门冬胰岛素30联和阿卡波糖与胰岛素4次皮下注射治疗2型糖尿病临床疗效观察

目的比较单用门冬胰岛素（诺和锐）30血糖控制差的2型糖尿病患者加用阿卡波糖后和其改用四次胰岛素皮下注射方案的有效性、安全性。方法将医院60例单用诺和锐30血糖控制差的2型糖尿病患者随机分为2组,对照组30例采用诺和锐30 3次皮下注射同时3餐嚼服阿卡波糖;研究组30例采用4次胰岛素皮下注射（生物合成人胰岛素R＋地特胰岛素）。根据血糖调整胰岛素剂量,连续治疗12周后比较2组空腹血糖、餐后血糖、糖化血红蛋白（HbA1c）、胰岛素使用剂量及低血糖发生情况。结果 2组空腹血糖,餐后血糖,HbA1c都较前明显下降（P〈0.05）,但2组之间3项指标无明显统计学差异（P〉0.05）;对照组胰岛素用量明显减少,且低血糖发生率低,差异均有统计学意义（P〈0.05）。结论诺和锐30＋阿卡波糖较4次胰岛素注射使血糖达标时所用的胰岛素量减少,并具有更少的低血糖发生率。     

门冬胰岛素治疗妊娠糖尿病的临床研究

目的：探讨门冬胰岛素治疗妊娠糖尿病（GDM）的临床效果。方法将复旦大学附属中山医院分院2010年4月—2013年8月确诊的GDM初诊患者136例随机分为对照组和治疗组,每组68例。对照组餐前30 min皮下注射精蛋白生物合成人胰岛素注射液;治疗组每日3餐进食前皮下注射门冬胰岛素30注射液。对两组患者进行随访,比较其血糖控制情况、炎性因子及母婴结局。结果治疗后两组患者空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1C）和尿C肽均明显好转,与治疗前差异具有统计学意义（P＜0.01）。治疗后,治疗组FPG、2 h PG、HbA1C低于对照组,餐后0.5、2 h尿C肽高于对照组,两组比较差异有统计学意义（P＜0.05、0.01）。治疗组血糖达标时间、每日胰岛素用量、低血糖发生率均低于对照组,两组比较差异具有统计学意义（P＜0.05）。治疗后,两组患者C-反应蛋白（CRP）、白细胞介素6（IL-6）、和正五聚蛋白（PTX-3）均较治疗前显著降低,同组治疗前后差异具有统计学意义（P＜0.01）;治疗后,治疗组这些指标低于对照组,两组比较差异有统计学意义（P＜0.01）。两组患者母婴结局差异均无统计学意义,未出现严重不良反应。结论门冬胰岛素治疗妊娠糖尿病具有较好的临床疗效,可减少药物用量,缩短血糖达标时间,对GDM炎性症状改善良好,值得临床推广应用。     

桥本甲状腺炎Th1／Th2平衡偏移的研究

目的探讨桥本甲状腺炎Th1／Th2的平衡偏移及其在发病中的作用。方法选择2004-01～06中国医科大学附属第一医院21例桥本甲状腺炎（HT组）和45名健康人（对照组）为研究对象，应用流式细胞技术检测外周血淋巴细胞中CD4^＋CCR5^＋和CD4^＋CD30^＋细胞，以其各自百分比和平均荧光强度（MFI）作为反映Th1／Th2免疫应答强度的指标。结果HT组中CD4^＋CCR5^＋和CD4^＋CD30^＋细胞的百分比均高于对照组（P〈0．05），而且二者的MFI都与甲状腺过氧化物酶抗体（TPOAb）的浓度呈正相关。结论在HT患者中CCR5^＋和CD30^＋的表达均增加，提示，Th1和Th2细胞可能共同参与了HT的发病。     

Nosocomial infections and hospital deaths. A case-control study

In an earlier study, nosocomial infections were reported to occur in one third of patients who died in the hospital. Lower respiratory tract infections appeared to be causally related to death, whereas urinary tract infections were not. A case-control study was therefore conducted to begin to explore epidemiologically these causal suppositions. By definition, all 100 patients in the case group died in the hospital and all 100 patients in the control group survived hospitalization. A patient in the control group was matched to a patient in the case group for age, sex, service, primary discharge diagnosis, and severity of primary diagnosis. Secondary discharge diagnoses were comparable in both groups. Nosocomial infections were present in 33 percent of patients in the case group and 13 percent of patients in the control group (p less than 0.001). Lower respiratory tract nosocomial infections occurred in 18 percent of patients in the case group and 4 percent of patients in the control group (p less than 0.005). Urinary tract nosocomial infections occurred in 6 percent of patients in the case group and 8 percent of patients in the control group (p = NS). Presence of a terminal prognosis on admission was found more often in case group patients than in control group patients (76 percent versus 11 percent, p less than 0.001). Nosocomial infections appeared to favor a fatal outcome only in those whose condition was not terminal on admission (p less than 0.05). In those whose condition was terminal on admission, the incidence of infection was equal in those who survived and in those who died. In conclusion, in these two groups well matched by many criteria, differences in prognosis on admission probably accounted for the major differences in survival. Nosocomial infections may affect outcome in those whose condition is not terminal on admission.     

Cardiac pathology after valve replacement by disc prosthesis: A study of 61 necropsy patients

Clinical and necropsy observations are described in 61 patients who had one or more cardiac valves replaced with a discoid prosthesis of the Hufnagel type. The most common (31 percent) cause of death among the 45 patients who died early (less than 65 days after operation) appeared to be prosthetic disproportion; that is, the prosthesis was too big for the aorta or ventricular cavity into which it was inserted so that inadequate space was present between the margins of the disc and the endocardium of ventricle or intima of aorta. Prosthetic thrombosis occurred in only 3 of the 45 patients who died early, but poppet movement appeared considerably altered in each. In contrast, thrombi were observed on a prosthesis in 14 of the 16 patients who died late (4 to 47 months [average 21] postoperatively), but in none did the thrombi appear of sufficient size to alter poppet function. Excessive bleeding occurred in 11 (24 percent) of the 45 early deaths and was primarily related to the insertion of a patch in the root of the aorta. Uncorrected valvular disease either by itself or by its ability to alter function of the prosthesis appeared responsible for death in 6 (13 percent) of the 45 patients who died early and in 2 (6 percent) of the 16 who died late. Insertion of a mitral poppet disc in a patient with uncorrected aortic regurgitation, even of mild degree, may be hazardous because the aortic regurgitant jet stream may interfere with proper function of the mitral disc. Likewise, insertion of a poppet disc only in the aortic valve position in a patient with combined aortic and mitral regurgitation may considerably increase the degree of mitral incompetence because the aortic prosthesis is intrinsically obstructive.Disc wear or variance was observed in all but one prosthesis in place for more than 1 year. Although hemolytic anemia of significant degree was not observed in any of the 16 patients who died late, the occurrence of renal hemosiderosis in 13 of the 16 patients indicates that the poppet disc prosthesis is considerably traumatic to erythrocytes. Thus, this type of prosthesis is not an ideal substitute cardiac valve. It clots, despite anticoagulant therapy, it is intrinsically stenotic, portions of it, that is, the disc, degenerate, and it causes hemolysis to erythrocytes.     

Tracing the Pathogenesis of Type 1 Diabetes: A Report on the 44th Annual Meeting of the European Association for the Study of Diabetes (EASD)

Clinical type 1 diabetes is preceded by autoimmune destruction of the pancreatic beta-cells. However, progression to disease is not uniform. One challenge facing current diabetes research is therefore to identify biomarker profiles that accurately reflect the individual stage of type 1 diabetes pathogenesis and develop new techniques to distinguish between these profiles and associated diabetes risks. This report highlights some of the recent studies on diabetes biomarkers, with a particular focus on zinc transporter ZnT8, presented at the EASD meeting in September 2008 in Rome, Italy.     

Coronary arterial disease in systemic lupus erythematosus: Quantification of degrees of narrowing in 22 necropsy patients (21 women) aged 16 to 37 years

The degrees of cross-sectional area luminal narrowing by atherosclerotic plaques of each 5 mm long segment of each of the four major (right, left main, left anterior descending and left circumflex) epicardial coronary arteries in 22 necropsy patients (age 16 to 37 years, 21 women) with systemic lupus erythematosus (SLE) was determined, and the findings were compared to those in 13 control subjects. Of 623 coronary segments (5 mm long) in the patients with SLE, 80 (13 percent) were narrowed 76 to 100 percent (controls = 0 of 431 segments); 125 (20 percent), 51 to 75 percent (controls = 6 percent); 273 (44 percent), 26 to 50 percent (controls = 63 percent) and 145 (23 percent), 0 to 25 percent (controls = 31 percent). Of the 22 patients with SLE, 10 had one or more of the four major coronary arteries narrowed 76 to 100 percent in cross-sectional area, and 12 patients had lesser degrees of narrowing similar to that in the 13 control subjects. The 10 patients with SLE and severe coronary narrowing compared to the 12 patients with SLE and no severe (> 75 percent) coronary narrowing had significantly higher (1) mean values of total serum cholesterol (382 versus 290 mg/dl), (2) mean systolic/diastolic systemic arterial pressures (175/119 versus 151/93 mm Hg), (3) frequencies of mitral valvular disease (seven of 10 patients versus none of 12 patients) and (4) frequencies of pericardial adhesions (seven of 10 patients versus three of 12 patients).