岛素及释放曲线面积和由HOMA模型计算的HOMA IR 和HOMAβ.血浆胰岛素用放射免疫分析法测定.平均9.0±4.8天的胰岛素强化治疗后,患者的血糖、HbA1c较治疗前明显降低(P＜0.01);胰岛素、胰岛素释放曲线下面积和HOMAβ较治疗前明显提高(P＜0.01),而HOMA IR明显降低(P＜0.01).其中随访的13例患者中,6个月和12个月后随访平均空腹血糖分别为6.28±0.75mmol/L和6.62±1.19mmol/L;餐后2h血糖分别为8.72±1.66mmol/L和10.03±4.49mmol/L;HbA1c分别为5.98%±0.72%和7.12%±1.81%;空腹胰岛素分别为10.67±5.08μIU/L和7.85±1.82μIU/L;HOMA IR分别为2.88±1.22和2.36±0.93;HOMAβ分别为90.01±61.29和56.9±25.4.仅采用饮食控制和体育锻炼,其中8例(8/13)获得长达一年的良好的血糖控制.明显高血糖的2DM患者,短期胰岛素强化治疗具有快速控制血糖和显著改善胰岛β细胞功能的作用.     

血糖、GSP、D-3H与尿β2-M/Cr的联合检测在糖尿病中的应用价值

探讨血糖控制水平与糖化血清蛋白(GSP)、D3羟丁酸(D3H)、尿Alb、尿β2M与尿Cr的比值联合检测在糖尿病(DM)早期肾损害的应用价值。采用葡萄糖氧化酶法、免疫比浊法和Cr氧化酶法对4组(包括240例血糖为7.0±0.05mmol/L的轻度DM组;75例血糖为8.9±1.4mmol/L的中度DM组;35例血糖为15.8±1.4mmol/L的重度DM组和100名对照组)的上述指标进行了检测。结果表明,在上述各项检测中:轻度DM组与对照组比较无显著性差异(P>0.05),中度DM组有显著性差异(P<0.05),重度DM组有非常显著性差异(P<0.01)。中度DM组与轻度DM组比较有显著性差异(P<0.05);重度DM组与中度DM组比较有非常显著性差异(P<0.01)。血糖为7.0±0.5mmol/L时,尿中Alb、β2M已开始升高。因此,血糖水平的控制与各项指标的联合检测对DM肾损害及其并发症的预测具有一定临床意义。     

胰岛素不同注射方式治疗应激性高血糖疗效及安全性观察

目的：观察胰岛素不同注射方式治疗应激性高血糖疗效及安全性。方法临床纳入60例应激性高血糖患者,根据胰岛素注射方式的不同进行临床分组,研究组给予胰岛素泵持续皮下注射,对照组给予三餐前或联用睡前皮下注射胰岛素。观察两组患者治疗后空腹血糖(FBG)、餐后血糖(PBG)、低血糖发生次数、血糖达标时间、黎明现象发生次数等。结果治疗后研究组FBG与PBG水平分别为(6.2±0.7)mmol/L、(7.9±1.4)mmol/L,对照组FBG与PBG水平分别为(7.5±1.0)mmol/L、(10.0±0.9)mmol/L,差异有显著性(P<0.05);研究组血糖达标时间(5.0±1.9)d,低于对照组的(9.3±2.0)d,差异有显著性(P<0.05);研究组低血糖、黎明现象发生率分别为6.7%、3.3%,对照组低血糖、黎明现象发生率分别为26.7%、20.0%,差异有显著性(P<0.05)。结论胰岛素泵持续皮下注射能够短时间内控制应激性高血糖患者血糖水平,减少低血糖以及黎明现象发生率。     

地特胰岛素或甘精胰岛素联合使用口服药物治疗2型糖尿病疗效及对体重的影响分析

目的 观察地特胰岛素或甘精胰岛素联合口服药物治疗T2DM的疗效及对体重的影响。方法 80例T2DM患者随机分为Det组和Gla组,每组40例。Det组采用阿卡波糖+二甲双胍+地特胰岛素治疗,Gla组采用阿卡波糖+二甲双胍+甘精胰岛素治疗。治疗12周后对比两组患者治疗前后HbA1C、FPG、2hPG、基础胰岛素用量、体重变化以及低血糖发生率。结果 两组患者FPG、2hPG及HbA1C均到有效控制,Det组HbA1C由（9.6±2.1）%降至（6.8±0.6）%,Gla组HbA1C由（9.2±2.1）%降至（6.4±0.7）%。Det组及Gla组FPG分别由（10.5±2.3）mmol/L、（10.6±2.4）mmol/L降至（6.1±0.6）mmol/L、（6.3±0.7）mmol/L;2hPG分别由（14.9±2.3）mmol/L、（14.5±2.1）mmol/L降至（9.1±1.1）mmol/L、（9.2±1.3）mmol/L,差异均具有统计学意义（P＜0.05）。达到同样空腹血糖水平,Det组基础胰岛素用量为（0.40±0.05）U/kg,少于Gla组的（0.60±0.04）U/kg,差异具有统计学意义（P＜0.05）。治疗12周后,Det组体重增加（1.3±0.4）kg,Gla组体重增加（2.5±0.3）kg,Det组体重增加低于Gla组,差异具有统计学意义（P＜0.05）。Gla组低血糖发生率为5.00%,Det组低血糖发生率为2.50%,两组间比较,差异无统计学意义（P＞0.05）。结论 T2DM患者口服药物联合基础胰岛素控糖是一种安全有效的选择,地特胰岛素对体重增加方面更有优势。     

广东佛山市电信职工血糖水平及糖尿病患病率调查

目的为了解广东佛山市电信局职工空腹血糖(FBG)水平及糖尿病(DM)、空腹血糖受损(IFG)患病率.方法受检者1084人FBG测定用葡萄糖氧化酶法.计量资料用±s表示,t检验进行组间比较;计数资料用%表示,χ2检验进行组间比较.结果 FBG 男性4.77±0.66 mmol/L ,女性 4.70±0.68 mmol/L,两者无显著性差异(p>0.05).FBG随年龄而升高.DM患病率为1.11%(12/1084),IFG患病率为1.66%(18/1084),两者均随年龄而升高.结论 FBG筛查DM简单易行,在高危人群中进行DM的筛查有利于DM早期诊断和治疗.     

胰岛素治疗2型糖尿病抑郁情绪与性激素水平的相关性研究

目的观察胰岛素强化治疗前后合并抑郁情绪的糖尿病患者性激素水平变化及其与情绪变化的相关性。方法选择187例2型糖尿病患者(T2DM),给予胰岛素强化治疗3个月,对入选患者治疗前后进行抑郁测定,化验其血糖、糖化血红蛋白(HbA1c)、血清性激素,并进行统计学处理。治疗期间空腹血糖(FBG)控制在4.4~6.1mmol/L,餐后2小时血糖(PBG2h)控制在4.4~8.0mmol/L之间。结果胰岛素治疗前合并抑郁情绪的男性促黄体生成素(LH)和女性泌乳素(PRL)、促卵泡生成素(FSH)明显高于无抑郁情绪患者,男性和女性雌二醇(E2)抑郁情绪患者明显低于无抑郁患者(P<0.01),睾酮(T)两者无显著差异(P>0.05);治疗后合并抑郁情绪患者抑郁指数较治疗前明显降低,合并抑郁情绪的男性LH、E2和女性PRL、FSH、E2较治疗前差异有显著性(P<0.01)。治疗前抑郁指数与男性LH和女性PRL、FSH正相关(r=0.565,0.478,0.617,P<0.01),与男性和女性E2呈负相关(r=-0.614,-0.527,P<0.05);治疗后抑郁指数下降与男性LH和女性PRL、FSH下降正相关(r=0.425,0.398,0.326,P<0.05),与男性和女性E2升高呈负相关(r=-0.357,-0.411,P<0.05)。结论胰岛素治疗可以显著改善2型糖尿病患者抑郁情绪,并且与性激素水平变化相关。     

对比西格列汀与达格列净辅助治疗对T2DM合并慢性心力衰竭患者血糖及心功能的影响

目的:对比研究西格列汀与达格列净治疗对2型糖尿病(Type 2 Diabetes,T2DM)合并慢性心力衰竭患者血糖及心功能的影响.方法:选取2021年4月至2022年2月期间我院收治的102例T2DM合并慢性心力衰竭患者作为研究对象,根据治疗方法的不同分为研究组(n=52)和对照组(n=50).两组患者均接受降糖、降压、抗心力衰竭等常规治疗.对照组增加晨起口服磷酸西格列汀,研究组增加餐前口服达格列净片.比较两组患者心功能、血糖水平及不良反应发生情况.结果:治疗前两组患者空腹血糖(Fasting plasma glucose,FPG)、餐后2h血糖(2-hour Postprandial blood glucose,2hPG)及糖化血红蛋白(Hemoglobin A1C,HbA1c)比较无明显差异(P>0.05),治疗后,两组患者FPG、2hPG、HbA1c均较治疗前降低,且研究组低于对照组(P<0.05);治疗前两组左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室舒张末期内径(Left ventricular end diastolic dimension,LVEDD)和左心室收缩末期内径(Left ventricular end systolic dimension,LVESD)无明显差异(P>0.05),治疗后,两组LVEDD、LVESD均较治疗前下降,且研究组明显低于对照组,而LVEF较治疗前上升,且研究组明显高于对照组(P<0.05);研究组不良反应率与对照组无明显差异(P>0.05).结论:相较西格列汀,达格列净治疗T2DM合并慢性心力衰竭对患者血糖、心功能的改善效果更佳,且具有一定安全性,值得在临床上推广使用.     

2.42老年糖尿病患者血糖与胃排空的相互关系

目的研究老年2型糖尿病(DM)胃排空与血糖间的关系. 方法将63例2型DM患者根据血糖控制情况分成2组:血糖控制正常组(DM1组)30例,空腹血糖(FBG)≤7.8mmol/L,餐后2小时血糖≤11.1mmol/L,男29例,女1例,平均年龄80.1±4.2岁(75～88岁),病程13.4±8.5年(6～30年);血糖异常组(DM2组)33例,空腹血糖(FBG)≥7.8mmol/L,餐后2h血糖≥11.1mmol/L,男31例,女2例,平均年龄80.5±4.2岁,病程18.6±9.3年(5～35年);均空腹给予99mTc标记的试餐,测定固相胃排空时间,并与30例正常对照组(男28例,女2例,年龄81.3±4.3岁)比较.     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.