罗格列酮与二甲双胍对糖尿病糖脂代谢的影响

目的:观察罗格列酮和二甲双胍对2型糖尿病患者胰岛素抵抗和脂代谢异常的作用。方法:40例血糖控制不良的2型糖尿病患者在原治疗方案下随机给予罗格列酮4mg/d(罗格列酮组),或二甲双胍0.5g2/d(二甲双胍组),疗程为12周。结果:治疗后两组血糖均有显著下降,罗格列酮组空腹c肽较前轻度下降,胰岛素抵抗稍有降低,β细胞功能明显改善;二甲双胍组c肽较前无改善。在脂代谢方面,罗格列酮组甘油三酯和低密度脂蛋白胆固醇较治疗前下降,高密度脂蛋白胆固醇较治疗前升高;二甲双胍组总胆固醇和低密度脂蛋白胆固醇较治疗前下降。结论:罗格列酮在改善胰岛素抵抗方面优于二甲双胍,两药均能改善2型糖尿病患者的脂代谢异常,但降脂谱不同。     

左旋氨氯地平联合替米沙坦治疗2型糖尿病高血压疗效观察

目的：探讨单用左旋氨氯地平、替米沙坦与两药合用治疗2型糖尿病高血压患者的有效性及安全性。方法：2006年1月一2009年12月人选268例2型糖尿病高血压患者,随机分为A,B,C组,3组患者均口服降糖药,少数患者皮下注射胰岛素控制血糖,入选者在用药前停用其他降压药1周。A组：左旋氨氯地平2．5～5．0mg,每日1次;B组：替米沙坦40mg,每日1次;C组：左旋氨氯地平2．5mg,每日早上1次,替米沙坦20～40mg,每日晚上1次。治疗4～6周血压平稳,连续观察3个月,每日监测血压、心率,观察不良反应情况。结果：A组89例,平均年龄（61±8）岁,总有效率67．4％;B组89例,平均年龄（60±7）岁,总有效率60．6％;C组90例,平均年龄（59±9）岁,总有效率80％。3组相比,C组总有效率高,副作用少。结论：左旋氨氯地平联合替米沙坦治疗2型糖尿病高血压患者安全、有效、耐受性好。     

罗格列酮对高血压合并糖耐量减低患者内皮功能的影响及其氧化应激机制

目的 探讨罗格列酮对高血压合并糖耐量减低患者血糖、血压、胰岛素抵抗、血管内皮功能的影响及其氧化应激机制.方法 100例高血压合并糖耐量减低(IGT)患者随机分为罗格列酮治疗组(55例)和常规治疗组(45例).另选取健康体检者作为对照组(45例).疗程8周,比较治疗前后血压、空腹血糖、胰岛素、胰岛素抵抗指数、一氧化氮、内皮素-1、丙二醛、红细胞超氧化物岐化酶的变化.结果 罗格列酮治疗8周后,血压、空腹血糖、胰岛素水平、胰岛素抵抗指数较前明显下降(P<0.05);内皮素-1、丙二醛水平显著降低(P<0.05);一氧化氮、红细胞超氧化物岐化酶水平显著升高(P<0.05).结论 罗格列酮可显著改善高血压并IGT患者的血压、血糖和胰岛素抵抗,其机制可能与降低机体氧化应激,改善内皮功能有关.     

替米沙坦对2型糖尿病合并高血压患者胰岛素抵抗及氧化应激水平的影响

目的 探讨替米沙坦对2型糖尿病合并高血压患者胰岛素抵抗及氧化应激水平的影响.方法 将四川省什邡市人民医院2012年1月至2013年6月收治的60例2型糖尿病合并高血压患者分为治疗组和对照组,每组30例,分别给予替米沙坦(80 mg,每天1次)、硝苯地平(10 mg,每天2次)治疗24周.检测并观察2组患者空腹血糖、空腹胰岛素、胰岛素抵抗指数(H OMA-IR)、氧化应激指标[血浆硫氧还蛋白(TRX)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、丙二醛(MDA)]的水平变化.结果 用药24周后,治疗组空腹血糖、HO-MA-IR较用药前降低(P<0.05),空腹胰岛素水平较用药前升高(P<0.05);治疗组TRX、SOD、CAT水平较对照组升高,差异均有统计学意义(P<0.05);治疗组MDA水平较对照组降低,差异有统计学意义(P<0.05).治疗前,2组间空腹血糖、空腹胰岛素、HOMA-IR比较,差异无统计学意义(P>0.05),治疗24周后,治疗组空腹血糖、HOMA-IR较对照组降低,差异有统计学意义(P<0.05);治疗组空腹胰岛素水平较对照组升高,差异有统计学意义(P<0.05).结论 替米沙坦可以改善2型糖尿病合并高血压患者的胰岛素抵抗,这可能与减轻氧化应激损伤有关.     

替米沙坦对高血压并糖尿病患者糖脂代谢的影响

目的:探讨替米沙坦对高血压并糖尿病者糖脂代谢作用的影响.方法:选择40名高血压并糖尿病者,随机分成替米沙坦治疗组和厄贝沙坦治疗组各20例,疗程3个月.比较治疗前后体质指数(BMI)、血压(BP)、血脂、空腹血糖(FPG)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)的变化.结果:与治疗前比较,两组治疗后收缩压和舒张压均有明显下降(P＜0.01),BMI、总胆固醇(TC)、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇无明显变化.替米沙坦组治疗后甘油三酯(TC)、FPG、FINS、HOMA-IR均有明显下降,差异有统计学意义(P＜0.01或P＜0.05),而厄贝沙坦组差异无统计学意义(P＞0.05).结论:替米沙坦在良好控制高血压并糖尿病者血压的同时,改善胰岛素抵抗及降低TG的水平.     

二甲双胍联合吡格列酮对2型糖尿病患者血糖、高敏C反应蛋白的影响

目的:观察二甲双胍联合吡格列酮对2型糖尿病患者血糖、高敏C反应蛋白的影响.方法:2型糖尿病患者60倒随机分为2组.A组30例给予二甲双胍联合格列吡嗪治疗,B组30例给予二甲双胍联舍吡格列酮治疗,疗程均为3个月.比较2组治疗前后空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹胰岛素、腱岛素抵抗、高敏C反应蛋白水平.结果:2组治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白均较治疗前下降(P<0.05);B组空腹胰岛素、胰岛素抵抗、高教C反应蛋白水平较治疗前降低(P<0.05),且低于A组治疗后水平(P<0.01).结论:二甲双胍联合吡格列酮可降低血糖,改善胰岛素抵抗.     

罗格列酮对2型糖尿病患者血浆tPA和PAI1活性的影响

目的:运用胰岛素增敏剂罗格列酮治疗2型糖尿病患者,观察罗格列酮对2型糖尿病患者血浆tPA和PAI1活性水平的影响。方法:48例2型糖尿病患者,口服罗格列酮(文迪雅)4mg/d,共12周,观察治疗前后的血浆tPA和PAI1活性、血糖和胰岛素等,计算胰岛素敏感指数和胰岛素抵抗指数,并将各指标进行分析比较。结果:罗格列酮治疗后2型糖尿病患者血浆tPA活性升高(P<0.05),PAI1活性及PAI1/tPA活性比值降低(P<0.05,P<0.01)。血糖、胰岛素水平降低(均P<0.05);胰岛素敏感指数明显升高(P<0.05);胰岛素抵抗指数降低(P<0.05)。结论:罗格列酮在降低血糖、改善胰岛素抵抗、提高胰岛素敏感指数的同时,能增强糖尿病患者纤溶系统的活性,对心血管起到保护作用。     

罗格列酮、二甲双胍缓释片、阿长波糖对中老年Ⅱ型糖尿病的治疗比较

目的：观察罗格列酮、盐酸二甲双胍缓释片、阿卡波糖对中老年人Ⅱ型糖尿病患者胰岛素抵抗(IR)等的治疗及影响。方法：95例中老年人血糖控制不良的Ⅱ型糖尿病患者在原治疗方案下，随机分组给予罗格列酮、盐酸二甲双胍缓释片、阿卡波糖对中老年人Ⅱ型糖尿病患者胰岛素抵抗(IR)等的治疗及影响，所有疗程16周。结果：在三组患者取得相当降糖疗效基础上，盐酸二甲双胍缓释片组．阿卡波糖组在空腹c肽、2hc肽均有较显著降低，餐后2h胰岛素和B细胞功能明显改善。盐酸二甲双胍缓释片在降低糖化血红蛋白优于阿卡波糖，阿卡波糖降低血游离脂肪酸优于盐酸二甲双胍缓释片。罗格列酮在降低餐后胰岛素、糖化血红蛋白、血游离脂肪酸，改善IR方面优于其它二组。结论：罗格列酮、盐酸二甲双胍缓释片、阿卡波糖均能有效降低IR和改善B细胞功能。在改善IR等方面，罗格列酮稍优于其它二组药物。     

左旋氨氯地平对高血压患者胰岛素抵抗的改善作用

目的:探讨左旋氨氟地平对高血压患者胰岛素抵抗的改善作用.方法:45例原定性高血压伴糖耐量异常患者随机分为实验组(25例)和对照组(20例).对照组给予卡托普利治疗,实验组在卡托普利治疗基础上联合应用左旋氨氯地平,疗程均为8周.比较2组治疗前、后血压、血脂、空腹血糖、胰岛素和胰岛素抗体水平.结果:2组治疗后血压、空腹血糖,空腹胰岛素和胰岛素抗体水平均较治疗前下降(P<0.05),实验组下降优于时照组(P<0.05);2组治疗前、后血脂水平比较差异无统计学意义(P>0.05).结论:左旋氨氯地平对高血压患者胰岛素抵抗有明显的改善作用.     

罗格列酮与二甲双胍对初发2型糖尿病患者血糖和胰岛素抵抗的影响

目的：观察罗格列酮对初发2型糖尿病患者血糖及胰岛素抵抗的影响,并研究其作用机制。方法选取2007年5月-2012年5月我院治疗的初发2型糖尿病患者74例,随机分为观察组和对照组,各37例。观察组患者使用罗格列酮进行治疗,对照组患者使用二甲双胍进行治疗,对比观察两组患者的血糖和胰岛素抵抗的临床影响。结果所有患者在接受治疗后空腹血糖水平（FPG）、餐后2h血糖水平（2hPG）、糖化血红蛋白水平（HbA1）及胰岛素抵抗指数（HOMA-IR）等指标相较于治疗前明显降低,且观察组患者降低程度明显优于对照组,差异有统计学意义（P〈0.05）。结论对初发2型糖尿病患者使用罗格列酮进行治疗,能够有效降低其血糖水平及胰岛素抵抗指数,临床效果显著。     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001