Plasma C-peptide levels and clinical remissions in recent-onset type I diabetic patients treated with cyclosporin A and insulin

Remission from insulin dependency in insulin-treated recent-onset type I (insulin-dependent) diabetic patients can result from a partial recovery of insulin secretion, an improvement in tissue sensitivity to insulin, or both. The same hypothesis must be analyzed when remission occurs in cyclosporin A (CsA)-treated patients. In this study, plasma C-peptide levels were serially measured in the basal state and after stimulation in 219 recent-onset type I diabetic patients; 129 received CsA, and all patients were similarly monitored and insulin treated. The results were analyzed in view of the occurrence of remission. Remission was defined as good metabolic control in the absence of hypoglycemic treatment for greater than or equal to 1 mo. Remission occurred in 44% of the CsA-treated group and lasted for mean +/- SE 10.0 +/- 0.9 mo vs. 21.6% in the non-CsA-treated group with a duration of 4.4 +/- 0.8 mo. Plasma C-peptide levels were initially dramatically lower than normal in both groups in the basal and stimulated states. C-peptide levels increased significantly later, at 3 and 6 mo, in both groups. C-peptide values were proportional to the rates of remission in both groups. In the non-CsA-treated group, C-peptide levels later decreased, and these patients inexorably relapsed to insulin dependency. In contrast, in the CsA-treated group, the initial recovery in insulin secretory capacity was maintained over the 18-24 mo of the study. Furthermore, higher remission rates and longer-lasting remission were obtained in patients who reached higher C-peptide levels at the 3rd mo of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

角膜地形图与角膜曲率计在白内障手术前后评价

本文应用计算机辅助的角膜地形图系统TMS-1和角膜曲率计TOPCONOM-4同时测定了200例(278眼)的角膜地形图和中央角膜屈光状态。比较了角膜地形图的模拟角膜曲率SIMK值和角膜曲率计的垂直和水平屈光度。结果显示,白内障术前组116例150眼的SIMK平均值分别为44.22D(垂直轴)和44.26D(水平轴),角膜曲率计的中央屈光度垂直轴平均为44.16D,水平轴为44.23D。统计学处理表明,2种组方法的结果之间差异无显著性(P>0.05),第2种术后组67例90眼的SIMK平均值分别为46.37D(垂直轴)和43.06D(水平轴),角膜曲率计的中央屈光度垂直轴平均为46.09D,水平轴平均为42.88D,统计学处理二种方法的结果之间差异无显著性(P>0.05)。研究提示,角膜地形图系统的模拟角膜曲率SIMK值和角膜曲率计的屈光度无论在白内障手术前还是在手术后其结果是一致的,临床应用具有同等的价值。但是,当角膜中央屈光度异常范围小于3毫米,角膜混浊,角膜严重不规则散光时,角膜曲率计不能满足临床需要。而计算机辅助的角膜地形图系统则具有极大的诊断及检测价值。眼科学报 1994;10:85—89。     

中国汉族群体D4S111位点的遗传多态性研究

目的：研究中国汉族群体中α艾杜糖苷酶基因Ｄ４Ｓ１１１位点的遗传多态性。方法：采用扩增片段长度多态性（ＡｍｐＦＬＰ）分析技术，检测了广州地区汉族无血缘关系健康个体９７名。结果：Ｄ４Ｓ１１１位点，在９７名无关个体中发现５个等位基因和９种基因型，等位基因片段长度为８３０～５１０ｂｐ，基因频率为０００５２～０３６０８，ＰＩＣ为０５９６６，杂合性为０７８。结论：中国汉族群体中Ｄ４Ｓ１１１位点具有高度多态性，并与其它种族间存在差异性。     

沟通艺术在护理管理中的运用

现代管理理念已由单纯管理型向服务型转变。为了能更好地服务于临床护理人员，实现护理的科学管理，管理者必须学会运用有效的沟通技巧与护理人员进行信息及情感交流。[第一段]     

Capillary blood flow as an index of the therapeutic effect of folinic acid in ischemia-reperfusion syndrome]

OBJECTIVE: An intestinal reperfusion study with two aims: a) to assess the usefulness of intestinal capillary blood flow measurement by laser-Doppler for intestinal reperfusion studies; and b) to compare the effects of racemic and levo forms of folinic acid in treating the syndrome. EXPERIMENTAL DESIGN: A murine model of intestinal ischemia by completely clamping the superior mesenteric artery for 90 minutes. A comparison was made of three treatment groups: saline, folinic acid, and levo-folinic acid. The following factors were analyzed: changes in biochemical parameters (levels of creatine kinase, lactic dehydrogenase, and alkaline phosphatase at 60 minutes, and at two and seven days after restoring blood flow), capillary flow in the jejunum and ileum by laser-Doppler (during ischemia and after the first hour of reperfusion), intestinal mucosa injury, and survival curve. RESULTS: Laser-Doppler provided reliable data on how the different treatments affected capillary flow during intestinal reperfusion. Levo-folinic acid improved capillary flow in the ileum after 25 minutes of reperfusion, and also reduced mucosal injury in the same stretch of intestine by the seventh day post-reperfusion (p<0.05). On the other hand, it produced an initial increase in serum enzymes during reperfusion, and did not modify survival. CONCLUSIONS: The changes observed in intestinal capillary blood flow measurement by laser-Doppler have similarities with the effects of drugs on pathological mucosal changes. We could not prove that the levo form of folinic acid has a stronger protective effect versus racemic folinic acid in intestinal ischemia-reperfusion syndrome.     

Carotid endarterectomy with internal carotid artery segmental resection, temporary shunt and vein patch angioplasty: early and mid-term results.

AIM: The authors report an alternative procedure to carotid endarterectomy with internal carotid artery (ICA) segmental resection and end-to-end anastomosis associated with temporary shunt and venous patch angioplasty. Design: prospective cohort study. METHODS: Between May 1995 and December 2004, 192 patients underwent 200 primary CEAs for significant ICA stenosis. There were 131 men and 61 women with a mean age of 72.4+/-8.4 years. The indications for CEA were asymptomatic lesions in 51.5%, transient ischemic attack in 27.5% and stroke in 21%. RESULTS: The combined early morbidity and mortality rate was 2%. Two patients died, one due to fatal intracerebral hemorrhage and the second patient died of acute mesenteric ischemia. Neurological complications occurred in 2 patients, including 1 TIA and 1 nondisabling cerebrovascular accident. Non-neurological complications occurred in 26 patients (13.5%). Seventeen patients (8.8%) developed hypertension, 3 neck hematomas (1.5%) required surgical evacuation, 1 patient had reversible supraventricular arrhythmia (0.5%) and 1 patient had pneumonia (0.5%). Furthermore, 1 asymptomatic carotid occlusion was identified (0.5%) and 3 patients suffered permanent cranial nerve injury (1.5%). Mean follow-up was 45.7 months and there were 41 late deaths (21.8%). Survival rates at 1 and 5 years were 96.7+/-1.2% and 73.58+/-4.2%, respectively. CONCLUSIONS: CEA with ICA shortening and reanastomosis is a safe and reliable procedure without any increase in morbidity or mortality.