基于MATLAB的CGMS数据整合分析软件的开发和在糖尿病合并低血糖时血糖波动特点研究上的使用

目的：观察低血糖血糖波动趋势,探究低血糖发生的特点。方法：通过矩阵实验室（MarxLabomtory,MATLAB）编程设计了与MmiMed解决方案（MiniMedSolutionsCGMSSensor,MSCS）的接口,利用MATLAB分析能力,实现大样本量的CGMS数据整合分析。结果：对829例CGMS数据进行筛选,符合研究条件405例,其中出现低血糖患者204例占50．62％。CGMS血糖监测系统与指测血糖在不同血糖范围均有较高一致性（P〈O．01）。低血糖患者整体血糖低于非低血糖患者,低血糖发生时间尤以半夜及午餐前居多。低血糖聚集发生时间平均在1点09分,标准差时间为5小时31分。不同年龄段低血糖患者比较．低血糖发生时间随年龄增长而提前（P〈O．01）。结论：MATLAB在大量CGMS监测数据处理具有速度快、设计灵活、使用方便等优点。低血糖的发生具有规律性,我们今后的研究方向是和低血糖发生可能相关的方向调节激素,神经内分泌的调节和脑生物钟的变化。     

血浆地高辛浓度危急值的应用与评估

目的 对血浆地高辛浓度危急值进行回顾性分析,为持续改进该项目危急值报告制度提供依据.方法 从实验室信息系统中筛选出血浆地高辛浓度危急值数据,经数据处理,统计出该项目危急值的发生率、天内分布、周内分布、科室分布,评估危急值范围和报告的周转时间.结果 血浆地高辛浓度危急值的发生率占该项目测试数的2.98％,科室分布以心内科为主.83.3％危急值报告的实验室周转时间在3小时之内.评估该项目频数分布图、临床症状符合率后,认为可以继续使用原定的血浆地高辛浓度危急值.结论 定期分析评估（一年一次）,持续改进血浆地高辛浓度危急值报告工作程序,可以提高检验科和临床科室的工作效率和质量,满足患者的安全要求.     

活性氧与丝裂原激活蛋白激酶通路的相互作用介导高糖引起的心肌细胞损伤

目的探讨活性氧(ROS)与丝裂原激活蛋白激酶(MAPK)通路的相互作用在高糖损伤H9c2心肌细胞中的作用。方法应用细胞计数盒(CCK-8)检测细胞存活率;Hoechst 33258核染色检测凋亡细胞形态及数量的改变;双氯荧光素(DCFH-DA)染色荧光显微镜照相检测细胞内ROS水平;Western blot测定蛋白质表达水平。结果高糖(35 mmol/L葡萄糖)处理H9c2心肌细胞24 h可引起明显的损伤,表现为细胞存活率下降,凋亡细胞数量及ROS水平明显升高。另方面,高糖可明显地上调磷酸化(p)p38MAPK、细胞外信号调节蛋白激酶1/2(ERK1/2)及c-Jun N端激酶(JNK)(为MAPK家族的3个成员)的表达水平。N-乙酰半胱氨酸(NAC,为ROS清除剂)能抑制高糖引起的心肌细胞毒性和细胞凋亡,也能阻断高糖对p-p38MAPK、p-ERK1/2及p-JNK表达的上调作用。此外,p38MAPK、ERK1/2和JNK的选择性抑制剂均能抑制高糖引起的心肌损伤,并能抑制ROS生成增多。结论在高糖损伤H9c2心肌细胞中,存在ROS与MAPK通路的正相互作用,这种相互作用可能在高糖引起的心肌细胞损伤中起着重要的作用。     

持续缓慢选择性与单纯血浆置换治疗高胆红素血症

目的探讨持续缓慢选择性血浆置换（CPPE）和单纯血浆置换（SPE）治疗高胆红素血症的临床疗效。方法分析71例（139例次）接受CPPE的患者（CPPE组）治疗前、治疗结束时及治疗后48h时血清清蛋白（ALB）、球蛋白（GLO）、凝血酶原活动度（PTA）及总胆红素（TBIL）的变化情况,并与36例（79例次）接受SPE的患者（SPE组）做比较。结果①同治疗前相比,2组患者治疗结束时及治疗结束48h时血PTA值均明显升高（P均〈0．01）,但2组问比较差异无统计学意义（P〉0．05）;②同治疗前比较,CPPE组治疗结束时及治疗后48h时血清ALB、GLO差异均无统计学意义（P〉0．05）,而SPE组则明显减少（P均〈0．01）;③同治疗前比较,2组治疗结束时TBIL下降幅度差异无统计学意义（P〉0．05）,但同治疗结束时比,CPPE组治疗结束48h时血TBIL上升幅度为22．91％±12．50％,而SPE组为39．30％±25．42％,差异有统计学意义（P〈0．05）;@CPPE组患者临床治愈好转率为59．16％（42／71）,高于SPE组的38．89％（14／36）,差异有统计学意义（x^2=3．933,P〈0．05）。结论CPPE治疗高胆红素血症时,可减少新鲜冰冻血浆的用量,减少血清ALB、GLO、纤维蛋白原及凝血因子等有益物质的丢失,延缓治疗后血清TBIL反弹的幅度和速度,提高高胆红素血症患者临床治愈好转率。因此,CPPE是治疗高胆红素血症有效且安全的方法。     

Differences in composition of sweat induced by thermal exposure and by running exercise

To determine the differences in sweat composition between sweat induced by thermal stress alone and that induced by physical exercise, seven young healthy men first sat in a hot room and then performed running exercise. A 20-minute stay in a climate chamber at 40 degrees C resulted in a 5% reduction in body weight. The same body weight loss was induced by running exercise. Both sodium and chloride concentrations were much lower in the sweat induced by thermal exposure than that induced by the running exercise (p less than 0.01), while urea nitrogen and creatinine concentrations were significantly higher after thermal exposure than after the running exercise (p less than 0.01). Potassium concentrations did not differ significantly with either procedure. These findings suggest that sweat composition varies with the kind of induction and that more salt seems to be lost through exercise-induced sweating than by just sitting in a hot environment.     

注氮改性纯钛表面的微观摩擦性能研究

目的改变纯钛表面的成分,提高其硬度和耐磨损性能。方法对纯钛试样表面行3×1017 ions.cm-2和9×1017 ions.cm-2两种剂量的氮离子注入。以能量散射光谱测定分析其表面元素的改变,显微硬度仪测量其显微硬度,纳米划痕仪测量其表面的耐磨损性能,扫描电子显微镜观察其注入前后的划痕形貌。综合分析其微观摩擦学性能的改变。结果氮离子注入后,纯钛试样表面成金黄色。在注入3×1017 ions.cm-2和9×1017 ions.cm-2剂量的氮离子试样表面,氮元素的原子百分率分别为24.08%和35.83%。试样表面的显微硬度值提高。纯钛的摩擦系数较氮离子注入前明显降低,其中注入剂量为9×1017 ions.cm-2的纯钛较剂量为3×1017 ions.cm-2的纯钛摩擦系数小。结论氮离子注入可提高纯钛的硬度,改善其耐磨损性能。     

High triglyceride-glucose index is associated with adverse cardiovascular outcomes in patients with acute myocardial infarction

Background and aimsTriglyceride glucose (TyG) index is considered a new surrogate marker of insulin resistance that associated with the development of vascular disease. The aim of this study was to evaluate the prognostic value of TyG index in patients with acute myocardial infarction (AMI).Methods and resultsA total of 3181 patients with AMI were included in the analysis. Patients were stratified into 2 groups according to their TyG index levels: the TyG index <8.88 group and the TyG index ≥8.88 group. The incidence of major adverse cardiovascular events (MACEs) during a median of 33.3-month follow-up were recorded. Multivariable Cox regression models revealed that the TyG index was positively associated with all-cause death [HR (95% CI): 1.51 (1.10,2.06), p = 0.010], cardiac death [HR (95% CI): 1.68 (1.19,2.38), p = 0.004], revascularization [HR (95% CI): 1.50 (1.16,1.94), p = 0.002], cardiac rehospitalization [HR (95% CI): 1.25 (1.05,1.49), p = 0.012], and composite MACEs [HR (95% CI): 1.19 (1.01,1.41), p = 0.046] in patients with AMI. The independent predictive effect of TyG index on composite MACEs was mainly reflected in the subgroups of male gender and smoker. The area under the curve (AUC) of the TyG index predicting the occurrence of MACEs in AMI patients was 0.602 [95% CI 0.580,0.623; p < 0.001].ConclusionHigh TyG index levels appeared to be associated with an increased risk of MACEs in patients with AMI. The TyG index might be a valid predictor of cardiovascular outcomes of patients with AMI.Trial registrationRetrospectively registered.     

Assessment of blood-products use as predictor of pulmonary complications and surgical-site infection after hepatectomy for hepatocellular carcinoma

Background

In perioperative management after hepatectomy, some patients require fresh frozen plasma (FFP) to treat coagulopathy associated with blood loss. However, several studies have suggested a correlation between blood products and pulmonary complications or surgical-site infection (SSI).

Methods

The subjects were 99 patients who underwent hepatectomy for hepatocellular carcinoma without plasma exchange for postoperative liver failure in the Department of Surgery, Jikei University Hospital, between January 2000 and December 2006. We investigated the association of 16 factors including age; gender; preoperative ICG_R15; type of resection; concomitant resection of other digestive organs; duration of operation; blood loss; hepatitis virus status; postoperative minimum platelet count, maximum serum total bilirubin (max T-Bil), minimum serum albumin, or minimum prothrombin time; and the dose of red-blood-cell concentration (RC), FFP, platelet concentration, or albumin given in relation to postoperative pulmonary complications and SSI.

Results

In univariate analysis, pulmonary complications were correlated with gender (P = 0.012), max T-Bil (P = 0.043), dose of RC given (P = 0.007), dose of FFP given (P < 0.001), and dose of albumin given (P < 0.001). In multivariate analysis, pulmonary complications were correlated with FFP given (P = 0.031) and albumin given (P = 0.020), while the incidence of SSI was not correlated with any factors.

Conclusion

Excessive FFP and albumin administration may cause pulmonary complications after hepatectomy.     

Improvement in glucose tolerance after one year of follow-up in a Hindu community in Africa

Oral glucose tolerance was studied following a 75 g glucose load in 108 (82.4%) of 131 male and 110 (79.1%) of 139 female members of a Hindu subcommunity aged 15 years and over in Dar es Salaam. One year later, the glucose tolerance tests were repeated in 93 (86.1%) and 93 (84.5%) of the 108 male, and 110 of the female subjects, respectively. In the first survey, 25 (26.9%) of the 93 male and 24 (25.8%) of the 93 female subjects had impaired glucose tolerance (IGT), 6 (6.4%) and 15 (16.1%), respectively, had diabetes mellitus; and 62 (66.7%) and 54 (58.1%), respectively, had normal glucose tolerance. In the repeat survey, of the 93 male and 93 female subjects, 8 (8.6%) and 7 (7.5%) had IGT, 4 (4.3%) and 10 (10.8%) had diabetes; and 81 (87.1%) and 76 (81.7%) were normal, respectively. Of the 21 subjects diagnosed as having diabetes in the first survey, 13 (61.9%) continued to show diabetic glucose tolerance; 4 (19%) IGT and 4 (19%) had normal glucose tolerance with no gender difference. One (1.6%) of the 62 male subjects and none of the 54 females with normal glucose tolerance in the first survey progressed to IGT, while the remainder retained normal glucose tolerance. Diabetes and IGT rates in both surveys were higher for the older than the younger persons. A significant fall in mean fasting and post-75 g blood glucose levels, and in mean systolic and diastolic pressure levels was observed between the first and second surveys in both genders. There was, however, no significant difference in body mass index (BMI), serum total cholesterol and triglyceride levels between surveys, suggesting that major dietary changes had not taken place. Male subjects who showed persistent IGT had significantly lower mean level of body mass index (kg/m²) than subjects who reverted to normal, whilst for the whole group those who had persistent IGT were older. It is tempting to speculate that these changes were due to community action. However, in view of the lack of change in weight and lipids and similar results in other communities in Tanzania when retested at 1 week, further studies are needed to establish the significance of the findings.     

The glucose dependent insulinotropic polypeptide response to oral glucose and mixed meals is increased in patients with Type 2 (non-insulin-dependent) diabetes mellitus

Summary Considerable disagreement exists regarding the levels of immunoreactive glucose dependent insulinotropic polypeptide in patients with Type 2 (non-insulin-dependent) diabetes mellitus. Glucose dependent insulinotropic polypeptide levels were therefore studied during oral glucose and mixed meal tolerance tests in normal subjects (n=31) and newly presenting previously untreated patients with Type 2 diabetes mellitus (n=68). The tests were performed in random order after overnight fasts and blood samples were taken at 30 min intervals for 4 h. During the oral glucose tolerance test plasma glucose dependent insulinotropic polypeptide levels increased in the normal subjects from a fasting value of 20±3 pmol/l to a peak of 68±5 pmol/l at 30 min and in the Type 2 diabetic patients from a similar fasting level of 27±3 pmol/l to a higher peak value of 104±6 pmol/l at 30 min (p<0.001). Glucose dependent insulinotropic polypeptide levels were significantly higher in the diabetic patients compared with the normal subjects from 30–90 min (p<0.01–0.001) following oral glucose. During the meal tolerance test glucose dependent insulinotropic polypeptide levels increased in the normal subjects from a pre-prandial value of 22±4 pmol/l to a peak of 93±6 pmol/l at 90 min and in the Type 2 diabetic patients from a similar basal level of 25±2 pmol/l to a higher peak of 133±7 pmol/l at 60 min. Glucose dependent insulinotropic polypeptide concentrations were significantly higher in Type 2 diabetic patients compared with the normal subjects at 30 min (p<0.001), 60 min (p<0.01) and from 210–240 min (p<0.05) during the meal tolerance test. The groups were subdivided on the basis of degree of obesity and glucose dependent insulinotropic polypeptide concentrations were still higher in the diabetic subgroups compared with the normal subjects matched for weight. Type 2 diabetes mellitus is associated with an exaggerated glucose dependent insulinotropic polypeptide response to oral glucose and mixed meals which is independent of any effect of obesity.