幽门螺杆菌感染与2型糖尿病大血管病变的相关性研究进展

［摘要］　幽门螺杆菌（Hp）感染是全球主要公共卫生威胁之一,Hp在2型糖尿病患者中具有更高的感染率,Hp感染是2型糖尿病患者发生大血管病变的危险因素之一。该文对Hp感染与2型糖尿病大血管病变的相关性研究进展作一综述。     

2型糖尿病与幽门螺杆菌感染

幽门螺杆菌（Hp）是一种在胃上皮细胞定居繁殖的革兰阴性螺旋状杆菌,1982年澳大利亚学者Warren和Marshall首次从慢性胃炎患者胃黏膜中成功分离出该菌.Hp感染是当前较为常见的慢性感染之一,全世界约有50％的人群感染Hp.研究显示,2型糖尿病（T2DM）患者Hp感染率高于非糖尿病者（NDM）,感染Hp的T2DM患者易发生糖尿病相关慢性并发症[1].本文就T2DM患者Hp感染情况、感染Hp后血糖波动及大血管、微血管病变风险综述如下.     

老年2型糖尿病与幽门螺杆菌感染的相关性分析

目的探讨老年人2型糖尿病(T2DM)与幽门螺杆菌(Hp)感染的相关性。方法老年T2DM患者85例,其中有恶心、腹胀等上消化道症状的45例,无上消化道症状的40例;糖尿病病程在1年以内者38例,1年以上者47例。通过胃镜取组织活检和进行黏膜快速尿素酶试验来检测Hp感染的发生率。结果 T2DM患者Hp感染率为62.4%,有上消化道症状与无上消化道症状者Hp感染率、胃黏膜病变检出率比较均有统计学差异(P均<0.05);糖尿病病程>1年与1年内者Hp感染率比较有统计学差异(P<0.05)。结论 Hp感染导致的胃黏膜病变与糖尿病上消化道症状有密切关系,对有上消化道症状的糖尿病患者进行Hp检测和抗Hp治疗有重要的临床意义。     

幽门螺旋杆菌感染与糖尿病患者大血管病变

人类对幽门螺旋杆菌(helicobacter pylori,HP)普遍易感.诸多研究认为糖尿病患者HP感染率升高,且HP感染是糖尿病患者心脑血管病变和外周血管病变的危险因素,但也有研究结果不一致.糖尿病患者HP感染与大血管病变之间的关系尚需进一步研究证实.     

糖尿病足部溃疡的原因及对策

糖尿病足部溃疡的原因 专家提出，糖尿病足部溃疡的原因主要是糖尿病神经病变、糖尿病血管病变，以及在此基础上合并感染。单纯因为糖尿病血管病变引起者占15％左右，单纯因为糖尿病神经病变引起者占30％左右，而多数糖尿病足部溃疡患者同时存在糖尿病血管病变和糖尿病神经病变。     

彩色多普勒超声在中老年2型糖尿病下肢血管病变诊断中的应用

2型糖尿病(T2DM)下肢血管病变是糖尿病最常见的慢性并发症之一,常累及肢体大、中、小动脉,并伴有周围神经病变,常因肢体缺血、缺氧,甚至坏疽、感染等病变而使患者失去正常的活动能力[1].据文献报道[2],下肢血管病变发生率达22％～46％,是糖尿病患者致残的主要原因之一.糖尿病下肢血管病变预防重于治疗,早期发现、早期诊断有重要的临床意义.彩色多普勒超声("彩超")能够对血管病变及早发现,以便早期干预[3].     

幽门螺杆菌感染与2型糖尿病患者缺血性心脑血管疾病关系的研究

目的测定144例2型糖尿病（DM）患者和37名健康对照者幽门螺杆菌（Hp）感染率。方法清晨空腹静脉血血清层析法Hp抗体测定。结果发现2型糖尿病患者Hp感染率升高，2型DM伴Hp感染者的冠心病和动脉粥样硬化性脑梗死发病率升高。结论提示Hp感染可能是2型DM患者缺血性心脑血管病变的危险因素之一。     

应重视糖尿病患者的幽门螺杆菌感染

糖尿病患者易合并多种感染,但糖尿病患者与幽门螺杆菌(Hp)感染的关系报道很少,而且还尚未引起医务人员的重视.现有的报道已表明,合并Hp感染的糖尿病患者往往具有较重的临床症状,血糖不易被控制,心脑血管并发症发生率高,治疗效果不佳.     

糖尿病足的综合治疗

1背景资料 “糖尿病足”的诊断名词1956年由Oakley提出。1999年,世界卫生组织（WHO）对糖尿病足（diabeticfoot,DF）的定义是：糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和（或）深部组织的破坏。其中包含了三种病变因素,即血管因素、神经因素、感染因素,临床表现常常侧重于某一方面,所以临床诊断上病名很多,如“糖尿病下肢血管病变”、“糖尿病性动脉硬化闭塞症（DAO）”、“糖尿病周围神经病变”、“糖尿病坏疽（DG）”等,实际上都归属于糖尿病足。     

P-选择素与糖尿病血管病变

糖尿病并发血管病变与血小板活化及内皮受损、血管内皮功能减退密切相关.近年研究证实,P-选择素通过促进白细胞与血小板和内皮细胞的粘附造成内皮损伤和血管内微血栓形成,在糖尿病大血管病变、糖尿病微血管病变的发生发展中具有重要作用.P-选择素及其单克隆抗体的研究将为临床诊治糖尿病血管病变提供新的思路.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.