血清apelin水平与2型糖尿病并颈动脉粥样硬化的关系

目的 探讨血清apelin水平与2型糖尿病(T2DM)惠者并颈动脉粥样硬化的关系.方法 分别测定正常时照组(30例)、T2DM无颈动脉粥样硬化组(简称:T2DM组,35例)、T2DM伴颈动脉粥样硬化组(35例)的体质量指数(BMI),空腹血糖(FPG),糖化血红蛋白(HbA1c),血脂,空腹胰岛素(FINS),胰岛素抵抗指数(HOMA-IR)等,采用酶联免疫吸附法(ELISA)测定血清apelin水平.结果 与正常对照组比较,血清apelin水平在T2DM组明显升高,(53.79±9.17)μg/L vs(44,44±9,20)μg/L(P<0.01);与T2DM组比较,血清apelin水平在T2DM伴颈动脉粥样硬化组也升高,(61.52±5.18)μg/L vs(53.79±9.17)μg/L(P<0.01).偏相关分析显示,血清apelin与HOMA-IR、FPG、总胆固醇(TC)呈正相关(r=0.486,0.400,0.491,P<0.05,P<0.01).logistic回归示:apelin、HOMA-IR是T2DM患者颈动脉粥样硬化的危险因素.结论 T2DM颈动脉粥样硬化患者的血清apelin水平升高,且与In、(HOMA-IR),FPG、TC呈正相关,推测apelin可能参与构成胰岛素抵抗综合征和动脉粥样硬化的病理生理基础.     

2型糖尿病患者血糖和胱抑素C水平与肾脏早期病变的关系

目的探讨2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)、餐后2 h血糖(2 hPBG)、胱抑素C(Cy-sC)与24 h尿清蛋白排泄率(UAE)和肾脏早期病变的关系。方法选择135例空腹血糖(FBG)控制达标的T2DM患者及30例体检健康人群。HbA1c检测采用酶法,2 hPBG检测采用葡萄糖氧化酶法,CysC检测采用免疫比浊法,尿微量清蛋白(mALB)检测采用免疫比浊法,记录24 h尿量算出UAE。按照HbA1c及2 hPBG水平将135例患者分为A组(HbA1c<7%且PBG<10 mmol/L)、B组(HbA1c<7%且P≥10 mmol/L)、C组(HbA1c<7%且PBG<10 mmol/L)和D组(HbA1c≥7%且PBG≥10 mmol/L)。结果 135例T2DM患者UAE和CysC均高于健康对照组(P<0.01);HbA1c>7%组的UAE和CysC水平明显高于HbA1c<7%组,差异有统计学意义(P<0.01或P<0.05)。2 hPBG和HbA1c未达标者的UAE和CysC明显高于达标者,也高于2 hPBG或HbA1c任何一项达标者。结论 T2DM患者FBG控制达标后,HbA1c及...     

2型糖尿病患者胰岛素抵抗与血清游离脂肪酸浓度的关系

目的探讨2型糖尿病(T2DM)患者空腹与餐后2 h游离脂肪酸(FFA)浓度和胰岛素抵抗的关系。方法测定100例T2DM患者(根据亚洲糖尿病论坛的推荐分为控制良好和控制不良2组)及50名正常对照者的糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、空腹FFA及餐后2 hFFA。以稳态模式评估胰岛素抵抗指数(HOMA-IR)。结果与对照组比较,T2DM组的FPG、2 h PG、FFA、2 h FFA、HbA1c、HOMA-IR均明显增高(P<0.01)。T2DM控制不良组各项指标均高于控制良好组(P<0.05),FFA、2 h FFA与HOMA-IR、HbA1c、FPG、2 h PG均呈明显的正相关(r分别为0.910、0.876,0.851、0.759,0.908、0.746,0.769、0.674,P<0.01)。结论 T2DM患者体内FFA浓度的增高与胰岛素抵抗存在明显相关性,与T2DM的发病机制有密切关系。     

黄芪葛根汤联合二甲双胍对2型糖尿病患者胰岛素抵抗的影响

目的:探讨黄芪葛根汤联合二甲双胍治疗2型糖尿病(T2DM)的疗效及胰岛素抵抗的影响。方法:选择82例T2DM患者为研究对象,随机分为2组,观察组与对照组各41例。对照组予二甲双胍治疗,观察组联合应用黄芪葛根汤,治疗8周后比较2组治疗前后FPG、2hPBG、HbA1c、HOMA-IR及血脂的变化。结果:治疗后,2组患者FPG、2hPBG、HbA1c及HOMA-IR水平均明显降低,且观察组明显低于对照组,差异有统计学意义;2组患者TC、TG、LDL-C水平均较治疗前明显下降,且观察组明显低于对照组,差异有统计学意义。结论:黄芪葛根汤联合二甲双胍对2型糖尿病可以有效改善T2DM患者的胰岛素抵抗程度及血糖控制水平,并且对改善脂代谢紊乱有利。     

2型糖尿病患者血清游离脂肪酸水平与胰岛素抵抗的关系

目的探讨2型糖尿病(T2DM)患者血清游离脂肪酸(FFA)水平与胰岛素抵抗(IR)的关系。方法选取106例T2DM患者为观察组,选择106例健康体检者为对照组,比较2组受检者体质量指数(BMI)、空腹血糖(FPG)、FFA、糖化血红蛋白(HbA1c)、总胆固醇(TG)、甘油三酯(TC)及胰岛素抵抗指数(HOMA-IR)水平。根据血糖控制水平将T2DM患者分为控制良好组(n=56)和控制不良组(n=50),比较2组患者FFA及HOMA-IR水平。分析T2DM患者血清FFA与HOMA-IR的相关性。结果观察组BMI、FPG、FFA、HbA1c、TC、TG、HOMA-IR均显著高于对照组(P0.05);血糖控制不良组患者FFA及HOMA-IR水平均显著高于控制良好组(P0.05);相关性分析显示,T2DM患者血清FFA与HOMA-IR水平呈正相关性(r=0.621,P0.05)。结论血清游离脂肪酸水平与2型糖尿病患者胰岛素抵抗程度关系密切,且可以反映患者血糖控制水平。     

瘦素与老年患者胰岛素抵抗和胰岛功能的相关性

目的:探讨瘦素是否与老年患者包括临床糖尿病(DM)、糖耐量减低(IGT)、空腹血糖调节受损(IFG)类型胰岛素抵抗和胰岛功能等指标相关联.方法:选择临床2型糖尿病患者40例(T2DM组),IGT患者30例(IGT组),IFG患者30例(IFG组)和正常对照组30例,检测各组循环瘦素、胆固醇、甘油三酯、高密度脂蛋白胆固醇、空腹血糖(FPG)、餐后2 h血糖、空腹胰岛素(FINs)、餐后2 h胰岛素、糖化血红蛋白(HbA1c)、C-肽等指标,用稳态模式(Homa Model)公式评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数.结果:T2DM组、IGT组和IFG组瘦素水平(*9滋g)分别为4.27 ± 1.82、4.15 ± 1.96、4.19 ± 1.9,高于正常对照组的2.43 ± 0.31;HOMA-IR数值分别为3.48 ± 0.84、3.01 ± 0.67、3.24 ± 0.26,高于正常对照组的1.23 ± 0.42;FINs、FPG、C-肽、HbA1c均高于正常对照组(P ＜ 0.01);T2DM组、IGT组和IFG组在校正胰岛素抵抗后的胰岛细胞功能分别为178 ± 49、165 ± 59、170 ± 52,低于正常对照组的346 ± 54.多元逐步回归分析显示:FPG、FINS、C-肽、HbA1c、瘦素水平是影响HOMA-IR的独立危险因素.结论:老年患者循环瘦素水平的升高是胰岛素抵抗和胰岛*9茁细胞功能缺陷的危险因素.     

2型糖尿病患者高血清游离脂肪酸水平与胰岛素抵抗的相关性研究

目的探讨2型糖尿病(T2DM)患者血清游离脂肪酸(FFA)水平与胰岛素抵抗的相关性。方法选取102例T2DM患者作为T2DM组,依据糖化血红蛋白(HbA1c)水平分为控制良好和控制不良组,选取62例健康体检者作为健康对照组,检测各组的HbA1c、三酰甘油(TG)、空腹血糖(FBS)、餐后2h血糖(PPBS)、空腹胰岛素(FINS)、空腹FFA及餐后2h游离脂肪酸(2hFFA)。以稳态模式评估胰岛素抵抗指数(HOMA-IR)。结果T2DM组HbA1c、TG、FBS、PPBS、FFA、2hFFA及HOMA-IR均较健康对照组明显升高(P0.05)。T2DM控制不良组各指标均高于控制良好组(P0.05)。FFA、2hFFA与其他指标均呈明显正相关(r0.5,P0.01)。结论T2DM患者体内FFA水平显著升高,与胰岛素抵抗存在明显相关性。     

2型糖尿病患者PRMT1的表达水平与胰岛素抵抗的相关性研究

目的 探讨2型糖尿病(T2DM)患者蛋白质精氨酸甲基转移酶1(PRMT1)的表达水平与胰岛素抵抗(IR)的相关性。方法 回顾性选取2021年4月至2022年7月在上海市奉贤区中心医院就诊的T2DM患者89例为T2DM组,另选取同期在上海市奉贤区中心医院进行体检的健康者60名作为对照组,收集整理所有患者的临床基本资料。采用实时荧光定量PCR法检测两组血清PRMT1 mRNA相对表达量并进行比较;检测T2DM组和对照组空腹胰岛素(FINS)、空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平,计算胰岛素抵抗指数(HOMA-IR),并进行比较分析;检测两组脂代谢指标[甘油三酯、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]进行比较分析;采用Pearson相关性分析T2DM患者HOMA-IR与PRMT1相对表达量、脂代谢指标的相关性;采用Logistic回归分析T2DM患者IR发生的影响因素。结果 T2DM组患者PRMT1、FINS、空腹血糖和HOMA-IR水平分别为1.56±0.40、(12.94±3.88) mU/L、(9.56±2.24...     

加减大柴胡汤干预肝胃郁热型2型糖尿病合并高尿酸血症的临床研究

目的观察大柴胡汤加减治疗肝胃郁热型2型糖尿病(T2DM)合并高尿酸血症(HUA)的临床疗效。方法前瞻性纳入2019年1月至2020年7月期间中国中医科学院广安门医院南区内分泌科收治的100例肝胃郁热型T2DM合并HUA患者。按照随机数字表法,将其分为2组。治疗组50例在常规西药治疗的基础上加服大柴胡汤,对照组50例予常规西药治疗,2组疗程均为12周。比较2组患者中医证候疗效。比较2组患者治疗前、治疗后12周血尿酸(UA)、血糖[空腹血糖(FBG)、餐后2 h血糖(2 hPG)]、糖化血红蛋白(HbA1c)、血脂谱[甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)]、体重指数(BMI)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)变化。结果治疗组证候改善总有效率为89.6%,明显高于对照组的50.0%,差异有统计学意义(P<0.001)。2组患者治疗前UA、FBG、2 hPG、HbA1c、FINS、HOMA-IR、BMI、TG、TC及LDL-C水平比较,差异无统计学意义(P>0.05)。治疗组患者治疗后12周UA、FBG、2 hPG、HbA1c、FINS、HOMA-IR、TG、TC及LDL-C水平分别为(287.62±46.06)μmol/L、(7.13±0.78)mmol/L、(9.67±0.79)mmol/L、(7.10±0.64)%、(10.74±3.38)mU/L、6.04±1.32、(1.54±0.51)mmol/L、(4.13±0.64)mmol/L、(2.32±0.58)mmol/L,显著低于对照组[(343.51±40.58)μmol/L、(7.86±1.08)mmol/L、(10.49±1.50)mmol/L、(7.83±0.68)%、(12.60±5.39)mU/L、7.84±2.12、(1.89±0.53)mmol/L、(4.68±0.98)mmol/L、(2.89±0.97)mmol/L],差异均有统计学意义(P<0.05)。治疗后12周治疗组BMI较对照组有所下降[(27.34±2.46)kg/m2vs.(28.56±3.39)kg/m2],但差异无计学意义(P>0.05)。结论大柴胡汤加减能有效纠正肝胃郁热型T2DM合并HUA患者的血糖、尿酸、脂代谢紊乱及减轻胰岛素抵抗,明显改善本病患者的临床症状。     

2型糖尿病患者糖化血红蛋白及餐后血糖与尿清蛋白排泄率的关系

目的探讨2型糖尿病(T2DM)病人糖化血红蛋白(HBA1c)、餐后2 h血糖(2hPBG)与12 h尿清蛋白排泄率(UAE)的关系。方法选择113例空腹血糖(FBG)控制达标的T2DM患者及54例体检正常人群。HbA1c检测用高效液相色谱法,2 hPBG检测用葡萄糖氧化酶法,尿清蛋白检测用放射免疫法,记录12 h尿量,计算出UAE。按照HbA1c及2 h PBG水平将113例患者分为A组(HbA1c<7%且PBG<10 mmol/L),B组(HbA1c<7%且PBG≥10 mmol/L),C组(HbA1c>7%且PBG<10mmol/L)和D组(HbA1c≥7%且PBG≥10 mmol/L)。结果113例T2DM患者UAE均高于正常对照组(P<0.01)。D组UAE水平明高于A,B,C组(P<0.01,P<0.05,P<0.01);A组UAE水平明显低于C组(P<0.05)。B组与A,C组UAE无差异(P>0.05)。结论T2DM病人FBG控制达标后,餐后血糖及HbA1c控制不良仍会加重尿清蛋白排泄。因此强化血糖控制要重视HbA1c和餐后血糖的监测及达标。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.