胰岛素强化治疗对初治2型糖尿病患者生活质量的影响

目的 探讨胰岛素强化治疗对初治2型糖尿病患者生活质量的影响.方法 对52例伴明显高血糖的初治2型糖尿病患者行胰岛素强化治疗.治疗前后采用健康检查简表(SF-36)和修订的糖尿病生活质量量表(A-DQOL)评价治疗生活质量.结果 本组患者治疗后SF-36量表躯体健康、躯体角色功能、总体健康和精力维度高于治疗前(P均＜0.05),而躯体疼痛、社会功能、情绪健康功能及心理健康维度的评分治疗前后差异无统计学意义;治疗后A-DQOL量表满意度、糖尿病相关的忧虑维度和总体健康评分高于治疗前(P均＜0.05),而影响程度及社会或职业忧虑维度的评分治疗前后差异无统计学意义.结论 短期胰岛素强化治疗可改善初治2型糖尿病患者的生活质量.     

新诊断2型糖尿病患者的短期胰岛素强化治疗意义

研究背景:2型糖尿病的发生与胰岛素分泌不足及胰岛素抵抗密切相关。本文研究新诊断2型糖尿病患者接受初期的胰岛素强化治疗后,对患者长期血糖控制的影响。研究方法:该研究共入选16例新诊断2型糖尿病患者,其治疗前的基本资料包括:年龄(52±2)岁,体重指数(30.8±1.9)kg/m2,空腹血糖(13.3±0.7)mmol/L等。所有患者在接受2～3周的初期胰岛素强化治疗使血糖控制基本达标后停用胰岛素,依据血糖控制状况分别接受饮食、运动治疗(7例)、口服降糖药物(8例)或胰岛素治疗(1例),共随访1年。结果:全部患者在胰岛素强化治疗结束及随访1年后空腹血糖较治疗…     

强化胰岛素治疗的2型糖尿病患者夜间低血糖危险因素调查研究

目的 :探讨强化胰岛素治疗的2型糖尿病患者夜间低血糖的危险因素。方法 :对501例强化胰岛素治疗2型糖尿病患者的临床资料进行回顾性分析,收集发生至少1次以上夜间低血糖患者临床资料,对收集的变量进行单因素分析和多因素分析。结果:高体质量指数(body mass index,BMI)、高三酰甘油和高空腹血糖是强化胰岛素治疗的2型糖尿病患者发生夜间低血糖的保护因素(均P<0.05)。结论:应加强夜间低血糖危险因素的防控,规范血糖监测,加强对患者的观察处理,避免夜间低血糖的发生。     

短期胰岛素强化治疗2型糖尿病的临床观察

目的观察研究用短期胰岛素强化治疗方案对血糖控制不理想的2型糖尿病患者实施治疗的临床效果。方法选择该院2012年2月—2014年2月收治的76例血糖控制不理想的2型糖尿病患者随机分为对照组和治疗组,平均每组38例。采用常规胰岛素治疗方案对对照组患者实施治疗;采用短期胰岛素强化治疗方案对治疗组患者实施治疗。结果治疗组患者2型糖尿病治疗效果显著优于对照组;血糖水平恢复正常时间和临床用药治疗总时间显著短于对照组;不良反应发生例数显著少于对照组。结论应用短期胰岛素强化治疗方案对血糖控制不理想的2型糖尿病患者实施治疗的临床效果非常显著。     

短期胰岛素强化治疗2型糖尿病的临床观察

目的观察研究用短期胰岛素强化治疗方案对血糖控制不理想的2型糖尿病患者实施治疗的临床效果。方法选择该院2012年2月—2014年2月收治的76例血糖控制不理想的2型糖尿病患者随机分为对照组和治疗组,平均每组38例。采用常规胰岛素治疗方案对对照组患者实施治疗;采用短期胰岛素强化治疗方案对治疗组患者实施治疗。结果治疗组患者2型糖尿病治疗效果显著优于对照组;血糖水平恢复正常时间和临床用药治疗总时间显著短于对照组;不良反应发生例数显著少于对照组。结论应用短期胰岛素强化治疗方案对血糖控制不理想的2型糖尿病患者实施治疗的临床效果非常显著。     

胰岛素泵与皮下注射诺和灵强化治疗初发2型糖尿病的疗效对比

目的探讨胰岛素泵强化疗法与胰岛素皮下注射强化疗法治疗初发2型糖尿病的临床疗效。方法将确诊为2型糖尿病的78例初发患者随机分为两组,分别为对照组(胰岛素皮下注射强化治疗组)39例和观察组(胰岛素泵强化治疗组)39例,对照组进行口服降糖药和多次皮下胰岛素注射强化治疗,观察组使用胰岛素泵强化治疗,观察两组患者治疗前、后2 w血糖及达标时间、用药量、胰岛素分泌指数、胰岛素抵抗指数、血浆MDA和SOD水平,采用SPSS16.0软件进行统计分析。结果两组患者治疗后的空腹血糖、餐后2 h血糖水平均较治疗前明显下降;治疗前后观察组与对照组空腹血糖、餐后2h血糖水平差异均无统计学意义(P>0.05)。观察组胰岛素用量、血糖达标时间、低血糖次数明显低于对照组(P<0.05或P<0.01);两组患者治疗后的MDA、HOMA-IR均较治疗前明显降低,SOD、HOMA-BE均较治疗前明显升高(P<0.01)。结论胰岛素泵强化治疗初发2型糖尿病临床疗效与皮下注射强化治疗疗效相当,氧化应激影响没有差异,但胰岛素泵强化治疗可缩短血糖达标时间,减少胰岛素用量,降低低血糖发生率,明显修复和恢复胰岛β细胞功能,有助于血糖的长期稳定,避免血糖波动,可能与其降低胰岛β细胞受到的氧化应激有关,对于严重高血糖的2型糖尿病患者或血糖控制不佳的2型糖尿病患者应作为首选。     

胰岛素强化治疗及其疗程对初诊2型糖尿病长期缓解的影响

目的 探讨胰岛素强化治疗及疗程对初诊2型糖尿病患者胰岛β细胞功能与长期缓解的影响. 方法 将初诊2型糖尿病患者按胰岛素强化疗程分为15天、30天、60天3组,检测其治疗前后胰岛β细胞功能,并长期随访,分析影响糖尿病缓解的相关因素. 结果 3组患者治疗后胰岛功能明显改善.30天、60天组均较15天组胰岛素早时相分泌指标明显改善,长期缓解率明显提高.回归分析提示胰岛素强化疗程、△I30/△G30治疗后增高值与糖尿病缓解时间呈正相关. 结论 胰岛素强化治疗可显著改善初诊2型糖尿病患者胰岛β细胞功能.适当延长胰岛素强化疗程可更好地恢复胰岛素早时相分泌,更容易取得糖尿病的长期缓解.     

胰岛素泵治疗2型糖尿病疗效研究

目的观察胰岛素泵连续皮下注射胰岛素(CSII)治疗2型糖尿病、减少低血糖反应、改善生活质量的效果.方法对血糖控制不良,需要住院使用或调整胰岛素治疗的2型糖尿病26例患者,随机分为CSII组(12例)和常规多次皮下注射胰岛素(MSII)组(14例) 进行强化胰岛素治疗.结果两组均达到目标血糖值,但CSII组血糖控制时间显著少于MSII组(P＜0.05),且胰岛素用量少于MSII组,低血糖发生率较低,能较有效地控制黎明现象发生.结论胰岛素泵治疗糖尿病快速、安全、方便,是难治性2型糖尿病患者理想的强化治疗方案.     

短期胰岛素强化治疗诱导2型糖尿病患者长期缓解的预测因素

目的探讨短期胰岛素强化诱导治疗对2型糖尿病患者长期缓解的预测因素。方法选取72例2012年8月—2013年8月在该院收治的初诊2型糖尿病患者,病程均6个月,给予2周胰岛素强化治疗。在强化治疗前和治疗后24 h检测标准餐试验以及葡萄糖耐量试验。在治疗后不使用降糖药血糖控制良好1年认为是长期缓解。结果治疗后共有58例长期缓解,缓解率为80.6%。缓解病例(缓解组)的肿瘤坏死因子-α(TNF-α)基线水平较治疗前下降显著,且(P0.05)差异有统计学意义。而未缓解病例(对照组)TNF-α基线水平无明显变化。结论对于2型糖尿病患者进行短期胰岛素强化治疗,能够使多数患者获得长期缓解,而TNF-α下降幅度同长期缓解正相关,可用于预测治疗效果。     

短期胰岛素强化治疗对肥胖2型糖尿病的影响

对初诊的2型糖尿病患者33例进行4周的强化胰岛素治疗.并对治疗成功组患者随访1年.结果4周的胰岛素强化治疗可以逆转初诊肥胖2型糖尿病患者β细胞的功能及改善他们的糖脂代谢指标.结论短期胰岛素强化治疗对初诊肥胖2型糖尿病患者血糖、血脂控制有良好的疗效,并能够改善这些患者的胰岛β细胞功能.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.