皮温反馈疗法在糖尿病治疗中的应用

本文对３０例非胰岛素依赖型糖尿病患者进行了药物治疗加皮温反馈治疗并与３０例ＮＩＤＤＭ的同类患者单纯用药物治疗作对照组，结果表明：（１）研究组血糖明显下降，降糖药物用量减少，皮温的升温值增高，与对照组相比有显著性差异，血清胰岛素与Ｃ－肽水平未见明显升高。（２）研究组部分患者足背动脉搏动增加，麻木，疼痛症状缓解。试验过程中未发现该方法对血电解质，肝肾功能有明显影响，治疗过程中未观察到明显的副作用。     

糖尿病与胰岛素基因的实验研究

用分子生物学的实验方法对非胰岛素依赖型糖尿病（NIDDM）患者的胰岛素基因进行检测。从NIDDM患者外周血的白细胞中提取DNA，以胰岛素基因5′-末端上游的某一DNA序列为引物，对特定的靶序列进行体外扩增，即TaqDNA聚合酶链式反应（PCR），将其扩增产物进行电泳分离，在紫外分析仪下观察结果并与正常人对照，发现16例NIDDM患者的胰岛素基因有所改变，提示胰岛素基因改变可能是导致NIDDM的原因之一。     

C肽、胰岛素在实验性NIDDM大鼠GT实验中的变化

为探讨C肽 (C -P)、胰岛素 (INS)在非胰岛素依赖型糖尿病 (NIDDM )模型糖耐量 (GT)实验中的变化 ,用小剂量尾静脉注射链脲佐菌素 (STZ)加喂高热量饮食形成NIDDM鼠模型 ,对GT实验中C -P、INS的变化进行观察。结果显示 :与对照组比 ,实验组INS升高的高峰时间是在两小时 ,C -P同INS反映一致 ,高峰推迟 (P <0 .0 5 )。提示 :血中C -P测定能准确反映胰腺内生INS水平 ,小剂量注射STZ加喂高热量饮食这种方法形成的NIDDM鼠模型非常理想     

糖尿病患者血、尿C-肽检测的临床意义

临床上对糖尿病(DM)进行分型，是指导治疗的依据。目前，主要通过测定患者血胰岛素和C-肽水平来评价胰岛β细胞功能，并对其进行分型。本文应用RIA测定了23例Ⅰ型DM(IDDM)．39例Ⅱ型DM(NIDDM)和30例正常人的口服葡萄糖耐量试验(OGTT)血清各时相胰岛素和C-肽水平，并同期测定了24小时尿C-肽含量，以探讨血、尿C-肽检测的临床意义。     

非胰岛素依赖型糖尿病人血浆内皮素水平与游离脂肪酸浓度的关系

为探讨非胰岛素依赖型糖尿病（Ｎｏｎｉｎｓｕｌｉｎ－ｄｅｐｅｎｄｅｎｔｄｉａｂｅｔｅｓｍｅｌｌｉｔｕｓ,ＮＩＤＤＭ）人内皮细胞损伤的可能机制,作者采用放射免疫法和反相高效液相色谱技术（ＨＰＬＣ）同时测定了３４例正常人和５６例ＮＩＤＤＭ病人血浆内皮素（ＥＴ）和游离脂肪酸（ＦＦＡ）浓度。结果显示：ＮＩＤＤＭ病人血浆ＥＴ和ＦＦＡ浓度较正常对照明显升高（均ｐ＜０．０１）,且血浆ＥＴ与空腹血糖（ＦＢＧ）水平和ＦＦＡ总浓度呈明显正相关（ｒ＝０．３２４和,ｒ＝０．３５１,均Ｐ＜０．０１）。结果提示：ＮＩＤＤＭ患者高血糖、脂肪酸代谢紊乱及胰岛素抵抗在其血管内皮损伤中可能有重要作用。     

糖尿病病人胰岛素、C肽测定的临床应用

目的 糖尿病是一种以糖代谢为主的常见内分泌代谢疾病,其实质是胰岛细胞受损而导致的一系列不可逆多系统并发疾病.尽早发现胰岛细胞损伤程度,尽快恢复胰岛细胞的功能,是预防和治疗糖尿病的关键.方法 检测2008年5月至2009年7月来我院就诊检查胰岛素、C肽的患者189人,采用化学发光免疫检测法进行测定.结果 与结论测定血清胰岛素、C肽的水平并结合血糖变化是判定胰岛细胞功能是否正常以及胰岛素敏感性的最佳选择.     

抵抗素在肥胖及糖尿病中的作用

Increased evidences indicate that resistin is a new hormone secreted from adipose tissue,it is reported to be an important signal molecule linking between obesity, insulin resistance and type 2 diabetes.Many factors can affect the gene expression of resistin. However, the detailed function of resistin still remainsmys terious and much work needs to be undertaken.     

肥胖和老年2型糖尿病患者血清C肽、胰岛素、血糖的关系

目的 通过口服葡萄糖耐量实验,观察血清C肽、胰岛素释放水平,计算胰岛素敏感指数,探讨肥胖对老年2型糖尿病患者几个指标的影响.方法 选择本院老年2型糖尿病患者136例,根据1999年WHO糖尿病的诊断标准及患者的体重指数分为非肥胖糖尿病组60例和肥胖糖尿病组76例;另选健康检查者92例,分为非肥胖对照组40例和肥胖对照组52例.采用己糖激酶法测定血糖,采用时间分辨荧光免疫法测定C肽和胰岛素.结果 非肥胖糖尿病组与非肥胖对照组,肥胖糖尿病组与肥胖对照组,肥胖对照组与非肥胖对照组,非肥胖糖尿病组与肥胖糖尿病组两两比较,各时间点C肽和胰岛素水平差异均有统计学意义（P ＜0.05或P＜0.01）.肥胖对照组与非肥胖对照组,非肥胖糖尿病组与肥胖糖尿病组两两比较,各时间点血糖水平差异均无统计学意义（P＞0.05）,肥胖者服糖后血糖下降更慢.结论 肥胖影响老年2型糖尿病患者的C肽和胰岛素,为该病的危险因子.     

短期胰岛素治疗新发Ⅱ型糖尿病的临床观察

目的观察短期胰岛素治疗对新发Ⅱ型糖尿病病人的胰岛β细胞功能和血糖控制的影响。方法采用自身前后对照，观察18例新诊断Ⅱ型糖尿病人接受短期胰岛素强化治疗前后血糖及C肽释放试验的变化，了解胰岛素治疗前后胰岛β细胞功能的变化。结果经短期胰岛素治疗后，患者血糖明显下降，各点C肽水平明显升高，且有高峰出现，胰岛β细胞功能有恢复。结论对明显高血糖的新发Ⅱ型糖尿病患者短期胰岛素治疗，能显著改善其胰岛β细胞功能，有利于以后长远控制好血糖。     

胰岛素泵在治疗Ⅱ型糖尿病患者中的作用

目的 探讨应用胰岛素泵治疗Ⅱ型糖尿病的临床价值.方法 将128例Ⅱ型糖尿病患者分为连续皮下注射胰岛素(continuos subcutaneous insulin infusion,CS Ⅱ,n=64)和每天多次皮下注射胰岛素(multiple subcutaneous instdin injection,MS Ⅱ,n=64).CSⅡ组将短效胰岛素置于胰岛素泵内持续皮下注射,进餐前再按所需输入负荷量;MS lI组将短效胰岛素装入普通注射器内于每天三餐前及22:00皮下注射,治疗2周后对两组的疗效进行比较.结果 2种方法 均可使患者的血糖达标.CS Ⅱ组血糖达标所需时间为(6.4±1.2)d,MS Ⅱ组所需时间为(9.9+1.8)d;CS Ⅱ组血糖达标所需胰岛素用量为(36.1±7.3)U/d,MS Ⅱ组血糖达标所需胰岛用量为(42.7±6.9)U/d,CS Ⅱ组低血糖发生次数为0.04次/(d·人),MS Ⅱ组低血糖发生次数为0.08次/(d·人).两组上述指标比较差异均有统计学意义,均为P＜0.05.结论 CS Ⅱ能更快速地控制Ⅱ型糖尿病患者的血糖,所需胰岛素用量较少,低血糖发生率较低.     

ASS对实验性Ⅱ型糖尿病大鼠胰岛素和C肽分泌作用研究

目的 研究刺五加叶皂甙（ASS）对实验性Ⅱ型糖尿病大鼠胰岛素和C肽分泌作用影响。方法 应用放射免疫学方法对正常组和Ⅱ型糖尿病模型组大鼠（尾静脉注射链尿佐菌素25mg/kg加高脂，高热、高能量喂养）。在给予ASS后其空腹及口服葡萄糖后血浆中胰岛素和C肽变化测定。结果 ASS可增强Ⅱ型糖尿病大鼠胰岛素和C肽分泌，对正常大鼠无影响。结论 ASS可以促进Ⅱ型糖尿病大鼠胰岛素和C肽分泌。     

Evaluation of skin temperature biofeedback training at two different sites for migraine

All combinations of cooling versus warming and finger versus temporal artery were used in the present study, the aim of which was to identify an optimal biofeedback training site and to assess the specific effects of skin temperature biofeedback upon migraine. After an initial 4-week baseline phase, during which daily records of headache activity and medication were kept, 24 migraine patients were randomly assigned to one of the four experimental conditions. Training sessions for all patients were of 50-min duration and occurred once per week for 8 weeks. The headache charts were completed for another 4 weeks after treatment was terminated and again at 6-month follow-up. The results showed significant reductions in migraine activity and drug usage. However, self-regulation of skin temperature in different directions at different sites did not in fact result in significantly different magnitudes of change in migraine activity across groups. The role of nonspecific factors is discussed and a physiological model is proposed to explain how warming and cooling may produce clinical improvement in migraine.This research was supported by grants from the Quebec Ministry of Education and the Quebec Ministry of Social Affairs.     

The use of electromyogram biofeedback to reduce Trendelenburg gait

Ten subjects suffering from incomplete spinal cord injuries, clinically diagnosed as walking with Trendelenburg gait, underwent a 2 month therapy program to strengthen their muscles and reduce their gait abnormalities. Therapy involved muscle strengthening and gait training for 2 h a day, 5 days a week in a clinic. Biofeedback was also accomplished for 30 min each training day on all subjects. In addition, five of the subjects wore a two-channel electromyogram (EMG) biofeedback training device at home to see if neuromuscular re-education outside of the clinical setting could speed their recovery. The difference for these five subjects was that they would have continuous biofeedback therapy every time they walked and not biofeedback limited to only 30 min a day. Since weakness of the gluteus medius muscles is the prime contributor to Trendelenburg gait, the device provided warning tones giving feedback of improper gait through bilateral assessment of the use of the gluteus medius muscles. If too little gluteus medius activity was seen on the affected side or the step was too short in duration, the microprocessor provided an audio cue to the subjects alerting them to correct the deficit. Subjects only undergoing clinical therapy showed about a 50% reduction in hip drop due to therapy. However, the group that used the home training device showed almost normal gait after the 2 month period. Electronic Publication     

The metabolic response to skin temperature

Experiments were done to assess that fraction of the metabolic response to external cold exposure, which is attributable to skin temperature. In 5 conscious and closely clipped goats the metabolic rate was determined at various stable levels of skin temperature in the range from 13 to 41°C, while core temperature was kept constant at 38.8°C. Skin temperature was manipulated by a rapidly circulating shower bath, while core temperature was controlled by means of heat exchangers acting on arterial blood temperature in a chronic arteriovenous shunt. The metabolic response to skin temperature fell into two clearly discernible sections: a first zone with skin temperatures above 25–30°C, within which the metabolic rate rose at a rate of –0.34±0.07 W/kg·°C with decreasing skin temperature, and a second zone with skin temperatures below 25–30°C, within which the metabolic rate either plateaued or even grew smaller with further decreasing skin temperature. It is concluded that the relationship between skin temperature and metabolic rate does not directly reproduce the temperature-response curve of cutaneous cold receptors but also reflects a complex interaction of several factors, including an unspecific temperature effect on muscle metabolism.     

Using skin temperature gradients or skin heat flux measurements to determine thresholds of vasoconstriction and vasodilatation

Forearm–fingertip skin temperature differentials (T _sk-diff) are used to indicate vasomotor tone, vasoconstriction defined as having occurred when T _sk-diff≥4°C (Sessler et al. 1987, 1988a, b). This study was conducted to determine whether T _sk-diff or finger pad heat flux (HF) can be used to predict when vasoconstriction and vasodilatation occur. Seven subjects (one female) sat in water at [mean (SD)] 40.7 (0.8)°C until their core temperature (T _c) increased by 1°C, ensuring vasodilatation. The water was then cooled [at a rate of 0.6 (0.1)°C.min^–1] until T _c fell to 0.5°C below pretesting values, causing vasoconstriction. Subjects were then rewarmed in water [41.2 (1.0)°C]. Skin blood flow (SkBF) was measured using laser Doppler flowmetry (LDF) on the left second finger pad [immersed in water at 10.4 (1.4)°C as part of another experiment], and infrared plethysmography on the third finger pad of both hands. T _sk-diff and HF were measured on the right upper limb, which remained in air. When vasodilated, the subjects had a stable T _sk-diff and HF. During cooling, rapid-onset vasoconstriction occurred coincidental with large gradient changes in HF and T _sk-diff (inflection points). In two subjects the original vasoconstriction definition (T _sk-diff≥4°C) was not attained, in the other five this was achieved 31–51 min after vasoconstriction. During rewarming, the T _sk-diff and HF inflection points less accurately reflected the onset of vasodilatation, although with one exception they were within 5 min of the LDF changes. We conclude that T _sk-diff and HF inflection points predict vasoconstriction accurately, and better than T _sk-diff≥4°C. Electronic Publication     

Bilateral skin temperature,handedness, and the biofeedback control of skin temperature

There are differences in physiological variables when they are recorded from the left and right side of the body simultaneously. In some cases, handedness has been found to have a significant relationship to bilateral differences. The present study examined the relationship between handedness and baseline heart rate and skin temperature, as well as bilateral differences in skin temperature during visual and auditory biofeedback. Subjects were 32 college females, 24 right-handed and 8 left-handed. Recordings of heart rate and skin temperature from both the dominant and the nondominant hand were made during baseline and during the 10-min experimental session while subjects attempted to warm their dominant hand. Both groups showed significantly increased skin temperature during the experimental session. No prominent bilateral differences in skin temperature were found. These results do not support bilateral differences as a generalizable construct.This work was supported in part by funds provided by The University of North Carolina at Charlotte.     

The influence of biofeedback training on trapezius activity and rest during occupational computer work: a randomized controlled trial

The aim of this study was to investigate effects of biofeedback training on trapezius activity and rest (gaps) during occupational computer work. A randomized controlled trial with 164 computer workers was performed. Two groups working with computer mouse more than 50% (n = 64) and less than 25% (n = 49) of their work time performed five sessions with unilateral electromyographical (EMG) biofeedback from the dominant trapezius during computer work. A third group working with computer mouse more than 50% of their work time (n = 51) served as controls. Bipolar EMG from the bilateral upper trapezius muscles during normal computer work was recorded. Changes in discomfort/pain were not recorded. The biofeedback training reduced activity (P < 0.05), and increased the frequency of short (P < 0.05) and long (P < 0.05) gaps, and the relative rest time (P < 0.05) of the trapezius during computer work. By improving trapezius inactivity during computer work, biofeedback training may have the potential to prevent trapezius myalgia in computer workers.     

负压封闭引流技术联合植皮治疗糖尿病足30例

目的总结负压封闭引流(VSD)技术联合植皮治疗糖尿病足的经验。 方法回顾性分析辽宁中医药大学附属医院血管疮疡外科2016年8月至2017年8月期间收治的30 例糖尿病足患者的临床资料,均为Wagner 分级4～5级的患者,处理方法主要包括清创、VSD技术、植皮等。观察住院时间、肢体功能及外形、植皮区瘢痕挛缩情况。出院后电话及门诊随访30例患者,随访时间3～12个月,平均5个月,观察肢体外形、功能、溃疡复发情况。 结果3例患者足部存在缺血,计算机体层血管成像(CTA)提示下肢动脉存在闭塞情况,行股浅动脉开通、球囊扩张、支架成形术,术后行清创、经VSD治疗后行植皮治疗,创面完全愈合。23例患者经清创后,行VSD技术治疗后,创面见新鲜肉芽组织生长,植皮后创面完全愈合。另4例患者由于创面感染严重,清创后组织缺损较多,间断行清创、VSD技术治疗后,肉芽组织填充生长良好,行植皮手术治疗,移植皮片大部分成活。所有糖尿病足创面均治愈,住院时间27～50 d,平均35 d; 27例皮片颜色良好,具有良好弹性,足部运动功能恢复良好;3例因植皮处为足底或足前端摩擦后出现小溃疡,经门诊换药1周左右后均愈合,随访期间,未见复发。 结论在清创的基础上,后期行VSD技术联合植皮治疗糖尿病足,能够缩短病程。     

糖尿病大鼠皮肤的组织化学改变

目的：研究糖尿病(DM)大鼠皮肤的组织化学改变，探讨DM难愈创面形成和发展的病理机制。方法： 用链脲佐菌素（STZ）将SD大鼠诱导成速发型DM大鼠模型，并以正常大鼠作对照，分别于致病后4、8和12周获取大鼠背部中央的皮肤标本。应用HE染色，观察皮肤组织学的改变；应用Beckman’s生化自动分析仪检测皮肤组织匀浆的糖含量；采用F－3010荧光分光光度计测定皮肤胶原提取液的荧光强度；应用免疫组化和图像分析技术检测皮肤组织晚期糖基化终末产物（AGEs）含量。结果： 组织学观察可见，DM大鼠表皮组织变薄，表皮细胞层次欠清晰，部分表皮缺乏复层排列；真皮层部分胶原萎缩、肿胀，退化变性，并伴有程度不等的炎性细胞浸润；皮下脂肪进行性萎缩或消失。皮肤糖含量在各时相点均显著高于正常对照（P<0.01）。皮肤胶原提取液的荧光值亦高于相应年龄正常鼠（P<0.05），并随病程增加。AGEs蛋白主要沉积于真皮基质和细胞中，以及皮肤血管基底膜周围，并随病程的发展，染色逐渐加深，呈片状。结论： DM皮肤在损伤前就已发生明显的组织化学改变，而这些改变可能是由于局部高糖和AGEs累积所引发，并可能是DM难愈创面形成和发展的病理基础之一。     

Effect of skin temperature on vibrotactile sensitivity

The vibration problems relating to living bodies have so far been studied from the perspectives of engineering physiology and psychology. This study shows the relationship between vibratory sensibility and temperature in the living body. Psychological experiments were carried out by using the vibrometer of an acoustic calibration apparatus in sine, triangular and square waves. The sensibility-threshold measurements were made using 30–700 Hz sine waves, 30–300 Hz triangular and sawtooth waves, or 30–250 Hz square waves. Each of ten subjects was kept seated. The average value of the vibratory levels, varied by ascending and descending steps, was taken as that of the threshold. As the vibrometer in the apparatus used makes a noise at frequencies greater than 250 Hz it was masked from the subject by presenting him with a different noise. The threshold curve for square waves is lower by 12·3 dB than that for sine waves at about 30Hz. The threshold curve of the 26°C sine wave was lower by 10 dB than that of the 58°C sine wave vibration near 200 Hz. For example with a sine wave, at 58°C the amplitude threshold was lowest at about 270 Hz, but at −11°C at about 200 Hz. At frequency stimulation higher than 120 Hz, as the temperature of the contact point was lowered, the amplitude threshold increased and the frequency at which the threshold curve was at a minimum shifted to a lower frequency.