Specific insulin assays, insulin sensitivity and blood pressure

Serum insulin concentrations have been used as markers of insulin resistance in population studies examining the relationship between insulin resistance and blood pressure, but the relationship is variable among studies. We hypothesized that differences in cross-reactivity of insulin assays with proinsulin and its split/des-amino products might account for the variation. We therefore examined fasting and post- glucose load serum insulin concentrations (determined by both specific and conventional assays), insulin sensitivity (measured by the euglycaemic clamp technique), and blood pressure, in a group of 56 diabetic (NIDDM) and non-diabetic subjects. Insulin concentrations as measured by the two methods were highly correlated (r = 0.97, p < 0.0001), and the relationships among serum insulin concentrations, insulin sensitivity and blood pressure were independent of assay method; for example, in non-diabetic subjects the univariate correlation between log10AUC insulin and insulin sensitivity index was similar with both methods [r = -0.81 vs. r = -0.82, p < 0.0001 (specific vs. conventional assay)]. Discrepancies between studies in the relationship between serum insulin concentrations and blood pressure are unlikely to be due to cross-reactivity of conventional insulin assays with proinsulin-like molecules.      

Polymorphous light eruption

Polymorphous light eruption (PLE) is a common idiopathic photosensitivity disorder with an estimated prevalence of 10-20%. It is characterized by an intermittent skin reaction to ultraviolet (UV) radiation exposure, consisting of non-scarring pruritic erythematous papules, vesicles or plaques that develop on light-exposed skin. Despite the different morphology in different individuals, the eruption tends to have a monomorphous presentation in any single subject. The histopathological features of PLE are distinct and comprise a perivascular lymphocytic infiltrate in the dermis, subepidermal oedema and variable epidermal changes. The pathogenesis of PLE is not well known, but findings suggest that it is a delayed-type hypersensitivity reaction to one or more UV-modified cutaneous antigens. The principal action of PLE is mainly in the UVA region, although some subjects exhibit sensitivity to UVB alone or to both UVA and UVB radiation at the same time. Preventive measures in PLE include the regular use of photoprotective methods combined with graduated exposures to natural sunlight. The induction of immune tolerance by phototherapy and photochemotherapy are useful prophylactic methods in moderate to severe cases. The role of systemic agents in the management of PLE is under investigation. This article reviews the epidemiological, pathogenetic and clinical aspects of PLE and discusses recent advances in the diagnostic approach and management of this condition.     

慢性乙型肝炎的口服抗病毒药物评价

美国食品和药品管理局（FDA）已批准拉米夫定（LAM）、阿德福韦（ADV）、恩替卡韦（ETV）和替比夫定（LdT）这四种口服抗病毒药物用于治疗慢性乙型肝炎（CHB）,其Ⅲ期临床试验的疗效、安全性及耐药情况总结于表1和表2。尽管每种药物均表现出良好的安全性,但对长期治疗而言也存在限制性。而且,这些药物均独立进行研发,仅作为单药治疗进行临床验证,     

远端与近端结肠癌在临床、病理和分子生物学特征上的区别

背景远端和近端结肠癌在起源,基因暴露,环境诱变及肠道菌群等方面均存在差异。然而这些差异很少被用来解释如何影响肿瘤的发生机制,特异的治疗响应及预后情况。研究系统性探索了远端与近端结肠癌的差异及这些差异的临床意义。资料与方法研究共纳入3 045例结肠癌患者的详细临床病理数据用于分析,这些患者资料均来源于PETACC3(关于结肠癌辅助化疗)临床试验。这些数据中,