Characteristics of autoimmunity in type 1 diabetes and type 1.5 overlap with type 2 diabetes

This presentation is an overview of mechanisms for developing and maintaining self-tolerance in mammalian organisms. Because this meeting is focused on type 1 diabetes and its mechanisms, the discussion deals primarily with mechanisms of T-cell tolerance, since type 1 diabetes in both effector and initiator phases is primarily a T-cell-mediated autoimmune disease. Emphasis is placed on more recently discovered mechanisms of maintaining self-tolerance (autoimmune regulator [AIRE]) and a new defect in T-cell negative selection. The emerging picture is that of a polygenic disease with various combinations of different alleles of many genes with important roles in the normal immune response or normal immune responses.     

Current perioperative treatment of patients with type 1 and type 2 diabetes

Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. Diabetic patients must be carefully evaluated for cardiovascular risk, keeping in mind micro- and macroangiopathic diabetic complications. Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.     

胃切除后Roux-en-Y与Billroth重建术式比较

目的:探讨胃大部切除术后常用胃肠重建术式的优劣.方法:回厩性分析117例胃切除术后消化道重建患者的资料.结果:45例Roux-en-Y胃肠重建者无反流性胃炎,无十二指肠残端瘘,预防远期残胃癌极其关键;仅有2例出现滞留综合征.72例Billroth胃肠重建术后反流所致的胃黏膜损害和碱性反流性胃炎,远期残胃癌及其他并发症至今尚无可靠而有效的预防方法.结论:胃切除术后的消化道重建如不能进行Billroth-I式,Roux-en-Y方式应是另一较好的消化道重建术式.     

可吸收螺钉治疗MasonⅡ型及部分Mason Ⅲ型桡骨头骨折

目的 探讨应用可吸收螺钉治疗Mason Ⅱ型及部分MasonⅢ型桡骨头骨折的疗效. 方法 自1999年1月至2006年5月共收治桡骨头骨折患者36例,其中18例采用切开复位.2.0 am或2.7 mm可吸收螺钉固定,术后早期进行肘关节的屈伸及前臂的旋转活动,定期随访患肘正、侧位X线片,观察肘关节屈伸及前臂的旋转活动度.按照Mayo评分评估患者肘关节功能.结果 18例患者均获得6～24个月随访,平均随访8.3个月.18例骨折均获Ⅰ期愈合,平均愈合时间10周,肘关节屈伸活动范围平均109°,前臂旋转活动范围平均92°,Mayo评分优良率为88.8%(16/18). 结论 对于Mason Ⅱ型及部分Mason Ⅲ型桡骨头骨折的患者采用切开复位,可吸收螺钉固定治疗,无需二次手术取出内固定,患者能早期进行功能锻炼,并获得良好疗效.     

Effects of smoking on renal function in patients with type 1 and type 2 diabetes mellitus.

BACKGROUND: Smoking increases the risk of end-stage renal failure in patients with primary renal disease. Whether and to what extent smoking affects the kidneys in diabetic patients with normal renal function and variable degrees of proteinuria has not been fully studied. METHODS: We followed 185 patients with type 1 or 2 diabetes mellitus and with or without signs of overt renal disease for at least 3 years, median 5.1 (3-6.8) years. Each patient had a baseline visit and at least four follow-up visits (average 4.8+/-0.3). Cases were patients who were smoking (n = 44) at the time the survey was started. Controls were patients who had never smoked (n = 141). Glomerular filtration rate (GFR) was estimated using the MDRD formula. Multiple logistic regression was used to correct for confounding factors. RESULTS: At baseline, smokers were younger (47+/-14 vs 54+/-16 years, P < 0.01), and had a lower GFR (95+/-26 ml/min) than non-smokers (107+/-33 ml/min, P < 0.05). Mean GFR remained constant during follow-up in non-smokers (106+/-31 ml/min), but decreased significantly in smokers (83+/-22 ml/min, P < 0.0001), and this relationship persisted when adjusted for retinopathy, glycaemic control, age, body habitus, ACE-inhibitor treatment, blood pressure control or severity of proteinuria. The effect of smoking on GFR decline was stronger in patients with type 1 diabetes or male gender. CONCLUSIONS: Cigarette smoking causes a decrease in GFR in diabetic patients with normal or near-normal renal function, independent of confounding factors including severity of proteinuria. The latter finding suggests a mechanism independent of glomerular damage.     

Urinary type IV collagen excretion reflects renal morphological alterations and type IV collagen expression in patients with type 2 diabetes mellitus

AIM: We tried to establish the significance of quantifying urinary type IV collagen (IV-C) excretion for the evaluation of renal involvement of type 2-diabetic patients. METHODS: Twenty patients (13 males and 7 females; age range 31 to 69 years) with type 2 diabetes mellitus had undergone renal biopsy and relationship between the severity of morphological alteration, IV-C expression and urinary IV-C excretion were examined. RESULTS: Urinary IV-C excretion significantly correlated with mesangial expansion score (p = 0.49, p < 0.05) and tubulointerstitial injury score (p = 0.56, p < 0.05). Furthermore, urinary IV-C excretion significantly correlated with both glomerular (r = 0.56, p < 0.01) and tubulointerstitial IV-C expression areas. Urinary protein excretion also correlated with mesangial expansion score and tubulointerstitial injury score. However, it did not correlate with the expression of IV-C in the kidney. CONCLUSIONS: These results suggest that urinary IV-C excretion reflects the pathogenetic process of diabetic nephropathy, which urinary protein excretion alone cannot do sufficiently. It can be concluded that urinary IV-C excretion could be a more useful marker for the evaluation of renal involvement of type 2-diabetic patients.     

Hyperfiltration and uricosuria in adolescents with type 1 diabetes

Background

Urine uric acid (UUA) has been implicated in the pathogenesis of diabetic nephropathy via its effect on tubular cells. We hypothesized that the UUA level would be higher in adolescents with type 1 diabetes (T1D) than in those without T1D. We also hypothesized that UUA and fractional uric acid excretion (FeUA) would be higher in adolescents with T1D and hyperfiltration [estimated glomerular filtration rate (eGFR) ≥141 mL/min/1.73 m²] than in those without hyperfiltration.

Methods

The UUA concentration was determined and FeUA calculated in adolescents with (n?=?239) and without T1D (n?=?75). The eGFR was calculated using the Zappitelli equation based on serum creatinine and cystatin C concentrations.

Results

Compared to the non-diabetic adolescents enrolled in the study, those with T1D had a higher eGFR (mean?±?standard deviation: 120?±?22 vs. 112?±?16 mL/min/1.73 m²; p?=?0.0006), lower urine pH (6.2?±?0.8 vs. 6.5?±?1.0; p =?0.01), and higher UUA (37.7?±?18.6 vs. 32.8?±?18.1 mg/dL; p ?=?0.049) and FeUA (median [interquartile range]: 6.2 [4.3–8.7] vs. 5.2 [3.6–7.0] %; p?=?0.02). Among adolescents with T1D, those with hyperfiltration had higher median FeUA (8.6 [5.2–9.9] vs. 6.0 [4.2–8.3] %; p?=?0.02) than those without hyperfiltration.

Conclusions

The adolescents with T1D enrolled in the study had higher eGFR, higher UUA and more acidic urine than the non-diabetic controls, which may have increased their risk of UUA crystallization. Adolescents with T1D and hyperfiltration had higher FeUA than those without hyperfiltration. These hypothesis-generating observations may suggest a potential pathophysiologic association between uricosuria and hyperfiltration.

     

Identical twins with malrotation and type IV jejunal atresia

Identical twins are reported, who associated with maternal anaphylactic shock at 101/2 weeks gestation, acquired a type IV jejunal atresia with total absorption of the small bowel beyond the third portion of the duodenum and persistence of the most terminal length of ileum in the ileocolic artery in an apple peel configuration. Both infants survived a tapered jejunoileostomy and have undergone a successful transition to a regular diet. This accidental occurrence in two infants at the same time and in an identical fashion is a rare event.     

Infection studies on human cell lines with porcine circovirus type 1 and porcine circovirus type 2

Abstract: Background: The lack of human donor organs in allotransplantation has led to a proposal for the use of porcine tissues and organs as alternative therapeutic material for humans. Besides immunological problems like graft rejection, one of the major concerns is the transmission of porcine microorganisms as viruses, bacteria and fungi to a human recipient. Methods: Human cell lines have been infected with porcine circovirus type 1 (PCV1) and porcine circovirus type 2 (PCV2) to investigate whether PCV can infect and replicate in human epithelial cells and lymphocytes. Infection of PCV1 was observed with 293, Hela and Chang liver cells, infection with PCV2 only in Rd cells. In addition, religated viral DNA of PCV1 and PCV2 has been used to transfect adherent human cell lines. Results: PCV1 persisted in most cell lines without causing any visible changes, while PCV2‐transfected cells showed a cytopathogenic effect. Presence of PCV DNA was detected in cells and supernatant by PCR, expression of viral proteins by an indirect immune fluorescence assay. A replication assay showed that the replication of PCV DNA was initiated at the origin of replication. When virus‐free cells were inoculated with the supernatant of PCV‐infected human cells, the infection was not passed. Conclusion: Although PCV gene expression and replication took place in human cells, the infection is non‐productive. Alteration of protein localization suggests that protein targeting may be disturbed in human cells.     

Mature mediastinal teratoma with somatic type malignancy including neuroblastoma and intestinal type of adenocarcinoma: A Case Report

Introduction and importanceThe majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth.Case presentationWe present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment.DiscussionMediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient.ConclusionRadiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.     

内侧锁定钢板与前侧“T”型钢板联合固定在C3型Pilon骨折中的临床应用

目的：探讨使用内侧锁定钢板与前侧“T”型钢板联合固定在C3型Pilon骨折中的临床应用效果。方法本院自2011年4月至2013年11月对11例C3型Pilon骨折患者采用内侧锁定钢板结合前侧“T”型钢板联合固定,治疗后观察骨折愈合、踝关节功能及术后相关并发症发生情况。结果全部患者均获得22~26个月的随访,平均（24±2）个月。所有患者骨折均达临床愈合,骨折愈合时间为12~16周,平均（13.5±1.4）周。末次随访按Mazur踝关节功能评分系统对患者的踝关节功能进行评分：优8例,良3例。术后患侧踝关节跖屈活动度为39.2°±1.8°,健侧为40.9°±2.2°。术后患侧踝关节背伸活动度为21.5°±1.8°,健侧为22.9°±1.7°。患侧与健侧比较差异均无统计学意义（均P＞0.05）。所有患者无术后相关并发症发生。结论采用内侧锁定钢板与前侧“T”型钢板联合固定C3型Pilon骨折,术后患者骨折均达临床愈合,且踝关节功能恢复正常,无术后相关并发症发生,该术式临床应用效果满意,值得推广。     

来氟米特对Ⅳ型及Ⅴ型狼疮肾炎的诱导维持治疗

目的 观察来氟米特诱导和维持治疗Ⅳ型及Ⅴ型狼疮肾炎（LN）的疗效及安全性。方法 单中心前瞻性临床研究。选取1个月内经病理证实的Ⅳ型及Ⅴ型狼疮肾炎患者，在使用激素的基础上随机入组分别使用来氟米特(口服30 mg/d，LEF组)或环磷酰胺（静1 g/月，CTX组）。6个月后，维持方案为LEF组续用LEF 20 mg/d，CTX组续用CTX 1 g/3月，两组泼尼松均使用5~10 mg/d。评价治疗的安全性和有效性。结果 共40例患者进入试验，其中LEF组19例，CTX组21例；LEF组17例、CTX组18例完成了诱导期治疗。LEF组诱导治疗总有效率达88.2％，完全缓解率为52.9％；CXT组治疗总有效率为72.2％，完全缓解率为44.4％；两组间差异无统计学意义。缓解的患者中，LEF组有7例进入维持期治疗，随访时间（18.6±6.5）月，未出现蛋白尿复发，其中3例进行了重复肾活检，结果显示肾脏病理类型均由重转轻，活动性指数下降，但慢性指数有所上升。CTX组有11例进入维持期治疗，随访时间（25.1±9.6）月，其中有3例在随访中蛋白尿复发。LEF组发生不良反应14例次，主要是感染，以带状疱疹多见。环磷酰胺组发生不良反应18例次，主要为感染和月经不调，组间比较差异无统计学意义。结论 来氟米特联合激素诱导及维持治疗Ⅳ型及Ⅴ型LN疗效显著，患者耐受性良好。     

Similar risks of nephropathy in patients with type I or type II diabetes mellitus

It is commonly assumed that in patients the risks of developing nephropathy and uraemia are high in type I and low in type II diabetes mellitus. Since type II occurs mostly in elderly individuals with limited life expectancy and high cardiovascular mortality, the true risk may have been underestimated, as many patients do not survive to experience renal complications. To assess renal risk further, we evaluated all patients with type II and type I diabetes mellitus without severe secondary disease who were followed in the outpatient clinic between 1970 and 1985. The cumulative risk of proteinuria after 20 years of diabetes mellitus was 27% in type II and 28% in type I, the findings after 25 years were 57% and 46% respectively. The cumulative risk of renal failure, i.e. serum creatinine greater than 1.4 mg/dl, after 3 years of persisting proteinuria was 41% in both type II and type I, and after 5 years of proteinuria were 63% and 59% respectively. We conclude that the renal risk is similar in patients with type II and type I diabetes mellitus.     

2型糖尿病患者乐观心理的调查分析

目的调查并分析2型糖尿病患者乐观心理现状及影响因素。方法采用方便抽样法抽取2型糖尿病患者245例,通过一般情况调查表、乐观问卷对其进行问卷调查。结果糖尿病患者乐观心理平均得分130.74±19.23,得分率69.17%;不同文化程度、人均月收入、家庭成员关系的患者其乐观心理得分差异有统计学意义(均P0.01);文化程度、人均月收入可解释糖尿病患者乐观心理变化的25.5%。结论 2型糖尿病患者乐观心理处于中等水平,文化程度高、人均月收入高的患者表现出更好的乐观心理。     

Remission of resistant MPGN type I with mycophenolate mofetil and steroids

Very few studies have been published on how to treat children with membranoproliferative glomerulonephritis type I (MPGN I), and as yet there is only one report on the use of mycophenolate mofetil (MMF) in children with MPGN I. We report a 12-year-old boy who presented with edema, hypertension, nephrotic range proteinuria, and microscopic hematuria following an upper respiratory tract infection. Laboratory tests revealed a serum creatinine of 90 μmol/l, albumin of 20 g/l, and a C3 of 0.11 g/l (normal range: 0.7–1.4). Renal biopsy showed the presence of MPGN I. Upon failure to induce remission with prednisone, we started the patient on MMF at 500 mg/day (300 mg/m²), increasing up to a final dose of 2 g/day (1200 mg/m²), with a MMF metabolite mycophenolic acid (MPA) target range of 2–5 mg/l. Prednisone was subsequently reduced to alternate day therapy and gradually weaned to 7.5 mg on alternate days over 9 months. Within 4 months of starting MMF therapy, there was significant improvement in serum creatinine (decrease from 156 to 64 μmol/l), serum albumin (increase from 23 to 40 g/l), and proteinuria (decrease from 13 g/day to 40 mg/day). Twelve months following the introduction of MMF into his therapeutic regimen, he remains in remission with no further relapses. In summary, this case suggests that there may be potential benefit for use of MMF in children with refractory MPGN I, which supports the rationale for prospectively evaluating MMF treatment in a treatment trial of refractory MPGN I.     

心脏穿透伤224例的临床分型和处理

目的　为了比较不同时期心脏穿透伤 (PCT)的流行病学、诊治疗效的发展趋势 ,探讨临床分型对 PCT救治的指导意义以及影响预后的因素。　方法　对 15家三级医院 1990年 1月～ 2 0 0 1年 10月收治的 PCT共 2 2 4例进行回顾性研究 ,按年代的先后将其分为两组 ,组 1(1990年 1月～ 1995年 12月 ,92例 )和组 2 (1996年 1月～ 2 0 0 1年 10月 ,132例 ) ;并根据入院时的临床表现分为亚临床型、临床型 ,后者又分为心脏压塞型和失血休克型。　结果　亚临床型 5 3例 ,其院前时间 (T1)、入院时修订创伤计分 1(RTS1)分别为 0 .74± 0 .5 4小时和 5 .35± 0 .87;临床型171例 ,T1、RTS1分别为 1.5 0± 2 .6 0小时和 4 .2 9± 1.6 4 (P<0 .0 5 ) ,两型的麻醉时修订创伤计分 (RTS2 )、损伤严重度评分 (ISS)差别无显著性意义 (P>0 .0 5 )。全组死亡 36例 ,总死亡率 16 .0 7%。其中亚临床型死亡 2例 ,心脏压塞型 9例 ,失血休克型 2 5例。组 1死亡 2 0例 ,死亡率为 2 1.74 % ;组 2死亡 16例 ,死亡率下降至 12 .12 % (P<0 .0 1)。　结论　 PCT的发生率呈逐年增高趋势 ,要提高 PCT的抢救成功率 ,应加强院前救治和转运 ,简化诊断方法 ,尽早开胸手术治疗。临床分型对救治具有指导意义。