严重Ⅱ型糖尿病人在直肠癌晚期空腹血糖转正常1例报告

1病例报告 病人男性，52岁，住院号：101642。患原发性2型糖尿病11年，曾因吃杨梅出现了“糖尿病酮症酸中毒昏迷”在我院抢救成功1次，当时体重达85kg，身高165cm，血糖最高〉20mmol／L。近5年来，予控制饮食及口服降糖药治疗，体重维持在80kg左右，空腹血糖仍高，一般在8～12mmol／L。因渐进性便秘1年，服用肠清茶不再有效，B超发现肝脏多发占位性病变，大小约直径25mm不等。肠镜示：距肛缘约12cm处见巨大浸润肿块，表面高低不平，有糜烂出血，质脆，占肠腔全周，形成狭窄，肠镜不能通过，于2005年2月4日入院，入院时T37．2℃，P72次／min，R18次／min，BP110／70mmHg，体重65kg，身高165cm，甘油三酯0．8mmol/L，胆固醇3．2mmol/L，空腹血糖5．0mmol／L。肝脏CT示：多发性低密度结节灶，直径大小25mm左右，考虑肝内多发转移瘤。     

The relationship between the electromyogram-amplitude and isometric extension torques of neck muscles at different positions of the cervical spine

A group of 12 healthy men volunteered for the experiment. Electromyograms (EMG) were obtained from semispinalis capitis, splenius capitis, levator scapulae, and trapezius muscles. The flexion angle of the cervical spine was precisely adjusted to 0°, 10°, 20°, and 30° relative to the horizontal, with a constant angle of the atlanto-occipital joint. The subjects made eight short (about 2 s) vertical extension forces (6%, 12%,18%, 24%, 30%, 36%, 42%, and 48% of maximal voluntary peak contraction force). For each position, the centre of pressure under the head was determine as the basis for the calculation of the external lever arm. The presence of motor endplate regions was ascertained by multiple surface electrodes. The slopes of individual linear regression lines for the root mean square (rms)-values were dependent on the existence of endplates in the area of the electrodes — endplates caused smaller rms values per Newton metres of external torque. Significant intersubject differences between regression equations could not be eliminated by the normalization of EMG-parameters and/or torques. The elimination of gravity, the continuous monitoring of positions, and the consideration of localization of motor endplate regions were essential prerequisites for the acquisition of reliable relationships between EMG of different neck muscles and external torques. Two important conclusions were derived for the prediction of torques from EMG measurements: firstly, individual regression equations which take into account the position of the head and neck should be used; secondly, normalization procedures do not justify the application of average regressions to a group of subjects.     

Marked individual variability in heart rate ‘normalization’ by ethanol

In order to test Kissin's (1974) concept of normalization by ethanol (deviant prealcohol parameter values becoming less deviant after alcohol) in nonalcoholics, data on unselected mice and nonalcoholic humans were analyzed. These data were on heart rates (HR) of 1055 HS mice and 24 young adults, measured before and after receiving a dose of ethanol (mice: 1.4g/kg, i.p.; humans: 1.3g/kg, oral). Both mice and humans, on the average, show marked normalization, initially low HR usually increasing after alcohol, and initially high HR usually decreasing. The correlation between (1) deviation in HR from the prealcohol mean and (2) change in HR after alcohol was-0.803 for mice and-0.538 for humans. There is very great individual variability, however, in the degree of this normalizing response, some individuals normalizing strongly and others not at all. Although first described in alcoholics, strong normalization by alcohol of several psychophysiological parameters is now known to occur in mice and seems likely to occur in some nonalcoholic humans. The possible relevance of these results to predisposition to alcoholism remains to be shown.     

Statistical Approaches in the Analysis of Gene Expression Data Derived from Bone Regeneration Specific cDNA Microarrays

Abstract

Recent advances in molecular biology (e.g., cDNA microarray technology) enables the simultaneous monitoring of the expression level of thousands of genes. Due to the massive amount of complex data generated, sophisticated statistical approaches are necessary in order to properly address the experimental investigation. In this paper, we present statistical analysis of cDNA microarray data derived from bone regeneration experiments. Several interesting features from these data distinguish it from commonly used microarray experiment (i.e., separate hybridization of mRNA samples from reference and experimental tissues, selectively spotted cDNA sequences and 1060 systematically selected blank spots included in each array). Using this data set, we propose new methods for bioinformatic data normalization, as well as the modification and application of various other published methods in order to identify co-regulated gene expression patterns during the healing of a bone fracture. The proposed normalization methods perform effectively to eliminate the variations with a simple algorithm. Results from our cluster analysis revealed several clusters having distinct gene expression patterns during fracture healing. Our simulation study supports the reliability of the proposed methods.     

Time-integrated propulsive and braking impulses do not depend on walking speed

BackgroundEnhancing propulsion during walking is often a focus in physical therapy for those with impaired gait. However, there is no consensus in the literature for assessing braking and propulsion. Both are typically measured from the anterior-posterior ground reaction force (AP-GRF). While normalization of AP-GRF force by bodyweight is commonly done in the analysis, different methods for AP-GRF time axis normalization are used.Research questionDoes walking speed affect propulsion and/or braking, and how do different methods for calculating propulsion and braking impact the conclusion, in both healthy adults and those with lower limb impairment?MethodsWe investigated three different analysis methods for assessing propulsion. 1. BW-TimeIntegration: Bodyweight (BW) normalized time integration of AP-GRF (units of BWs). 2. BW-%StanceIntegration: BW normalized AP-GRF is resampled to percent stance phase prior to integration (units of BW%Stance). 3. BW-Peak: BW normalized peak force (units of BW). We applied these methods to two data sets. One data set included AP-GRFs from trials of slow, self-selected, and fast walking speeds for 203 healthy controls (HCs); a second data set included subjects with lower limb orthopedic injuries.ResultsUsing the BW-TimeIntegration method, we found no effect of walking speed on propulsion for HCs. Time integration over the longer stance phase of slower walking balanced the lower magnitude AP-GRFs of slower walking, resulting in a time-integrated impulse that was the same regardless of walking speed. In contrast, the other two methods that are not time integration methods found that propulsion increased with walking speed. Similarly, in the gait pathology data set, differences in results were found depending on the analysis method used.SignificanceFor many gait studies concerning propulsion and/or braking, the impulse measure used should be related to the body’s change of momentum, necessitating an analysis method with a time integration of the AP-GRF.     

Normalization as a barometer: Recreational drug use and the consumption of leisure by younger Britons

This article discusses the development of the normalization thesis in respect of monitoring sustained increases in young Britons’ consumption of illicit drugs and alcohol over the past decade. It describes five dimensions of normalization which have been applied in a cluster of studies undertaken by the author, highlighting results from the N.W. England Longitudinal Study showing easy accessibility, high rates of drug trying (76% at 22 years) and long-term recreational drugs careers involving both alcohol and illicit drugs. The social accommodation of ‘sensible’ substance use was apparent amongst most drug abstainers in the cohort who routinely had close friends who used drugs ‘recreationally’. Further cultural acceptance of recreational drug use is described. A sixth dimension – state or government responses to widespread recreational drug use – is introduced and illustrated. The article concludes by emphasizing the negative outcomes associated with recreational poly substance use in terms of personal and public health highlighting the ‘slippage’ from recreational to problem drug use as a growing phenomenon. It calls for a more integrative national strategy to address negative aspects of normalization.     

基层医疗卫生机构新型冠状病毒肺炎疫情防控常态化工作存在的问题和对策建议

在新型冠状病毒肺炎疫情防控中,基层医疗卫生机构对社区疫情防控和防疫关口前移发挥重要作用,是外防输入、内防扩散的最有效防线。在面对当下乃至未来较长一段时间内存在的新型冠状病毒感染局部暴发或区域性流行的情况下,基层医疗卫生机构需要把防疫工作常态化,及时补足重大疫情防控中的短板,包括环境建设欠规范、应急物资储备不足、制度建设流于形式、基层医疗卫生应急能力不足等。建议改善基层医疗卫生机构场地环境、完善制度、提升基层应急能力,重视基层医疗卫生工作者的劳动价值并建立有效激励措施,以利于基层医疗卫生机构持久战疫。