胰岛素强化治疗疗程与初诊2型糖尿病胰岛β细胞功能的关系

对110例初诊2型糖尿病（T2DM）患者,分为胰岛素强化治疗15 d组、30 d组、60 d组,检测3组治疗前后空腹血糖（FBG）、空腹胰岛素（FIns）,行标准口服馒头餐—胰岛素—C肽释放试验,分析比较3组患者治疗后血糖控制及胰岛β细胞功能恢复情况。发现3组患者治疗后血糖明显下降,胰岛β细胞功能明显改善;30 d组、60d组胰岛β细胞早时相分泌指标较15 d组改善更明显。可见适当延长胰岛素强化治疗疗程可进一步改善胰岛β细胞早时相分泌。     

胰岛素泵强化治疗新诊断的2型糖尿病临床观察

采用自身前后对照,观察28例新诊断2型糖尿病患者空腹血糖≥10.0mmol/L,接受2周短期胰岛素泵治疗.结果2周的胰岛素泵强化治疗显示出快速稳定的降血糖效果.其中27例患者的空腹、餐后2h血糖分别于治疗后(3.1±1.8)d、(8.9±3.6)d达到良好控制,且未见明显低血糖.胰岛β细胞功能在治疗后获得显著改善静脉注射葡萄糖后10min内出现了明显增加的胰岛素分泌相,更有部分患者可以见到典型的胰岛素第一时相分泌尖峰,由Homa模型计算的Homaβ值均较治疗前明显提高,而反映胰岛素抵抗的Homa IR也较治疗前明显降低.结论对伴明显高血糖的初诊2型糖尿病患者,短期胰岛素泵强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能的作用.     

短期持续胰岛素输注治疗酮症起病的2型糖尿病疗效观察

目的 比较持续皮下胰岛素输注(CSII,胰岛素泵治疗)与多次皮下注射胰岛素(MSII)治疗酮症起病的2型糖尿病患者,观察其降糖效果和对胰岛β细胞功能的影响.方法 对新发的空腹血糖≥11.1 mmol/L,酮体阳性的60例初诊糖尿病患者随机分组.胰岛素泵持续注射胰岛素组(CSII组)30例,多次皮下注射胰岛素组(MSII组)30例.比较两种方法治疗前后血糖、胰岛素用量、血糖达标时间、低血糖发病率;标准馒头餐胰岛素释放试验的胰岛素及C肽、空腹血浆胰岛素及Homaβ等.结果 CSII组在血糖达标时间、胰岛素用量及低血糖发病率上均优于MSII组(P＜0.05).胰岛β细胞功能在治疗后获得显著改善(P＜0.05).结论 对酮症起病的2型糖尿病患者,短期CSII强化治疗具有快速稳定纠正代谢紊乱、控制血糖和显著改善胰岛β细胞功能的作用.     

胰岛素短期强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

目的　观察胰岛素短期强化治疗对初诊 2型糖尿病患者胰岛β细胞功能的改善作用及降糖效果。方法对 2 4例初诊 2型糖尿病患者应用胰岛素泵进行 2周的胰岛素强化治疗 ,治疗第 15天时对比治疗前后静脉葡萄糖耐量试验所诱发的胰岛素第 1时相的分泌、胰岛素曲线下面积及由 Homa模型计算胰岛素分泌指数 (Homa B)、胰岛素抵抗指数 (Homa A) ,同时观察空腹血糖、餐后 2小时血糖变化 ;3个月时对比糖化血红蛋白变化。结果　患者空腹血糖及餐后 2小时血糖分别在治疗 (3.7± 1.8)天、 (5 .5± 1.7)天达到控制标准 ,胰岛 β细胞功能显著改善 ,静脉葡萄糖耐量试验各时点的胰岛素分泌及 Homa B值较治疗前明显升高 (P<0 .0 5 ) ,Hom a A指数下降(P<0 .0 5 )。随访 3个月 ,13例患者单纯控制饮食即可维持血糖控制标准 ,糖化血红蛋白由治疗前的 (9.8± 1.2 ) %降至 (6 .3± 0 .7) %。结论　胰岛素短期强化治疗可明显改善及恢复初诊 2型糖尿病患者胰岛素第 1时相分泌 ,不同程度的缓解病情     

短期诺和锐强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

目的　探讨短期诺和锐强化治疗对初诊2型糖尿病(T2DM)患者胰岛β细胞功能和血糖控制的影响。　方法　对45例初诊T2DM患者进行为期两周的诺和锐强化治疗,分析比较治疗前后空腹(FPG)及餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、静脉葡萄糖耐量试验时第一时相胰岛素及C肽分泌和胰岛素及C肽曲线下面积、胰岛素抵抗指数、胰岛素分泌指数、胰岛素敏感指数、空腹胰岛素(FIns)与FPG比值。　结果　诺和锐强化治疗后,FPG、2 hPG、HbA1c均较治疗前明显下降(P<0.01);空腹及第一时相胰岛素和C肽的分泌、胰岛素和C肽曲线下面积、FIns与FPG比值、胰岛素分泌指数、胰岛素敏感指数均较治疗前明显升高(P<0.01)。胰岛素抵抗指数较治疗前明显下降(P<0.01)。　结论　短期诺和锐强化治疗可显著改善初诊T2DM患者胰岛β细胞功能。     

短期胰岛素强化治疗对初诊2型糖尿病长期血糖控制观察

采用患者自身前后对照,观察30例新诊断2型糖尿病患者接受二周短期胰岛素强化治疗,结果治疗2周后显示快速稳定降糖效果,其中28例空腹血糖,餐后2h血糖均良好控制,未见明显低血糖,胰岛β细胞功能在治疗后获得明显改善,静脉注射葡萄糖后10分钟内出现明显的胰岛素、C肽分泌相.部分患者可见到胰岛素第一时相分泌高峰.结论短期胰岛素强化治疗可以显著恢复代表胰岛β细胞功能的血糖刺激的胰岛素第一时相分泌,使患者血糖良好控制.     

短期胰岛素强化治疗对初诊2型糖尿病长期血糖控制观察

采用患者自身前后对照，观察30例新诊断2型糖尿病患者接受二周短期胰岛素强化治疗，结果：治疗2周后显示快速稳定降糖效果，其中28例空腹血糖，餐后2h血糖均良好控制，未见明显低血糖，胰岛β细胞功能在治疗后获得明显改善，静脉注射葡萄糖后10分钟内出现明显的胰岛素、C肽分泌相。部分患者可见到胰岛素第一时相分泌高峰。结论：短期胰岛素强化治疗可以显著恢复代表胰岛β细胞功能的血糖刺激的胰岛素第一时相分泌，使患者血糖良好控制。     

胰岛素强化方法治疗成人隐匿性自身免疫性糖尿病老年患者的疗效及其对胰岛β细胞功能的影响

目的研究并探讨胰岛素强化方法治疗成人隐匿性自身免疫性糖尿病的临床疗效及其对胰岛β细胞功能的影响。方法于2010年1月—2015年6月该院收治的糖尿病患者中,随机选取50例老年隐匿性自身免疫性糖尿病患者和50例老年2型糖尿病患者进行对比研究,分别将其设置为观察组和对照组。两组患者均进行胰岛素强化治疗,对比两组患者治疗前、后的空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素、餐后2h胰岛素、空腹C肽、餐后2hC肽以及胰岛β细胞功能指数。结果与治疗前相比,治疗后两组患者的空腹血糖、餐后2小时血糖、糖化血红蛋白、空腹胰岛素、餐后2h胰岛素、空腹C肽、餐后2hC肽以及胰岛β细胞功能指数均得到显著改善(P0.05);治疗后,对照组患者和观察组患者的血糖、糖化血红蛋白水平均差异无统计学意义(P0.05),观察组患者的胰岛素、C肽以及胰岛β细胞功能指数较之对照组均明显更低(P0.05)。结论给予老年隐匿性自身免疫性糖尿病患者胰岛素强化治疗,能够有效改善患者的胰岛β细胞功能,促进胰岛素的分泌,使血糖得到有效控制。     

持续皮下胰岛素输注对2型糖尿病早期胰岛功能改善作用的临床研究

目的探讨初发的2型糖尿病患者,应用持续皮下胰岛素输注(CSII)或多次胰岛素皮下注射(MSII)的治疗,对胰岛β细胞功能和血糖的影响。方法CSII组采用持续皮下胰岛素输注形式,在3天内使血糖达标;MSII组采用小剂量起步,平均2~3周逐步将血糖调整到位的方法,观察治疗前后血糖、血浆C肽(C-P)空腹、餐后1小时、2小时及HbAlc的变化。结果两组的血糖及HbAlc较治疗前明显下降(P<0.05),而CSII组下降更为明显(P<0.05),且该组C-P空腹及餐后1小时值有所升高(P<0.05),胰岛素用量也较MSII组有所减少。结论对初诊的血糖较高的2型糖尿病患者尽早应用持续皮下胰岛素输注的方式,更有助于将血糖控制在理想水平及改善胰岛功能。     

强化胰岛素治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

目的探讨强化胰岛素治疗对初诊2型糖尿病患者的疗效。方法将123例初诊2型糖尿病患者随机分为胰岛素组（32例）、格列齐特组（33例）、二甲双胍组（32例）和毗格列酮组（31例）,在饮食及运动治疗的基础上,胰岛素组行强化胰岛素治疗,另三组分别予相应121服药物,均治疗12周。比较各组治疗前后空腹血糖（FPG）、餐后2h血糖（FPG2h）、糖化血红蛋白（HbAlc）、胰岛素糖负荷后曲线下面积（胰岛素Auc）、C肽糖负荷后曲线下面积（C肽AUC）、胰岛素分泌指数（Homa—β）和胰岛素抵抗指数（Homa-IR）变化。结果胰岛索组胰岛素AUC0—30min、C肽AUC0～30min、Homa-β均明显高于3个口服降糖药组（P均〈0．05）;胰岛素组、二甲双胍组、吡格列酮组Homa—IR均明显降低（P均〈0．05）。结论对初诊2型糖尿病患者,强化胰岛素治疗比常规口服降糖药可更好地改善胰岛β细胞功能和胰岛索抵抗。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.