血清visfatin与老年2型糖尿病及其大血管病变的相关性研究

目的：探讨visfatin与老年2型糖尿病及其大血管并发症和相关代谢指标的关系。方法：将66例老年糖尿病患者分为合并大血管病变组（MCV）35例和非大血管病变组（nMCV）31例,并选64例健康人做对照。采取酶联免疫测定法（ELISA）测定空腹血清visfatin浓度;并测定各组的空腹血糖、胰岛素、血压和血脂水平;用胰岛素抵抗指数（HOMA—IR）HOMA—IR评价胰岛素抵抗,分析各指标问的相关性及与大血管并发症的相关性。结果：①老年2型糖尿病组血清visfatin浓度高于正常对照组,差异有统计学意义（P〈0．01）。但正常对照组与2型糖尿病组中nMCV组比较,visfatin浓度差异无统计学意义（P〉0．05）。②老年2型糖尿病组中大血管病变组（MCV）血清visfatin浓度明显高于非大血管病变组（nMCV）,差异有统计学意义（P〈O．01）。③相关分析显示,老年2型糖尿病组血清visfatin浓度与腰围（WC）、甘油三酯（TG）均呈显著正相关,与性别、年龄、HOMA—IR呈正相关。进一步以visfatin为应变量,以年龄、性别、BMI、WC、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、空腹血糖（FPG）、空腹胰岛素（FINS）、HOMA—IR为自变量进行多元逐步回归分析,TG、WC和年龄是血清visfatin独立相关因素。④在老年T2DM组,以有无大血管并发症为应变量（Y=1,n=0）,各指标为自变量,进行logistic回归分析,visfatin进入回归方程。结论：血清visfatin与2型糖尿病的发病不相关,但在老年2型糖尿病中与其大血管并发症有关。     

血浆纤溶功能对2型糖尿病血管病变的影响

目的：探讨2型糖尿病患者纤溶功能的改变及其对外周血管病变的影响，分析其纤溶功能紊乱的可能原因。方法：根据研究对象的临床表现及各种检查结果，分为4组。对照组23例，无并发症2型糖尿病组20例，微血管病变组20例，大血管病变组19例，采用酶联免疫吸附法测定其血浆纤溶酶-α2抗纤溶酶复合物、组织型纤溶酶原激活剂、纤溶酶原激活剂抑制物水平，同时测定其它一些临床生化指标。结果：无并发症2型糖尿病组、微血管病变组及大血管病变组与对照组比较血浆纤溶酶-α2抗纤溶酶复合物浓度显著增高（P〈0．01），凝血酶无时间缩短（P〈0．05）。微血管病变组、大血管病变组的纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂、和纤维蛋白原高于对照组（P〈0．01）。大血管病变组纤溶酶原激活剂抑制物、APTT明显高于无并发症2型糖尿病组（分别为P〈0．01，P〈0．05），微血管病变组的纤维蛋白原高于无并发症2型糖尿病组（P〈0．01）。结论：2型糖尿病合并血管痛变者血浆纤溶酶-α2抗纤溶酶复合物、纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂水平均升高，这种纤溶功能异常可能是糖尿病性血管病变形成的原因之一。     

超敏C反应蛋白及脂联素与2型糖尿病大血管病变的相关性研究

[目的]分析2型糖尿病（DM）合并大血管病变及无大血管病变与血清超敏c反应蛋白（hs—CRP）及脂联素水平的相关性。[方法]79例2型糖尿病患者，按有无大血管病变分为伴大血管病变组（A组）40例，无大血管病变组（B组）39例。另选40例健康者作正常对照组（C组），均检测血清hs—CRP，脂联素及空腹血糖（FBG）、空腹胰岛素（FINS）、血脂等指标。[结果]A组血清hs—CRP高于B组及C组（P〈0．05，P〈0．01），B组明显高于C组（P〈0．01），A组脂联素水平明显低于B组及C组（均P〈0．01），B组明显低于C组（P〈0．01）。相关分析提示血清hs—CRP与脂联素有相关性（P〈0．01）。[结论]hs～CRP，脂联素对于DM患者发生大血管病变的预测具有重要意义。     

2型糖尿病合并大血管病变患者肝细胞生长因子水平观察

目的观察2型糖尿病合并大血管病变患者肝细胞生长因子（HGF）水平的变化，探讨HGF与2型糖尿病大血管病变发生的关系。方法用酶联免疫吸附法测定2型糖尿病患者、无糖尿病的大血管病变患者以及正常对照组的血清HGF水平。结果与正常对照组相比，2型糖尿病伴或不伴大血管病变患者及无糖尿病的大血管病变患者血清HGF水平明显增高（P〈0.05或P〈0．01）；无糖尿病大血管病变患者和2型糖尿病无大血管病变患者血清HGF水平差异无显著性；2型糖尿病伴大血管病变患者血清HGF水平较2型糖尿病无大血管病变患者及无糠尿病大血管病变者明显增高（P〈0．05）。结论2型糖尿病患者血清HGF水平显著增高，2型糖尿病合并大血管病变者增高更明显；HGF可作为反映糖尿病患者大血管病变严重程度的指标之一。     

血清可溶性血管细胞黏附分子-1和可溶性细胞间黏附分子-1与2型糖尿病血管病变的相关性

目的 探讨血清可溶性血管细胞黏附分子-1（sVCAM-1）和可溶性细胞间黏附分子-1（siCAM-1）在2型糖尿病大、小血管病变中的作用。方法 应用酶联免疫吸附试验（ELISA）法检测了62例2型糖尿病患者血浆sVCAM-1和siCAM-1水平,并与20例健康人作对照。结果 糖尿病各组血清sVCAM-1和siCAM-1水平明显高于健康对照组（P〈0．01）,无血管病变组、微血管病变组和大血管病变组的含量逐步升高（P〈0．01）;逐步多元回归分析表明sICAM-1水平与血浆假性血友病因子（vWF）、甘油三酯（TG）、收缩压（SBP）、舒张压（DBP）呈正相关（r=0．43、0．45、0．52、0．62,均P〈0．01）;sVCAM-1水平与TG、胆固醇（TC）及尿白蛋白／肌酐（Alb／Cr）呈正相关（r=0．59、0．46、0．73,均P〈0．01）;多因素logistic回归分析表明sVCAM-1与是否惠有微血管病变显著相关（β=2．48,P〈0．05）,sICAM-1与是否惠有大血管病变显著相关（β=2．46,P〈0．05）。结论 sICAM-1和sVCAM-1参与了2型糖尿病血管病变的发生和发展,可作为早期2型糖尿病患者慢性血管并发症发生的预测及监测指标。     

2型糖尿病患者血清可溶性血管细胞粘附分子-1和选择素-E检测的临床意义

目的研究可溶性血管细胞粘附分子-1（sVCAM-1）和可溶性E-选择素（sE-selectin）在2型糖尿病患者血管病变中的变化及其临床意义。方法应用酶联免疫吸附法检测78例2型糖尿病患者（其中并发大血管病变21例,并发微血管病变34例,无微血管病变23例）、28例葡萄糖耐量减退（IGT）组、21例空腹血糖受损（IFG）组和33名健康对照者的血清sVCAM-1和sE-selectin水平。结果2型糖尿病组和IGT组血清中sVCAM-l和sE-selectim水平显著高于健康对照组（P〈0．01）;糖尿病伴大血管病变组血清sVCAM-1、sE-selectin显著高于微血管病变组,伴微血管病变高于无微血管病变患者（P〈0．01）;IFG组检测结果与正常对照差异无统计学意义在不同数量的微血管病变组间,血清sVCAM-1和sE-selectin存在显著性差异（P〈0．05）;sVCAM-1和sE-selectin存在相关性（7=0．42,P〈0．05）;sE-selectin与GHb存在相关性（γ=0．59,P〈0．01）。结论VCAM-1和sE-selectin可能参与了2型糖尿病血管病变的发生和发展,检测血清sVCAM-1和sE-selectin水平在一定程度上可反映2型糖尿病血管病变的情况。     

血清FFA、TNF-α与2型糖尿病患者大血管病变的相关性研究

目的：探讨游离脂肪酸、肿瘤坏死因子-α与糖尿病大血管病变的关系。方法：60例2型糖尿病患者，根据是否合并大血管病变，分为非大血管病变组29例和大血管病变组31例，与28名正常对照组比较，采用比色法测血清游离脂肪酸，ELISA法测血清肿瘤坏死因子-α，对大血管病变的危险因素行Logistic回归分析。结果：2型糖尿病组较正常对照组血清游离脂肪酸、肿瘤坏死因子-α显著增高（P〈0．01），大血管病变组血清游离脂肪酸、肿瘤坏死因子-α与非大血管病变组、正常对照组比较，差异有统计学意义（P〈0．01）。2型糖尿病组为整体，有无大血管病变为因变量Y（有=1，无=0），以肿瘤坏死因子-α、游离脂肪酸及其他危险因素为自变量进行Logistic回归分析，年龄、病程、收缩压、肿瘤坏死因子-α、游离脂肪酸进入回归方程。结论：游离脂肪酸、肿瘤坏死因子-α是2型糖尿病大血管病变的重要的危险因素。     

血清C-反应蛋白（CRP）对2型糖尿病大血管病变的临床意义探讨

目的：研究血清C肽浓度及其相关因素在2型糖尿病（DM）大血管病变的临床意义。方法：测定糖尿病（A组）、糖尿病合并大肢血管病变（B组）、非搪尿病大血管病变（C组）和健康对照组（D组）的C反应蛋白（CRP）并做相关性分析。结果：A、B、C三组CRP水平均明显高于D组（P〈0．01）B组较A组和C组更为明显，两两比较差别有显著性意义。结论：提示急性时相蛋白在2型糖尿病的发生及其大血管病变并发症的发展中起到重要作用。     

2型糖尿病患者血清hsCRP和IL-18与大血管病变的相关性

目的：探讨高敏C反应蛋白（high-sensitivity C-reactive protein,hsCRP）、白介素18（In—terleukin-18）与2型糖尿病并发大血管病变的相关性。方法：收集72例2型糖尿病（DM）患者和36例健康对照,分别测定各组血清hsCRP和IL-18的水平,并进行相关性分析。结果：2型糖尿病组hsCRP和IL-18水平显著高于健康对照组,具有显著性差异（P〈0．01）,并发大血管病变患者hsCRP和IL-18较无大血管病变者有显著性意义（P〈0．05）,相关分析：血清IL-18与hsCRP（r=0．240,P〈0．05）,hsCRP与空腹血糖（FBG）（r=0．300,P％0．05）正相关。结论：hsCRP与IL-18在2型糖尿病并发大血管病患者中升高,可能在2型糖尿病的发病及进展过程中起到重要的作用。     

2型糖尿病患者血管病变及血糖变化与基底膜蛋白的关系

目的：观察基底膜的主要组成蛋白Ⅳ型胶原和层粘连蛋白与2型糖尿病血管病变和血糖变化的关系。 方法：选择1999／2003哈尔滨市第一医院收治的82例2型糖尿病患者，按有无血管病变分为大血管病变组（n=8），微血管病变组（n=36）和无并发症组（n=38）；以44例正常人为正常对照组。用放射免疫法测定所有被试者的血清Ⅳ型胶原和层粘连蛋白水平，同时测定患者空腹血糖、糖化血红蛋白、胆固醇、等相关生化指标，用相关和多元回归分析各指标间相关性。 结果：按意向处理分析，126例被试者全部进入结果分析。①血清Ⅳ型胶原水平：糖尿病组明显高于正常对照组[（98．69&;#177;26．67）（78．41&;#177;19．12）μ／L，P〈0．01]；其中微血管病变组高于其他各组（P〈0．01）。②血清层粘连蛋白水平：糖尿病组明显高于正常对照组[（172．78&;#177;25．69），（147．02&;#177;27．64）μg/L，P〈0．01]；其中微血管病变组高于其他各组（P〈0．01）。③不同病程糖尿病患者比较：各病程组间（〈5年，5-，≥10年）的血清Ⅳ型胶原水平虽逐渐递增，但无差异（P〉0．05）。病程6～10年及11-22年的患者血清层粘连蛋白水平高于正常对照组，亦高于病程〈1年及1～5年者（P〈0．01）。④不同血糖值的糖尿病患者比较：三组（〈8，8-，≥11．1mmol／L）血清层粘连蛋白与Ⅳ型胶原值均高于正常对照组（P〈0．01），但组间无差异。⑤2型糖尿病患者的血清Ⅳ型胶原和层粘连蛋白水平与血糖、病程呈正相关（P〈0．01，0．05）。⑥血清Ⅳ型胶原和层粘连蛋白水平呈显著正相关（r=0．58，P〈0．001）。 结论：血清Ⅳ型胶原和层粘连蛋白水平与2型糖尿病微血管并发症的发生、发展及血糖的变化密切相关。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.