脂联素水平与运动及机体肥胖的相关性

学术背景:脂联素在健康机体血浆中含量丰富,但在冠心病、肥胖、2型糖尿病及原发性高血压等疾病中,脂联素水平下降,且其下降程度与病情严重程度呈正相关.目的:分析近年来有关运动对肥胖与2型糖尿病患者机体脂联素水平的影响.检索策略:应用计算机检索PubMed数据库1995-01/2006-12有关脂联素与运动的文献.检索词“adiponectin,exercise“,限定文章语言种类为English.同时计算机检索中文数据库CNKI 1995-01/2006-12有关脂联素与运动的文献,检索词“脂联素,运动“,限定文章语言种类为中文.共收集到51篇相关文献.对资料进行初审,选取所有运动与脂联素水平相关的文献,并查找原文.纳入标准:重点选择有关探讨运动对肥胖及2型糖尿病患者脂联素影响的文献.排除标准:重复研究.文献评价:排除19篇因研究目的与本研究无关的文献,最终纳入符合标准的文献32篇.资料综合:脂联素是脂肪细胞特异分泌的一种激素蛋白,具有调节能量平衡、增强胰岛素敏感性、抗动脉粥样硬化及抗炎等广泛的生物学作用,是肥胖与糖尿病患者体内第一个下调的脂肪因子,与胰岛素抵抗的发生发展密切相关.运动作为一种对机体有益的刺激因子能否影响肥胖及糖尿病患者体内脂联素水平,或通过刺激内源性脂联素增加从而改善患者体内胰岛素抵抗,是近年来研究运动与脂联素的热点之一.文章在介绍脂联素生物学概况的基础上,对近年来有关运动对肥胖及糖尿病患者脂联素水平影响的研究进行了评述.结论:由于脂联素所具有的机体保护作用,近年来有关运动对肥胖及糖尿病患者脂联素水平影响的研究结果不够一致,仍需进一步的深入研究,尤其需要从机制方面进行探讨.     

关节部位Ⅲ度烧伤削痂植皮与切痂植皮的效果比较

目的:Ⅲ度烧伤创面的处理临床上仍然以切痂植皮术治疗为主,由于切痂时切除了并未损伤的皮下脂肪组织,使其愈后外观变化明显。实验拟观察关节部位Ⅲ度烧伤削痂后于脂肪层移植大张自体中厚皮的疗效,并与切痂植皮进行比较。方法:①于2001-01/2007-06南昌大学第一附属医院烧伤科收治的关节Ⅲ度烧伤患者中抽取39例(45个关节)作为削痂组,同时抽取45例(共60个关节)作为切痂组。所有患者对治疗及实验方案均知情同意,且得到医院伦理道德委员会批准。②削痂组削痂植皮,保留正常皮下脂肪等组织。切痂组切痂植皮,切痂平面包括全层皮肤和皮下脂肪组织一并切除直至深筋膜层。削痂或切痂后植大张自体中厚皮。③创面修复后4￣6周观察两组患者的关节外观和关节活动功能;比较两组患者术后2周的植皮成活率和创面修复时间。结果:两组患者均进入结果分析。①两组患者烧伤关节创面修复后与对称的正常关节比较,削痂组外观变化不明显,周径缩小3.6%(P>0.05),功能好,关节活动度减少5.3%(P>0.05);切痂组外观变化明显,周径缩小23.4%(P<0.05),功能较差,关节活动度减少21.9%(P<0.05)。②两组患者术后2周植皮成活率和创面修复时间差异均无显著性意义(P>0.05)。结论:脂肪层移植大张自体中厚皮于Ⅲ度烧伤削痂后关节部位,能够维护肢体的美观,保护关节功能,疗效优于切痂植皮。     

Th1型细胞因子干扰素γ及Th2型细胞因子白细胞介素10水平在慢性心力衰竭患者接受己酮可可碱干预过程中的变化：随机对照

目的:观察己酮可可碱治疗心力衰竭患者后Th1型细胞因子干扰素γ及Th2型细胞因子白细胞介素10水平的变化,评价己酮可可碱对慢性心力衰竭患者免疫异常调节作用。方法:选择2005-09/2006-04华中科技大学同济医学院附属协和医院心内科收治的心力衰竭患者38例。①实验分组:随机分为常规治疗组20例,常规治疗包括利尿剂,洋地黄类药物,血管紧张素转换酶抑制剂,β-受体阻滞剂等。己酮可可碱治疗组18例,在常规治疗的基础上加用己酮可可碱400mg,3次/d,饭时口服。两组治疗时间为1周,且均禁用免疫抑制剂。另选取10例健康体检者作为健康对照组。②实验评估:采用流式细胞分析法对各组患者进行CD4 Th1型细胞因子干扰素γ和Th2型细胞因子白细胞介素10水平进行检测,从而测出相应Th1,Th2细胞的百分比。结果:参与常规治疗组实验患者均进入结果分析,参与己酮可可碱治疗组患者18例,脱落3例,余15例患者均进入结果分析。①慢性心力衰竭患者CD4 干扰素γ表达水平和Th1/Th2值高于健康对照组(P<0.05),CD4 白细胞介素10表达水平低于健康对照组(P<0.05)。②己酮可可碱治疗组治疗1周后,CD4 干扰素γ水平和Th1/Th2值低于常规治疗组(P<0.05)。CD4 白细胞介素10水平无显著性变化。结论:心力衰竭患者存在Th1/Th2失衡,己酮可可碱调节了慢性心力衰竭患者Th1/Th2的失衡,该效应可能是己酮可可碱改善慢性心力衰竭患者症状作用机制之一。     

饮食、运动和生活方式变更在肥胖型糖尿病患者治疗中的作用

2型糖尿病（2－DM）与肥胖、肾病、微血管病和动脉粥样硬化有关。因为该病的并发症及慢性化,所以通过改变生活方式而降低饮食、起居方面的危险因素,对2－DM患者长期健康是极为重要的。患者要学会、低脂的饮食习惯和正规的运动模式。本文要介绍针对肥胖的糖尿病患者生活方式的改良。还将讨论一些关于改变生活方式和提高长期随访率的困难。最后,我们要介绍2－DM高危人群,在美国的墨西哥人是怎样实施这些方案的。     

Upper tibial corticocancellous flap anatomy study (19.2.93)

Summary A cortico-cancellous flap from the anterolateral aspect of the upper third of the tibia was presented. Sixty lower limbs of fresh cadavers were dissected. The vascular bundle includes the anterior tibial artery and its recurrent collateral branches and recurrent and muscllo periostal arteries. The flap is harvested with the interosseous membrane and can be used either free or pedicled. We used this flap for two patients suffering from pseudarthrosis. Long range clinical and radiological results are good.

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Le transfert osseux vascularisé tibial superieur

Résumé Les auteurs décrivent un transfert ostéo-periosté vascularisé, prélevé sur la face antéro-latérale de l'extremité supérieure du tibia. L'étude anatomique porte sur soixante membres inférieurs, conservés au froid. La vascularisation métaphysaire du transfert provient de la branche récurrente tibiale antérieure et de ses rameaux, la vascularisation diaphysaire étant issue des branches musculo-périostiées proximales. Le transfert vascularisé est prélevé avec la membrane interosseuse et peut être pediculé ou libre. L'expérience clinique porte sur deux cas de pseudarthroses multiopérées. Les résultats cliniques et radiologiques sont bons à long terme.

     

Antenatal differentiation of the human intervertebral disc

Summary To study the antenatal differentiation of the human intervertebral disc, the columns of forty eight embryos and fetuses were examined histologically. The primitive disc is composed of two structures: the notochord which shows a progressive expansion into the disc, and the fibrocartilaginous perinotochordal disc. No histological sign of interaction between notochordal and perinotochordal cells, which may explain the notochordal expansion into the discs, was seen. On the other hand, the notochordal intervention in the cartilaginous differentiation of the inner zone is probable.

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Différenciation anténatale du disque intervertébral humain

Résumé Cette étude de la différenciation anténatale du disque intervertébral humain repose sur l'examen de coupes histologiques de quarante huit colonnes vertébrales d'embryons et de foetus. Le disque primitif est composé de deux structures : la notochorde, qui présente une expansion progressive de son diamètre au sein du disque, et le disque périnotochordal, d'abord mésenchymateux puis fibrocartilagineux. Il n'a pas été mis en évidence de signe histologique témoignant d'une interaction entre les cellules notochordales et les cellules périnotochordales qui puisse expliquer l'expansion de la notochorde au sein des disques. Le rôle de la notochorde dans la différenciation cartilagineuse de la zone centrale est par contre probable.

     

Adipose derived stem cells and nerve regeneration

Injuries to peripheral nerves are common and cause life-changing problems for patients alongside high social and health care costs for society. Current clinical treatment of peripheral nerve injuries predominantly relies on sacrificing a section of nerve from elsewhere in the body to provide a graft at the injury site. Much work has been done to develop a bioengineered nerve graft, precluding sacrifice of a functional nerve. Stem cells are prime candidates as accelerators of regeneration in these nerve grafts. This review examines the potential of adipose-derived stem cells to improve nerve repair assisted by bioengineered nerve grafts.     

Lymphoproliferative response to synthetic V3 loop P18 peptide and HIV-1 envelope glycoprotein among individuals immunized with gp160 candidate vaccines

Because T-cell responses are critical for defense against viral infections, the synthetic P18 peptide (RIQRGPGRAFVTIGK) and active component of gp160 protein has previously been shown to induce cytotoxic and helper T-lymphocyte responses. In order to further define the T-helper cells, responses which are known to play a role in enhancing the immunological response to foreign antigen, we studied the response of individuals immunized with HIV gp160 candidate vaccines. We investigated the proliferative cellular response of peripheral blood mononuclear cells (PBMC) derived from individuals immunized with gp160 antigens in three different protocols. We found a PBMC proliferative response to synthetic P18 peptide in healthy immunized individuals induced by gp160 antigen with or without vaccinia virus. There was correlation between the proliferative response to P18 peptide and other antigens such as HIV-like proteins and gp160 molecule. HLA-DR typing revealed the possible presentation of P18 peptide by several different class II molecules. Since these class II molecules occur frequently in the general population, P18 peptide appears to contain broadly reactive epitopes and thus is presented by mutiple HLA class II molecules. Due to its broad reactivity P18 peptide is one of the candidates for inclusion as a subunit vaccine against HIV-1.