瑞格列奈联合二甲双胍治疗老年2型糖尿病的效果分析

目的观察瑞格列奈联合二甲双胍治疗老年2型糖尿病的有效性和安全性。方法138例老年糖尿病患者使用瑞格列奈联合二甲双弧治疗（观察组）,136例老年糖尿病患者单用二甲双胍治疗（对照组）,比较治疗前后两组患者空腹血糖、餐后血糖、糖化血红蛋白、肝肾功能、血乳酸等指标的变化。结果观察组的降血糖、降血脂效果较对照组更加明显;治疗前后两组患者的肝肾功能和血乳酸水平均无显著变化,无乳酸酸中毒发生。结论老年糖尿病患者合理应用瑞格列奈联合二甲双胍治疗较为安全,并可达到更佳的降血糖效果。     

二甲双胍佐治高血压伴肥胖的临床研究

目的观察二甲双胍对高血压伴肥胖症患者血压、血脂的影响。方法对照组70例,治疗方案：苯磺酸氨氯地平片。二甲双胍组75例：苯磺酸氨氯地平片＋二甲双胍。结果治疗后两组收缩压、舒张压都明显下降,比较差异有显著性,有统计意义;二甲双胍组血压下降更显著,与对照组比较差异有统计意义;二甲双胍组降压达标率更高,与对照组比较有统计意义。二甲双胍组TC、LDL、TG显著下降,HDL有提高,与对照组比较差异显著,有统计学意义。结论二甲双胍对高血压伴肥胖症患者有协同降压、改善血脂作用。     

服用二甲双胍伤肾?专家为您揭密

正在临床工作中,常常会听到很多糖友对二甲双胍药品的质疑声:"二甲双胍伤肾"。那么真相到底是怎样的呢?我们请火箭军特色医学中心内分泌风湿免疫科主任杜瑞琴来向大家普及相关知识。在解答二甲双胍是否会损伤肾脏这个问题之前,我们首先需要了解二甲双胍药物的代谢机制。二甲双胍主要以原形由肾脏从尿中排出,清除迅速,12～24小时大约可清除90%;经肾小管排泄是二甲双胍清除的主要途径。但是,二甲双胍只是经肾脏排泄,其本身对肾脏并没     

不同药物治疗多囊卵巢综合征的疗效分析

目的：分析比较达英-35、妈富隆、地屈孕酮、黄体酮、二甲双胍治疗多囊卵巢综合征的临床疗效。方法：将100例多囊卵巢综合征患者按照治疗方式不同分为达英-35组、妈富隆组、地屈孕酮组、黄体酮组、二甲双胍组各20例,在用药3个月后测定各组的血LH、睾酮水平并比较。结果：达英-35组、妈富隆组、地屈孕酮组、黄体酮组的血LH均明显下降（P〈0.05）,且达英-35组、黄体酮组的效果明显优于妈富隆组、地屈孕酮组（P〈0.05）。达英-35组、妈富隆组、二甲双胍组的血睾酮水平均明显下降（P〈0.05）,且达英-35组明显优于二甲双胍组,二甲双胍组明显优于妈富隆组（P〈0.05）。结论：达英-35治疗多囊卵巢综合征效果明显,药物的联合治疗效果更好。     

二甲双胍和常规减肥饮食在非酒精性脂肪肝治疗中的临床研究

目的探讨二甲双胍对非酒精性脂肪肝的治疗作用。方法选取非糖尿病的非酒精性肪肝55例，分两组予相应处理：二甲双胍组（28例）给予二甲双胍1500mg／d，常规减肥饮食组（27例）只给予常规减肥饮食，为期4个月。结果评价采用下例指标：肝酶、胰岛素抗性、肝组织学。结果二甲双胍对肝酶、肝组织学的改善显著，而单纯饮食治疗使肝组织学有一定改善，但肝酶增高持续存在。结论对于非酒精性脂肪肝，二甲双胍治疗比常规减肥饮食的效果好。     

二甲双胍治疗2型糖尿病36例疗效观察

目的探讨二甲双胍对2型糖尿病的疗效。方法采取平行双盲随机对照法,两组病例随机分为二甲双胍治疗组和苯乙双胍治疗组,疗程3个月。于治疗后第1、2、3月末分别测定空腹血糖,并于治疗结束后复查肝肾功能。结果两种药均有降低血糖作用．但二甲双胍降糖作用优于苯乙双胍,差异有显著性意义。结论二甲双胍对2型糖尿病疗效显著且安全可靠。     

二甲双胍通过抑制MAPK信号通路增强卵巢癌细胞对顺铂的敏感性

目的：探讨二甲双胍是否可以提高卵巢癌细胞对顺铂的敏感性及相关的作用机制。方法：BRDU ELISA方法检测顺铂联合或者不联合二甲双胍对SKOV3细胞增殖的影响;二甲双胍联合或者不联合MAPK信号通路阻断剂后BRDU ELISA方法检测细胞增殖的变化。Western blotting检测二甲双胍作用下卵巢癌细胞系SKOV3的磷酸化AMPK/总AMPK水平和磷酸化p38 MAPK/总MAPK水平的变化。结果：（1）二甲双胍不仅能抑制卵巢癌细胞系SKOV3细胞的增殖,而且能提高对顺铂的敏感性,并且这种作用是依赖于AMPK激活的;（2）p38 MAPK阻断剂SB203580能够抑制SKOV3的增殖,二甲双胍能够增强这种抑制作用。结论：二甲双胍可增强顺铂对卵巢癌细胞的抑制作用,并且二甲双胍可能通过激活AMPK信号通路进而抑制MAPK信号通路增加顺铂对卵巢癌细胞的抑制增殖作用。     

160例老年糖耐量受损患者综合干预效果

目的对老年糖耐量受损（IGT）患者进行综合干预，观察2型糖尿病的患病情况。方法经葡萄糖耐量试验确诊的160例IGT患者随机分为对照组、二甲双瓜组和综合治疗组，对照组按原生活方式，不规律服药；二甲双胍组服用二甲双胍0．25g，3次／d；综合治疗组除根据个体情况制定饮食及运动方案，每年复查时重复宣传教育饮食、运动干预的意义外，且服用二甲双胍0．25g，3次／d。结果干预2a后综合治疗组糖尿病患病率为34．0％，二甲双胍组44．2％，对照组66．6％（P〈O．05）。结论老年IGT患者采用综合治疗方式进行干预治疗可降低糖尿病发病率及血糖水平。     

二甲双胍与复方醋酸环丙孕酮对多囊卵巢综合征患者内分泌、糖及脂代谢的影响

目的:观察二甲双胍与复方醋酸环丙孕酮对多囊卵巢综合征(PCOS)患者内分泌、糖及脂代谢的影响,了解二甲双胍预防心血管疾病的作用。方法:将50名PCOS患者随机分为两组,分别用二甲双胍或复方醋酸环丙孕酮共3个周期。用药前后观察体重指数(BMI)、腰臀比(WHR),并检测血脂、胰岛素、血糖胰岛素比值(Glucose-to-Insulin ratio,GIR)和性激素。结果:用二甲双胍治疗后BMI、WHR、血脂、胰岛素水平下降,GIR上升;复方醋酸环丙孕酮可使血睾酮明显下降,对血脂、胰岛素和GIR无影响。结论:二甲双胍治疗PCOS可减轻体重、改善血脂、提高胰岛素敏感性,有利于预防心血管疾病。     

生活干预加二甲双胍对老年代谢综合征患者CRP和IL-6水平的影响

目的观察生活方式改善加二甲双胍对老年代谢综合征（MS）患者临床、血生化指标及血清C-反应蛋白（CRP）、白介素-6（IL-6）的影响。方法选择MS患者59例，随机分为生活干预组（生活干预组）29例和生活干预加二甲双胍治疗组（二甲双胍组）30例。干预前后观察体重指数（BMI）及血压，抽血查空腹血糖（FBS）、甘油三酯（TG）、高密度脂蛋白（HDL—C）、空腹胰岛素（FINS）、C反应蛋白（CRP）、白细胞介素6（IL-6）。结果患者生活干预或生活加二甲双胍干预前后，患者血压、BMI、FBS、TG、FINS、CRP、IL-6、HOMA—IR的差异具有显著性（P〈0．05）。二甲双胍治疗组收缩压（SBP）、BMI、FBS、TG、CRP、IL-6、HOMA—IR均较生活干预组低，差异有显著性（P〈0．05）。结论MS患者CRP、IL-6明显增高，存在低度炎症。单纯生活方式可改善MS多种代谢异常，加用二甲双胍能进一步改善胰岛素抵抗和炎症状态。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.