老年糖尿病患者骨科手术围手术期处理

目的　探讨老年糖尿病患者骨科手术围手术期血糖的控制和对手术的影响。　方法　回顾性分析 3 0例骨疾病并存糖尿病患者接受骨科手术治疗围手术期的血糖调控情况。　结果　 3 0例患者入院时空腹血糖 ( 1 3 .0± 1 .3 ) mmol/L,经术前用胰岛素控制血糖至 ( 7.0± 1 .0 ) mmol/L后 ,分别接受全髋关节置换、股骨头置换、颈椎后路双开门、颈椎前路椎间盘摘除、腰椎 Steeff钢板内固定、腰椎滑脱 CD及 RF脊柱内固定系统复位固定等复杂骨科手术治疗 ,术中及术后继续用胰岛素控制血糖至基本正常水平 ,本组术后血糖为 ( 8.0± 1 .1 ) mmol/L。 3 0例中 ,仅 1例 ( 3 .3 % )伤口愈合不良 ;与同期接受骨科手术的非糖尿病患者 4 0 3 9例中 3 3例 ( 0 .8% )伤口愈合不良比较 ,二者差异无显著性 ,未发生其他并发症。术后患者症状和体征均明显改善 ,肢体功能恢复良好。　结论　老年糖尿病患者经正确的围手术期处理 ,将血糖控制至基本正常水平 ,可耐受复杂的骨科手术。     

糖尿病并冠心病患者冠状动脉旁路移植围术期特点

目的 :研究糖尿病 (DM )并冠心病 (CHD)患者冠状动脉旁路移植术 (CABG)前后临床特征。方法 :回顾性分析我科 2 0 0 0年 1月～ 2 0 0 2年 12月 118例患者 ,其中DM并CHD(DM组 ) 2 2例 ,同期非DM并CHD(对照组 ) 96例的术前准备、手术类型及术后并发症。结果 :DM组平均年龄 (5 9.8± 9.3)岁 ,女性 7例 (31.8% ,P<0 .0 5 ) ;体外循环阻断时间 (92 .0± 4 0 .9)min ,冠状动脉病变远端细小 8例 (36 .4 % ,P <0 .0 5 ) ;术前血糖 (6 .4±1.1)mmol/L ,术中血糖 (16 .1± 2 .3)mmol/L ,术后当天初测血糖 (17.5± 4 .4 )mmol/L ,予静脉推注胰岛素 ,次晨空腹血糖 (11.6± 2 .8)mmol/L ;术后并发肺部感染 7例 ,伤口愈合不良 5例 ,口腔溃疡 5例 ,6个月内复发心绞痛 3例 ,与对照组比较 ,均P <0 .0 5。结论 :DM并CHD患者行CABG病情复杂 ,围术期处理应采取综合疗法     

“降糖煎”对糖尿病血糖疗效的临床观察

目的 :探讨中药益气养阴之剂“降糖煎”对糖尿病空腹血糖水平的影响。方法 :比较 30例降糖煎治疗组和 2 0例中成药降糖舒对照组糖尿病患者的血糖变化。结果 :治疗组有效率为 86 .7% ,对照组有效率为 5 5 % ,两组比较有显著差异 ,P <0 .0 5 ,;治疗组血糖由 9.6 2± 0 .47mmol/L降为 7.32± 0 .36mmol/L(P <0 .0 1) ,对照组由 8.5 9± 0 .45mmol/L降为 7.2 2± 0 .2 3mmol/L (P <0 .0 1)。结论 :益气养阴降糖剂可以改善糖尿病糖代谢紊乱     

瑞格列奈和拜糖平对2型糖尿病降糖作用的比较

目的　比较瑞格列奈和拜糖平治疗 2型糖尿病时的降糖作用。方法　将 5 6例 2型糖尿病患者分为瑞格列奈组 3 2例和拜糖平组 2 4例 ,观察治疗 8周。定期检测患者的空腹及餐后血糖、HbA1c、C肽和体重。结果　瑞格列奈组的空腹血糖从 (11.0 1± 1.63 )mmol/L降至 (6.73±1.47)mmol/L(P <0 .0 1) ,平均下降了 3 .47mmol/L ;拜糖平组空腹血糖从 (10 .43± 0 .5 3 )mmol/L降到 (7.0 5± 1.2 1)mmol/L (P <0 .0 1) ,平均下降了 2 .84mmol/L。瑞格列奈组的餐后血糖从(13 .98± 2 .5 6)mmol/L降至 (8.67± 2 .5 9)mmol/L(P <0 .0 1) ,拜糖平组的餐后血糖从 (14 .17±3 .71)mmol/L降至 (8.80± 2 .14 )mmol/L(P <0 .0 1)。瑞格列奈和拜糖平都能明显降低HbA1c(P <0 .0 1) ,分别降低 1.16%和 0 .91%。两药对C肽和体重均无明显影响。结论　瑞格列奈和拜糖平均有明显的降低空腹和餐后血糖以及HbA1c的作用。瑞格列奈降空腹血糖的作用优于拜糖平 ,两种药物对餐后血糖和HbA1c的降低程度相似。     

西洛他唑对OLETF大鼠胰岛素敏感性的影响

目的　探讨西洛他唑对自发 2型糖尿病的动物模型OLETF大鼠胰岛素敏感性的影响。　方法　将雄性OLETF大鼠在 32周龄时根据体重及胰岛素耐量试验中 5 0min血糖下降百分率随机分成三组 :正常喂养组 ,罗格列酮治疗组及西洛他唑治疗组 ,每组 7只鼠。测给药 2 9d后的血脂水平 ;给药 38d后测空腹血糖 ,以正常血糖高胰岛素钳夹技术对以上各组进行胰岛素敏感性评价。　结果　西洛他唑组血甘油三酯水平 ( 1.95± 0 .19mmol/L)较对照组 ( 3.11± 0 .32mmol L)降低 (P <0 .0 1) ;胆固醇 ( 1.32± 0 .17mmol/L)较对照组 ( 2 .2 6± 0 .17mmol/L)降低 (P <0 .0 1) ;游离脂肪酸 ( 0 .46± 0 .11mmol/L)较对照组 ( 1.5 3± 0 .35mmol/L)降低 (P <0 .0 5 ) ;葡萄糖输注速率 ( 11.0 4±1.12mg·kg- 1 ·min- 1 )较对照组 ( 7.33± 1.12mg·kg- 1 ·min- 1 )增加 (P <0 .0 1) ;空腹血糖 ( 6 .1± 0 .7mmol/L)较对照组 ( 7.87± 1.2 3mmol/L)有所下降 ,但差异无显著意义 (P >0 .0 5 )。　结论　西洛他唑能改善OLETF大鼠的胰岛素敏感性。     

胰岛素口腔喷雾剂治疗糖尿病有效性和安全性的初步临床观察

目的　评价胰岛素口腔喷雾剂 (华中科技大学药物研究所制备 )治疗糖尿病的有效性及安全性。方法　采用开放、多中心、随机、自身交叉、阳性对照研究 ,共入选 61例糖尿病患者 ,随机分为两组 ,分别先用试验药胰岛素口腔喷雾剂或对照药短效胰岛素皮下注射剂 ,经 4周观察 (2周剂量调整期 ,2周维持期 )后交换药物种类 ,分别于试验前、交叉改用试验或对照药前、试验结束时测空腹和餐后 1h、2h血糖及安全性指标。结果　经一个月的胰岛素口腔喷雾剂治疗 ,能有效地降低空腹血糖、餐后 1、2h血糖、固定餐试验血糖曲线下面积 ,治疗前、后值分别为 (10 .7± 3 .2到 8.7± 2 .4,15.0± 4.3到 12 .5± 3 .2、15.7± 5.1到 11.9± 3 .5)mmol/L及 (2 8.2 4± 7.91到 2 2 .74± 5.74)mmol·L- 1·h ,其差异均有显著性 (P =0 .0 0 1) ;而与胰岛素皮下注射剂相比 ,治疗后空腹血糖差异无显著性〔(8.66± 2 .42对 8.55± 2 .3 6)mmol/L〕 ,而餐后1h、2h血糖差异有显著性〔分别为 (12 .48± 3 .15对 10 .93± 3 .0 3 )mmol/L ,P <0 .0 5;(11.87± 3 .48对 9.87± 3 .2 8)mmol/L ,P <0 .0 1〕 ,口腔喷雾剂降糖效果不如皮下注射 ,胰岛素口腔喷雾剂和胰岛素皮下注射剂的药量比约为 5.46:1。安全性指标治疗前后差异无显著性。两种     

糖尿病低血钙致明显J波1例

患者,男,52岁。糖尿病8年,近半个月精神差、胸闷、心慌,入我院急诊科。T35·5℃(腋下)P74次/min,BP90/60mmHg(1mmHg=0·133kPa),HR75次/min,律齐,各瓣膜区未闻及病理性杂音,两肺呼吸音稍粗糙,腹软、肝脾肋下未触及。血常规各项指标在正常范围,查心肌酶谱正常,随机血糖7·8mmol/L,血K+4·9mmol/L,Na+135mmol/L,Cl-98mmol/L,Ca2+1·5mmol/L,尿蛋白++,尿素氮7·0mmol/L(正常2·5~6·4mmol/L),血肌酐130mmol/L(正常70~121mmol/L),尿酮体(+),超声心动图检查、X线胸片均未见异常。临床诊断:2型糖尿病,糖尿病肾病,低血钙。心电图示(图1),…     

糖尿病合并甲状腺机能亢进症24例分析

我院 198 0年至 1999年收治 2 4例糖尿病合并甲状腺机能亢进症 (简称甲亢 )患者 ,现分析如下。一、临床资料2 4例均符合 WHO糖尿病诊断标准 ,其中 T1DM型 4例 ;T2 DM型 2 0例。男 6例 ,女 18例 ,年龄 2 2～ 6 4岁 ,平均年龄38.6岁。病程 6月至 2 0年。合并甲亢距诊断糖尿病 3月至 15年。 2 4例糖尿病患者在确诊糖尿病并给予降糖药物治疗过程中 ,渐出现消瘦 ,“三多”症状明显加重 ,血糖增高而原有降糖药物难以控制。 2 4例糖尿病患者空腹血糖 14.32± 3.2 1mmol/ L ,餐后 2 h血糖为 17.35± 3.6 2 mmol/ L。 FT38.2 3± 3.12 pg/ ml(…     

糖尿病性胃轻瘫综合治疗疗效分析

糖尿病性胃轻瘫为糖尿病消化道常见并发症 ,发病率达50 %～ 70 % ,对血糖控制产生不利影响。用综合治疗方案 (高纤维素饮食 +盐酸依托必利 )治疗报道较少 ,我们临床应用取得较好疗效 ,现总结报告如下。对象与方法1 对象 :2 0 0 2年～ 2 0 0 3年 6月间收治 60例糖尿病住院病人 ,符合 2 0 0 0年诊断标准[1],男 3 5例 ,女 2 5例。Ⅰ型糖尿病 10例 ,Ⅱ型糖尿病 50例。年龄 13～ 65岁 ,平均 55± 3 4岁。平均病程 6 5± 3 2年。空腹血糖 10 2～ 18 5mmol/L ,平均 14 3±3 2mmol/L。临床出现不同程度的恶心、早饱、餐后腹胀、纳差、呕吐、腹…     

住院期间血糖升高对急性冠状动脉综合征患者近期预后的影响

目的:观察住院期间血糖升高对急性冠状动脉综合征(ACS)患者近期预后的影响。方法:对786例ACS患者入院4d内进行空腹血糖测定。根据空腹血糖,把患者分为糖尿病血糖异常组(空腹血糖>6·67mmol/L)、非糖尿病血糖异常组、血糖正常组(空腹血糖≤6·67mmol/L)。结果:496例(63·1%)ACS患者空腹血糖>6·67mmol/L,其中确诊糖尿病患者218例(27·7%),血糖升高组多为高龄女性,住院期间心肌缺血事件发生率及病死率明显高于血糖正常组(P<0·05)。结论:住院期间血糖升高是影响ACS患者预后的一个重要的危险因素,对血糖升高的患者应给予积极的治疗。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.