Insulin therapy: progress and prospects

Approaches to better control of diabetes with more sophisticated insulin therapy are being tested in the hope that they will prevent the sequelae that incapacitate and kill. Some of the regimens and techniques are relatively simple and practicable; others are less easily implemented; still others are speculative. Collectively, they add up to an encouraging outlook for effective treatment.     

HIV感染及抗病毒治疗与糖尿病关系研究进展

随着抗病毒治疗的广泛使用,HIV感染者的预期寿命、生活质量得到较大改善。与此同时,HIV相关的代谢性疾病,尤其是糖尿病的患病风险也有所增加。HIV感染者中糖尿病的风险增加与很多因素共同作用有关。近年来研究表明HIV感染及抗病毒治疗与糖尿病密切相关。本文综述了近年来HIV感染及抗病毒治疗在糖尿病发生发展中的作用机制。     

妊娠糖尿病的饮食治疗

通过对 12例已确诊的妊娠糖尿病患者进行饮食治疗 ,治疗前后血糖、尿糖、尿酮有显著性差异 ( P<0 .0 5 ) ,提示饮食治疗效果显著。出生的新生儿经产后 4 d临床观察均健康 ,产妇分娩后血糖恢复正常。说明饮食与妊娠糖尿病关系密切 ,合理的饮食治疗有助于母亲和胎儿健康 ,减少流产、早产及巨大儿等发生。     

妊娠糖尿病的饮食治疗

通过对12例已确诊的妊娠糖尿病患者进行饮食治疗,治疗前后血糖、尿糖、尿酮有显著性差异(P＜0.05),提示饮食治疗效果显著.出生的新生儿经产后4 d 临床观察均健康,产妇分娩后血糖恢复正常.说明饮食与妊娠糖尿病关系密切,合理的饮食治疗有助于母亲和胎儿健康,减少流产、早产及巨大儿等发生.     

Pancreatic islet and stem cell transplantation: new strategies in cell therapy of diabetes mellitus

Long-term studies strongly suggest that tight control of blood glucose can prevent the development and retard the progression of chronic complications of type 1 diabetes mellitus. In contrast to conventional insulin treatment, replacement of a patient's islets of Langerhans either by pancreas organ transplantation of by isolated islet transplantation is the only treatment to achieve a constant normoglycemic state and avoiding hypoglycemic episodes, a typical adverse event of multiple daily insulin injections. However, the expense of this benefit is still the need for immunosuppressive treatment of the recipient with all its potential risks. Islet cell transplantation offers the advantage of being performed as a minimally invasive procedure, in which islets can be perfused percutaneously into the liver via the portal vein. As of June 2003, 705 pancreatic islet transplants worldwide have been reported to the International Islet Transplant Registry (ITR) at our Third Medical Department, University of Giessen/Germany. Data analysis shows at 1 year after adult islet transplantation a patient survival rate of 97%, a functioning islet graft in 54% of the cases, whereas insulin independence was meanwhile achieved in 20% of the cases. However, using a novel protocol established by the Edmonton Center/Canada, the insulin independence rates have improved significantly reaching meanwhile a 50-80% level. Finally, the concept of islet cell or stem cell transplantation is most attractive since it offers many perspectives: islet cell availability could become unlimited and islet or stem cells my be transplanted without life-long immunosuppressive treatment of the recipient, just to mention 2 of them.     

Stem cell therapy for neurological disease and injury

Despite the anatomical protection provided to the central nervous system (CNS) by the skull and vertebral column, it is still vulnerable to a variety of injuries as well as a number of neurodegenerative diseases. There is little endogenous repair of the CNS, so functional recovery from injury is typically modest. Most neurodegenerative diseases are progressive in their course and few effective therapies exist to delay this disease progression or to promote any recovery. With the understanding that the adult brain can support the generation of new neurons in certain locations and with advances in understanding the biology of such stem or progenitor cells, there is now considerable hope that neural or non-neural derived stem cells can be used for structural brain repair. This review provides an overview of our current understanding of the biology of neural stem cells and their ability to integrate into the mature CNS. The prospects for using grafted stem cells or recruiting endogenous stem cells to treat neurological injury or disease are evaluated.     

Prediction and prevention of type 1 diabetes mellitus: initial results and recent prospects

Epidemiological studies indicate that the incidence and prevalence of type 1 diabetes mellitus is rising worldwide. The increase in incidence has been most prominent in the youngest age group of childhood. Prediction of type 1a autoimmune diabetes can be established by a positive family history or by genetic, immunological or metabolic markers. Prevention of type 1 diabetes can be implemented at three different levels of pathogenesis: primary prevention in individuals without any sign of beta-cell damage, secondary prevention in individuals with signs of beta-cell destruction and tertiary prevention in patients with newly diagnosed type 1 diabetes. In recent years our knowledge of the disease pathogenesis has grown quickly, and several new prevention trials have been initiated worldwide. Immunologic intervention for type 1 diabetes will prove to be probably the most effective.     

Stem cell strategies for Alzheimer's disease therapy

We have found much evidence that the brain is capable of regenerating neurons after maturation. In our previous study, human neural stem cells (HNSCs) transplanted into aged rat brains differentiated into neural cells and significantly improved the cognitive functions of the animals, indicating that HNSCs may be a promising candidate for cell-replacement therapies for neurodegenerative diseases including Alzheimer's disease (AD). However, ethical and practical issues associated with HNSCs compel us to explore alternative strategies. Here, we report novel technologies to differentiate adult human mesenchymal stem cells, a subset of stromal cells in the bone marrow, into neural cells by modifying DNA methylation or over expression of nanog, a homeobox gene expressed in embryonic stem cells. We also report peripheral administrations of a pyrimidine derivative that increases endogenous stem cell proliferation improves cognitive function of the aged animal. Although these results may promise a bright future for clinical applications used towards stem cell strategies in AD therapy, we must acknowledge the complexity of AD. We found that glial differentiation takes place in stem cells transplanted into amyloid-( precursor protein (APP) transgenic mice. We also found that over expression of APP gene or recombinant APP treatment causes glial differentiation of stem cells. Although further detailed mechanistic studies may be required, RNA interference of APP or reduction of APP levels in the brain can significantly reduced glial differentiation of stem cells and may be useful in promoting neurogenesis after stem cell transplantation.     

Non-profit multi-hospital organizations: challenges and prospects

This study seeks to determine the relative importance of factors non-profit hospital administrators rely on in their decisions to join a non-profit multihospital organization (MO) and their assessments of an MO in satisfying these motives. A related objective of the study is to determine whether or not the administrators of different types of hospitals (i.e. general vs specialty, member of a national vs non-national MO and church-affiliated vs non-church affiliated) differ in their judgements. The analytical framework of the importance-performance technique is used in analyzing the data gathered from the top administrators of a nation-wide sample of hospitals in the USA. Results and implications of the study are discussed.