不同程度有氧运动对代谢综合征的疗效

目的观察不同程度长期规律有氧运动对代谢综合征(metabolic syndrome,MS)的疗效。方法将106例平时缺乏运动的MS患者按随机数字表法分为对照组和研究组,每组各53例。2组均进行规律的有氧运动训练,观察组每次持续运动46~60 min,对照组每次持续运动30~45 min。比较2组治疗前及治疗6个月后体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、腰围(wc)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)。结果治疗后6个月,观察组BMI、SBP、DBP、TC、TG、LDL-C、wc、FPG及2 hPG较治疗前明显下降,HDL-C明显升高(均P<0.05);对照组TC、TG、LDL-C较治疗前明显下降(均P<0.05),BMI、SBP、DBP、HDL-C、wc、FPG及2 hPG较治疗前比较差异无统计学意义(均P>0.05)。与对照组比较,观察组BMI、TC、wc、FPG及2 hPG均明显下降,HDL-C明显升高(均P<0.05);2组间血压、TG、LDL-C比较差异均无统计学意义(均P>0.05)。结论控制饮食、长期规律每次持续运动46~60 min比运动30~45 min的有氧运动可以更有效地降低MS患者的BMI、血压,调节血脂,减少wc,降低FPG及2 hPG等指标。     

治疗型生活方式对中老年人代谢综合征的影响

目的探讨治疗型生活方式对中老年人代谢综合征(MS)的不同影响及可能的原因。方法64例代谢综合征(MS)患者按年龄不同分为中年组(32例)和老年组(32例),进行生活方式改变的干预,比较干预前及干预6个月后两组患者的体质量指数(BMI)、空腹血糖(FPG)、餐后2h血糖,三酰甘油(TG)、高密度酯蛋白胆固醇(HDL-C)及血压(BP)的变化。结果干预后两组患者的BMI、FPG、2hPG、TG、BP均较干预前患者显著下降(P<0.01),HDL-C较干预前升高(P<0.01);干预后中年组的BMI、2hPG下降较老年组显著(P<0.01),中年组HDL-C升高较老年组显著(P<0.01)。结论生活方式的改变对中、老年MS患者各种指标的改善是有效的,但中年组指标的改善较老年组更为显著。     

西格列汀与沙格列汀治疗2型糖尿病的疗效对比研究

目的:比较西格列汀与沙格列汀治疗2型糖尿病的疗效。方法:将50例门诊初次确诊为2型糖尿病的患者随机分为西格列汀组和沙格列汀组各25例,分别用西格列汀或沙格列汀治疗12周,观察患者BMI、FPG、2 hPG、HbA1c等指标变化及低血糖发生情况。结果:治疗后两组FPG、2 hPG、HbA1c较治疗前均有明显下降,有统计学意义(P<0.01),BMI较治疗前均有轻度下降,但无统计学意义(P>0.05);两组间BMI、HbA1c、FPG、2 hPG、低血糖发生率等指标相比较无统计学意义(P>0.05)。结论:西格列汀及沙格列汀均能有效地控制2型糖尿病患者的血糖,轻度减轻体重,且低血糖发生率较低,但两者的疗效无明显差别。     

王不留行籽耳穴埋豆对2型糖尿病前期治疗的效果观察

目的 探讨王不留行籽耳穴埋豆对2型糖尿病前期治疗的效果及作用机制。方法 选择2016年1月~2017年5月于我院门诊就诊的2型糖尿病前期患者48例,随机分为观察组和对照组各24例。两组患者均采用饮食控制和运动治疗,观察组在对照组的基础上联合王不留行籽耳穴埋豆治疗。8周后比较两组空腹血糖(FPG)、糖化血红蛋白(GHB)、餐后2h血糖(2hPG)、体重指数(BMI)及治疗效果。结果 两组患者治疗前FPG、GHB、2hPG、BMI均无显著性差异(P＞0.05),治疗8周后两组患者FPG、GHB、2hPG、BMI均较治疗前有改善(P＜0.05),观察组总有效率高于对照组(P＜0.05)。结论 王不留行籽耳穴埋豆对2型糖尿病前期治疗效果肯定,且操作简便易行,值得在社区推广。     

罗格列酮对早期糖尿病肾病脂联素的影响

目的:探讨罗格列酮对早期糖尿病肾病脂联素的影响.方法:80例2型糖尿病早期糖尿病肾病患者随机分为罗格列酮治疗组(A组40例)及对照组(B组40例),罗格列酮治疗组在糖尿病常规治疗的基础上,给予罗格列酮,对照组则不用罗格列酮;12周后,观测两组治疗前后空腹及餐后2 h血糖(FBG,2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(Fins)、高敏C反应蛋白(hs-CRP)、脂联素(APN)、尿微量白蛋白(MA)及尿肌酐(UCr)等指标变化.结果:两组治疗后FBG及2 hPG、HbA1c、Fins、HOMA指数均明显下降(P均＜ 0.05),罗格列酮治疗组治疗后HOMA指数较对照组明显下降(P ＜ 0.05).两组治疗后尿微量白蛋白排泄率 (UAER)均明显下降(P ＜ 0.05),但罗格列酮治疗组治疗后UAER下降较对照组更显著(P ＜ 0.05);罗格列酮治疗组治疗后hs CRP显著下降(P ＜ 0.05),APN明显升高(P ＜ 0.05),而对照组无明显变化.结论:罗格列酮可能通过抑制炎症反应对糖尿病肾病起保护作用.     

2型糖尿病肾病患者血清visfatin、Apelin的变化及其临床意义

目的检测2型糖尿病肾病患者血清visfatin、Apelin水平,探讨其在2型糖尿病肾病发生发展中的作用及临床意义。方法根据24 h尿微量白蛋白排泄率(UAER)将105例2型糖尿病患者分为正常白蛋白尿组(NA组,39例)、微量白蛋白尿组(MA组,36例)、临床白蛋白尿组(CP组,30例),选取健康者作为对照组(NC组,35例)。采用酶联免疫吸附法(ELISA)测定血清visfatin、Apelin水平,同时测定患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂、血尿素氮、血肌酐(Scr)、BMI,计算UAER,比较各组间的差异。结果与NC组比较,3组糖尿病患者血清visfatin、Apelin水平显著升高(P<0.01),3组糖尿病患者之间血清visfatin、Apelin逐渐升高(P<0.05或P<0.01)。相关分析显示,visfatin与BMI、FPG、HbA1c、HOMA-IR、TG、LDL-C、Scr、UAER、Apelin呈正相关(P<0.05);Apelin与BMI、收缩压、FPG、HbA1c、HOMA-IR、LDL-C、Scr、UAER、visfatin呈正相关(P<0.05);visfatin、Apelin均与HDL-C呈负相关(P<0.05)。多元线性回归分析显示:Scr、UAER是糖尿病组患者血清visfatin的独立相关因素(r2分别为0.325、0.267,P<0.05)。HOMA-IR、UAER是糖尿病组患者血清Apelin的独立相关因素(r2分别为0.256、0.487,P<0.05)。结论血清visfatin、Apelin随UAER升高而逐渐升高,其可能参与了糖尿病肾病的发生和发展。     

胰岛素强化治疗老年早期糖尿病肾病的疗效

目的 观察胰岛素注射与口服降糖药物对老年早期糖尿病肾病尿蛋白的影响.方法 116例老年早期糖尿病肾病患者随机分为A组(诺和锐及诺和灵N注射)、B组(诺和锐30注射)、C组(甘精胰岛素注射)和D组(口服格列奎酮),治疗12周.观察4组治疗前、后尿微量白蛋白排泄率(UAER)、糖化血红蛋白(HbA.c)、空腹血糖(FBG)、2 h血糖(2 hPG).结果 4组治疗后UAER、HbA1c、FBG、2 hPG较治疗前均有下降,A、B、C治疗组疗效优于D组(P均＜0.05),A组疗效最好.结论 胰岛素注射治疗对老年早期糖尿病肾病有显著疗效,并使血糖控制达标.     

高频超声评价2型糖尿病合并微量白蛋白尿患者颈动脉粥样硬化

目的 评价高频超声对2型糖尿病(T2DM)合并微量白蛋白尿(MA)患者颈动脉粥样硬化的诊断价值.方法 将91例T2DM患者根据尿白蛋白排泄率(UAER)分为T2DM未合并MA患者组(T2DM1组)49例;T2DM合并MA患者组(T2DM2组)42例,利高频超声检测T2DM患者颈动脉内-中膜厚度(IMT)及粥样硬化斑块形成情况.同时获得血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbAlc)、尿酸(URIC)、血肌酐(CREA)、超敏C反应蛋白(HSCRP)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、尿白蛋白排泄率(UAER)、体质指数(BMI)等指标.结果 T2DM2组2hPG、BMI、TC、CREA、UAER、HbAlc、IMT均高于T2DM1组,差异均有统计学意义(P<0.05).Pearson相关分析显示两组中IMT与CREA、UAER、HbAlc及病程呈正相关(r=0.311、P<0.05,r=0.309、P<0.05,r=0.441、P<0.05,r=0.350、P<0.05).在多元线性回归分析中,两组中UAER、HbAlc、病程是IMT的独立预测因子.两组组内斑块检出率:软斑>混合斑>硬斑,差异有统计学意义(P<0.05).结论 T2DM合并MA患者的颈动脉IMT增厚,UAER、HbAlc及病程与IMT密切相关.高频超声能够准确、快捷地检测T2DM合并MA患者颈动脉粥样硬化.     

培哚普利对糖尿病患者早期肾功能的影响

目的 探讨培哚普利对糖尿病患者尿微量白蛋白(mALB)的影响.方法 87例糖尿病患者,其尿微量白蛋白排泄率(UAER)均在20～200 μg/min之间.所有患者的血糖经降糖治疗后控制在可接受水平,即空腹血糖(FBG)＜7.0 mmol/L,餐后2h血糖(2hPBG)＜10 mmol/L.随机分成两组:A组38例为对照组,给予降糖治疗;B组49例为治疗组,在降糖治疗的基础上加用培哚普利4 mg,每天1次.分别于治疗前及治疗后12、24周检测病人的血压、UAER、α1微球蛋白(α1-MG)及肾小球滤过率(GFR)等各项指标.结果 A组在治疗后12、24周检测UAER及肌酐清除率与治疗前相比无明显变化;B组在治疗后12、24周检测UAER及肌酐清除率与治疗前相比有明显下降,差异有统计学意义(P＜0.05);两组治疗后UAER相比差异有统计学意义(P＜0.05).结论 培哚普利可以减少糖尿病患者尿微量白蛋白的排出,提示有肾脏保护作用.     

胰岛素强化治疗对初诊2型糖尿病患者尿白蛋白排泄率、糖化血红蛋白及血脂水平的影响

目的探讨胰岛素强化治疗对初诊断为2型糖尿病(T2DM)的患者尿白蛋白排泄率(UAER)、糖化血红蛋白(HbAlc)及血脂水平的影响。方法选取内分泌科治疗的82例初诊断为T2DM的患者,采用随机方法将其分为对照组与强化组,每组41例。对照组口服药物治疗,强化组胰岛素强化治疗,8周后比较两组患者的疗效指标。结果治疗后,两组患者FPG、2 h PG、HbAlc水平低于治疗前(P0.05),且强化组低于对照组,差异有统计学意义(P0.05)。两组TG、TC及UAER水平治疗后较治疗前降低(P0.05),强化组UAER水平低于对照组(P0.05),两组TG、TC水平比较,差异未见统计学意义(P0.05)。结论胰岛素强化治疗初诊T2DM能有效改善患者UAER、HbAlc、血脂水平,降低血糖,减轻胰岛素抵抗,延缓病情向糖尿病肾病进展,推荐临床使用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.