Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

Abstract   We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15–2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN.     

1例系统性红斑狼疮患者视网膜中央动脉阻塞及脑出血的护理

对1例系统性红斑狼疮并发视网膜中央动脉阻塞及脑出血患者，给予糖皮质激素、免疫抑制剂、高压氧、改善微循环及对症支持治疗．同时予以密切观察病情、药物护理、高压氧治疗护理及健康教育等措施，结果患者恢复良好出院。提出该病虽然少见且后果严重，但及时采取综合性治疗护理措施，可以提高治疗效果。     

Lipid extract from completely sporoderm‐broken germinating Ganoderma sinensis spores elicits potent antitumor immune responses in human macrophages

Ganoderma sinensis has been used widely in Oriental countries for the prevention and treatment of various diseases including cancer. Previous studies have shown that the lipid extract from Ganoderma exhibits direct cytotoxicity against tumor cells. Here, it is reported that the lipid extract from germinating G. sinensis spores, at lower concentrations that have no direct tumoricidal activity, induce potent antitumor immune responses in human monocytes/macrophages. Upon stimulation with the lipid extract, monocytes/macrophages exhibited markedly increased production of proinflammatory cytokines and surface expression of costimulatory molecules. Conditioned medium from stimulated cells effectively suppressed the growth of tumor cells. Apparently, the lipid extract triggered macrophage activation via a mechanism different from that associated with LPS. Moreover, it was observed that the lipid extract could partially re‐establish the antitumor activity of the immunosuppressive tumor‐associated macrophages. These results indicated that in addition to its direct tumoricidal activity, the lipid extract from G. sinensis spores could exert antitumor activity by stimulating the activation of human monocytes/macrophages. Copyright © 2008 John Wiley & Sons, Ltd.     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

淋巴瘤样肉芽肿与韦格内肉芽肿临床特点的比较

目的 总结淋巴瘤样肉芽肿病(lym phom atoid granulom atosis,LG)与韦格内肉芽肿( egener granulo Wm atosis,W G)的临床特点,从临床上加以鉴别。 方法 回顾性总结我院与北京协和医院 1989 年以来收治的 6 例 LG和20 例 W G 患者的临床资料,并进行比较。 结果 发热、咳嗽及呼吸困难在 LG 中较常见,流涕、鼻衄及关节痛以W G 为多,肺受累以 LG 为多,耳鼻喉、眼及肾病变在 W G 中明显增多,皮肤受损两者相似。W G 患者常有 c-ANCA 阳性及尿沉渣异常。 LG X 线胸片为双侧多发结节,边界不清,多无肺门、纵隔淋巴结肿大; G 则为双侧多发边界清晰W的结节, 易形成空洞, 肺门和纵隔淋巴结可肿大。LG 病理改变为血管中心性淋巴增生性病变, 浸润的细胞主要是小淋巴细胞和不同数量大的不典型淋巴细胞; 而在 W G 中可见坏死性血管炎及大量中性白细胞、浆细胞及少量嗜酸细胞浸润形成的肉芽肿, 部分有多核巨细胞。W G 经治疗后, 多数患者病情缓解; 则疗效不佳。 结论 LG 和 W G 在临 LG床表现、实验室检查、 影像及病理诸方面的差异有利于两者的鉴别诊断。     

使用新型倒刺电极的骶神经调节治疗神经源性膀胱的初步临床结果

目的探讨应用新型倒刺电极（Tined-lead）对神经源性膀胱患者行S骶神经调节（SNM）的初步疗效。方法对5例神经源性膀胱患者采用新型倒刺电极，在X线监测下将电极植入S3骶神经孔，进行SNM。术前、术后详细记录排尿日记，用影像尿动力学方法评估患者的膀胱尿道功能。结果患者1（隐性骶裂）术后排尿次数和排尿量分别改善22％和49％；患者2（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．7％、11％和46％；患者3（隐性骶裂）术后排尿次数、排尿量和残余尿量分别改善0．4％、18％和44％。患者4（脑外伤）术后漏尿次数和漏尿量分别改善36％和54％。患者5（高位截瘫）术后间歇导尿次数和导尿量分别改善42％和54％，尿动力学参数改善37％～45％。结论用新型倒刺电极进行SNM为神经源性膀胱的治疗提供了一条新的可供选择的微创方法。     

子宫腺肌症病变中雌激素、孕激素、癌基因、凋亡抑制基因的表达研究

目的 研究雌激素（ER）、孕激素（PR）及癌基因（cerbB-2）、凋亡抑制基因（Bcl-2）在子宫腺肌症病变中的表达和子宫腺肌症发病的相关性。方法 用免疫组化方法检测40例子宫腺肌症病变组织中ER及其他生物学指标的表达。结果 ER、PR与CerbB．2、Bcl-2在子宫腺肌症病变中均有不同程度的阳性表达，子宫肌层异位内膜ER阳性表达率97．5％，PR阳性率97．5％，cerbB-2阳性率82．5％，Bcl-2阳性率62．5％。在位内膜和异位内膜ER、PR均呈阳性，阳性率比较差异无统计学意义（P〉0．05）。异位内膜cerbB-2的强阳性率高于在位内膜，差异有统计学意义（P〈0．05）。ER、PR与cerbB-2、Bcl-2阳性率相比具有相关性（P〈0．05）。结论 ER、PR与cerbB．2、Bcl-2在异位内膜高表达，提示这些生物学指标在子宫腺肌症发生发展中发挥作用。     

Pathways from first health care seeking to diagnosis: obstacles to tuberculosis care in rural China.

OBJECTIVE: To examine health care seeking pathways for patients with tuberculosis (TB) and barriers related to these pathways in counties under the National TB Control Programme in rural China. METHODS: A cross-sectional study was conducted in two counties of east China in 2004-2005. A total of 557 TB patients were recruited and interviewed by physicians at the time of TB diagnosis. RESULTS: Of 557 participants, 13.3% had presented to a specialised county TB dispensary (CTD) directly after onset of symptoms, 31.4% had first sought care at a village health station and 51.2% had visited a township or county hospital first. The proportion of referral by a first health care provider to a CTD was highest in county level hospitals (73.5%) and lowest in village health stations (21.7%). The most prompt pathway from first health care seeking to TB diagnosis was to visit a CTD directly, with a median provider's delay of only one day. There was an increase in provider's delay when more health facilities were involved. CONCLUSION: To improve direct referral from general health care providers, especially village health care workers, to TB specialists would significantly shorten the delays in TB diagnosis in rural China.     

脊柱复合性损伤的救治风险与早期治疗

目的评估脊柱复合性损伤的特点和救治风险,探讨风险控制与最佳治疗的方法。方法采用AIS、ISS、TRISS及APACHEⅡ等评分方法对273例脊柱复合性损伤患者进行定量评价与救治分类,并依据伤后的损伤分级、参数评定及计量评分等指标进行量化分析和统计处理。结果颈椎合并伤115例,胸椎合并伤141例,胸腰椎合并伤294例,腰骶椎合并伤181例;患者的救治风险和脊椎伤的治疗选择或手术时机与其合并伤的解剖伤势及由此所构成的整体伤情密切相关(P<0.01或<0.05);高风险性伤员往往综合伤势严重,生存概率(Ps)趋低,并发症和死亡率高(P<0.01或<0.05)。结论脊柱脊髓损伤常合并有严重的多发伤,高危伤情不仅可增加其救治风险和脊柱伤的处理难度,且还易于丧失手术最佳时机。分类救治对伤员的风险控制和脊柱伤的专科治疗是有益的。     

Cytotoxic lipid esters from Peucedanum ledebourielloides

Two cancer cell growth inhibitory esters, 1,2-dipalmitoyl-3-glucosyl glycerol (1) and 1,6-dihydroxy-hexane-bis-palmitoyl ester (2), together with arachidic acid-2-hydroxy-glycerol ester, daucosterol, and oleanolic acid, were isolated from the roots of Peucedanum ledebourielloides (Apiaceae family). The structures were determined by spectroscopic analyses. The esters 1 and 2 displayed significant activity against the SGC-7901, HT-29, and HL-60 cancer cell lines.