糖脂消方治疗2型糖尿病血脂异常及胰岛素抵抗30例疗效观察

目的观察糖脂消方治疗2型糖尿病血脂异常及胰岛素抵抗疗效观察。方法将58例患者随机分为治疗组30例，对照组28例。两组基础治疗相同，治疗组用糖脂消方治疗，对照组用盐酸吡格列酮治疗，疗程结束后比较疗效。观察两组治疗前后空腹血糖（FBG），空腹胰岛素（FINS），胰岛素敏感指数（IAI），血脂胆固醇（TC），甘油三酯（TG），低密度脂蛋白（LDL—C），高密度脂蛋白（HDL—C）等指标的变化。结果总有效率治疗组为88．66％，对照组为57．14％，两组比较差异有显著性意义（P〈0．05）。治疗组治疗后各项指标改善优于对照组，差异有非常显著性意义（P〈0．05）。结论糖脂消方能显著改善2型糖尿病各项指标，增强胰岛素敏感性，可降低胰岛素抵抗作用。     

普伐他汀对原发性高血压高脂血症及胰岛素抵抗的影响

目的 观察普伐他汀对原发性高血压高脂血症及胰岛素抵抗的影响。方法60例1、2级原发性高血压伴高脂血症者随机分为治疗组和对照组各30例，在3个月降压治疗中，治疗组加用普伐他汀（10mg-20mg，qn），对照组维持原治疗，观察治疗前后的血脂、空腹血糖和胰岛素的变化。结果治疗组治疗后胆固醇下降12．8％，甘油三酯下降8．9％，低密度脂蛋白胆固醇下降10．7％，高密度脂蛋白胆固醇上升了8．2％，胰岛素敏感指数（ISI）显著改善（P〈0．05），且与对照组有显著差异；而对照组血脂水平、ISI虽有下降，但无显著性意义。结论普伐他汀治疗原发性高血压伴高脂血症患者效果明确，并且显著改善其胰岛素抵抗。     

血清脑硫脂与2型糖尿病的相关性研究

目的探讨脑硫脂与2型糖尿病的关系及可能的作用机制。方法测定54例2型糖尿病患者身高、体重、腰围及血压,检测血糖、血脂、真胰岛素及脑硫脂;另设健康对照组48例。结果糖尿病组空腹血糖、胰岛素抵抗指数（HOMA—IR）水平高于对照组（t=9．216,4．609;P〈0．05）,脑硫脂水平低于对照组（t=12．116,P〈0．05）;HOMA—IR与体重指数、腰围、收缩压、空腹血糖、高密度脂蛋白胆固醇（HDL—C）和真胰岛素存在单变量相关（r值分别为0．348,0．419,0．368,0．539,-0．533,0．757）;脑硫脂与体重指数、腰围、收缩压、舒张压、空腹血糖、HDL-C和HOMA—IR存在单变量相关（r值分别为-0．326,-0．363,-0．414,-0．342,-0．676,0．430,-0．566）;行多元线性回归显示,脑硫脂（β=-48．651,P=0．000）,性别（β=-0．933,P=0．002）,腰围（β=0．033,P=0．042）为HOMA—IR的独立危险因素。结论2型糖尿病患者血清脑硫脂降低,血清脑硫脂与糖尿病、胰岛素抵抗之间有密切的相关性,在糖尿病的发生、发展中可能起重要作用。     

二甲双胍治疗82例胰岛素强化治疗后逆转为糖耐量减低的新诊断2型糖尿病临床观察

目的给予经短期胰岛素强化治疗逆转为糖耐量减低（IGT）的新诊断2型糖尿病患者口服二甲双胍治疗，观察二甲双胍对血糖控制和胰岛B细胞功能的作用。方法在饮食和运动治疗的基础上，给予新诊断2型糖尿病患者短期胰岛素强化治疗，停用胰岛素强化治疗后复查口服葡萄糖耐量试验（OGTT），筛选出IGT的病例82例，分为两组：A组为单纯饮食运动治疗；B组为联用二甲双胍治疗，均治疗1年。1年后比较两组患者的体重指数（BMI）及空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbA1C）等，观察两组病例的临床转归，比较180min内胰岛素释放曲线下面积（AUCI）、C肽曲线下面积（AUCC）和糖耐量曲线下面积（AUCG）的变化；用稳态模式评估法计算胰岛素抵抗指数（HOMA-IRI）及胰岛B细胞基础功能（HOMA-B）的变化。结果1年后，B组较A组BMI减低，血糖控制更好，三酰甘油（TG）、低密度脂蛋白-胆固醇（LDL-C）、总胆固醇（TC）降低；复查OGTT、胰岛素和C肽释放试验发现，非糖尿病病例数更多；HOMA-IRI和AUCG降低，HOMA-B升高。结论2型糖尿病患者经短期胰岛素强化治疗后，部分病例可逆转为IGT；继续二甲双胍治疗，可以更好地控制血糖和血脂，减轻体重，改善胰岛素抵抗，延缓病程。     

西格列汀联合二甲双胍治疗2型糖尿病的疗效观察

目的：对西格列汀联合二甲双胍控制和治疗2型糖尿病的效果进行观察，分析其在降低患者血糖、血脂含量及控制体重等方面的功效，为治疗手段的更新、进步创造条件。方法择取入住我院的120例2型糖尿病人作为研究对象，要求其之前服用过降低血糖的药物且对西格列汀联合二甲双胍无过敏反应。通过随机抽签将这部分病患分为治疗组与对照组，每组60例。对照组病人实行胰岛素治疗，实验组患者每天口服1次西格列汀联合二甲双胍。观察记录空腹血糖（FBG）、空腹胰岛素（FINS）、饭后2h血糖（2hGB）、血脂（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]）、胰岛素抵抗指数（HOMA-IR）、体质指数（BMI）等指标在14周前后具体变化情况并加以分析。结果胰岛素治疗及口服西格列汀联合二甲双胍对降血脂、血糖都具有一定效果，而在减少胰岛素抵抗和限制体质指数方面，西格列汀联合二甲双胍的效用显著优于只进行胰岛素治疗，其差异与统计学意见匹配（P<0.05）。结论西格列汀联合二甲双胍和单纯胰岛素治疗对降血糖、血脂都有明显作用，而前者在减少病患胰岛素抵抗和限制体重方面也具有显著作用，后者则无明显效果。     

普罗布考对2型糖尿病患者血浆脂联素水平的影响

目的观察普罗布考对2型糖尿病患者血浆脂联素水平的影响。方法用酶联免疫吸附法检测109例2型糖尿病患者血浆脂联素水平，并用随机双盲法比较109例2型糖尿病患者用普罗布考和安慰剂干预治疗12周后的血浆脂联素、血脂、血糖、胰岛素抵抗指数、糖化血红蛋白、氧化低密度脂蛋白改变情况。结果普罗布考组和安慰剂组治疗前血浆脂联素水平差异无统计学意义（P〉0．05）。经普罗布考治疗后，患者血糖、糖化血红蛋白、氧化低密度脂蛋白降低，胰岛素抵抗明显改善，血浆脂联素水平显著升高（P〈0．05）。结论普罗布考在调节血脂、降低血糖及氧化低密度脂蛋白、改善胰岛素抵抗的同时，可使糖尿病患者血浆脂联素水平升高。     

阿托伐他汀对代谢综合征患者的代谢与炎症反应的影响

目的评价阿托伐他汀对代谢综合征患者的糖脂代谢以及血清炎性标志物的影响。方法收集本院2008年1月至2009年12月内科门诊代谢综合征患者共76例,随机分成治疗组与对照组（各38例）。治疗组患者给予阿托伐他汀20mg／d,对照组不予药物治疗。比较试验前后对照组和治疗组的一般临床特征（体重、体重指数、腰围）、血清学指标（总胆固醇、高／低密度脂蛋白胆固醇、甘油三脂、空腹／餐后2h血糖、空腹胰岛素、HOMA胰岛素抵抗指数）及c反应蛋白、CD3、CD11b、CD11c、CD54的变化。结果治疗后2组患者的体重、体重指数、腰围、总胆固醇、低密度脂蛋白胆固醇、甘油三脂、空腹胰岛素、C反应蛋白、CD3、CD11b比较差异均有统计学意义（P〈0．01或P〈0．05）。结论阿托伐他汀能有效地降低血脂,同时减轻代谢综合征患者的慢性炎症反应,但对血糖的影响较小。     

非酒精性脂肪性肝病的危险因素分析

目的探讨非酒精性脂肪肝（NAFLD）发病与患者空腹血糖（FBG）、胰岛素抵抗指数（IR）、体重指数（BMI）及血脂紊乱的关系。方法67例诊断为AFLD患者为研究组，在年龄、性别相匹配情况下，与正常对照者67例进行1：1配对，检测空腹血糖，空腹胰岛素水平及血脂，采用稳态模式评估法计算胰岛素抵抗指数、测量身高、体重，计算BMI及腰臀比。结果研究组与对照组之间空腹胰岛素、胰岛素抵抗指数、BMI及血脂紊乱比较有显著差异（P〈0．05或0．01）；多元逐步回归显示，胰岛素抵抗、腰臀比是影响肝脏脂肪含量主要的危险因素。结论胰岛素抵抗、腰臀比是影响NAFLD的主要危险因素。     

初探有氧运动对2型糖尿病老年患者的影响

目的针对老年糖尿病患者年龄大、慢性并发症多、不适合大强度的运动，但又不能不运动的特点，观察运动对2型糖尿病患者的影响。方法选取130例2型糖尿病老年患者，随机分为运动组和非运动组，进行对比，观察运动前后体重指数（BMI）、空腹血糖（FBG）、糖化血红蛋白（HbAlc）、空腹胰岛素、胰岛素抵抗指数（HOMA—IR）、胰岛素分泌指数（HOMA—IS），并与未进行有氧运动治疗的65例患者对照比较。结果36周后运动组的BMI、FBG、HbAlC、HOMA—IR均有明显降低（P〈0．05），HOMA—IS无明显变化；非运动组各项指标均无明显差异（P〉0．05）。结论有氧运动能明显降低2型糖尿病患者的BMI、IR、FBG、HbAlC，恢复胰岛素敏感性。老年2型糖尿病患者至少应坚持轻度运动，以改善病情。     

多囊卵巢综合征干预治疗的临床研究(附76例报告)

目的：观察多囊卵巢综合征（PCOS）的临床表现及干预治疗的结果。方法：将76例多囊卵巢综合征患者，按治疗方法不同分为3组，A组单为饮食加运动组，B组为饮食运动基础上加用二甲双胍治疗组，C组为饮食运动基础上加用罗格列酮治疗组，治疗6个月，观察治疗前后的临床表现，黄体生成素（LH），卵泡刺激素（FSH），LH／FSH的比值，血睾酮（T），血脂分析，空腹血糖，空腹胰岛素，OGTY2h血糖，2h胰岛素，计算体重指数（BMI）及胰岛素抵抗指数Homa IR。结果：治疗6个月后，B组BMI下降差异有统计学意义（P〈0．05），A、C组BMI变化不明显。A组临床症状改善不明显，B组、C组临床症状改善明显，差异有统计学意义（P〈0．05）。3组的LH、LH／FSH、T、空腹胰岛素、OGTT2h胰岛素、胰岛素抵抗指数均下降，A组下降差异无统计学意义（P〉0．05），B组、C组下降差异有统计学意义（P〈0．05），B组与C组比较，C组下降更明显，差异有统计学意义（P〈0.05）。结论饮食和运动可作为PCOS患者的基本治疗，但需加用增加胰岛素敏感性的药物更能达到临床疗效，罗格列酮比二甲双胍更能改善PCOS患者的胰岛素抵抗,适用干胰岛素抵抗较严重的PCOS患者。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.