地特胰岛素联合格列美脲治疗老年 2 型糖尿病临床疗效分析

目的对地特胰岛素联合格列美脲治疗老年2型糖尿病的临床疗效进行分析。方法选取2012年3月至2013年3月老年2型糖尿病患者62例,将其分为对照组和观察组各31例。对照组患者采用中性精蛋白人胰岛素联合格列美脲治疗．观察组采用地特胰岛素联合格列美脲治疗,比较两组临床疗效。结果两组患者治疗后空腹血糖（FPG）、餐后2小时血糖（2hPG）、糖化血红蛋白（HbAlc）及空腹C肽等均优于治疗前,差异均有统计学意义（P〈0．05）,观察组血糖各项指标控制情况与对照组比较,差异无统计学意义（P〉0．05）;但观察组空腹C肽明显优于对照组,差异有统计学意义（P〈0．05）。两组安全性评价,观察组患者3例（9．68％）出现低血糖症,明显低于对照组[29．03％（9／31）],差异有统计学意义（P〈0．05）。结论地特胰岛素联合格列美脲能够有效控制老年2型糖尿病患者血糖水平,降低低血糖症发生率,对改善患者的依从性和耐受性具有重要意义,值得在临床中广泛应用。     

玉泉胶囊联合胰岛素治疗气阴亏损型2型糖尿病的临床研究

目的：探讨玉泉胶囊联合胰岛素治疗气阴亏损型2型糖尿病的临床疗效。方法120例患者随机分为对照组和治疗组,每组60例。治疗组给予玉泉胶囊联合胰岛素治疗,对照组单纯给予胰岛素治疗。12周后观察2组临床疗效。检测治疗前后体重指数（BMI）、空腹胰岛素水平（FINS）、空腹血糖（FBG）、餐后2 h 血糖（2 hBG）、糖化血红蛋白（HbA1c）水平。结果治疗后2组症状积分均有改善,治疗组更为明显（P ＜0．05）;治疗后治疗组血清 FBG、2 hBG、HbA1c 表达水平与对照组比较改善更为明显（P ＜0．05）。治疗组低血糖发生率低于对照组（P ＜0．05）。结论玉泉胶囊联合胰岛素治疗气阴亏损型2型糖尿病具有较好的临床疗效。     

综合治疗妊娠期糖尿病对妊娠结局的影响

目的：研究在新诊断标准下,综合治疗妊娠期糖尿病对妊娠结局的影响,为临床用药提供依据。方法选择2011年1月至2013年12月接受治疗的妊娠期糖尿病患者147例,按照随机数字表法分为综合治疗组和胰岛素治疗组、营养治疗组,3组患者一般资料比较差异无统计学意义（ P ＞0？．05）。胰岛素治疗组患者均给予胰岛素皮下注射治疗,营养治疗组给予营养治疗,综合治疗组联合使用胰岛素皮下注射治疗、营养治疗、运动治疗。观察并比较3组空腹血糖、餐后2h血糖、血糖达标时间,孕妇以及新生儿围生期并发症以及剖宫产等指标。结果综合治疗组空腹血糖、餐后2 h血糖以及血糖达标时间均优于胰岛素治疗组与营养治疗组,差异有统计学意义（ P ＜0．05）;胰岛素治疗组空腹血糖、餐后2 h血糖以及血糖达标时间优于营养治疗组,但差异无统计学意义（ P ＞0．05）。综合治疗组妊娠除产褥感染发生率外,其他围生期并发症发生率均优于胰岛素治疗组与营养治疗组,差异有统计学意义（P ＜0．05）。胰岛素治疗组新生儿围生期并发症发生率优于营养治疗组,但差异无统计学意义（ P ＞0．05）。综合治疗组围生期并发症发生率均优于胰岛素治疗组与营养治疗组,且差异有统计学意义（ P ＜0．05）;胰岛素治疗组新生儿围生期并发症发生率优于营养治疗组,但差异无统计学意义（ P ＞0．05）。结论综合治疗妊娠期糖尿病能够显著改善妊娠结局,降低母婴围生期并发症发生率。     

中药联合地特胰岛素治疗肥胖或超重2型糖尿病的临床效果观察

目的：观察中药联合地特胰岛素治疗肥胖或超重2型糖尿病的临床效果。方法将30例超重或肥胖的2型糖尿病（T2DM）患者随机分为治疗组和对照组各15例。2组均予地特胰岛素治疗,治疗组加用中药减肥降脂方。比较2组治疗前后体质量、体质量指数（BMI）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）和腰围、臀围变化。结果治疗前2组体质量、BMI、FPG、腰围、臀围差异无统计学意义（P＞0．05）。治疗后2组体质量、BMI、FPG和HbA1c均低于治疗前,且治疗组低于对照组,差异均有统计学意义（P＜0．05）。治疗组治疗后腰围小于治疗前,差异有统计学意义（P＜0．05）;对照组治疗前后腰围差异均无统计学意义（P＞0．05）。2组治疗前后臀围差异均无统计学意义（P＞0．05）。结论中药减肥降脂方联合地特胰岛素对患者体质量下降更明显,对患者的体质量控制更有益,值得临床推广应用。     

艾塞那肽联合二甲双胍治疗老年2型糖尿病临床观察

目的：观察艾塞那肽联合二甲双胍治疗老年2型糖尿病的临床效果。方法将60例老年2型糖尿病患者随机分为联合组和对照组各30例。对照组给予二甲双胍治疗,联合组在对照组基础上加用艾塞那肽治疗,疗程3个月,治疗后比较2组临床疗效、治疗前后糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2h血糖（2hPG）的变化,计算血糖比值（ FINS／FPG）。结果观察组总有效率为96．67％高于对照组的83．33％,差异有统计学意义（ P＜0．05）。治疗前2组HbA1c、FPG和2hPG差异无统计学意义（ P＞0．05）。2组治疗后HbA1c、FPG,2hPG均较治疗前下降（P＜0．05）,且观察组低于对照组（P＜0．05）;2组治疗前后BMI、FINS、FINS／FPG等差异无统计学意义（P＞0．05）。结论艾塞那肽联合二甲双胍治疗老年2型糖尿病安全、有效,值得临床推广应用。     

持续皮下注射胰岛素治疗糖尿病合并甲亢的临床疗效分析

目的：观察持续皮下注射胰岛素治疗糖尿病合并甲亢患者的临床疗效。方法纳入我院收治的90例糖尿病合并甲亢患者参与临床研究,并将90例患者分为持续组和对照组,给予持续组患者持续皮下注射胰岛素治疗,给予对照组患者多次皮下注射胰岛素治疗。结果两组患者治疗前的血糖状况、SF－36量表（生活质量评价量表）评分比较均无显著性差异（ P＞0．05）,治疗后持续组患者的血糖控制状况明显优于对照组患者（ P＜0．05）,SF－36量表评分明显高于对照组患者（ P ＜0．05）,治疗过程中的并发症发生率为4．4％,低于对照组患者的20．0％（ P ＜0．05）。结论持续皮下注射胰岛素治疗糖尿病合并甲亢患者,疗效确切,并发症少,能够有效改善患者生活质量。     

探究沙格列汀在胰岛素控制不佳的2型糖尿病中的疗效与安全性

目的 观察病程在5年以上的2型糖尿病患者使用胰岛素联合二肽基肽酶4（DPP-4）抑制剂治疗,血糖控制不佳的情况下加用沙格列汀对血糖控制和改善胰岛功能的作用.方法 选取2012年1月-2013年1月在我院内分泌科住院的2型糖尿病患者64例,随机分成原方案组（对照组）和加用沙格列汀组（试验组）,对照组根据血糖情况继续加用胰岛素至血糖控制达到规定目标,试验组在原方案基础上加用沙格列汀,根据血糖情况调整胰岛素和沙格列汀剂量.比较治疗12周前后两组空腹血糖、餐后2h血糖、糖化血红蛋白（HbA1c）、空腹C肽、空腹胰岛素、稳态模型评估的胰岛素抵抗指数（HOMA-IR）、胰岛素每日剂量、体质量及低血糖事件的变化.结果 两组患者经过12周治疗,空腹血糖、餐后2h血糖、HbA1c、HOMA-IR均较治疗前降低,差异有统计学意义（P＜0.05）;试验组治疗前后体质量变化比较,差异无统计学意义（P＞0.05）.治疗12周后,试验组空腹血糖、餐后2h血糖、HbA1c、HOMA-IR、空腹C肽、胰岛素用量均低于对照组,差异有统计学意义（P＜0.05）.结论 胰岛素联合非DPP-4抑制剂治疗血糖控制不佳的2型糖尿病患者加用沙格列汀后,明显降低胰岛素每日使用量,不增加低血糖风险的前提下有效控制血糖达标,改善胰岛素抵抗.     

甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病的临床分析

目的观察甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病的临床疗效。方法选择初诊2型糖尿病患者112例随机分为两组,观察组56例采用甘精胰岛素联合瑞格列奈治疗,对照组采用诺和灵30R进行治疗,比较治疗前后两组空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAIC）水平变化,及血糖达标时间、胰岛素用量及低血糖发生率情况。结果两组治疗后FPG、2hPG及HbAlc水平均明显降低（均P〈0．05）,但两组治疗后FPG、2hPG及HbA1c水平差异无均统计学意义（均P〉0．05）。观察组血糖达标时间、胰岛素用量及低血糖发生率均少于对照组（均P〈0．05）。结论甘精胰岛素联合瑞格列奈治疗初诊2型糖尿病,能有效的控制空腹和饭后血糖,且血糖达标时间短,胰岛素用量少,大大降低了低血糖的发生。     

三精锐普降糖仪在糖尿病治疗过程中胰岛素水平的变化

目的：研究糖尿病患者及大鼠在使用三精锐普降糖仪治疗前后胰岛素水平及作用效果的变化。方法：（1）临床实验：观察了12例非胰岛素依赖性糖尿病（NIDDM）患者治疗前后空腹血糖（FBS），胰岛素（INS），胰岛素敏感性指数（ISI）的变化；（2）动物实验：取32只Wistar大鼠分为4组：A：正常对照组，B：糖尿病对照组，C：糖尿病大鼠治疗1次组，D：糖尿病大鼠治疗10次组。在治疗前后分别测FBS作自身对照，同时在治疗前后测INS作组间对照。结果：（1）临床实验：FBS在治疗后显著降低（P＜0．05），INS变化无显著性差异（P＞0．05），ISI在治疗后上升（P＜0．05）。（2）动物实验：A，B，C组FBS无显著性改变（P＞0．05），D组在治疗后FBS下降（P＜0．05），INS与B组相比上升（P＜0．05）。结论：三精锐普降糖仪有可能通过改善胰岛功能及胰岛素与受体的亲合力来达到治疗糖尿病的目的。     

甘精胰岛素联合格列美脲治疗老年2型糖尿病临床分析

目的：观察甘精胰岛素、格列美脲联合治疗老年2型糖尿病的临床疗效及安全性。方法将126例老年2型糖尿病患者随机分为观察组和对照组各63例,观察组给予甘精胰岛素与格列美脲联合治疗;对照组给予30／70混合重组人胰岛素注射液治疗,治疗3个疗程后比较2组治疗前后的FPG、2hPG、HbA1c、肝、肾功能及低血糖的发生情况。结果2组治疗前FPG、2hPG、HbA1c比较,均未见明显差异（P＞0．05）;治疗后2组2hPG比较,未见明显差异（P＞0．05）,但FPG、HbA1c组间比较,观察组明显优于对照组（P＜0．05）;观察组低血糖发生率明显低于对照组（P＜0．05）。结论甘精胰岛素、格列美脲联合治疗老年2型糖尿病安全,且疗效显著。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.