老年2型糖尿病肾病与胰岛素抵抗及血脂异常的关系分析

目的 研究老年2型糖尿病肾病(DN)患者胰岛素抵抗、血脂异常与微量白蛋白尿(mUAE)的关系,以及胰岛素抵抗(IR)、血脂异常在糖尿病肾病发生和发展中的作用.方法 对74例无伴肾损害老年2型糖尿病(NIDDM)患者和163例老年DN患者的胰岛素敏感指数(ISI)、24 h微量白蛋白尿(mUAE)、血清脂质进行回顾性分析.结果 DN组与NIDDM组相比,总胆固醇(CHO)、甘油三酯(TG)、低密度脂蛋白(LDL-C)明显升高,ISI明显降低.并且CHO、TG与mUAE呈正相关,ISI与mUAE呈负相关.Logistic回归分析显示,CHO、TG、IR与DN发生和DN的进展显著关联.结论 IR、血脂异常是老年DN发病及病程进展的危险因素.     

高果糖饲料诱导SD大鼠氧化应激及对其脂质代谢的影响

目的探讨高果糖饲料诱导SD大鼠氧化应激和对其脂质代谢的影响。方法实验大鼠分为2组熏分别用普通饲料和高果糖饲料喂养8周,检测大鼠空腹血糖(FBG)、血胰岛素(FSI)、血脂、总抗氧化力(T鄄AOC)、丙二醛(MDA)及超氧化物岐化酶(SOD)等。结果高果糖饲料组胰岛素敏感指数(ISI)低于普通饲料组(P<0.01),甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL鄄C)升高(分别为P<0.01,P<0.05和P<0.01),高密度脂蛋白胆固醇(HDL鄄C)降低(P<0.05),T鄄AOC、SOD活性降低(P<0.01),MDA水平升高(P<0.01)。结论高果糖饲料可诱导SD大鼠产生氧化应激,引起脂质代谢紊乱。     

抗性淀粉对糖尿病大鼠胰岛素抵抗的影响

目的研究抗性淀粉(RS)对2型糖尿病大鼠胰岛素抵抗的干预作用。方法将40只Wistar大鼠随机选取10只饲以基础饲料(正常对照组),其余30只食用红花油高脂饲料并进行腹腔链脲霉素(20mg/kgbw)注射(模型组)。对诱导成2型糖尿病的大鼠随机分为三组,分别饲食高脂饲料(B组)、高脂RS饲料(C组)、单纯RS饲料(D组);原基础饲料组为A组。继续喂养5w,观察RS对大鼠糖脂代谢、胰岛素敏感指数影响及肝、肾组织病理学变化。结果与糖尿病对照组(B组)相比,RS干预组(C组、D组)糖耐量各时间点血糖值及曲线下面积比明显下降;血胰岛素水平显著降低,而胰岛素敏感指数显著升高;血脂各项指标下降;肝脂肪变性明显减轻,肝糖原合成增加。结论RS可改善糖尿病模型大鼠的糖脂代谢紊乱,提高胰岛素敏感性,具有拮抗或减轻胰岛素抵抗的作用。     

不同糖代谢异常大鼠心肌超微结构改变及TNF-α的表达

目的 观察不同糖代谢异常(糖调节受损和糖尿病)大鼠心肌的超微结构改变及肿瘤坏死因子-α(Tumor necrosis factor-alpha ,TNF-α)的表达,揭示糖尿病心肌病(Diabetic Cardiomyopathy, DC)发生发展的炎性机制.方法 30只雄性Wistar大鼠随机分为A组为正常对照组;B组为胰岛素抵抗组;C 组为2型糖尿病组.用免疫组化法检测心肌组织中TNF-α的表达,透射电镜观察心肌的超微结构,并测定空腹血糖(FBG)、空腹血清胰岛素(FINS)等生化指标及计算胰岛素敏感指数(insulin sensitivity index, ISI).结果 TNF-α在B、C组大鼠心肌组织中的阳性表达平均积分光密度值(IDP)显著高于A组(p<0.01);且 C组大鼠IDP值显著高于B组(p<0.01).B、C组ISI负值均显著高于A组(P<0.01). 电镜下B、C组大鼠心肌超微结构发生不同程度的损害.相关分析表明TNF-α的IDP值与FBG水平、糖化血红蛋白(HemoglobinA1c, HbA1c)、甘油三脂(Triglyceride,TG)、总胆固醇(Total Cholesterol,TC) 呈明显正相关(r=0.905,0.602, 0.493, 0.430,p均< 0.01), 与ISI明显呈负相关(r=-0.896, p < 0.01),多元逐步回归分析显示FBG、ISI是影响TNF-α水平的重要因素.结论 TNF-α的表达与高血糖、胰岛素抵抗(insulin resistance,IR)密切相关,且TNF-α作为一种重要的炎症因子可能参与了DC的发病机制.     

优化复合纤维对糖尿病大鼠胰岛素敏感指数及血脂的影响

目的 探讨在2型糖尿病大鼠模型中胰岛素敏感指数（ISI）的影响因素及优化复合纤维（SFC）对该模型ISI和血脂的影响。方法 将Wistar雄性大鼠26只,用小剂量链脲霉素＋高糖、高脂饲料处理10周诱导形成2型糖尿病大鼠模型。进行糖耐量试验（GTT)、测定空腹胰岛素（FINS）、胆固醇（TC）、甘油三酯（TG）,并计算糖耐量曲线下面积（AUC）和ISI。以7只正常大鼠做对照。用多因素逐步回分析,探讨影响ISI的主要因素,并比较糖尿病大鼠用优化的复合纤维（SFC）治疗8周前后的效果。结果 模型组与对照组比较AUC增大,FINS、TC、TG增同,ISI降低。TG和AUC是影响糖尿在鼠ISI的主要因素。SFC可降低TC和TC和TC,减少AUC和提高ISI。结论 本实验所建立的2型糖尿病大鼠模型中高TG血症和糖耐量异常是影响ISI的主要因素。SFC对降低高血脂、改善糖耐量、提高ISI有重要意义。     

妊娠期糖尿病妇女胰岛素抵抗的相关性研究

目的:探讨胰岛素抵抗在妊娠期糖尿病发生机制中的作用。方法:选择来菱湖人民医院进行妊娠期糖尿病筛查的孕妇259例。完全正常(NGT组)167例,妊娠期糖耐量受损(G IGT组)62例,妊娠期糖尿病(GDM组)30例。比较3组血糖、胰岛素、胰岛素敏感指数(ISI)、胰岛素抵抗指数(IR I)和胰岛分泌功能指数(IFI)。结果:妊娠期糖代谢异常发生率为35.52%(92/259),其中妊娠期糖尿病发生率为11.58%(30/259)。G IGT组和GDM组的血糖、胰岛素、ISI、IFI和IR I均明显高于NGT组,均具统计学差异(P<0.01);G IGT组和GDM组的血糖、胰岛素、ISI、IFI和IR I也有明显差异(P<0.05);正常妊娠、G IGT孕妇及GDM患者的IR程度依次加重。结论:妊娠期糖尿病和糖耐量受损患者存在明显的胰岛素抵抗。     

吡咯喹啉醌对高脂血症大鼠糖脂代谢肝功能及脂质过氧化影响的实验研究

目的探讨吡咯喹啉醌(PQQ)对实验性高脂血症大鼠血脂、血糖、肝功能及脂质过氧化的影响。方法将SD大鼠随机分为正常组和高脂造模组,正常组饲予基础饲料,高脂造模组饲予高糖高脂饲料5个月建立高脂血症模型,从中挑选出40只高脂血症大鼠,按血脂水平随机分为模型对照组、PQQ低剂量组、PQQ中剂量组和PQQ高剂量组,每组10只,分别灌胃给予15、30、60mg/kg PQQ,连续6周,检测血清中总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、血糖(GLU)、胰岛素(INS)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px),并对肝脏做病理组织学检查。结果 PQQ可降低高脂血症大鼠血清中TC、TG、LDL-C、ALT、AST水平,升高HDL-C/TC比值;同时能提高血清中SOD、GSH-Px的活力,降低MDA水平,并且能降低血清中血糖和胰岛素抵抗水平。结论 PQQ可以调节高脂血症模型大鼠血脂、血糖水平和因高血脂导致的肝损伤,同时具有一定的抵抗脂质过氧化作用,提示其对预防高脂血症具有积极作用。     

冠心病患者的胰岛素抵抗及对血脂代谢异常的影响

目的 研究冠心病患者的胰岛素抵抗(IR)及其对血脂代谢异常的影响.方法 选择冠心病78例,检测空腹血糖(BG)、胰岛素(INS)、总胆固醇(TC)、甘油三酯(TG)和高密度脂蛋白胆固醇(LDL-C),按公式计算胰岛素敏感指数(ISI)和低密度脂蛋白胆固醇(LDL-C).结果 所有冠心病患者的TC、TG、LDL-C和INS与对照组相比(P<0.05)均升高,ISI和HDL-C与对照组相比均下降(P<0.05)且IR与血脂代谢异常密切相关.结论 冠心病患者无论有无合并高血压病,均存在IR和脂质代谢紊乱,且IR与血脂代谢异常密切相关,提示防治IR及血脂代谢紊乱可减少冠心病的发生和发展.     

黑米花色苷对果糖喂养大鼠的抗氧化及胰岛素增敏作用

目的观察黑米花色苷提取物(AREBR)对果糖喂养胰岛素抵抗大鼠的抗氧化及胰岛素敏感性的影响。方法将48只SD大鼠分成4组,设置对照,通过向高果糖饲料中添加8w或4w的AREBR(5g/kgdiet),观察膳食添加花色苷对大鼠血液氧化应激水平、胰岛素敏感性和葡萄糖耐量的影响。结果摄入AREBR能预防果糖引起的胰岛素抵抗;显著降低果糖喂养大鼠血液中脂质过氧化产物丙二醛(MDA)和氧化型谷胱甘肽(GSSG)的含量,改善大鼠胰岛素敏感性和葡萄糖耐量,但AREBR干预4w不能消除高胰岛素血症。结论AREBR可预防和改善果糖引起的大鼠胰岛素抵抗及葡萄糖耐量异常,这可能与其抗氧化作用有关。     

桑叶黄酮对胰岛素抵抗大鼠氧化应激影响

目的 观察桑叶黄酮对2型糖尿病胰岛素抵抗大鼠氧化应激作用,并探讨其改善胰岛素抵抗的分子机制.方法高脂饮食饲养成年雄性SD大鼠8周诱导大鼠胰岛素抵抗模型,随机分为糖尿病模型组(MOD组)和桑叶黄酮治疗组(MLF组),对照组为正常SD大鼠(NOR组);测量各组大鼠空腹血糖(FPG)、胰岛素(FINS)及血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性,计算胰岛素敏感指数(ISI)和胰岛素抵抗指数(IRI).结果 与NOR组比较,MOD组MDA升高,为(8.73±0.85) nmol/L,SOD、GSH-Px活性均降低,分别为(226.45±17.54)、(529.03±69.56)U/mL;与MOD组比较,MLF组能降低病鼠FINS和IRI,分别为(25.83±2.1) mU/L和(8.86±0.96),提高ISI,为(5.08±0.09),降低FPG和MDA含量,分别为(7.95±1.85) mmol/L和(6.82±0.79) nmol/mL,增强SOD活性,为(297.85±22.16) U/mL.结论桑叶黄酮能改善2型糖尿病胰岛素抵抗大鼠高胰岛素血症,降低血糖,提高胰岛素敏感性,降低氧化应激水平,具有抗氧化能力.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.