二甲双胍治疗2型糖尿病合并NAFLD的疗效观察

收集初发的T2DM合并脂肪肝31例。随机分为2组，治疗组给予二甲双胍或二甲双胍加胰岛素，对照组给予胰岛素治疗。疗程12周。结果：治疗组BMI和WHR及TG、LDL明显下降（P〈0．05），对照组有所升高，但差异无显著性（P〉0．05）。两组ASTHbA1c及ALT均明显下降（P〈0．05），尤以治疗组ALT明显（P〈0．01）；治疗组HDL—C明显上升（P〈0．05）。对照组治疗前后无明显变化。治疗组肝／脾CT值明显升高（P〈0．05），而对照组有所上升，但无统计学差异。结论：二甲双胍对合并糖尿病的脂肪肝患者不仅降血糖，尚能明显减轻脂肪肝的程度。     

二甲双胍治疗2型糖尿病合并NAFLD的疗效观察

收集初发的T2DM合并脂肪肝31例。随机分为2组，治疗组给予二甲双胍或二甲双胍加胰岛素，对照组给予胰岛素治疗。疗程12周。结果：治疗组BMI和WHR及TG、LDL明显下降（P〈0．05），对照组有所升高，但差异无显著性（P〉0．05）。两组ASTHbA1c及ALT均明显下降（P〈0．05），尤以治疗组ALT明显（P〈0．01）；治疗组HDL—C明显上升（P〈0．05）。对照组治疗前后无明显变化。治疗组肝／脾CT值明显升高（P〈0．05），而对照组有所上升，但无统计学差异。结论：二甲双胍对合并糖尿病的脂肪肝患者不仅降血糖，尚能明显减轻脂肪肝的程度。     

心理干预对哮喘患儿情绪、肺功能的影响

目的观察心理干预对哮喘患儿情绪、肺功能的影响。方法随机分成两组，两组均常规治疗和常规护理。心理干预组在应用药物的同时，进行心理疏导，健康宣教，即认知、心理和行为干预。结果两组患儿治疗结束时焦虑和抑郁症状的评分与实验前比较均有所降低，但对照组治疗前后差异无显著性（P〉0．05），治疗组治疗前后差异有显著性（P〈0．05），组间减分比较也有统计学意义，治疗组减分大于对照组（P〈0．05）。治疗组测得的FEV．和PEFR在治疗后明显改善，结果高于对照组，差异有显著性；治疗组的FVC与对照组相比有所提高，但差异无显著性（P〈0．05）。治疗组FEV．和PEFR在治疗后明显改善，结果高于对照组，差异有显著性；治疗组的FVC与对照组相比有所提高，但差异无显著性（P〈0．05）。结论采取心理干预措施，能够缓解哮喘病人的抑郁、焦虑情绪，稳定病人的心态，降低气道的高反应性，改善临床症状。     

甲磺酸二氢麦角碱对急性脑梗死患者血液流变学的影响

目的 研究甲磺酸二氢麦角碱对急性脑梗死血流变的影响。方法 将120例患者随机分为对照组和治疗组，60例为治疗组静滴甲磺酸二氢麦角碱0．6毫克，60例为对照组，静滴复方丹参20毫升，每天一次，持续两周，治疗组患者治疗前后做血液流变学检查。结果 甲磺酸二氢麦角碱治疗后神经功能缺损，积分减少及生活能力指数较治疗前差异有显著性（P〈0．05或P〈0．01），与对照组相比，有显著性（P〈0．05或P〈0．01），血液黏度下降，红细胞聚集指数及血小板聚集率下降（P〈0．05或P〈0．01）。结论 甲磺酸二氢麦角碱是治疗急性脑梗死的一种较好有效的药物。     

黄芪注射液联合阿魏酸钠治疗早期DN疗效观察

早期DN患者50例，分治疗组28例，给予黄芪注射液50m1（含黄芪20g／10m1）及阿魏酸钠0．3分别溶于生理盐水250ml。每日1次静滴2周，对照组22例，只子阿魏酸钠，用法同治疗组，结果：联合治疗早期DN，降低尿蛋白，比对照组显著（P〈O．05），血肌酐、尿素氮下降高于对照组，但无显著性差异（P〉O．05），治疗组用药前后比较，有显著性差异（P〈0．05）。结论：黄芪与阿魏酸钠联合有效治疗早期DN。     

阿魏酸钠、前列腺素E1联合治疗2型糖尿病肾病

48例2型糖尿病肾病患者随机分成对照组和治疗组各24例，再根据24小时尿蛋白排泄率（UAER）不同，分为早期肾病组（UAER在20～200μg／min之间）12例和临床期肾病组（UAER大于200μg／min）12例两个亚组。对照组每日静脉滴注PGEI 100μg，疗程14天；治疗组每日静脉点滴阿魏酸钠0．3g、PGEI 100μg，疗程14天。结果：治疗组和对照组治疗后mA、UP、Scr均明显降低，与治疗前比较有显著性差异（P〈0．05）；治疗后尿蛋白变化与对照组比较也有显著差异（P〈0．05）。结论：阿魏酸钠与PGE1联合治疗DN优于单药组。     

高原地区应用利血平股动脉注射配合脑心通胶囊治疗0级糖尿病足的临床观察

观察利血平股动脉注射配合口服脑心通胶囊治疗高原地区0级糖尿病足的临床疗效。方法：将84例高原地区0级糖尿病足患者随机分为2组，治疗组42例在基础治疗的同时予以利血平股动脉注射配合脑心通胶囊口服治疗；对照组42例在基础治疗同时予以注射用前列地尔静脉滴注。结果：治疗组总有效率97．6％，对照组总有效率78．6％，两组疗效比较有显著性差异（P〈0．05）。结论：利血平股动脉注射配合脑心通胶囊治疗高原地区0级糖尿病足有较好疗效。     

甘精胰岛素强化治疗2型糖尿病的疗效与安全性分析

60例2型糖尿病患者随机分为两组：一组给予甘精胰岛素和门冬胰岛素治疗,一组给予中效和短效人胰岛素治疗,比较两组降糖效果、达标时间、胰岛素用量和低血糖事件发生率。结果：治疗后两组FPG、2HPG、胰岛素用量无显著性差异（P〉0．05）;达标时间：甘精组短于NPH组（P〈0．01）,低血糖事件发生率：甘精组低于NPH组（P〈0．05）。结论：甘精胰岛素联合门冬胰岛素能有效模拟人的生理胰岛素分泌,尽早使血糖平稳达标,且低血糖发生率较低。     

胰岛素泵治疗糖尿病酮症酸中毒临床探讨

30例DKA病人,随机分为胰岛素泵治疗（CSII）组和常规小剂量胰岛素静脉滴注治疗（对照）组各15例,两组年龄、血糖和体重指数（BMI）相比无显著性差异,结果CSII组与对照组的血糖恢复时间、胰岛素用量无明显差异（P〉0．05）,但CSII组较对照组尿酮体转阴时间、血pH值恢复正常所需时间明显缩短（P〈0．01）,低血糖发生频率明显低于对照组（P〈0．01）。结论胰岛素泵是一种更安全、更快、更有效、更方便的DKA治疗方法。     

“蚕食”清创疗法联合胰岛素局部喷洒治疗糖尿病足30例疗效观察

目的探讨“蚕食”清创疗法联合胰岛素局部喷洒治疗糖尿病足的疗效及安全性。方法将60例糖尿病足患者（均用二甲双胍控制血糖）随机分为观察组和对照组各30例,观察组予“蚕食”清创疗法和胰岛素局部喷洒,对照组行常规清创处理。两组均于换药前0．5h及换药后0．5、1、2、3h经末梢毛细血管测定血糖水平,并于治疗7d后评价疗效。结果观察组和对照组总有效率分别为93％、77％（P〈0．05）;观察组换药后血糖水平较换药前及对照组显著下降（P〈0．05）。结论“蚕食”清创疗法联合胰岛素局部喷洒治疗糖尿病足效果确切,但应注意监测血糖水平。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.