非酮症高血糖性舞蹈症

目的对非酮症高血糖性舞蹈症患者的临床表现、影像学特征及发病机制进行分析。方法结合相关文献对5例非酮症高血糖舞蹈症患者的临床资料进行分析。结果 5例均急性起病,可表现为单侧或双侧肢体的舞蹈症状;血糖和血渗透压明显增高;影像学表现为特异性斑片状脑出血和纹状体T1高信号;联合应用降糖药物和多巴胺受体阻滞剂可控制舞蹈症状。结论非酮症性高血糖、舞蹈症以及MRI显示为纹状体T1高信号,可能构成舞蹈症临床综合征;影像学改变可能表示由代谢紊乱引起的斑片状脑出血,后者导致基底神经节运动环路受损,从而产生舞蹈样症状。     

实验性2型糖尿病大鼠模型的建立和评价(Ⅰ)——体重、血糖和肝糖原的变化

目的：用高脂饲料加小剂量STZ腹腔注射建立实验性2型糖尿病大鼠模型。方法：采用Wistar大鼠,分为正常对照组、高脂饲料组、小剂量STZ组（30 mg/kg）和高脂饲料加小剂量STZ（30 mg/kg）组,每10 d测定大鼠体重、空腹血糖和肝糖原等指标,连续50 d,对各组大鼠上述指标进行比较和评价。结果：①体重：高脂饲料组大鼠体重呈连续上升趋势,小剂量STZ组和高脂饲料加小剂量STZ组大鼠体重呈先降低再恢复的趋势;②空腹血糖：高脂饲料组大鼠空腹血糖轻微升高,小剂量STZ组大鼠空腹血糖呈上升的趋势,高脂饲料加小剂量STZ组大鼠空腹血糖呈明显上升趋势;③肝糖原：高脂饲料组大鼠肝糖原明显升高,小剂量STZ组、高脂饲料加小剂量STZ组大鼠肝糖原未见明显改变;结论：高脂饲料加小剂量STZ腹腔注射能成功诱导2型糖尿病大鼠模型,这种造模方法具有成模后血糖维持在较高水平、自身缓解较少、症状较轻和动物状态良好等优点。     

卒中后高血糖机制及其管理策略

脑卒中后应激性高血糖的发生严重影响到了患者的预后情况,本文阐述了卒中后高血糖发生及危害的机制假说,同时围绕卒中后血糖控制目标、血糖控制方式、预防低血糖发生等方面进行探讨。     

Diabetic and nondiabetic hyperglycemia in the ICU

Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion).The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients.Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days.However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues—such as the optimal target glucose concentration and the most effective insulin regimen—especially in the general surgical patient.     

蛋白激酶Cβ2在高糖与缺氧/复氧诱导的心肌细胞焦亡中的作用

目的:探讨蛋白激酶Cβ2 (protein kinase Cβ2, PKCβ2）在高糖与缺氧/复氧（hypoxia/reoxygenation, HR）诱导的心肌细胞焦亡中的作用。方法:将培养的H9c2心肌细胞按随机数字表法分为5组（每组6孔）：低糖组（LG组）、低糖缺氧/复氧组（LG+HR组）、高糖组（HG组）、高糖...     

胰腺癌神经浸润及临床研究新进展

胰腺癌的特点是神经浸润非常高发(可高达90%～100%),这与其生存率不高有关.肿瘤细胞胰内、胰外神经浸润是胰腺癌神经变化的典型表现.胰外神经丛浸润增加可以促进胰内神经浸润的发生,从而造成疼痛.胰腺癌诊断率的显著增加与新发糖尿病的诊断有关,高血糖也有促进胰腺癌神经浸润的可能.控制高血糖和光基因技术可作为胰腺癌神经浸润的辅助治疗,并且可以利用光基凶技术对胰腺癌的神经浸润进行监测.

Abstract：

The high occurrence of neural invasion in pancreatic carcinoma, which can be as much as 90%-l00%,leads to the poor survival rate in patients. The classical pathology includes invasion of both the extrapancreatic and intrapancreatic neurons. Metastasis into the extrapancreatic plexus promotes invasion into the intrapancreatic neurons and therefore results in pain. An increased in the diagnosis of new-onset diabetes mellitus, on the other hand, correlates with an increase in pancreatic cancer. This implies that hyperglycemia may promote neural invasion of pancreatic carcinoma. Novel auxiliary therapy of pancreatic carcinoma with neural invasion includes controlling of blood sugar and optogenetics, a new genetic technology which can further be utilized for surveillance.     

Effective reduction in stress induced postoperative hyperglycemia in bariatric surgery by better carb loading

BackgroundPreoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP’s), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics.MethodsUsing our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading.ResultsThe population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p < 0.05) and diabetic patients (66% vs 34%; p < 0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status.ConclusionFollowing bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.     

Refractive properties of the healthy human eye during acute hyperglycemia

PURPOSE: To measure the refractive properties of the healthy human eye during acute hyperglycemia by means of Scheimpflug imaging and Hartmann-Shack aberrometry. METHODS: Acute hyperglycemia was induced in five healthy subjects (two males, three females, mean age +/-SD 24.8 years +/- 4.6) by means of an oral glucose tolerance test (OGTT) after subcutaneous somatostatin injection. Before and every 30 minutes after the OGTT, measurements with Scheimpflug imaging and Hartmann-Shack aberrometry were performed. The main outcome measures were the thickness and shape of the lens, and the ocular refractive error and higher order aberrations. The equivalent refractive index of the lens was calculated from these parameters. Measurements at baseline and during hyperglycemia were analyzed by means of Wilcoxon signed rank sum tests. RESULTS: During hyperglycemia (mean blood glucose level at baseline: 4.0 mmol/l; mean maximal blood glucose level: 18.4 mmol/l) no changes could be found in the refractive properties within the group. In one subject, a hyperopic shift (0.4 D) was observed, together with a more convex shape of the anterior lens surface and a decrease in the equivalent refractive index of the lens. CONCLUSIONS: This study shows that hyperglycemia generally does not cause changes in the refractive properties of the healthy eye. Nevertheless, in one subject a hyperopic shift accompanied by a change in shape and refractive index of the lens was measured. This finding could provide an explanation for the mechanism underlying the refractive changes that are often observed during hyperglycemia.     

NS-398对高糖诱导的系膜细胞结缔组织生长因子表达的影响

［摘要］目的研究选择性环氧化酶 2抑制药NS 398对高糖诱导的系膜细胞刺激结缔组织生长因子（CTGF）表达的影响。 方法20 μmol&#8226;L-1 NS 398加入30 mmol&#8226;L-1高糖培养的大鼠肾小球系膜细胞中，分别培养0，12，24，48，72 h，应用逆转录聚合酶链反应的方法评价CTGF mRNA的表达改变，应用免疫细胞化学方法评价CTGF蛋白的表达水平。结果未加高糖刺激的肾小球系膜细胞CTGF mRNA和蛋白表达水平较低，高糖刺激后肾小球系膜细胞CTGF mRNA和蛋白表达水平增加，6 h活性已渐增高，12 h达高峰，18 h开始下降，24 h降至较低水平。用NS 398干预30 min后再用30 mmol&#8226;L-1高糖刺激，未见 CTGF mRNA和蛋白表达水平增加（P＞0.05）。 结论高糖能上调肾小球系膜细胞CTGF mRNA和蛋白的表达，NS 398能抑制高糖诱导系膜细胞CTGF的表达。