2型糖尿病下肢血管病变炎症因子及丹参的干预作用

目的研究2型糖尿病下肢血管病变炎症因子及丹参对炎症因子的干预作用。方法将2型糖尿病下肢血管病变病人56例分为两组,对照组28例予以基础治疗,治疗组28例在基础治疗上加丹参治疗,另选糖尿病未合并下肢血管病变者20例为非治疗组。结果糖尿病合并下肢血管病变者炎症因子C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)明显高于非治疗组;治疗组治疗后炎症因子明显低于对照组。结论2型糖尿病下肢血管病变病人炎症因子明显升高,丹参能明显减低炎症因子。     

彩色多普勒超声在中老年2型糖尿病下肢血管病变诊断中的应用

2型糖尿病(T2DM)下肢血管病变是糖尿病最常见的慢性并发症之一,常累及肢体大、中、小动脉,并伴有周围神经病变,常因肢体缺血、缺氧,甚至坏疽、感染等病变而使患者失去正常的活动能力[1].据文献报道[2],下肢血管病变发生率达22％～46％,是糖尿病患者致残的主要原因之一.糖尿病下肢血管病变预防重于治疗,早期发现、早期诊断有重要的临床意义.彩色多普勒超声("彩超")能够对血管病变及早发现,以便早期干预[3].     

中药外敷联合马来酸桂哌齐特治疗老年糖尿病下肢血管病的疗效

糖尿病下肢血管病变(LEVD)是老年糖尿病患者常见的大血管病变之一[1].潘长玉等[2]报道,国内90%的病程5年以上的2型糖尿病患者合并下肢动脉病变,约有一半的患者合并重度的下肢动脉病变,严重影响了患者的劳动,严重者可导致肢体坏疽.我们应用自制中药红花祛瘀汤外敷联合马来酸桂哌齐特静滴治疗老年糖尿病下肢血管病变,取得了良好的疗效,现报道如下.     

辛伐他汀治疗糖尿病下肢血管病变前后LPA的变化及意义

糖尿病下肢血管病变是糖尿病严重并发症之一,是糖尿病患者致残的主要原因,患者可因血管狭窄或闭塞而导致肢体坏疽、截肢,严重影响患者的生存质量.其病理改变为动脉粥样硬化(atherosclerosis,AS),而血小板活化是AS形成的关键步骤.溶血磷脂酸(lysophosphatidic acid,LPA)主要来源于活化的血小板,其在血管疾病的作用引起人们强烈的重视[1].有研究发现T2DM及伴下肢血管病变患者均有不同程度的LPA升高,其升高的幅度可反映血管病变的程度,且LPA是糖尿病下肢血管病变的独立危险因素,与总胆固醇呈正相关[2].本研究旨在研究应用辛伐他汀治疗糖尿病下肢血管病变前后对LPA的影响.     

丹奥对糖尿病下肢血管病变的影响

目的探讨丹奥(注射用奥扎格雷钠)对糖尿病病人下肢血管病变血流动力学的影响及临床应用的疗效及安全性.方法选择2型糖尿病并下肢血管病变病人41例,积极控制血糖,应用丹奥注射液80 mg溶于生理盐水250 ml中静脉输注治疗,每日1次,疗程为14 d.治疗前后应用彩色多普勒进行血流动力学检查,并进行肝肾功能、血、尿常规检查.结果治疗后病人症状改善明显,治疗后治疗前下肢血管血流动力学指标均有明显改善,且无不良反应.结论丹奥注射液能改善糖尿病病人下肢血管病变,安全可靠,值得临床推广应用.     

藻酸双酯钠对糖尿病血管病变及血脂的疗效

糖尿病由于缺血、神经病变、血脂代谢异常等易引发一系列并发症,由于高发病率、致残率,越来越引起临床重视.用藻酸双酯钠(Pss)可治疗已发生下肢血管病变者.现对本院2004年度收治的已发生下肢血管病变的100例糖尿病患者的治疗前后疗效观察报告如下:     

2型糖尿病周围血管病变与肾动脉粥样硬化性狭窄的相关性

目的 肾动脉粥样硬化性狭窄(简称肾动脉狭窄,ARAS)是引起老年人高血压的重要原因.探讨糖尿病患者周围血管病变与ARAS的关系.方法 对216例临床拟诊为2型糖尿病合并下肢血管病变患者,进行下肢血管多谱勒超声和肾动脉造影结合数字减影检查,用SPSS10对两组病人的动脉粥样硬化的易患因素[包括年龄、血压、血脂、糖基化血红蛋白(HbA1c)、血肌酐(Cr)等]进行独立t检验、趋势χ2检验和多元logistic回归分析.结果 经血管多谱勒证实的179例下肢血管病变患者中,ARAS及病变的发生率为28.5%;下肢血管超声完全正常的37例糖尿病患者中,无1例有ARAS及病变存在.多元logistic回归分析表明仅年龄大于60岁,HbA1c大于8%,Cr大于100 μmol/L和周围血管病变是ARAS的独立预测因素.结论 对糖尿病合并周围血管病变的患者,应高度警惕ARAS的存在.     

2型糖尿病下肢血管病变的临床流行病学分析

目的探讨和研究2型糖尿病下肢血管病变的临床流行病学。方法选取在武警后勤学院附属医院接受治疗的2型糖尿病患者作为研究对象,将选取患者的身高、体重以及糖尿病的病程、血糖浓度、胆固醇含量和验证因子等临床数据进行分析研究,并对所选患者队形下肢的超声检查。结果选取的1 000例2型糖尿病患者当中共有450例2型糖尿病患者出现了下肢血管病变。并且下肢出现血管病变的患者的年龄、糖尿病病程以及体质指数较未出现下肢血管病变的2型糖尿病患者更高,差异有统计学意义(P0.05)。并且出现下肢血管病变的2型糖尿病患者的超敏C反应蛋白(hsCRP)、总胆固醇含量(TC)以及甘油三酯(TG)的含量均要高出未出现下肢血管病变的患者,但下肢血管病变的2型糖尿病患者的高密度脂蛋白胆固醇(HDL-C)的含量较未出现下肢血管病变的患者更低,差异有统计学意义(P0.05)。结论随着患者的病程以及超敏C反应蛋白(hsCRP)、总胆固醇含量(TC)/高密度脂蛋白胆固醇(HDL-C)以及甘油三酯(TG)d的增加患者出现下肢血管病变的概率将会增大。     

老年糖尿病患者下肢动脉病变与血脂关系

目的 探讨老年糖尿病患者血脂水平与下肢动脉血管并发症的关系.方法 老年糖尿病患者(糖尿病组)260例,同期健康体检老年人(对照组)206例,均测定空腹血糖(FPG)、餐后2 h血糖(PG2h)、TC、TG、HDL-C、LDL-C、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)、纤维蛋白原和血压等,同时行下肢动脉血管彩色多普勒超声检查.结果 (1)糖尿病组FPG、PG2h、TC、TG、VLDL·C、HDL-C、LDL-C、apoB、纤维蛋白原与对照组比较,差异有统计学意义(P<0.05或P<0.01);(2)下肢动脉彩色多普勒超声显示,糖尿病组下肢动脉内中膜明显增厚、斑块多发、病变弥漫、多支血管受累及由此导致的血管狭窄及闭塞,而且以膝关节以下节段性动脉病变为主,狭窄最严重的是胫前动脉,糖尿病组下肢动脉内中膜增厚、斑块、多支血管病变(2条血管以上)、血管狭窄分别为205例(78.85%)、241例(92.69%)、60例(23.08%)和89例(34.23%),对照组分别为37例(17.96%)、51例(24.76%)、27例(13.11%)和3例(0.01%),差异有统计学意义(P<0.01);(3)回归分析显示,下肢血管病变与LDL-C、低水平HDL-C有关.结论 脂代谢异常是血管并发症形成的基础,下肢动脉粥样硬化斑块是糖尿病患者早期主要血管病变之一,彩色多普勒超声检查能及早提示老年糖尿病患者下肢血管病变.     

自体外周血干细胞移植治疗糖尿病下肢血管病变的临床研究

目的 观察自体外周血干细胞移植治疗糖尿病下肢血管病变的临床疗效.方法 100例糖尿病下肢血管病变患者纳入本研究,其中48例自愿接受自体外周血干细胞移植治疗下肢血管病变的患者组成移植组,其余52例患者分配到药物组仅采用药物治疗下肢血管病变.治疗后6个月进行疗效评价.结果 移植组83.3%(40/48)的患者Fontaine分级好转,有效率显著高于药物组(P<0.05).移植组患肢皮温与经皮氧分压均明显升高,治疗前后差值与药物组差异有统计学意义(P<0.01).结论 自体外周血干细胞移植治疗糖尿病下肢血管病变是一种有效的手段.     

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.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.