LOWER POSTPRANDIAL PLASMA GLUCOSE AND INSULIN AFTER ADDITION OF ACACIA CORIACEA FLOUR TO WHEAT BREAD

Many Australian Aboriginal bushfoods contain slowly digested carbohydrate which elicit low postprandial blood glucose and insulin responses compared to Western foods, such as wheat bread. This study has shown that incorporation of flour made from a slowly digested seed, Acacia coriacea , into wheat bread (18 g/82 g wheat flour) significantly reduces the initial rise in plasma glucose levels ( p < 0.05) and the area under the plasma glucose curve ( p < 0.005) in six healthy subjects. Insulin values were also lowered at 60 minutes ( p < 0.025) and 90 minutes ( p < 0.05). Our findings suggest that Acacia flour, when used to dilute wheat flour in the manufacture of breads, produces a very palatable food which could be useful in the diets of diabetic individuals.     

大鼠下丘脑室旁核及其邻近区域至室管膜的传出联系

用20只Wistar大鼠以PHA—L免疫组织化学顺行追踪技术研究了下丘脑室旁核及其邻近区域对脑室系统室管膜的传出联系。在脑室系统某些部位的室管膜层或其下方见有丰富的标记纤维并见许多膨结和终末膨突。这些纤维似乎参与形成室管膜上、下丛,构成脑—脑脊液神经体液回路的重要环节。     

Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial.

AIMS: Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. This prospective, two-centre study assessed sick day management using blood 3-hydroxybutyrate (3-OHB) monitoring compared with traditional urine ketone testing, aimed at averting emergency assessment and hospitalization. METHODS: One hundred and twenty-three children, adolescents and young adults, aged 3-22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels > or = 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (> or = 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months. RESULTS: There were 578 sick days during 21,548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05). CONCLUSIONS: Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings.     

久泻宁动物毒性试验研究

目的 （1）观察久泻宁一日内小鼠灌胃1～3次后的毒性反应和死亡情况，测定最大耐受量；（2）观察久泻宁给大鼠连续灌胃3个月，对机体产生的毒性反应、严重程度及可逆性，确定无毒剂量。为人拟用量提供参考。方法 （1）久泻宁小鼠灌胃，一日2～3次，观察急性毒性反应．测定最大耐受量；（2）久泻宁高、中、低三个剂量组和一个对照组，大鼠连续灌胃3个月，观察外观行为和体质量变化。试验期结束。每组取1/2动物活杀。检测血常规、血液生化、病理组织；1／2动物停药进行3周的恢复期观察后。同法检测上述指标。结果 久泻宁小鼠灌胃给药的最大耐受药量为750g／kg（含生药）。相当临床日拟用量（2．5g／kg）的300倍；大鼠连续3个月灌胃给药的无毒剂量为125g／kg（含生药）．相当临床拟用量50倍。结论 久泻宁无明显毒性，安全范围大。临床日拟用量2.5g／kg、疗程1个月是安全的。     

Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot).

OBJECTIVE: To determine the mortality of a population of patients diagnosed with Charcot neuropathic osteoarthropathy managed by a single specialist unit and to compare the results with a control population. METHODS: We have undertaken a retrospective analysis of all cases of Charcot foot on the comprehensive database which has been maintained at the specialist diabetic foot clinic at the City Hospital, Nottingham since 1982. Survival and the incidence of amputation (major and minor) was compared with a control population referred with uncomplicated neuropathic ulceration. Controls were individually matched for gender, age (+/-2 years), disease type, disease duration (+/-2 years) and year of referral (+/-3 years). RESULTS: Forty-seven cases (21 female, 26 male) of Charcot foot were identified, of whom 18 (38.3%) had Type 1 diabetes. Mean age and disease duration at presentation were 59.2 +/- 13.4 (sd) and 16.2 +/- 11.2 years, compared with 59.7 +/- 12.6 and 16.3 +/- 11.2 years, respectively, in the controls. Twenty-one (44.7%) of those with Charcot had died, after a mean interval of 3.7 +/- 2.8 years. This compared with 16 (34.0%) after a mean 3.1 +/- 2.7 years in the control group. Mean duration of follow-up in the survivors was 4.7 +/- 4.9 years (Charcot) and 5.3 +/- 3.9 years (controls). A total of 11 (23.4%) Charcot patients had had a major amputation on the side of the index lesion, compared with five (10.6%) controls. There was no difference between the two groups (P > 0.05, Chi-square). CONCLUSIONS: The mortality in this group of patients with Charcot foot was higher than expected. Nevertheless, there was no difference between those with Charcot and those with uncomplicated neuropathic ulceration. It is possible that it is neuropathy, rather than Charcot osteoarthropathy, which is independently associated with increased mortality in diabetes. The mechanism underlying any such association is not known. There is a need for a formal, prospective, multicentre study to investigate the life expectancy and cardiovascular risk of those with Charcot osteoarthropathy.     

糖尿病大鼠膀胱储尿期功能改变的实验研究

目的 研究糖尿病膀胱病变(Diabetic cystopathy，DCP)储尿期尿动力学特征及膀胱感觉功能障碍，为阐明DCP的发病机制提供实验依据。方法 分别以链脲佐菌素(STZ)、蔗糖诱导制作大鼠DCP模型及利尿模型，正常大鼠作对照。采用免疫组化结合图像分析技术观察膀胱感觉神经递质CGRP及其纤维改变；制备离体全膀胱，作膀胱灌注测压观察膀胱顺应性改变；放免法测定逼尿肌舒张信号转导分子cAMP。结果 DCP8周时，膀胱壁尤其是粘膜下层的CGRP及其神经纤维明显减少；离体膀胱测压显示糖尿病膀胱顺应性升高；膀胱舒张作用明显弱于对照组和利尿组，逼尿肌cAMP含量显著低于后者。结论 ①DCP对膀胱功能的损害是多方面的：CGRP为主要递质的粘膜下层膀胱容量感觉纤维明显减少，膀胱顺应性改变是DCP的致病机制之一。②DCP早期即已发生储尿期功能障碍，并且可能是膀胱收缩功能损伤的因素。③非糖尿病性利尿状态(多尿)对膀胱功能构成一定的损害作用，但不是DCP形成的主要原因。提示临床上对糖尿病患者作必要的尿动力学检查能较早发现DCP，有助于保护膀胱功能。     

Intravenous drug abuse and Type 1 diabetes: financial and healthcare implications.

AIMS: To determine the morbidity, mortality and healthcare costs of intravenous drug-abusing patients with Type 1 diabetes (IVDA-DM), who are admitted to hospital. METHODS: Retrospective case note analysis of admissions, complications and cost estimation over a 6-year period. Each drug-abusing patient (IVDA-DM) (n = 9) was compared with two controls (n = 18) with Type 1 diabetes but without a history of intravenous drug abuse (DM-controls). Admissions were also analysed for patients with intravenous drug abuse, but without Type 1 diabetes (IVDA-controls) (n = 198). Admissions were at a University teaching hospital in Liverpool, UK. DM-controls were drawn from a population attending diabetes outpatient clinics between 1997 and 2002 at the same hospital. The main outcome measures were: the duration and healthcare costs of hospital admissions per year, outpatient attendances per year, glycated haemoglobin (HbA(1c)), weight, micro- and macrovascular complications and mortality. RESULTS: Multiple admissions, mainly related to ketoacidosis, led to marked differences in mean (95% CI) inpatient days per year per patient [IVDA-DM 28.1 (13.6-42.7) vs. DM-control 1.1 (0.2-1.9); P < 0.0001], mean inpatient days per year per patient in critical care bed (IVDA-DM 1.7 (-0.7-4.2) vs. DM-control 0; P < 0.02) and mean costs of admission, per patient per year (pound sterling 7320 vs. pound sterling 230). The IVDA-DM group frequently omitted insulin, were underweight, failed to attend as outpatients and five had died by the end of 2002. The IVDA-controls spent considerably less time in hospital [3.4 (2.8-3.9) days per patient per year]. CONCLUSION: IVDA-DM patients have higher rates of diabetes complications, are admitted more frequently and have a high mortality compared with DM and IVDA-controls. The cost of inpatient care of this small group of patients was considerable.     

六味地黄汤对实验性糖尿病大鼠心、肝、肾组织中过氧化氢酶活性和过氧化脂质含量的影响

用四氧嘧啶诱导雄性Ｗｉｓｔａｒ大鼠为模型进行研究．结果发现，四氧嘧啶大鼠血糖明显升高，且心、肝、肾组织中过氧化氢酶活性较正常组明显降低，过氧化脂质含量在心、肝组织中明显增高，过氧化脂质与过氧化氢酶比值在心、肝、肾组织中均明显高于正常组，表明糖尿病状态下大鼠心、肝、肾组织中均自由基生成增多，氧化损伤加重．经六味地黄汤治疗后，血糖明显下降，但心、肝、肾组织中的过氧化氢酶活性无改变；而心肌中过氧化脂质含量和过氧化脂质与过氧化氢酶比值则明显降低，过氧化脂质含量和过氧化脂质与过氧化氢酶比值在肝、肾组织中无变化，表明六味地黄汤能明显清除心肌中自由基，抑制心肌中脂质过氧化，且此作用并不是通过提高过氧化氢酶活性来达到．     

刺激视上核对大鼠痛阈及电针镇痛的影响

以钾离子透引起的大鼠甩尾反应为痛指标，观察了电和化学刺激视上核（ＳＯＮ）对大鼠痛阈（ＰＴ）和电针（ＥＡ）镇痛的影响。电刺激ＳＯＮ后，ＰＴ明显高于假刺激组（Ｐ＜０．０５～０．００１），电刺激ＳＯＮ后电针足三里，镇痛效应明显提高，并有明显的量效关系。电刺激ＳＯＮ的近旁部位（０．５—１ｍｍ）对ＰＴ及电针镇痛无明显影响。ＳＯＮ内注射Ｌ－谷氨酸（Ｌ－Ｇｌｕ）后痛阈和电针镇痛效应都明显对照组，也有明显的量效关     

Age-related Changes in Excitability and Recurrent Inhibition in the Rat CA1 Hippocampal Region

In hippocampal slices from male Wistar rats aged 1–34 months, we recorded the synaptic field potential responses of the CA1 neurons to stimulation of Schaffer collaterals. Eight electrophysiological indexes were extracted from input/output curves and compared in 11 age groups from 1 to 30 months. Neuronal excitability presented a U-shaped curve of development with a minimum at ˜7–8 months of age. There was a significant continuous increase in neuronal excitability, i.e. a decrease in excitatory postsynaptic potential (EPSP) producing both the threshold and half-maximal population spike from middle age (8–10 months) to senescence (30 months). Synaptic efficiency also increased in old rats to reach a maximum during senescence, i.e. both the current for threshold EPSP and that for half-maximal EPSP reached a minimum in senescence, although the earlier developmental patterns of these two indexes were non-linear. The duration of the field EPSP elicited with maximal stimulation presented an abrupt decay after the first month. Aged animals presented a relatively small maximal population spike. Recurrent inhibition was most prominent on neuronal excitability rather than synaptic strength. Measured as the percentage change in the half-maximal EPSP and half-maximal population spike, recurrent inhibition was found to decrease during the first 7–10 months of life and remained small in later development.