初诊T2DM短期胰岛素强化治疗40例分析

目的观察初诊T2DM短期胰岛素强化治疗的疗效。方法对40例初诊T2DM患者采用三餐前皮下注射短效胰岛素和睡前注射中效胰岛素2wk，并检测治疗2wk前后FPG、PPG、GHbA1C及血脂等值进行比较。结果两组治疗后FPG、PPG、GHbA1C及血脂各值均显著低于治疗前p〈0．05（x^2=4．940—11．544）。结论胰岛13细胞功能异常和（或）胰岛素抵抗是T2DM发病的基本环节，早期强化胰岛素治疗能获得血糖的有效控制，减少或延缓并发症的发生。     

推拿治疗老年高血压及对动态血压负荷的影响

目的研究推拿治疗老年高血压及对动态血压负荷的影响。方法选择60例轻、中度高血压患者，随机分为推拿治疗组30例，药物对照组组30例。结果推拿治疗组总有效率为83．3％。药物对照组为86．7％；治疗组主要症状疗效前后对比有显著性差异（p〈0．05），治疗组治疗后动态血压负荷值明显降低，较治疗前差异有显著性（p〈0．01，p〈0．05）。结论推拿治疗老年高血压疗效显著，推拿可降低动态血压负荷。     

Monitoring pressure ulcer healing in persons with disabilities.

Pressure ulcers are a high-risk, high-volume, and high-cost problem for persons with disabilities. This article describes four tools published in the literature and reports the validity, reliability, strengths, and limitations of each. These tools include the Pressure Ulcer Scale for Healing (PUSH), the Pressure Sore Status Tool (PSST), the Sussman Wound Healing Tool (SWHT), and the Sessing Scale. Rehabilitation nurses should use a consistent framework with accurate quantification to assess, document, and monitor changes in pressure ulcers over time. Such a measurement tool must prove valid for the disabled population in which the tool is used. This will enable healthcare providers to communicate more effectively and evaluate the therapeutic plan of care.     

血糖水平对18F-FDG PET/CT图像质量的影响

目的 研究血糖水平对18F-脱氧葡萄糖(FDG) PET/CT图像质量的影响.方法 80例行体格检查或评价肿瘤性质的受检者,按空腹血糖水平分为9组(组间距为1mmol/L),第1组为血糖正常组,即血糖＜6.0mmol/L(10例);第2～9组血糖水平高于正常,分别为6.0～6.9mmol/L(11例),7.0～7.9mmol/L(13例),8.0～8.9mmol/L(11例),9.0～9.9mmol/L(11例),10.0～10.9mmol/L(8例),11.0～11.9mmol/L(6例),12.0～12.9mmol/L(5例),≥13.0mmol/L(5例).受检者做完PET/CT检查后,图像质量由2位有经验的医师独立判断.同时根据肝不同层面的标准摄取值(SUV)最大值(SUVmax)及SUV平均值(SUVavg)分别计算肝图像噪声.采用SPSS 12.0软件进行统计学处理.结果 (1)9组之间图像质量评分、肝噪声差异有统计学意义(P均＜0.05).将第2～9组图像质量评分、肝噪声分别与第1组进行比较,第2～7组与第1组差异无统计学意义(P均＞0.05);第8,9组与第1组比较差异有统计学意义(P均＜0.05),且评分低于第1组.(2)血糖水平与图像质量评分呈负相关(r=-0.52,P＜0.05);血糖水平与肝噪声呈正相关(SUVmax、SUVavgr值分别为0.33和0.60,P均＜0.05);SUVavg所算噪声与血糖水平的相关性优于SUVmax.结论 图像质量随血糖水平的升高而下降,血糖＜12.0mmol/L时与血糖正常者PET/CT图像质量差异无统计学意义,但当血糖水平≥12.0mmol/L时图像质量将显著下降.     

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.     

A comparative study of angiogenic and cytokine responses after laparoscopic cholecystectomy performed with standard- and low-pressure pneumoperitoneum

Background  Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation. The purpose of the study was to access the influence of low-pressure CO₂ pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy. Methods  The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO₂ pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent assay (ELISA). Results  Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or by age, gender, or body mass index (BMI) of the patients. Conclusions  The results obtained in our study do not show any significant differences between studied operative procedures with regards to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences and implications.     

空腹血糖——急性心肌梗死患者早期死亡的独立预测因子

目的研究急性心肌梗死(AMI)患者空腹血糖的预后价值。方法本研究入选257例无糖尿病病史AMI患者。测量患者入院时血糖(AG)和禁食至少8h后的血糖(FG)。随访患者30d,分析AG和FG与患者预后之间的关系。结果共24(9.3%)例无糖尿病病史患者在AMI后30d内死亡。FG正常组死亡2例(1.5%),FG升高者的第一、第二、第三个三分位数组分别死亡4例(9.8%)、5例(12.2%)、13例(31%)。和FG正常组患者相比,校正后的30d死亡的相对危险比(OR)随FG三分位数的增加而增加,第一、第二和第三个三分位数组分别为:2.5(95%CI,0.71～8.5;P=0.011),8.6(95%CI,3.2～23.5;P=0.0005),12.7(95%CI,4.5～36.4;P<0.0003)。同FG和AG都正常的患者相比,AG升高FG正常预测患者30d死亡的OR为0.69(95%CI,0.25～3.80;P=0.59);AG正常FG升高者为3.6(95%CI,2.1～11.5;P=0.04);FG和AG都升高者为10.6(95%CI,4.3～25.6;P<0.0001)。镶嵌模型的比较显示AG并不能增加FG模型预测30d死亡(2=5.2,3df,P=0.20)或预测30d死亡和心力衰竭(2=4.8,3df,P=0.31)的价值。相反,FG却能增加AG模型预测30d死亡(2=24.5,3df,P=0.0001)或预测30d死亡和心力衰竭(2=24.7,3df,P=0.0001)的价值。结论无糖尿病病史AMI患者30d死亡率随AG和FG浓度的增加而增加,FG比AG的预测价值更大。     

应用电子计算机计算血液流变学的正常值及分析

为评价血流粘滞诸因素生理与病理的异常,对济南地区338例正常人血液流变学的各项指标进行了检测,统计了血液流变学各项指标的总平均及男女的平均值和正常范围,并计算了血液流变学各项指标间的相关系数。