不同血糖水平人群脂联素血清水平与胰岛素抵抗的关系

目的探讨不同糖耐量人群血清脂联素水平与胰岛素抵抗(IR)的关系。方法240例受试者,其中2型糖尿病患者(DM组)104例,糖耐量减低者(IGT组)46例,正常对照组(NGT组)90例,各组按体质量指数(BMI)分成肥胖亚组和非肥胖亚组。放射免疫法测定胰岛素(FINS);酶联免疫吸附测定(ELISA)法测定血清脂联素水平,同时测量身高、体质量、腰围、臀围。结果①IGT组和DM组脂联素水平较NGT组明显降低,(5.29±1.13)mg/L,(4.15±0.76)mg/Lvs(8.08±0.45)mg/L,DM组降低最显著(P<0.05)。②与NGT组相比,IGT组的BMI、腰臀比(WHR)、空腹血糖(FBG)、总胆固醇(TG)明显升高,高密度脂蛋白胆固醇(HDL-C)明显下降(P<0.05或P<0.01);DM组的收缩压(SBP)、BMI、WHR、FBG、胰岛素抵抗指数(IRI)、TG的水平均高于前两组,HDL-C明显低于NGT组(P<0.05或P<0.01)。③脂联素与WHR、IRI、SBP、FBG和TG呈显著负相关,与HDL-C呈显著正相关。结论①脂联素水平在IGT和DM人群中明显降低,提示脂联素在2型DM发病中可能起着一定作用,可以作为2型DM发病的一个预测指标。②各组肥胖亚组中IRI明显升高,说明肥胖人群存在IR,而各组肥胖亚组脂联素水平也明显降低,提示脂联素可能是联系肥胖、IR和2型DM的一个纽带。     

不同血糖水平人群血清脂联素水平与胰岛素抵抗的关系

目的研究天津地区不同糖耐量人群血清脂联素水平与胰岛素抵抗的关系。方法290例受试者中2型糖尿病患者(DM组)124例、糖耐量减低者(IGT组)66例、正常对照组(NGT组)100例,各组按体重指数(BMI)分成肥胖亚组和非肥胖亚组。测定受试者的身高、体重、腰围、臀围及血浆胆固醇和甘油三酯,并采用放射免疫法测定胰岛素(FINS)、酶联免疫吸附测定(ELISA)法测定血清脂联素水平。结果(1)IGT组和DM组脂联素水平较NGT组明显降低,分别为5.31±1.20mg/L,4.12±0.73mg/L和8.09±0.39mg/L,DM组降低最显著(P<0.05)。(2)与NGT组相比,IGT组的BMI、腰臀比(WHR)、空腹血糖(FBG)、总胆固醇(TC)明显升高,高密度脂蛋白胆固醇(HDL-C)明显下降(P<0.05或P<0.01);DM组的收缩压(SBP)、BMI、WHR、FBG、胰岛素抵抗指数(IRI)、TG的水平均高于前两组,HDL-C明显低于NGT组(P<0.05或P<0.01)。(3)血清脂联素与BMI、WHR、腰围(YW)及体脂含量(FAT%)呈显著负相关,与血胆固醇(TC)水平无相关性,与甘油三酯呈负相关。在本年龄段中,与年龄关系不大。结论(1)脂联素水平在IGT和DM人群中明显降低,提示脂联素在2型DM发病中可能起着一定作用,可以作为2型DM发病的一个预测指标。(2)各组肥胖亚组中IRI明显升高,说明肥胖人群存在IR,而各组肥胖亚组脂联素水平也明显降低,提示肥胖是影响该脂肪因子的重要因素。脂联素可能是联系肥胖、IR和2型DM的一个纽带。     

脂联素rs＋16861194多态性在2型糖尿病中的研究

目的：（1）明确2型糖尿病患者和健康人群的脂联素rs＋16861194（A/G）位点的三种基因型分布是否有差异;（2）探讨脂联素rs＋16861194的基因多态性与T2DM及健康人群部分生化指标水平的关系。方法：选取158例2型糖尿病患者为实验组,132例健康体检人群为对照组。分别对实验组和对照组进行联素基因rs＋16861194基因型进行检测;同时检测空腹葡萄糖,甘油三酯（TG）,高密度脂蛋白-胆固醇（HDL）,低密度脂蛋白-胆固醇（LDL）;采用化学发光法测定空腹胰岛素,并计算胰岛素抵抗指数。结果：①T2DM组和CON组脂联素rs＋16861194位点的基因型分布分别为：AA（70.00%）、AG（24.37%）、GG（5.63%）和AA（74.24%）、AG（24.24%）、GG（1.52%）;②以脂联素rs＋16861194位点的基因型分组,在T2DM组和CON组内,各基因型之间的FBG、FIN、IRI、TG、CHOL、HDL-CH、LDL-CH水平均无统计学差异（P〉0.05）。③在T2DM组与CON组之间比较,T2DM组AA型与CON组AA型的FBG,FIN,IRI,TG,HDL差异有统计学意义（P〈0.05）;CHOL,LDL差异无统计学意义（P〉0.05）。T2DM组AG＋GG型与CON组AG＋GG型的FBG,IRI,TG,HDL差异有统计学意义（P〈0.05）;FIN,CHOL,LOL差异无统计学意义（P〉0.05）。结论：（1）脂联素rs＋16861194（A/G）位点的三种基因型分布无显著性差异。（2）脂联素rs＋16861194的基因型在2型糖尿病人群内或健康人群内对FBG、FIN、IRI、TG、CHOL、HDL-CH、LDL-CH水平无影响。     

广州地区2型糖尿病人群脂联素SNP+45基因型与胰岛素抵抗水平的研究

目的:探讨广州地区2型糖尿病人群与健康对照组人群脂联素+45(SNP+45)住点不同基因型组之间胰岛素抵抗水平的变化及意义.方法:分别测定广州地区已知SNP+45位点基因型的2型糖尿病人群和健康对照组人群的腰臀比(WHR)、体质指数(BMI)、体脂分布(BF)、空腹血糖(FBG)、空腹胰岛素(FIN),并计算胰岛素抵抗指数(IRI).结果:(1)2型糖尿病人群和健康对照人群各个组内SNP+45位点的TT基因型组与GG+TG基因型组之间的WHR、BMI、BF、FBG和IRI比较,差异没有统计学意义.(2)2型糖尿病人群SNP+45位点TT、GG+TG基因型组与健康对照人群SNP+45位点TT、GG+TG基因型组之间的WHR、BMI、BF、FBG和IRI有统计学意义上的差异.结论:脂联素SNP+45位点与2型糖尿病的发生有关;在2型糖尿病的发生发展过程中,胰岛素抵抗起到重要的作用.     

新诊断2型糖尿病患者血清肌联素与胰岛素抵抗的相关性研究

目的 探讨新诊断2型糖尿病(nT2DM)患者血清肌联素与胰岛素抵抗的关系.方法 纳入维吾尔族健康人群89例(对照组)、糖耐量受损(IGT)128例(IGT组)和nT2DM患者111例(nT2DM组)为研究对象,采用酶联免疫法检测血清肌联素的水平.结果 IGT组和nT2DM组年龄、体质量指数(BMI)、全身脂肪百分比(FAT％)、腰臀比(WHR)、甘油三酯(TG)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FINS)、759葡萄糖负荷后2h血糖(2 hPG)、759葡萄糖负荷后2h血浆胰岛素(2 hINS)、稳态模型评估胰岛素抵抗指数(HOMA-IR)和肌联素均高于对照组,差异有统计学意义(P＜0.05或P＜0.01).IGT组和对照组患者高密度脂蛋白胆固醇(HDL-C)高于nT2 DM组患者,差异有统计学意义(P＜0.05或P＜0.01).IGT组与nT2 DM组在FAT％、总胆固醇(TC)、HbA1c、FBG、FINS、2 hPG、2 hINS、HOMA-IR和肌联素方面比较,差异有统计学意义(P ＜0.05或P＜0.01).肌联素与年龄、BMI、WHR、HbA1c、FBG、2 hPG、FINS、2 hINS、HOMA-IR呈显著正相关(P＜0.05或P＜0.01),与HDL-C呈显著负相关(P＜0.01).多元逐步回归分析提示,2 hPG、2 hINS及HOMA-IR是影响肌联素水平的独立相关因素(β=0.34、0.42、0.90,P＜0.01、0.01、0.05).受试者工作特征(R0C)曲线显示,血清肌联素预测IGT和T2DM的曲线下面积分别为0.72和0.92.结论 T2DM和超重/肥胖人群血清肌联素水平明显升高,肌联素与胰岛素抵抗密切相关,在T2DM、胰岛素抵抗的发生发展中发挥着重要的作用.     

中国汉族人脂联素基因rs2241766及rs1501299多态性与2型糖尿病及代谢指标的关系

目的在中国汉族人群中,观察脂联素基因rs2241766(T>G)和rs1501299(G>T)多态性与2型糖尿病及胰岛素抵抗的关系。方法使用聚合酶链反应-单链构象多态性(PCR-SSCP)银染技术结合基因直接测序法,对糖耐量正常(NGT)者150例及2型糖尿病(T2DM)患者285例,进行基因的检测及代谢指标的观察。结果 rs2241766 TT、TG、GG基因型和rs1501299 GG、GT、TT基因型,在T2DM组及NGT组中的分布存在显著差异。rs2241766 G(TG+GG)等位基因携带者患T2DM的风险增加2倍,而rs1501299 TT携带者患T2DM的风险下降;偏相关分析显示,rs2241766 G(TG+GG)等位基因与HOMAIR呈现正相关,rs1501299 TT基因型与HOMAIR呈现负相关;rs2241766 G携带者以及rs1501299 TT携带者的体质量指数(BMI)、腰臀部(WHR)、体脂百分比(%body fat)显著升高。结论 rs2241766 G是中国汉族人T2DM的危险因素,而rs1501299 TT则是保护因素。     

脂联素基因SNP+45(T/G)多态性与昆明汉族2型糖尿病的相关性研究

目的:研究脂联素基因SNP+45(T/G)多态性与昆明地区汉族2型糖尿病(T2DM)患者之间的关系。方法:PCR-RFLP方法检测脂联素SNP+45(T/G)多态性。结果:昆明汉族脂联素SNP+45(T/G)多态性分布与国内其他地区类似,而与德国人群有差别。T2DM患者GG基因型频率明显增高,GG型HOMA-IR增高、HDL-C降低。结论:昆明汉族脂联素SNP+45(T/G)多态性与T2DM相关,GG型基因可能是中国昆明汉族人群T2DM的遗传危险因素。     

内脂素和脂联素与2型糖尿病代谢综合征的相关性研究

目的探讨内脂素和脂联素与2型糖尿病(T2DM)代谢综合征的相关性。方法选择T2DM代谢综合征患者(T+MS组)和单纯T2DM患者(T2DM组)进行检测并比较2组研究对象体质量指数(BMI)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)、内脂素和脂联素的差异,分析2组患者内脂素、脂联素和BMI、TC、TG、LDL-C、HDL-C、FBG、HOMA-IR的相关性。结果 T+MS组患者BMI、TC、TG、LDL-C、FBG、HOMA-IR均显著高于T2DM组患者,而HDL-C、内脂素和脂联素均显著低于T2DM组患者,差异均有统计学意义(P0.05)。T2DM代谢综合征患者内脂素、脂联素和BMI、TC、TG、LDL-C、FBG、HOMA-IR呈负相关关系(P0.05),和HDL-C呈正相关(P0.05)。结论 T+DS组患者血清内脂素及脂联素显著低于T2DM组患者,其低内脂素和脂联素血症与T2DM合并代谢综合征密切相关。     

血清CTRP9水平与胰岛素抵抗及肥胖的关系

目的 探讨血清补体C1q肿瘤坏死因子相关蛋白(CTRP)9水平与胰岛素抵抗及肥胖的关系。方法 选取2020年9月至2022年9月在该院就诊的患者为研究对象,其中新诊断的2型糖尿病(nT2DM)患者102例(nT2DM组)、糖耐量受损(IGT)患者98例(IGT组),选择同期于该院体检的体检健康者92例作为糖耐量正常(NGT)组。采用双抗体夹心法测定血清CTRP9和脂联素水平。采用Pearson相关和多因素Logistic回归分析血清CTRP9水平与胰岛素抵抗及肥胖的关系。结果 IGT组和nT2DM组血清CTRP9水平均高于NGT组,血清脂联素水平均低于NGT组(P<0.05)。超重和肥胖者血清CTRP9水平明显高于正常体重者(P<0.05)。血清CTRP9水平与体重指数、空腹血糖、空腹胰岛素、糖化血红蛋白、胰岛素抵抗指数和低密度脂蛋白胆固醇呈正相关(P<0.05),与高密度脂蛋白胆固醇和脂联素呈负相关(P<0.05)。血清CTRP9水平为T2DM发生的独立危险因素(OR=1.835,95%CI 1.227～1.843,P<0.05)。结论 血清CTRP9水...     

不同糖耐量人群血清内脂素、脂联素水平的变化及其临床意义

目的测定糖耐量正常(NGT)、糖耐量异常(IGT)及2型糖尿病(T2DM)患者血清内脂素、脂联素水平,观察血清内脂素、脂联素水平变化;分析内脂素、脂联素与人体测量参数和生化指标及胰岛素抵抗指数(HOMA-IR)之间的相关性。探讨内脂素、脂联素在T2DM的发生、发展机制中的作用。方法选择T2DM、IGT、NGT各30例,留取血清测定空腹胰岛素(FINS)、脂联素、内脂素,并检测有关项目。用酶联免疫吸附测定(ELISA)法测定内脂素;用放免(RIA)法测定脂联素和FINS。结果①NGT、IGT、T2DM3组血清内脂素,分别为(55.07±16.58)μg/L、(65.01±14.57)μg/L、(80.61±19.28)μg/L,其差异有统计学意义(P<0.05或P<0.01)。血清脂联素,分别为(20.84±4.52)mg/L、(16.08±5.19)mg/L、(12.17±3.76)mg/L,其差异有统计学意义(P<0.05或P<0.01)。②血清内脂素与体质量指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、HOMA-IR、呈正相关(R=0.352,0.405,0.291,0.248,0.250,P<0.05或P<0.01),血清脂联素与内脂素、BMI、FPG、FINS、HOMA-IR、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、HbA1c呈负相关,与高密度脂蛋白胆固醇(HDL-C)呈正相关(R=-0.296,-0.345,-0.610,-0.422,-0.630,-0.228,-0.215,-0.548,0.368,P<0.05或P<0.01)。③多元逐步回归分析显示WHR、FPG是影响血清内脂素水平的独立影响因素,FPG、BMI、FINS、LDL-C是影响血清脂联素水平的独立影响因素。结论内脂素是与肥胖、糖代谢有关的一种激素,内脂素与内脏脂肪之间存在密切联系,T2DM胰岛素抵抗的产生与低脂联素血症有关,内脂素、脂联素可能在T2DM的发生发展中发挥一定作用。     

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.