内脂素与肥胖、2型糖尿病关系的研究进展

 肥胖的特点在于脂肪组织过多的积累,脂肪细胞增生且肥大^[1]。脂肪组织是一种活跃的代谢组织,分泌多种代谢相关的脂肪因子,这些因子包括白细胞介素-6、肿瘤坏死因子-α及内脂素等,它们在胰岛素抵抗、脂肪酸氧化、炎性反应等方面发挥重要作用^[2]。内脂素是新近被发现的一个脂肪因子,也被称为前细胞集落刺激因子(PBEF)和烟酰胺磷酸核糖转移酶(NAMPT),在内脏脂肪组织高表达,具有类胰岛素作用,主要通过结合到不同胰岛素结合位点的胰岛素受体上,激活下游信号通路产生效应,同时还可以促进脂肪细胞分化^[3],与肥胖和2型糖尿病的发生、发展存在一定联系,是治疗2型糖尿病的潜在分子靶点,已成为近年来研究热点。笔者就内脂素与肥胖、2型糖尿病关系的研究进展做一综述。     

不同运动强度对糖尿病大鼠血清骨代谢生化指标的影响

目的:探讨不同运动强度对糖尿病大鼠血清骨代谢生化指标的影响。方法:以87只雄性SD大鼠为研究对象,通过6周高脂高糖膳食并注射链脲佐菌素建立糖尿病模型后,随机取43只分为糖尿病安静对照组,糖尿病运动1组、2组和3组。运动组每天运动1小时,每周5天,运动强度分别为10m/min、15m/min、20m/min。实验6周后检测血糖、糖化血清蛋白与胰岛素等糖代谢相关指标以及血清骨代谢生化指标如骨钙素、碱性磷酸酶、钙和磷。结果:与糖尿病安静组相比,各糖尿病运动组空腹血糖、糖化血清蛋白和胰岛素抵抗指数降低,其中以糖尿病运动1组和运动2组的下降具有统计学意义(P<0.05,P<0.01),而胰岛素水平升高,其中以糖尿病运动3组具有统计学意义(P>0.05);同时,糖尿病运动1组和运动2组血清骨钙素水平显著升高(P<0.01),而血清碱性磷酸酶、钙未见显著性变化(P>0.05),糖尿病运动2组和3组血磷显著升高(P<0.05)。结论:低、中强度运动可较好控制糖尿病大鼠血糖水平及提高血清骨钙素水平,从而改善糖尿病骨代谢状况,有利于防治糖尿病性骨质疏松。     

运动与代谢性炎症反应——有氧运动改善机体代谢机制研究进展

最新研究认为,机体脂肪组织除了储存能量之外,还是分泌多种脂肪因子的重要内分泌器官。脂肪组织功能失调常伴发肥胖、胰岛素抵抗等代谢性疾病,其原因可能与机体代谢性炎症反应有关。机体在肥胖状态下血液中的单核巨噬细胞进入组织内分化为M1型促炎巨噬细胞,M1型巨噬细胞可释放多种细胞因子并作用于体内胰岛素敏感细胞,抑制细胞胰岛素信号敏感性。同时,血液中淋巴细胞、嗜酸性粒细胞和中性粒细胞等也可通过影响巨噬细胞的迁移及活化而发挥代谢调节作用。因此,巨噬细胞对于发展组织代谢性炎症及维持代谢状态至关重要。本综述总结目前国内外有关运动改变机体组织内多种转录调控因子从而影响巨噬细胞极化及代谢性炎症调控的研究进展,为揭示运动改善机体代谢状态的机制提供理论依据。     

代谢综合征与糖尿病

代谢综合征(MS)及其重要危险因子胰岛素抵抗(IR)概念的形成和发展,使糖尿病的诊治观念也随之发生了某些变化[1]。1糖尿病定义研究进展在IR作为一个概念被明确提出之前,有关糖尿病的定义中并无IR的确切含义,多描述为胰岛素绝对缺乏或相对缺乏。随着学术界对MS和IR研究的深入,糖尿病定义也发生了改变。众多文献将IR的含义纳入糖尿病定义中,或在发病机制中对其进行阐述。2糖尿病发病机制研究进展[2]糖尿病,尤其是2型糖尿病的发病机制较为复杂,至今尚未完全阐明,但对糖代谢由正常向异常甚至糖尿病过渡的过程已基本清楚,即其是IR和胰岛β细胞功能缺陷2个因素共同作用的结果。由于血糖正常的超重者及许多糖耐量异常患者中均存在高胰岛素血症,因此,有学者推论,在产生IR后,机体为维持血糖于正常范围,会出现胰岛β细胞功能代偿状态,糖耐量异常及糖尿病的发生则取决于胰岛β细胞的代偿能力或其功能储备。尽管如此,仍然难以阐明IR与胰岛β细胞分泌缺陷的关系。以往对糖尿病发病机制的研究主要集中在IR方面,并已取得较多研究成果。近年来,一些学者开始关注胰岛的作用机制,提出胰岛是2型糖尿病发病的“中央舞台”,并加强了对糖尿病胰岛β细胞结构与功能变化...     

肝硬化性骨质疏松症及其CT评价研究

肝硬化常引起全身多系统的损害,亦可引起维生素D、钙磷代谢异常,影响骨代谢,增加非外伤性骨折的危险．且早期不易发现。随着高分辨力技术和三维重组技术的发展,以及有限元分析模型的引入,大大拓展及突显了CT在该研究领域的能力和优势。现综述肝硬化性骨质疏松症的流行病学、病因、病理生理学机制,并探讨多种CT扫描技术对骨量的测定。     

肝硬化性骨质疏松症及其CT评价研究

肝硬化常引起全身多系统的损害,亦可引起维生素D、钙磷代谢异常,影响骨代谢,增加非外伤性骨折的危险,且早期不易发现.随着高分辨力技术和三维重组技术的发展,以及有限元分析模型的引入,大大拓展及突显了 CT在该研究领域的能力和优势.现综述肝硬化性骨质疏松症的流行病学、病因、病理生理学机制,并探讨多种CT扫描技术对骨量的测定.     

老年人及绝经妇女骨质疏松症的药物治疗

本文介绍了预防骨质疏松症的注意事项，重点介绍治疗骨质疏松症的骨代谢调节剂、骨吸收抑制剂和骨形成促进剂等三类药物，评价目前使用的各种代表药物的基本作用，并提出联合应用骨代谢调节剂、骨吸收抑制剂和骨形成促进剂是治疗老年人和绝经妇女骨质疏松症的最佳方法。     

脂肪组织在胰岛素抵抗中的作用及其运动调控

脂肪组织为调节能量代谢稳态的主要器官之一,一方面,脂肪组织可通过脂肪合成、脂肪动员储存或释放能量,应对进食、运动、饥饿等代谢应激;另一方面,脂肪组织可通过分泌脂肪因子调控摄食行为、能量消耗、胰岛素敏感性等。脂肪组织对健康与疾病起双向调控作用,随着内脏脂肪含量的增加,胰岛素抵抗、糖尿病、动脉粥样硬化等风险相应地提高。本文通过氧化应激、慢性炎症、表观遗传学等视角剖析脂肪组织与胰岛素抵抗的关系,总结脂肪组织对运动训练的积极应答和相关机制。     

分子生物学在创伤的应用有哪些?

解答:分子生物学在创伤基础研究和治疗等方面的应用日益广泛,并发挥越来越重要的作用.主要体现在以下几个方面:(1)多种生长因子在创伤修复中的作用及机制研究.(2)生长因子对创伤治疗作用研究,将有治疗作用的因子基因引入创伤部位 ,在原位表达产生因子以达到治疗目的.如将促进成骨因子基因转染骨髓间充质干细胞(MSCs),可加速成骨过程及骨修复能力.(3)影响创伤修复的机制研究,如研究慢性溃疡与瘢痕过度增生的分子基础.(4)从基因组和蛋白质组水平上系统研究和探讨创伤后全身性损害和组织修复的分子机制,筛选与组织修复和再生启动与关闭相关的基因,为创伤个体化治疗提供基础.     

糖尿病性骨质疏松症的比较影像学研究现状

骨质疏松症是糖尿病的常见并发症之一,其发病率为24%～52%.在目前的糖尿病治疗中,常常忽略对此并发症的诊治.骨质疏松症早期不易被发现,往往是在骨折发生后才作出回顾性诊断.就糖尿病性骨质疏松症的发病机制、病理学基础以及影像学诊断等予以综述,并就多种影像学技术对骨量的测定进行探讨.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.