原发性高血压患者代谢综合征发病情况及相关危险因素分析

目的：探讨原发性高血压患者代谢综合征（MS）的发生率及其相关危险因素。方法：对1136例原发性高血压患者依据中华医学会糖尿病分会关于MS的定义进行MS筛查,并对年龄、性别、高血压病程、腹围及胰岛素抵抗指数（HOMA-IR）与Ms的发生进行回归分析,统计心血管事件、脑血管事件、肾功能异常等高血压并发症发生率。结果：男性高血压患者MS发生率较女性高（P〈0．05）;在非MS高血压患者中,女性合并血脂紊乱以及合并高BMI的比率明显高于男性（P〈0．01）,男性单纯高血压及合并高血糖的比率高于女性（P〈0．01）;年龄、腹围、空腹血糖、HOMA-IR是高血压患者发生MS的危险因素,而高血压病程、收缩压、舒张压、腰臀比、BMI与MS的发生无关;MS组与非MS组相比,心血管事件及脑血管事件发生的比例均较高（P〈0．05）。结论：MS在男性中发病率较高,其发生与年龄、腹围、空腹血糖、HOMA—IR等因素有关,高血压合并MS人群发生心脑血管事件的可能性较大。     

Toxicodynamic evaluation of a cisplatin-chondroitin sulfate complex using a perfused kidney and human proximal tubular cells

Cisplatin (CDDP) is an anticancer drug. The clinical limitations associated with CDDP have stimulated the development of macromolecular drug-carrier systems, in attempts to decrease its toxicity. A complex (CDDP-CSA-23) between CDDP and chondroitin sulfate (CSA), a natural polysaccharide with a mean molecular weight of 23 kDa, proved to have the same anticancer activity as CDDP. A toxicodynamic study was performed on perfused kidneys to determine the effect of CDDP-CSA-23 on renal functions and the extent of platinum accumulation. The results showed that CDDP-CSA-23 attenuates the reduction in urine flow and creatinine clearance induced by CDDP. Moreover, significantly lower amounts of platinum were excreted into the urine in the case of CDDP-CSA-23, compared with CDDP alone. Meanwhile, CDDP-CSA-23 effectively retarded the rapid perfusion of platinum into kidney tissues, as occurs when CDDP is being perfused alone. The cytoprotective effects of CDDP-CSA on human proximal tubular (HK-2) cells were examined by measuring the growth of HK-2 cells in the presence of CDDP or CDDP-CSA-23. Interestingly, CDDP-CSA-23 was found to have a significantly reduced cytotoxicity, compared to CDDP. These results suggest that CDDP-CSA-23 greatly decreased the negative effects of CDDP on glomerular filtration and tubular transport in kidneys at early stages of its administration.     

Double-blind, randomized, multicentre study of the efficacy and safety of gliclazide-modified release in the treatment of Chinese type 2 diabetic patients

BACKGROUND AND AIM: Gliclazide-modified release (gliclazide MR) is a new formulation of the sulfonylurea gliclazide designed for once-daily administration. The hydrophilic matrix of hypromellose-based polymer in the new formulation induces a progressive drug release, which parallels the 24-h glycaemic profile in type 2 diabetic patients. The aim of this study was to compare the efficacy and safety of gliclazide MR (once-daily administration) versus gliclazide (twice-daily administration) in Chinese type 2 diabetic patients. MATERIALS AND METHODS: Sixty-three type 2 diabetic Chinese patients who had been on diet control alone or on treatment with metformin or on low dose of sulfonylurea were randomized to either gliclazide MR taken once daily or gliclazide taken twice daily. Dosage of metformin was maintained throughout the study, and the sulfonylurea was stopped. The dose of gliclazide MR was increased at 1-month intervals from 30 mg to 120 mg, while that of gliclazide from 80 mg to 320 mg until metabolic control was achieved [fasting plasma glucose (FPG) < or = 7.7 mmol/l] or the maximum dose reached. Efficacy was mainly evaluated by levels of haemoglobin A1c (HbA1c) and FPG. RESULTS: The mean baseline characteristics of the full analysis set 1 (FAS1) (HbA1c, n = 58) and the FAS2 (FPG, n = 61) were comparable in both groups. The levels of HbA1c decreased similarly in both groups over the treatment period: -1.6 +/- 1.6% (p < 0.001) on gliclazide MR (n = 31) and -1.6 +/- 1.4% (p < 0.001) on gliclazide (n = 27). Decrease in HbA1c was observed irrespective of pre-existing therapy for diabetes: -2.3 +/- 1.5% for patients on diet alone; -0.6 +/- 1.3% for patients switched from sulfonylurea to study drug and -1.4 +/- 0.8% for patients on metformin in combination with study drug. FPG decreased significantly from 177.5 +/- 63.5 to 136.7 +/- 42.2 (p < 0.001, n = 32) on gliclazide MR and not significant from 188.2 +/- 62.6 to 163.7 +/- 67.9 (p = 0.059, n = 29) on gliclazide. Both treatments were very well tolerated with no major hypoglycaemic episodes requiring external assistance; only three patients experienced mild hypoglycaemic episodes. CONCLUSIONS: Once-daily gliclazide MR showed a better trend in improving blood glucose control in comparison with gliclazide in type 2 diabetic Chinese patients irrespective of the pre-existing anti-diabetic treatment. The safety profiles of gliclazide MR and gliclazide were similar with a small number of patients having reported hypoglycaemic episodes. Once-daily dosing with gliclazide MR should improve patient compliance, an important factor in long-term glycaemic control.     

The combined occluding effects of fluoride-containing dentin desensitizer and Nd-Yag laser irradiation on human dentinal tubules: an in vitro study

The purpose of the present study was to evaluate the combined occluding effects of fluoride-containing dentin desensitizer and neodymium:yttrium aluminum garnet (Nd-YAG) laser irradiation on human dentinal tubules. All six of the groups of dentin samples (A-F) included in this study received applications of fluoride-containing dentin desensitizer. Groups B, D, and F also received Nd-YAG laser irradiation. Groups A and B served as controls, to allow observations of the occluding effects on the dentinal tubules before and after Nd-YAG laser irradiation. Groups C and D were treated with 0.5 M vitamin C solution, whereas groups E and F underwent brushing with an electric toothbrush. Scanning electron microscopy (SEM) revealed that the fluoridated dentinal tubule-occluding agent (FDTOA) formed a fine crystalline deposit on the dentin surface. After soaking in 0.5 M vitamin C solution for 3 hours, the crystalline deposit of the FDTOA was completely dissolved. Furthermore, brushing of the teeth 3,600 times removed most of the occluding agent. When the application of FDTOA was combined with Nd-YAG laser irradiation, the dentin melted and then recrystallized. The occluding agent was thus 'burned into' the dentinal tubules, and could neither be dissolved by vitamin C solution nor removed by brushing. Therefore, we concluded that the FDTOA combined with Nd-YAG laser irradiation burns the occluding agent into the dentinal tubules, thereby resisting the effects of an acidic diet and brushing, and increasing the duration of the desensitizing effect.     

Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study

Wei J‐N, Li H‐Y, Wang Y‐C, Chuang L‐M, Lin M‐S, Lin C‐H, Sung F‐C. Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study. Objectives: Recently, the incidence of type 2 diabetes (T2D) in children has increased dramatically. Mass screening is suffering and costly. It remains unknown if a detailed family diabetes mellitus history (FDMH) can identify children with different risks of T2D. This study investigated how FDMH was associated with childhood T2D. Methods: From 1992 to 1997, a nationwide survey conducted in Taiwan for all 3 000 000 school children aged between 6 and 18 yr identified 1966 children with diabetes. For comparison, 1780 children were randomly selected as the control group from all students with normal fasting glycemia (NFG). Telephonic Interviews were conducted using questionnaire for detailed FDMH. In the present analysis, 505 children with T2D and 619 children with NFG were enrolled. Results: Children with more family members having diabetes were more likely to have T2D. Children with the parental FDMH had a higher risk for T2D than children with the grandparental FDMH; the odds ratios (ORs) were 2.61 (95% confidence interval (CI) 1.25–5.48, p < 0.05) for boys and 6.47 (95% CI 2.69–15.6, p < 0.05) for girls, adjusting for age, birth weight, gestational age and body mass index (BMI) z‐score. Children with maternal FDMH had a higher risk for T2D than children with paternal FDMH, and much greater in boys (OR = 29.5, 95% CI 3.67–237, p < 0.05) than in girls (OR = 7.63, 95% CI 2.05–28.4, p < 0.05), adjusted for age, birth weight, gestational age, BMI z‐score, and FDMH in grandparents. Conclusions: Children with parental FDMH, especially the maternal FDMH, have an elevated risk for T2D. Detailed FDMH is a convenient alternative to identify children with different risks of T2D.     

Clinical experiences of the infections caused by extended-spectrum beta-lactamase-producing Serratia marcescens at a medical center in Taiwan

CTX-M-3 has become the most common extended-spectrum beta-lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.