2型糖尿病血管紧张素转换酶基因与隐性心肌缺血的关系

目的　为了探讨2型糖尿病(diabetes mellitus,DM)患者血管紧张素转换酶(angiotensinconverting enzyme,ACE)基因与运动诱发的隐性心肌缺血(exercise- induced silent myocardial ischemia,SI)的关系。方法　选择静息心电图正常的2型DM患者10 8例和5 0名健康人。采用踏车运动试验进行筛选SI。应用PCR技术检测ACE基因。结果　(1)对照组及2型DM组ACE基因型及等位基因频率分布相似(P>0 .0 5 )。与非SI组比较,SI组ACE D等位基因频率明显增高(χ2 =4 .5 0 1,P<0 .0 5 ) ,两组ACE基因型频率分布相似(P>0 .0 5 )。(2 ) 2型DM患者不同ACE基因型组间临床特征及血脂水平相似(P>0 .0 5 )。(3) 2型DM患者DD型SI发生率为6 8.2 % ,明显高于II基因型组的39.5 % (χ2 =4 .5 93,P<0 .0 5 )。结论　ACE D等位基因增高2型DM患者并发SI的危险性。     

The excitability of human cortical inhibitory circuits responsible for the muscle silent period after transcranial brain stimulation

The silent period after transcranial magnetic brain stimulation mainly reflects the activity of inhibitory circuits in the human motor cortex. To assess the excitability of the cortical inhibitory mechanisms responsible for the silent period after transcranial stimulation, we studied, in 15 healthy human subjects, the recovery cycle of the silent period evoked by transcranial and mixed nerve stimulation delivered with a paired stimulation technique. The recovery cycle is defined as the time course of the changes in the size or duration of a conditioned test response when pairs of stimuli (conditioning and test) are used at different conditioning-test intervals. The recovery cycle of the duration of the silent period in the first dorsal interosseous (FDI) muscle during maximum voluntary contraction after transcranial magnetic stimulation was studied by delivering paired magnetic shocks (a conditioning shock and a test shock) at 120% motor-threshold intensity. Conditioning-test intervals ranged from 20-550 ms. The recovery cycle of the silent period in the FDI muscle during maximum voluntary contraction after nerve stimulation was evaluated by paired, supramaximum bipolar electrical stimulation of the ulnar nerve at the wrist (conditioning-test intervals ranging from 20 to 550 ms). Electromyographic activity was recorded by a pair of surface-disk electrodes over the FDI muscle. The recovery cycle of the silent period after transcranial magnetic stimulation delivered through the large round coil showed two phases of facilitation (lengthening of the silent period), one at 20-40 ms and the other at 180-350 ms conditioning-test intervals, with an interposed phase of inhibition (shortening of the silent period) at 80-160 ms. The conditioning magnetic shock left the size of the test motor-evoked potentials statistically unchanged during maximum voluntary contraction. Paired transcranial stimulation with a figure-of-eight coil increased the duration of the test silent period only at short conditioning-test intervals. Conditioning nerve stimulation left the silent period produced by test nerve stimulation unchanged. In conclusion, after a single transcranial magnetic shock, inhibitory circuits in the human motor cortex undergo distinctive short-term changes in their excitability, probably involving different mechanisms.     

糖尿病对精液质量的影响及其机制

糖尿病是由多种病因引起的代谢性疾病,不仅影响男性性功能而且影响男性精液质量。本文综述了糖尿病对男性精液的影响如精子活动力、精子密度、精子DNA损伤等及其发生机制。     

糖尿病患者个性EPQ评定

目的 探讨糖尿病患者个性特征。方法 以艾森克个性问卷为工具，对７２例患者和７例正常健康志愿进行对照研究。结果 糖尿病患者Ｎ量表和Ｐ量表分显著高于对照组，性格呈不稳定型也显著多于对照组。结论 糖尿病患者具有性格不稳定和精神质的个性特征。     

长链非编码RNA与糖尿病关系的研究进展*

Long non-coding RNAs (lncRNAs) are a group of RNAs, which are longer than 200 nucleotides without containing functional open reading frame and cannot encode protein. The study of lncRNA will help to understand the multi-level expression regulatory network of the body, and is expected to provide the basis of prediction, diagnosis and treatment of complex diseases. Although the functions and mechanism of lncRNA remain unclear, some studies indicate that lncRNA is involved in the development of diabetes mellitus, and those lncRNAs may be new diagnostic markers and therapeutic targets.     

The cutaneous silent period in carpal tunnel syndrome

OBJECTIVES: The cutaneous silent period (CSP), a sustained voluntary contraction following a painful stimulus applied over the appropriate dermatome produces a brief period of electrical silence, may be useful if the routine nerve conduction studies and needle electromyography are insufficient to diagnose entrapment neuropathies. MATERIAL AND METHODS: To investigate whether symptomatic or asymptomatic patients with entrapment neuropathies are differed in terms of CSP, one hundred fifty four hands of 58 patient and 19 controls were studied according to the clinical and electrophysiological findings. RESULTS: CSP latency and duration could be affected in severe forms of entrapment neuropathies. However, even in patients with dysesthetic pain -which lead to the belief that small fibers may be involved-, results of electrophysiological evaluation could not support the clinical findings. CONCLUSION: In this study it was suggested that CSP studies provide no additional information in entrapment neuropathies.     

Nodular fibrosis of the lung in diabetes mellitus

The target organs in diabetes mellitus include the kidneys, the eyes and the small vessels. In these organs some specific histopathological changes have been described but there are few reports of histopathoogical changes in the lung in diabetic patients. Several reports describe abnormal pulmonary function in diabetic patients and consider these abnormalities to be due to histopahtological changes found in the pulmonary vessels. We have studied the histopathological changes in the diabetic lung comparing the findings in the autopsies of 61 diabetic and 50 non-diabetic patients. Statistically significant differences in the incidence of chronic obstructive lung disease and pulmonary haemorrhage exist. There are no differences in the incidence of fibrosis of the alveolar walls or intimal and medial thickening of small vessels, changes associated with diabetes according to the literature. We have found a specific type of nodular fibrosis not previously reported which we believe to be typical of diabetes.     

Plasma catecholamines and renin in diabetes mellitus

Summary Plasma and urinary norepinephrine (PNE, UNE) and epinephrine, plasma renin activity (PRA) and their interrelations with posture, age, the body sodium-volume state and blood pressure were analyzed in 90 normal and 100 non-azotemic diabetic subjects. Ages ranged from 18 to 76 yrs, urinary sodium from 51 to 249 mEq/24h. Fortysix patients had a normal supine blood pressure, 54 had hypertension. Diabetics had an increased (p<0.01) mean exchangeable sodium, while blood volume was normal. Upright posture caused a comparable increase in PNE in normal and diabetic subjects; but the response of PRA was blunted (p<0.001) in diabetics, with subnormal responsiveness in 32% of cases. Epinephrine levels in diabetics were normal and unchanged with posture or age. In both groups supine and upright PNE and PRA correlated (p<0.05) positively with age, but not with urinary sodium. Comparison with dynamic normal ranges relative to age revealed low upright PNE in 14% and low or high PRA in 12 and 6% of diabetics, respectively. The low-norepinephrine subgroup had a higher exchangeable sodium and lower PRA than the normal-norepinephrine patients (p<0.025). Low-renin patients had a higher exchangeable sodium and lower UNE than normal or high-renin patients. Orthostatic decrease in blood pressure was noted in low or normal-renin, but not in high-renin patients. These findings suggest that patients with non-azotemic diabetes mellitus have usually a normal adrenergic response to postural changes; and physiological variations of PNE and PRA with age are largely maintained. However, diminished renin-responsiveness is common. Distinct sodium retention could contribute to norepinephrine or renin suppression in some patients and possibly also to the frequent development of hypertension in diabetes mellitus.This work was supported by the Swiss National Science Foundation     

Ultrastructural studies of the rat submandibular gland in streptozotocin induced diabetes mellitus

Summary Increased fluid intake (polydipsia) is one of the classic symptoms of diabetes mellitus. Xerostomia (dry mouth) and resultant thirst are other symptoms of the disease and bear a close relationship to polydipsia. The xerostomia in individuals with diabetes is primarily due to decreased saliva flow which appears to be associated with degenerative changes in the salivary glands. This study examines the response of the rat submandibular gland to streptozotocin induced diabetes mellitus. Adult male rats were given a single I.V. dose of streptozotocin (65 mg/kg body weight) in citrate buffer (pH 4.5). Salivary glands were examined by light and electron microscopy at 4, 8 and 24 h and 3, 7, 14 and 21 days posttreatment. The changes in the acinar cells were characterized by an accumulation of secretory material within the cytoplasm. This secretory protein accumulation was followed by degenerative changes in the acinar cells which frequently resulted in cell death and replacement of secretory cells by connective tissue elements. The loss of secretory volume and potential changes in secretory kinetics are discussed with regard to the xerostomia, thirst and polydipsia exhibited by individuals with diabetes mellitus.This work was supported in part by N.I.H. grant DE-03933. We would like to thank Mrs. Valerie Every for her secretarial assistance.     

32例糖尿病患者交感神经皮肤反应的探讨

目的 :应用交感神经皮肤反应 (SSR)探讨与糖尿病 (DM)相关的植物神经功能状况。方法 :对 32例DM患者及正常组采用电刺激法进行SSR检测。结果 :正常组SSR波形可分为三种类型 :P型、N型、M型 ,其中M型易产生适应性 ,受皮温、刺激强度、深呼吸等影响。 32例DM患者SSR潜伏期异常 17例 ,异常率为 5 3%。DM组与正常组的SSR相比 ,潜伏期和波幅的差异均有非常显著性意义 (P <0 0 1)。病程≤ 5年DM组与正常组的SSR相比 ,潜伏期和波幅的差异均有显著性意义 (P <0 0 5 ) ;而与病程 >5年DM组相比 ,仅潜伏期差异显示显著性意义 (P <0 0 5 ) ,波幅虽有降低 ,但无统计学差异。结论 :SSR可以评价DM患者的植物神经功能状况 ,尤其是潜伏期更有价值 ,可以作为一项动态观察指标。     

2型糖尿病患者的肺弥散功能检测分析(英)

目的：检测2型糖尿病患者的肺通气和弥散功能，探讨肺脏是否为糖尿病慢性病变的靶器官。方法： 对107名2型糖尿病患者行肺通气及弥散功能检测，并与61名年龄、性别匹配的健康者比较。糖尿病患者需行糖化血红蛋白（HbA1c）、尿白蛋白排泄率（AER）检测、眼底检查以及神经传导速度检查，以评价血糖控制水平以及糖尿病微血管病变状况。结果： 2型糖尿病组肺通气功能与正常对照组相比，无显著差异。2型糖尿病组一氧化碳弥散量（DLCO）及单位肺泡容积的一氧化碳弥散量（DLCO/VA）较对照组明显降低（P<0.05）。DLCO、DLCO/VA与微血管病变积分呈负相关（r分别为-0.291、 -0.324，P<0.01）。此外，DLCO/VA还与年龄、病程呈负相关（r分别为-0.269、-0.236，P<0.05）。结论： 2型糖尿病患者虽然肺通气功能基本正常，但有弥散功能受损，提示肺脏可能也是糖尿病慢性病变的靶器官之一。     

Cortical silent period following TMS in a patient with supplementary sensorimotor area seizures

The cortical silent period (CSP) following transcranial magnetic stimulation (TMS) was evaluated in a patient with a dysembrioplastic neuroepithelial tumor (DNET) in the lateral portion of the right superior frontal gyrus (SFG) who suffered from supplementary sensorimotor area (SSMA) seizures. CSP duration was shortened on the affected side. Ipsilateral alterations of motor cortex excitability with TMS in epileptogenic DNET located outside the PMA argue in favour of cortico-cortical connections to primary motor cortex from SSMA. This functional connectivity should be taken into consideration to better understand the pathophysiology of ictal motor manifestations.     

Localized insulin-derived amyloidosis in patients with diabetes mellitus: a case report

Three patients with insulin dependent type 1 diabetes mellitus and one with insulin dependent type 2 diabetes mellitus developed localized amyloid tumors at their general insulin injection sites. All 4 patients (two women and two men) were treated with modern recombinant human insulin or insulin analogues. In addition, 1 patient had used both recombinant and animal insulin. The amyloid tumors were resected and examined histologically using Congo red staining and immunohistochemistry. Insulin was found to be the major component of the amyloid tumors in all four patients. These 4 cases were diagnosed recently within a relatively short period of time, which leads to the conjecture that local insulin-derived amyloid tumors remain principally a differential diagnosis of skin tumors in insulin-dependent diabetic patients.     

Adrenergic mechanisms and blood pressure regulation in diabetes mellitus

Summary Changes in blood pressure (BP) and plasma norepinephrine (NE) following various stimuli of the sympathetic nervous system were studied in six healthy subjects and in 17 diabetic patients. The latter were subdivided in three groups: (1) six patients with neither peripheral neuropathy nor autonomic dysregulation, (2) six patients with severe peripheral neuropathy without autonomic dysregulation, and (3) five patients with autonomic dysregulation, three of whom suffered also from peripheral neuropathy. The following procedures were performed: (1) cold pressor test (2 min), (2) mechanical irritation of the skin by suction (0.75 kg/cm², 10 min), (3) orthostasis (10 min), and (4) i.v. infusion of NE (50, 100, 200 ng kg^–1 min^–1 for 15 min each). Both the stimulated endogenous plasma NE levels and BP response to exogenous NE were the same in normal subjects, in diabetic controls and in diabetics with peripheral neuropathy without autonomic dysregulation. In contrast, diabetics with postural hypotension showed a less pronounced release of NE to standing (P<0.05), but not to cold pressor test and mechanical skin irritation. Furthermore, they showed increased vasoreactivity to the highest dose (P<0.05), but not to the lower doses of exogenous NE. Thus NE release and adrenergic BP regulation seem to be altered only in diabetics with clinical signs of autonomic dysregulation. These alterations can only be evaluated when patients are exposed to stimuli of higher intensity, such as orthostasis or infusion of a high NE dose.     

Asymptomatic bacteriuria in diabetes mellitus patients in Southwest Cameroon

Background

Asymptomatic bacteriuria (ASB) is common in diabetics and predisposes these patients to more severe urinary tract infections (UTIs). Reports on the prevalence and etiology of ASB especially in developing countries appear contradictory.

Objectives

To determine the prevalence and etiology of ASB and antimicrobial resistance of urinary isolates in diabetics and non-diabetics.

Methods

The study involved a total of 265 participants including 154 diabetes mellitus patients and 111 non-diabetics in Southwest Cameroon. Mid-stream urine was collected from consented subjects and each sample tested using the dipstick, microscopy and culture techniques. Isolates were identified using standard biochemical tests.

Results

ASB was detected in 33.2% of participants; 38.3% in diabetics and 26.1% in non-diabetics (P = 0.03). Coagulase-negative staphylococci (CNS) were the predominant organisms (36.3%) isolated from urine in both diabetics and nondiabetics. Other isolates included Klebsiella sp (15.9%), Candida sp (13.7%), E. coli (10.8%) and Serratia sp (10.8%). Candida sp was isolated more from diabetics than non-diabetics (P = 0.01). There was no significant difference in resistance between diabetics and non-diabetics (P > 0.05). Most isolates showed multiple resistance and ciprofloxacin was the most active ingredient against bacterial uropathogens.

Conclusion

The study revealed a high prevalence of ASB in diabetics than in non-diabetics. A change in the aetiologic spectrum was observed with Staphylococcus sp accounting for majority of ASB. Most isolates showed multiple resistance in both diabetics and non-diabetics; therefore the need to speed up sensitization against antibiotic abuse in Southwest Cameroon.     

Pervanadate对大鼠类I型糖尿病的影响

钒盐衍生物 (ｐｅｒｖａｎａｄａｔｅ)在离体研究中表现出多种明显的类胰岛素效应 ,包括促脂质生成 ,促蛋白合成和抗脂质分解等 ,但其在体研究的报道并不多见。本研究旨在观察ｐｅｒｖａｎａｄａｔｅ对链脲菌素 (ｓｔｒｅｐｔｏｚｏｃｉｎ ,ＳＴＺ)所致大鼠类Ｉ型糖尿病的血糖水平的影响 ,并探讨其可能机制 ,以期为糖尿病的研究和治疗提供新的资料。材　料　和　方　法1　动物模型雌性Ｗｉｓｔａｒ大鼠 ,体重 1 4 0 - 1 60ｇ ,ＳＴＺ(Ｓｉｇｍａ)溶于 0 1ｍｏｌ/Ｌ柠檬酸缓冲液 (ｐＨ 4 5)中 ,按 65ｍｇ/ｋｇ体重尾静脉一次注射复制类Ｉ型…     

Plasma adiponectin and insulin resistance in Korean type 2 diabetes mellitus

Insulin resistance, which implies impairment of insulin signaling in the target tissues, is a common cause of type 2 diabetes. Adipose tissue plays an important role in insulin resistance through the dysregulated production and secretion of adipose-derived proteins, including tumor necrosis factor-alpha, plasminogen activator inhibitor-1, leptin, resistin, angiotensinogen, and adiponectin. Adiponectin was estimated to be a protective adipocytokine against atherosclerosis, and also to have an anti-inflammatory effect. In this study, the relationship between fasting plasma adiponectin concentration and adiposity, body composition, insulin sensitivity (ITT, HOMAIR, QUICK), lipid profile, fasting insulin concentration were examined in Korean type 2 diabetes. The difference in the adiponectin concentrations was also examined in diabetic and non-diabetic subjects, with adjustment for gender, age and body mass index. 102 type 2 diabetics and 50 controls were examined. After a 12-h overnight fast, all subjects underwent a 75 gram oral glucose tolerance test. Baseline blood samples were drawn for the determinations of fasting plasma glucose, insulin, adiponectin, total cholesterol, triglyceride, LDL-cholesterol, and HDL-cholesterol. The body composition was estimated using a bioelectric impedance analyzer (Inbody 2.0). The insulin sensitivity was estimated using the insulin tolerance test (ITT), HOMAIR and QUICK methods. In the diabetic group, the fasting adiponectin concentrations were significantly lower in men than in women. They were negatively correlated with BMI (r=-0.453), hip circumference (r=-0.341), fasting glucose concentrations (r=-0.277) and HOMAIR (r= -0.233). In addition, they were positively correlated with systolic blood pressure (r=0.321) and HDL-cholesterol (r= 0.291). The systolic blood pressure and HDL-cholesterol were found to be independent variables, from a multiple logistic regression analysis, which influenced the adiponectin concentration. Compared with the non-diabetic group, the adiponectin concentrations were significantly lower in the diabetic group, with the exception of obese males. In conclusion, the plasma adiponectin concentrations were closely related to the insulin resistance parameters in Korean type 2 diabetic patients.     

Peripheral neuropathy in patients with diabetes mellitus presenting as Bell's palsy

The aim of this study is to evaluate the peripheral nerves in diabetes mellitus with or without peripheral facial paralysis (PFP). A total of 49 diabetic patients with PFP within the last year (23 females, mean age 60.3 +/- 9.3), and 83 diabetic patients without PFP (41 females, mean age 59.5 +/- 9.9) were enrolled. The neurological examination, eye-blinking response, needle EMG and electrophysiological parameters of peripheral nerves were evaluated. The neuropathic pain, other positive and negative sensory symptoms were statistically more frequent in controls than the PFP group, while no difference was noted in total neuropathy score. Sural sensorial nerve action potential amplitudes were same in both groups, but median nerve amplitudes were significantly lower in the PFP group. It is suggested that PFP is not a part of multifocal neuropathy in diabetes mellitus. However, at least some parts of the nerve conduction studies were involved, focal neuropathies were more frequent while sensory neuropathies with small nerve fiber involvement were less frequent in diabetes patients with PFP.     

Evaluation of autonomic neuropathy in diabetes mellitus

Summary Quantitative assessment of signs or symptoms of neuropathy, and the beat-to-beat variation, valsalva, orthostasis, handgrip and cold pressor tests, and measurements of plasma renin and catecholamine excretion rate were performed in 23 diabetic patients and 10 age-matched normal subjects.Significant inverse correlations were found between the clinical score and the beat-to-beat variation (a test of efferent vagus function) (r=-0.72,P<0.0005) or the pressor response to handgrip (possible test of efferent sympathetic integrity (r=-0.55,P<0.005) or the values of both tests combined (r=-0.79,P«0.0005); but not with the other measured parameters. Beat-to-beat variation was abnormal in all 9 diabetics with increased and in 9 of 14 with normal clinical score, whereas only seven and one patient from these subgroups, respectively, had an abnormal Valsalva ratio. The pressor response to handgrip was only slightly reduced in the diabetic patients, with greater tendency in those with abnormal clincal score. Additional possible indices of adrenergic dysfunction such as the pressor response to cold stimulus, plasma renin levels and noradrenaline or adrenaline excretion rates did not differ significantly between normal subjects and diabetics.These findings demonstrate a greater prevalence of parasympathetic as compared to sympathetic impairment in diabetic autonomic neuropathy; the beat-to-beat variation was the most sensitive among the tests used. An assessment of clinical evidence combined with non-invasive functional procedures such as the beat-to-beat variation and handgrip tests provide a valuable and easy to perform tool in the evaluation of diabetic neuropathy.     

Kidney biopsy findings in cyclosporine-treated patients with insulin-dependent diabetes mellitus

Summary Renal biopsy specimens of 40 patients with recent-onset insulin-dependent diabetes mellitus treated with cyclosporine (CSA) for 6–29 months were examined. Cyclosporine-associated chronic vascular interstitial toxicity of moderate intensity was found in 10 patients (25%). The most prominent lesions were interstitial fibrosis and tubular atrophy. Arteriolopathy was less pronounced and glomerular damage unremarkable.A significant correlation exists between the extent of tubular atrophy and CSA trough whole blood levels.These data indicate that the development of CSA-associated chronic nephropathy is dose-dependent.