家庭医生式服务对社区2型糖尿病患者的干预效果分析

目的探讨家庭医生式服务对社区2型糖尿病患者糖代谢指标、自我管理能力及生活质量的影响。方法选择2016年1月—2017年7月在该社区随访管理的2型糖尿病患者79例为观察组,选择同期在我社区随访管理的2型糖尿病患者71例为对照组,对照组患者予社区常规随访管理,观察组患者实施为期一年半的家庭医生式服务。比较两组患者干预前后空腹血糖、餐后2 h血糖、糖化血红蛋白等糖代谢指标、自我管理情况及生活质量DSQL评分。结果干预前,两组患者空腹血糖、餐后2 h血糖、糖化血红蛋白等指标,DSQL生理维度、心理维度、治疗维度、社会关系维度评分和总评分差异无统计学意义(P0.05);干预后观察组空腹血糖、餐后2 h血糖、糖化血红蛋白等指标均低于对照组,DSQL生理维度、心理维度、治疗维度、社会关系维度评分和总评分均低于对照组,差异有统计学意义(P0.05);观察组患者在饮食控制、运动情况、血糖监测、遵医嘱用药、足部护理等方面依从性高于对照组,差异有统计学意义(P0.05)。结论家庭医生式服务可改善社区2型糖尿病患者糖代谢指标及生活质量,提高其自我管理能力。     

2型糖尿病患者药物治疗现状及药学服务干预探析

目的探讨目前2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果。方法 2013年8月—2014年7月该院收治了65例2型糖尿病患者。现特整理这些患者临床资料作为研究对象加以分析2型糖尿病的临床特点和药物治疗方法以及药学服务干预效果。对比分析患者经过药学服务干预前后的空腹血糖达标率、餐后两小时血糖达标率、糖化血红蛋白达标率以及低血糖症状患者的比例,以此衡量治疗效果和药学服务干预效果。结果通过记录患者在药学服务干预前后的空腹学让值、餐后两小时血糖值以及糖化血红蛋白达标率的情况来分析2型糖尿病患者的药物治疗结果以及药学服务干预的治疗效果。结果表明,经过药学服务干预后,患者低血糖发生率明显降低,差异具有统计学意义(P0.05)。结论药学服务干预对于提高2型糖尿病患者的药物治疗效果具有显著作用。     

综合性自我管理新模式对老年糖尿病治疗的辅助作用

目的探讨综合性自我管理对老年糖尿病的影响。方法87例老年糖尿病患者随机分为自我管理组（57例）和对照组（30例）。仅对自我管理组患者进行为期半年的综合性自我管理教育。分别检测两组患者的空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）和体质量指数（BMI）。采用《密两根糖尿病管理评定量表》评价两组患者的血糖监测行为、饮食行为、运动行为、用药行为和自我管理水平总分。结果与对照组相比,自我管理组患者的空腹血糖、餐后2h血糖、糖化血红蛋白和体质量指数,以及血糖监测行为、饮食行为、运动行为、用药行为和自我管理水平均得到明显的改善,两组差异有统计学意义（P〈0．05;P〈0．01）。结论综合性自我管理在治疗老年糖尿病中具有较好的辅助作用。     

综合护理干预提高2型糖尿病患者自我管理能力的效果分析

目的探讨综合护理干预提高2型糖尿病患者自我管理的效果。方法根据1999年WHO制定的2型糖尿病诊断标准选择186例2型糖尿病,随机分成对照组和观察组各93例。两组患者均给予常规的糖尿病健康宣教,其中包括血糖自我监测、饮食指导、用药指导、运动方式及运动量等自我管理内容。在常规健康宣教的基础上对观察组患者及其亲属进行"三对二强化健康宣教",饮食、用药及运动的综合护理干预。比较两组护理干预前后的空腹血糖、餐后2 h血糖以及糖化血红蛋白水平;通过随访对患者糖尿病控制情况进行调查分析。结果观察组患者空腹血糖、餐后2 h血糖及糖化血红蛋白于干预后低于对照组(P0.05)。结论通过综合护理干预措施,不仅可有效地提高2型糖尿病患者的自我管理水平,还能提高患者的自我保健意识,从而有效控制血糖水平,提高患者的生活质量。     

分析多元化护理在2型糖尿病患者自我管理行为中的应用

目的在2型糖尿病患者的自我管理行为中,分析多元化护理的应用效果。方法收治2017年12月—2018年12月240例2型糖尿病患者,分为观察组与对照组,每组均120例,对照组应用常规护理干预,观察组应用多元化护理方式,比较两组患者的SDSCA评分情况,以及空腹血糖、餐后2 h血糖以及糖化血红蛋白水平。结果观察组患者经过多元化护理之后,观察组SDSCA评分明显高于对照组,差异有统计学意义(P0.05)。观察组的空腹血糖、餐后2 h血糖,以及糖化血红蛋白均明显下降,各项指标均明显低于对照组,差异有统计学意义(P0.05)。结论对2型糖尿病患者自我管理行为进行临床护理中,通过多元化护理方式的应用,有效改善了患者的空腹血糖、餐后2 h血糖以及糖化血红蛋白水平,并且,提升了SDSCA评分,在临床护理中,具有应用价值,可以推广应用。     

2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果

目的研究2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果。方法将2017年6月—2018年5月期间本院接收的2型糖尿病患者70例作为观察对象,分析其药物治疗现状,并进行药学服务干预。将干预前、干预6个月后患者的血糖水平及达标率、低血糖反应发生率进行比较。结果干预6个月后2型糖尿病患者的空腹血糖、餐后2 h血糖、糖化血红蛋白水平以及低血糖发生率均低于干预前数据,差异有统计学意义(P0.05),血糖达标率则显著高于干预前,差异有统计学意义(P0.05)。结论目前口服降糖药仍是2型糖尿病患者的主要药物治疗方式,加强对患者的药学服务干预可使血糖水平控制在理想范围内,促使低血糖等不良反应发生率降低。     

多药联合治疗2型糖尿病的药学干预方法探讨

目的探讨多药联合治疗2型糖尿病的药学干预方法。方法于2017年7月—2018年7月,将该院收治的98例行多药联合治疗的2型糖尿病患者随机划分为常规组、研究组,各49例。常规组不进行任何干预,研究组则接受药学干预。结果研究组餐后2 h血糖、空腹血糖、糖化血红蛋白均低于常规组,组间差异有统计学意义(P0.05);研究组不良反应少于常规组,组间差异有统计学意义(P0.05)。结论通过药学干预,可进一步改善患者的血糖水平,减少不良反应。值得临床借鉴应用。     

药学服务干预对于2型糖尿病患者治疗效果的影响研究

目的探讨药学服务干预对于2型糖尿病患者治疗效果的影响研究。方法采集时间段为2017年3月—2019年5月内于该院接受治疗的2型糖尿病患者200例,通过随机表法分为100例常规组与100例实验组,其中常规组接受常规用药指导,实验组接受药学服务干预,比较两种干预方法对患者治疗效果的实际影响。结果经过对比后,发现两组患者干预前血糖值差异无统计学意义(P>0.05);经过干预后,相较于常规组,实验组空腹血糖及餐后2 h血糖均更低(P<0.05);同时实验组空腹血糖达标率、餐后2 h血糖达标率、糖化血红蛋白达标率及低血糖发生率更优(P<0.05)。结论在2型糖尿病患者中,可通过药学服务干预方法促进治疗效果提高,有助于减少患者血糖值,促进各血糖指标合格率的提高,有效减少低血糖发生情况。     

药学服务干预对糖尿病患者治疗依从性与血糖指标的影响

目的探讨药学服务干预对糖尿病患者治疗依从性与血糖指标的影响。方法随机抽取100例糖尿病患者作为该次研究对象,病例起止时间为2018年6月—2019年7月,100例患者分组方式为随机数表法,即观察组50例选择药学服务干预,对照组50例选择常规用药,对比两组患者血糖指标以及治疗依从性。结果①干预前对比观察组与对照组空腹血糖、餐后2 h血糖以及糖化血红蛋白水平,组间差异无统计学意义(P>0.05);干预后对比观察组与对照组空腹血糖、餐后2 h血糖以及糖化血红蛋白水平,组间比较差异有统计学意义(P<0.05)。②观察组干预后依从率为94%,对照组干预后依从率为78%,组间对比差异有统计学意义(P<0.05)。结论糖尿病患者在治疗时通过药学服务干预可提升其治疗依从性,并且改善血糖指标,有利于控制血糖水平。     

米格列奈治疗初发2型糖尿病的疗效观察

88例初诊2型糖尿病,用随机、双盲、双模拟、那格列奈阳性对照的研究方法,分为2组,米格列奈组患者44例,那格列奈组患者44例,两组均治疗16周,比较两组用药前后的糖化血红蛋白、空腹血糖、餐后血糖、空腹胰岛素。结果治疗后,两组空腹血糖、餐后2h血糖、糖化血红蛋白及空腹胰岛素水平均能有效降低。2种药物作用比较未见统计学差异(P>0.05)。米格列奈不良反应主要为低血糖、轻度胃肠道反应。结论米格列奈降糖作用与那格列奈相似,能降低空腹与餐后血糖,降餐后血糖较明显,无明显药物不良反应。     

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.     

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.     

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.