胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes(T2DM).Methods Bone fracture patients with T2DM were randomly divided into three groups:continuous subcutaneous insulin infusion group(insulin aspart,group CSII,n=20),glargine treatment group(insulin aspart+insulin glargine,group GA,n=20),and NPH treatment(insulin aspart+rh-insulin,group NA,n=20).The levels of fasting plasma glucose(FPG)and the 2 hours postprandial glucose(2h PG),blood glucose fluctuation(BGF),insulin dosage(ID),good effective time(GET),incidence of hypoglycemia,dawn phenomenon and infection,average time of stitches removal(ATSR),average hospitalized length(AHL)of three groups were compared.Results FPG and 2hPG,ID in group CSII[(6.32±1.18)mmol/L,(7.72±1.53)mmol/L,(35.40±1.60)IU]and group GA [(6.25±0.88)mmol/L,(7.32±1.17)mmol/L,(36.20±0.80)IU]were significantly lower than those of group NA [(7.44±1.36)mmol/L,(8.52±0.76)mmol/L,(40.50±2.40)IU,all P<0.05],simulaneously,BGF,GET incidence of complications,ATSR,AHL of group CSII and GA were significantly lower than those of group NA(all P<0.05).There were not significant difference between group CSII and group GA.Compared with group CSII,group GA had less costs in-hospital and better practicability.Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively,safely,rapidly and stablely control hyperglycemia.and might be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.     

Predictors of low CD4 count in resource-limited settings: based on an antiretroviral-naive heterosexual thai population

A barrier to the appropriate provision of antiretroviral therapy to treat immunosuppressed HIV-infected persons in resource-poor countries is identifying who requires treatment. The World Health Organization (WHO) has suggested using a clinical algorithm combined with a total lymphocyte count (TLC) < 1200 cells/mm as a surrogate for a CD4 count less than 200 cells/mm when it is not possible to measure the CD4 count. We evaluated various TLC levels, anemia, and body mass index and compared our data with the WHO criteria to develop a more sensitive algorithm to predict CD4 counts of < 200 cells/mm and < 350 cells/mm in 839 men and women from Thailand infected with HIV-1 subtype E (CRF01_AE). The December 2003 WHO guidelines had a sensitivity of 34.1% in men and 31.8% in women to detect persons with a CD4 count < 200 cells/mm in this HIV-infected population from Thailand. The use of a TLC < 1500 cells/mm or TLC < 2000 cells/mm combined with anemia or WHO stage II infection doubled the sensitivity to detect persons with a CD4 count < 200 (63.0% in men, 68.2% in women) with less than a 6% decrease in specificity.     

丹参注射液与异甘草酸镁抗肝纤维化的临床对比研究

Objective To observe the change of liver function and liver fibrosis indexes of the chronic hepatitis B patients that were treated by Danshen injection(DI) and magnesium isnglyeyrrhizinate(MI). Methods 80 chronic hepati-tis B patients based on the conventional treatment were randomly divided into D1 group(40 patients) and MI group(40 pa-tients). The two groups were used with DI and MI injection for 30 days respaetively and then,the levels of liver function and serum hepatic fibrosis(HA, LN, Ⅳ -C) were detected and compared before and after treatment. Results Treatment by DI and MI could both improve liver function significantly, the effect of Ml group was better than DI group(P < 0.05). Moreover, in improving serum hepatic fibrosis, the effect of DI group was better than MI group (P < 0.05). Conclusions The efficacy of the improvement to hepatic fibrosis DI is better than MI, while in improvement of liver function MI is superior to DI.     

丹参注射液与异甘草酸镁抗肝纤维化的临床对比研究

目的 观察慢性乙型肝炎患者应用丹参注射液和异甘草酸镁治疗后肝功能和肝纤维化指标的改善情况.方法 将80例慢性乙型肝炎患者,随机分为丹参组40例,异甘草酸镁组40例,在常规保肝治疗基础上,两组分别加用丹参注射液和异甘草酸镁注射液治疗,疗程均为30 d.观察两组患者治疗前、后的肝功能和肝纤维化指标[血清透明质酸酶(HA)、层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)]的变化.结果 治疗后丹参注射液和异甘草酸镁均可明显改善慢性乙型肝炎患者的肝功能,异甘草酸镁组较丹参组为优(P<0.05).丹参组肝纤维化指标较治疗前有下降(P<0.05);异甘草酸镁组肝纤维化指标与治疗前比较差异无统计学意义(P>0.05);两组治疗后的肝纤维化指标比较,差异有统计学意义(P<0.05).结论 丹参注射液改善肝纤维化的疗效优于异甘草酸镁,而异甘草酸镁改善肝功能的疗效优于丹参注射液.     

某部密闭舱室军事作业环境和人员健康调查评价

目的 评价特殊军事作业人工环境影响因素特征及其对人员健康的影响,为进一步开展控制措施的研究提供依据.方法 采用电磁辐射场强仪、声级计、温湿度计、风速仪、一氧化碳检测仪和二氧化碳分析仪,分别对某部军事作业密闭环境的微波辐射、噪声、温度、湿度、风速、一氧化碳和二氧化碳进行监测分析;采用自觉症状问卷,调查评价作业人员健康...     

Effects of Tick-Control Interventions on Tick Abundance,Human Encounters with Ticks,and Incidence of Tickborne Diseases in Residential Neighborhoods,New York,USA

Tickborne diseases (TBDs) such as Lyme disease result in ≈500,000 diagnoses annually in the United States. Various methods can reduce the abundance of ticks at small spatial scales, but whether these methods lower incidence of TBDs is poorly understood. We conducted a randomized, replicated, fully crossed, placebo-controlled, masked experiment to test whether 2 environmentally safe interventions, the Tick Control System (TCS) and Met52 fungal spray, used separately or together, affected risk for and incidence of TBDs in humans and pets in 24 residential neighborhoods. All participating properties in a neighborhood received the same treatment. TCS was associated with fewer questing ticks and fewer ticks feeding on rodents. The interventions did not result in a significant difference in incidence of human TBDs but did significantly reduce incidence in pets. Our study is consistent with previous evidence suggesting that reducing tick abundance in residential areas might not reduce incidence of TBDs in humans.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折疗效的比较

目的 比较掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折的长期疗效.方法 对2005年9月-2007年11月间,采用切开复位掌侧锁定接骨板或普通接骨板内固定的45例随访资料完整的患者,进行两种疗法的比较.其中23例行锁定接骨板内固定,22例行普通接骨板内固定.按照AO分型:A型11例,B型11例,C型23例.随访内容包括:腕关节活动度(屈曲、背伸、尺偏、桡偏),前臂旋前、旋后活动范围,影像学资料(尺偏角、掌倾角、桡骨高度),应用DASH上肢功能评定标准和Gartland/Wertey腕关节评分法进行评分.结果 术后随访时间平均为18.8个月(12～36个月).腕关节活动度中,锁定板组背伸及两组的桡偏范围低于Gartland/Werley腕关节评分的基本范围.两组DASH值、腕关节活动度及前臂旋转范围,握力、捏力的恢复差异无统计学意义.Gartland/Werley腕关节评分普通接骨板治疗组优于锁定接骨板治疗组,差异有统计学意义.掌倾角均值两组都低于正常范围,尺偏角与桡骨高度均值在正常范围内,两组间差异无统计学意义.结论 掌侧锁定接骨板与普通接骨板在桡骨远端骨折治疗中具有相同疗效.     

单纤维肌电图在诊断腕管综合征中的表现和评价

目的 分析、评价单纤维肌电图(single fiber electromyography,SFEMG)在诊断腕管综合征中的表现和作用.方法 将临床确诊的14例腕管综合征患者(共20侧)根据常规电生理神经传导检测数据分为两组:患侧跨腕段SNCV(感觉神经传导)均减慢,但拇短展肌CMAP(复合肌肉动作电位)潜伏期正常者为腕管Ⅰ组(10侧),拇短展肌CMAP的潜伏期4.3ms者为腕管Ⅱ组(10侧).各组均行SFEMG检测,得到拇短展肌的纤维密度(fiber density,FD)和单纤维动作电位间间隔的连续差均值(mean of consecutive difference,MCD).10例(10侧)健康志愿者为对照组,同法测取FD、MCD值.结果 术前各组SFEbfG检测结果 :拇短展肌MCD平均值,腕管Ⅰ组为67.86μs,较对照组延长了27.47μs;腕管Ⅱ组为83.36μs,较对照组延长了42.97μs.拇短展肌FD平均值,腕管Ⅰ组较对照组增加了0.46,腕管Ⅱ组较对照组增加了0.60.腕管Ⅰ、Ⅱ组的MCD、FD明显高于对照组,Ⅱ组MCD又明显高于Ⅰ组,而Ⅰ组、Ⅱ组FD则无明显差异.结论 单纤维肌电图检测为腕部正中神经卡压,特别是早期卡压的诊断提供了一项新的更为直接的客观指标.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.