OCT在Vogt-小柳原田综合征临床诊疗中的作用

目的 探讨频域相干光断层扫描(Optical Coherence Tonography,OCT)在Vogt-小柳原田综合征(VKH)临床诊疗过程中的作用.方法 对14例28只眼VKH患者早期行OCT检查,并行荧光素眼底血管造影(FFA).全部病例均应用甲强龙冲击3天后糖皮质激素口服治疗,在用药前、口服药前及口服强的松1周、1个后月均行OCT检查.结果 14例28只眼VKH患者早期OCT检查表现为视网膜神经上皮层及色素上皮层渗出性脱离、隆起呈泡状或多囊状.神经上皮最大脱离高度4058μm,最小脱离高度156 μm,平均(2869±138.65)μm,最大脱离直径超过6 mm扫描范围,最小直径1348 μm,色素上皮单发或多发脱离,应用甲强龙冲击3天后神经上皮脱离快速消退,神经上皮最大脱离高度2058 μm,最小脱离高度49μm,平均(1345±115.85) μm,最大脱离直径2568 μm,最小直径563μm,平均(1078±98.43)μm,与治疗前对比差异有统计学意义(P＜0.05).用药7～10天后 神经上皮及色素上皮脱离均消退,视乳头水肿明显减轻,所有患者均恢复至发病前视力,1个月后黄斑区神经上皮及色素上皮恢复正常,合并视乳头水肿者水肿均消退,视力稳定无下降.结论 OCT在VKH临床早期诊断、诊疗效果的评价以及与患者沟通方面均具有重要临床意义.     

Chitooligosaccharide ameliorates diet-induced obesity in mice and affects adipose gene expression involved in adipogenesis and inflammation

Chitooligosaccharide (CO) has been reported to have potential antiobestic effects in a few studies, but the antiobesity properties of CO and its related mechanisms in models of dietary obesity remain unclear. We investigated the effect of CO on body weight gain, size of adipocytes, adipokines, and lipid profiles in high-fat (HF) diet-induced obese mice and on the gene expression in adipose tissue using a complementary DNA microarray approach to test the hypothesis that CO supplementation would alleviate HF diet-induced obesity by the alteration of adipose tissue-specific gene expression. Male C57BL/6N mice were fed a normal diet (control), HF diet, or CO-supplemented HF diet (1% or 3%) for 5 months. Compared with the HF diet mice, mice fed the 3% CO-supplemented diet gained 15% less weight but did not display any change in food and energy intake. Chitooligosaccharide supplementation markedly improved serum and hepatic lipid profiles. Histologic examination showed that epididymal adipocyte size was smaller in mice fed the HF + 3% CO. Microarray analysis showed that dietary CO supplementation modulated adipogenesis-related genes such as matrix metallopeptidases 3, 12, 13, and 14; tissue inhibitor of metalloproteinase 1; and cathepsin k in the adipose tissues. Twenty-five percent of the CO-responsive genes identified are involved in immune responses including the inflammatory response and cytokine production. These results suggest that CO supplementation may help ameliorate HF diet-induced weight gain and improve serum and liver lipid profile abnormalities, which are associated, at least in part, with altered adipose tissue gene expression involved in adipogenesis and inflammation.     

Alteration in insulin action: role of IRS-1 serine phosphorylation in the retroregulation of insulin signalling

Insulin resistance, when combined with impaired insulin secretion, contributes to the development of type 2 diabetes. Insulin resistance is characterised by a decrease in insulin effect on glucose transport in muscle and adipose tIssue. Tyrosine phosphorylation of insulin receptor substrate 1 (IRS-1) and its binding to phosphatidylinositol 3-kinase (PI 3-kinase) are critical events in the insulin signalling cascade leading to insulin-stimulated glucose transport. Modification of IRS-1 by serine phosphorylation could be one of the mechanisms leading to a decrease in IRS-1 tyrosine phosphorylation, PI 3-kinase activity and glucose transport. Recent findings demonstrate that "diabetogenic" factors such as FFA, TNFalpha, hyperinsulinemia and cellular stress, increase the serine phosphorylation of IRS-1 and identified Ser307/612/632 as phosphorylated sites. Moreover, several kinases able to phosphorylate these serine residues have been identified. These exciting results suggest that serine phosphorylation of IRS-1 is a possible hallmark of insulin resistance in biologically insulin responsive cells or tIssues. Identifying the pathways by which "diabetogenic" factors activate IRS-1 kinases and defining the precise role of serine phosphorylation events in IRS-1 regulation represent important goals. Such studies may enable rational drug design to selectively inhibit the activity of the relevant enzymes and generate a novel class of therapeutic agents for type 2 diabetes.     

Hormonal and metabolic disturbances during acute and subacute myocardial infarction in man

Summary To investigate the cause of glucose intolerance (GIT), frequently seen during acute myocardial infarction (AMI), seventeen males without history of diabetes were studied with intravenous glucose tolerance tests within seventy-two hours after uncomplicated myocardial infarction and again three weeks later. Seventy percent (12/17) of the patients showed GIT during AMI. In 7 of these patients (41%) glucose tolerance (GT) remained abnormal after 3 weeks. In addition, all 7 showed markedly diminished insulin responses to glucose during both the acute and subacute phase. Therefore, their GIT was considered to be due to newly-recognized chemical diabetes. In the remaining patients in whom the initially depressed GT improved during SMI elevated serum levels of FF A, insulin, HGH and cortisol suggested the temporary presence of insulin antagonism. Increased adrenal medullary activity was not found to be a major factor inhibiting glucose tolerance.Supported in part by the Genesee Valley Heart Association, Rochester, New York and PHS Research Grant No. 5 MOI RR349.     

Einfluß der Gewichtsreduktion auf Metabolite des Kohlenhydrat- und Fettstoffwechsels und auf das Verhalten des Seruminsulins bei Adipositas

Zusammenfassung Um Anhaltspunkte dafür zu gewinnen, welche der bei der Fettsucht beobachteten Stoffwechselanomalien durch eine Reduktionsdiät rückbildungsfähig sind, untersuchten wir unter ambulanten Bedingungen 37 adipöse Patienten mit einem mittleren Übergewicht von 71% nachBroca. Ein klinisch-manifester Diabetes und endokrine Erkrankungen wurden ausgeschlossen. 20 der Probanden zeigten Störungen der Kohlenhydrattoleranz. Bei 17 lagen der i.v. und der orale Glucosetoleranz-Test im Normbereich. Beide Teilkollektive behandelten wir mit einer 1000 Cal.-Mischkost und sahen darunter eine Gewichtsabnahme von 21.2 bzw. 17.5 kg, entsprechend 34 bzw. 28% nachBroca, d.h. im Durchschnitt etwas weniger als die Hälfte des bestehenden Übergewichtes. — Beim Teilkollektiv mit gestörter Kohlenhydrattoleranz traten dabei folgende Veränderungen ein: — 1. Signifikante Besserung der Glucosetoleranz mit weitgehender Normalisierung des Nüchternblutzuckers und des 120 Minuten-Wertes nach oraler Glucosegabe, sowie derk-Werte für die i.v. und oralen Glucosetoleranz-Teste. — 2. Ein hochsignifikanter Abfall der stark erhöhten Nüchternwerte für das freie Serumglycerin mit Normalisierung des Quotienten: Freie Fettsäuren/ Glycerin im Nüchternblut. — 3. Signifikanter Rückgang der überhöhten Werte für die insulinähnliche Aktivität und für das immunologisch reagierende Insulin. — Unter den gleichen Bedingungen fanden wir im Teilkollektiv mit normaler Kohlenhydrattoleranz lediglich einen mäßigen Anstieg der freien Fettsäuren 90 und 120 nach Glucose. — Im Gesamtkollektiv der Fettsüchtigen war unter der Reduktionsdiät ein signifikanter Rückgang der Esterfettsäuren festzustellen. — Die unter 1–3 geschilderten Veränderungen traten unter dieser Diätbehandlung deutlicher hervor als bei den bisher beschriebenen Fastenkuren und betreffen vorwiegend das Teilkollektiv mit gestörter Kohlenhydrattoleranz. Die Befunde deuten daraufhin, daß der Hyperinsulinismus, der von einigen Autoren als ursächlich für die Fettsucht angesehen wird, eher adaptiver Natur ist.

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Influence of weight reduction on carbohydrate and fat metabolism and on serum insulin response in obesity

Summary To find out which of the metabolic changes observed in obesity are reversible by a reducing diet, we examined 37 obese out-patients with a mean overweight of 71%Broca. A manifest diabetes mellitus and endocrine diseases were excluded by clinical means. 20 subjects showed disturbances of carbohydrate-tolerance. Oral and i.v. glucose-tolerance tests gave normal results in 17. Both subgroups were put on a 1000 cal. mixed diet and had mean weight-losses of 21.2, vs. 17.5 kg, corresponding to 34% vs. 28%Broca, i.e. less than half of their overweight. — The following changes were observed in the subgroup with impaired carbohydrate-tolerance: — 1. Significant improvement of glucose-tolerance with beginning normalization of fasting blood sugar, 120 value after oral glucose and of thek-values for i.v. and oral glucose-tolerance tests. — 2. Highly significant reduction of the elevated fasting values for free serum glycerol with normalization of the quotient: free fatty acids/glycerol in fasting serum. — 3. Significant fall of the high levels for insulin-like activity and for immunologically reacting insulin. — Under identical conditions the subgroup with normal carbohydrate-tolerance showed only a moderate increase of free fatty acids 90 and 120 after glucose. In the obese group as a whole, we found a reduction of serum esterified fatty acids under low calorie diet. — The changes described under 1–3 were more pronounced with this dietary treatment than in fasting periods generally described until now, and occurred predominantly in the subgroup with impaired carbohydrate-tolerance. Our findings indicate that hyperinsulinism held responsible for obesity up to now by some authors is probably adaptive.

Mit dankenswerter Unterstützung der Deutschen Forschungsgemeinschaft und des Landesamtes für Forschung des Landes Nordrhein-Westfalen. — Die Befunde wurden auszugsweise auf dem 6. Kongreß der Internationalen Diabetes Föderation vom 30. 7. — 4. 8. 1967 in Stockholm vorgetragen.     

训练时间、负荷内容对血液三羧酸循环产物和游离脂肪酸组分影响的观察

采用气相色谱法分析表明:发展脂代谢能力,提高血液中红细胞含量,不仅可以通过选择负荷内容,而且可通过选择最佳负荷时间。实验显示,早晨训练对三羧循环和FFA(游离脂肪酸)及其组分影响最大。     

外科病人围手术期血脂代谢的变化及其临床意义

对二组外科择期手术病人围手术期血浆游离脂肪酸即软脂酸（C16：0）、硬脂酸（C18：0）、油酸（C18：0）、亚油酸（C18：2）、花生四烯酸（C20：4）和甘油三脂及胆固醇水平变化的观察，发现手术后早期即有血脂水平的全面降低。血脂的降低随创伤应激的加重而具显著性且持久，提示在创伤应激早期机体主要通过利用血脂而获得能量，同时血糖应激性升高以保证神经细胞和红细胞的能量供应，并减少了乳酸生成，有利于维持重要的生命中枢功能和体液内环境稳定。本研究还发现，创伤后存在着显著而持久的低胆固醇血症，且血胆固醇水平与创伤程度及病人预后有较密切关系。创伤后在保证机体氧合状态正常的前提下，早期补充脂肪酸（特别是多不饱和脂肪酸）和胆固醇，将有助于减轻机体组织的分解代谢，稳定细胞结构和功能，保护机体内环境，防止多器官功能障碍的发生。     

A comparative study of metabolic and hormonal responses to somatostatin and propranolol in man

Summary The aim of this study was to compare the metabolic and hormonal effects of somatostatin to those of propranolol, a β-adrenergic blocking agent known to reduce basal insulin secretion. For this purpose, 6 normal subjects received somatostatin (4 μg/min) per 60 min and 6 subjects were infused with propranolol (0.08 mg/min). Somatostatin resulted in a significant decrease of basal insulin (p<0.05) and glucagon (p<0.01) and raised plasma FFA levels from a mean basal value of 417±24 μEq/l (x±SEM) to 600±46 μEq/l at 60 min (p<0.01). Propranolol significantly decreased basal insulin (p<0.05) and glucagon (p<0.05); FFA levels rose slightly at the end of propranolol administration (p>0.05). The levels of FFA which were significantly higher (p<0.025) during somatostatin as compared to those observed during propranolol, seem to suggest a role for this tetradecapeptide in lipid metabolism independent of its inhibiting action on islet hormone release.     

In vivo alpha 2-adrenoceptor-mediated inhibition of isoproterenol-stimulated free fatty acid output in dog bone marrow adipose tissue

Clomdine, an α₂ agonist, inhibited the isoproterenol-induced free fatty acid outflow from perfused bone marrow adipose tissue of dog tibia. This effect was suppressed by the α₂-antagonist, yohimbine. These in vivo experiments clearly demonstrate an α₂-adrenoceptor-mediated inhibition of isoproterenol-induced lipid mobilization and argue for a physiological interplay between β- and α₂-site stimulation in the regulation of lipolysis.     

Reabsorption ofl-glutamine andl-histidine from various regions of the rat proximal convolution studied by stationary microperfusion: Evidence that the proximal convolution is not homogeneous

Summary The glycogen depletion pattern in human muscle fibers was followed throughout the course of prolonged exercise at a work load requiring 67% of the subjects' maximal aerobic power. Biopsy samples were taken from the vastus lateralis muscle at rest and after 20, 60, 120, and 180 (or when unable to continue at the prescribed load) min of exercise. Muscle fibers were identified as fast twitch (FT) or slow twitch (ST) on the basis of myofibrillar ATPase activity. The glycogen content of muscle samples was determined biochemically. At the end of the exercise total muscle glycogen content was very low. Glycogen was also estimated in the fibers with the PAS stain. ST fibers were the first to become depleted of their glycogen but as the exercise progressed, the FT fibers were also depleted. These data may suggest a preferential utilization of ST fibers during prolonged, intense exercise, with a secondary recruitment of FT occuring as the ST fibers became depleted of their glycogen stores.