胰岛素泵在合并感染2型糖尿病患者中的临床应用

目的:比较连续皮下胰岛素注射(CSII)对伴和不伴感染的2型糖尿病(T2DM)患者治疗的有效性。方法:CSII感染组96例、CSII非感染组95例,均进行短期胰岛素强化治疗,比较2组血糖水平、血糖达标时间、单位体重胰岛素用量、低血糖发生率及CSII应用方法。结果:CSII感染组血糖达标时间较非感染组长[(6.75±2.74)d vs(5.69±2.54)d,P0.05],且胰岛素用量较非感染组增加了约13%;感染组CSII应用中主要是基础率水平较高;影响血糖达标时间和胰岛素用量的主要因素是感染、血糖水平和体质指数。结论:CSII在合并感染的T2DM患者中能有效控制血糖,但胰岛素需要量增加,可通过增加凌晨和白天段的基础率来达到理想的血糖控制。     

胰岛素泵在2型糖尿病合并感染中毒症患者中的临床应用

目的:观察胰岛素皮下连续注射(CSⅡ)在2型糖尿病(T2DM)合并感染中毒症患者中的临床应用.方法:T2DM合并感染中毒症组20例,T2DM不伴感染组20例,均进行CSⅡ强化治疗,比较两组血糖水平、血糖达标时间、达标时胰岛素用量等指标,并对上述指标进行相关性分析.结果:合并感染中毒症组平均达标时间为(10.9±2.8)d,较不伴感染组(6.2±2.6)d明显延长(P＜0.01);伴感染中毒症组达标时单位胰岛素用量为[0.9±0.5U/(kg·d)],较不伴感染组[0.7±0.3 U/(kg·d)]明显增加(P＜0.01);而血糖达标时间和达标时胰岛素用量主要和基础血糖、HbA1c水平及感染状况有较强的相关性.结论:在糖尿病合并败血症的患者中用CSII治疗是一种灵活而有效的胰岛素强化治疗方法,患者基础血糖控制情况和感染的严重程度是影响其血糖达标的主要因素.     

老年2型糖尿病患者应用胰岛素泵的有效性和安全性

目的比较持续皮下胰岛素注射(CSII)和多次皮下胰岛素注射(MDI)治疗年龄≥60岁的老年2型糖尿病(T2DM)病人的有效性和安全性。方法CSII组236例,MDI组206例,均进行短期胰岛素强化治疗,比较2组血糖水平、血糖达标时间、达标时胰岛素用量、低血糖发生率等。结果CSII组达标时间为(6.3±2.1)d,MDI组为(7.4±2.5)d,CSII组明显较快(P<0.05);且CSII组血糖控制水平更低(P<0.05);2组低血糖的发生率无显著性差异(P>0.05)。结论通过较大样本的对老年T2DM的2种强化治疗方法的比较,证实在老年T2DM的高血糖急性期,CSII能更快、更有效地控制血糖,且低血糖的风险无明显增加。     

合并感染与否的2型糖尿病患者CSII应用的胰岛素剂量比较

对伴与不伴感染的2型糖尿病（T2DM）患者行连续皮下胰岛素输注（CSII）治疗,发现感染组平均胰岛素用量（0．67±0．24U·kg^-1·d^-1）,较非感染组（0．60±0．18U·kg^-1·d^-1）高（P〈0．05）;主要为基础率高,餐前量在两组间无统计学差异（P〉0．05）;影响血糖达标和胰岛素用量的主要因素是感染、血糖水平和体质指数。     

初诊与非初诊2型糖尿病患者胰岛素泵的应用

目的探讨短期持续皮下胰岛素输注（CSⅡ）对明显高血糖的初诊和非初诊2型糖尿病（T2DM）患者的应用方法。方法T2DM患者1276例,其中初诊组479例,非初诊组797例,观察两组血糖达标时间、胰岛素用量、低血糖的发生率及其相关因素。结果CSⅡ治疗使初诊和非初诊糖尿病患者血糖达标时间分别为4．76±2．56天和5．87±2．69天,初诊组达标较快（P〈0．05）,两组胰岛素用量相似,平均每天0．69±0．31U／kg,基础用量占全天用量的61％,但初诊组达标后胰岛素减量较早,降幅较大（P〈0．05）;两组低血糖的发生率相差不多（P〉0．05）。结论CSII治疗于高糖急性期的初诊和非初诊患者都能迅速减轻胰岛素抵抗,改善B细胞功能。     

胰岛素泵治疗老年2型糖尿病的疗效观察

目的对比应用胰岛素泵(CSII)与多次皮下注射胰岛素(MSII)对血糖控制不佳的老年2型糖尿病(T2DM)患者的治疗效果及安全性。方法将58例老年T2DM患者随机分为CSII组(30例)和MSII组(28例),进行胰岛素治疗。分别检测2组治疗前后的三餐前后及睡前血糖、血糖控制时间、每日胰岛素用量、低血糖发生的次数以及治疗后的糖化血红蛋白(HbA1c)水平并进行统计分析。结果2组均能达到目标血糖值,但CSII组血糖控制达标时间、胰岛素用量及低血糖发生率均明显少于MSII组(P<0.01),CSII治疗后HbA1c水平显著低于MSII组(P<0.01)。结论CSII有效模拟人体生理胰岛素分泌,用于老年T2DM患者能更快、更有效地控制高血糖,减少低血糖的发生率,并且效果能持续较长时间。     

合并感染与否的2型糖尿病患者CSⅡ应用的胰岛素剂量比较

对伴与不伴感染的2型糖尿病(T2DM)患者行连续皮下胰岛素输注(CSⅡ)治疗,发现感染组平均胰岛素用量(0.67±0.24U·kg-1·d-1),较非感染组(0.60±0.18U·kg-1·d-1)高(P<0.05);主要为基础率高,餐前量在两组间无统计学差异(P>0.05);影响血糖达标和胰岛素用量的主要因素是感染、血糖水平和体质指数.     

门诊短期持续皮下胰岛素注射强化治疗2型糖尿病的临床研究

目的比较门诊短期持续皮下胰岛素注射(CSII)治疗及门诊多次皮下注射胰岛素(MDI)治疗T2DM的疗效。方法收集门诊CSII(A组)、住院CSII(B组)及门诊MDI(C组)患者,比较血糖控制情况、达标时间、胰岛素用量、低血糖发生率、治疗费用。结果 A组与B组比较,血糖达标时间、胰岛素用量、低血糖发生率等差异无统计学意义(P>0.05),治疗费用A组小于B组(P<0.01);A组与C组比较,血糖控制情况、达标时间、低血糖发生率等差异有统计学意义(P<0.01)。结论门诊胰岛素泵短期强化治疗能平稳有效控制血糖,且费用较低,降糖效果优于门诊MDI。     

不同疗程胰岛素泵治疗对口服降糖药失效的糖尿病患者胰岛β细胞功能的保护作用

目的评价不同疗程持续皮下胰岛素注射（CSII）治疗对口服降糖药（OHA）治疗失效的2型糖尿病（T2DM）患者胰岛β细胞功能改善的作用。方法48例OHA治疗失败的T2DM患者按CSII疗程分成三组,7天组10例、14天组18例、28天组20例。结果14天组和28天组在疗程结束时,血糖达标的胰岛素基础用量和餐前日追加量均较治疗第一天减少;28天组平均胰岛素日用总量显著低于7天组;14和28天组第一时相胰岛素和C肽分泌显著改善;三组HbA1c均下降,以28天组最明显。P均〈0.05。1年后28天组60%单用口服降糖药即可有效控制血糖。结论CSII治疗4周更有利于OHA失效的T2DM患者胰岛β细胞功能的改善。     

胰岛素泵两种基础率设定法治疗2型糖尿病比较的观察

目的 比较1段和6段法设定胰岛素泵基础率对T2DM患者疗效的影响. 方法 观察我院149例应用胰岛素泵治疗的T2DM患者,据治疗方案分为1段基础率组(A组,n=74)和6段基础率组(B组,n=75),比较两组血糖达标时间、胰岛素用量、血糖控制情况及低血糖发生率. 结果 两组达标时间差异无统计学意义;B组每日胰岛素总量[(38.2±9.26)vs(41.9±9.67) U/d,P＜0.05]及餐前量[(20.7±6.56)vs(23.15±6.12)U/d,P＜0.05]低于A组,两组基础量差异无统计学意义;达标时,两组5个时点血糖水平差异均无统计学意义,但B组一日内血糖水平标准差[(2.23±0.83)vs(2.72±1.09),P＜0.05]低于A组;B组低血糖发生率也低于A组. 结论 6段法设定胰岛素泵基础率可减少每日胰岛素用量,特别是餐前量,降低血糖波动,减少低血糖发生,更平稳地改善T2DM患者的血糖控制.     

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.     

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.     

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.     

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.