Case Report: Transient Stress Hyperglycemia in the Patient With ST-Elevation Myocardial Infarction

Transient stress hyperglycemia in the setting of acute myocardial infarction is a frequent phenomenon. Its transient nature should not dissuade the clinician from management of elevated blood glucose in a patient after an ST-elevation myocardial infarction. This case presents an adult patient after an ST-elevation myocardial infarction with transient stress hyperglycemia and the evidence used to identify optimal pharmacologic management and secondary prevention.     

重度失水所致应激性高血糖症

本文报道2例肠梗阻和1例有机磷农药中毒患者出现暂时性高血糖症。该3例患者均无糖尿病史,因有重度失水,经大量补液纠正失水后血糖迅速恢复正常。口服葡萄糖耐量试验正常。作者认为非糖尿病患者可因重度失水而致应激性高血糖症。     

Effects of a brisk walk on lipoprotein lipase activity and plasma triglyceride concentrations in the fasted and postprandial states

This study aimed to determine whether changes in plasma heparin-releasable lipoprotein lipase (LPL) activity following a brisk walk were associated with decreases in fasting and/or postprandial triglyceride (TG) concentrations. Two groups of pre-menopausal women participated. In one group (fasting study group, n=10), TG concentrations and post-heparin plasma LPL activity were measured in the fasted state on two occasions: ~18 h after a 2-h treadmill walk at 50% maximal oxygen uptake (exercise trial); and after a day of no exercise (control trial). The other group (postprandial study group, n=9) undertook two oral fat tolerance tests (blood samples taken fasting and for 6 h after a high-fat meal), with plasma LPL activity measured 6 h after meal ingestion. Pre-conditions were the same as for the fasting study group (i.e. control and prior exercise). Prior exercise reduced fasting TG concentrations by 23 (7)% (fasting study group) [mean (SEM)] and by 18 (9)% (postprandial study group) (both P<0.05), and the postprandial TG response by 23 (6)% (postprandial study group) (P<0.01). Plasma LPL activity was not significantly increased by exercise in either the fasting or postprandial study groups. However, exercise-induced changes in both fasting and postprandial LPL activity were significantly correlated with the respective exercise-induced changes in fasting TG concentration and the postprandial TG response (r=−0.70 and −0.77 respectively, P<0.05 for both). These data suggest that increased LPL activity may contribute to the hypotriglyceridaemic effect of moderate exercise, although other mechanisms are also likely to be involved. Electronic Publication     

慢性束缚应激致大鼠持续性高血糖症与孤束核损伤有关

目的 探讨孤束核联合亚核前部（acNTS）损伤在慢性束缚应激（CRS）所致的胰岛素抵抗性高血糖症发生中的作用。 方法 采用CRS大鼠模型（n=20;7 d束缚+3 d自由活动，共40 d），检测葡萄糖代谢相关指标。 结果 CRS导致约1/3的个体（n=7）持续性的中度胰岛素抵抗性高血糖（空腹血糖不超过11 mmol/L）。CRS高血糖鼠acNTS可观察到神经元染色浓缩，Caspase-3表达和TUNEL阳性染色，提示出现神经元凋亡样改变。机械损伤acNTS（n=6），空腹血糖水平逐渐升高，也能导致胰岛素抵抗性高血糖, 且高胰岛素血症、胰岛平均体积增大和血清皮质酮水平不变等特点与CRS小鼠一致。 结论 CRS损伤了acNTS的葡萄糖敏感神经元，从而使血糖调节紊乱。     

Theophylline disrupts diurnal rhythms of humoral factors with loss of meal cyclicity

To test the possibility that theophylline induced circadian disappearance of food intake might depend upon rhythmic disruption of blood glucose, insulin and free fatty acids (FFA), theophylline was administered chronically. This markedly lengthened postprandial intermeal intervals during the dark, and induced approximately identical intermeal intervals and identical meal sizes in the light and dark periods. In contrast to the clear light-dark dependent oscillations of serum glucose, insulin and FFA in the controls, the theophyllinized rats lost circadian fluctuation of each of these three chemical substances. Further, theophyllinized rats, unlike controls, had no time-dependent fluctuation in the levels of these substances at ? 120, ?60 or ?15 min preceding the onset of the first meal before the dark. These findings, together with previous reports, explain the disappearance of nocturnal feeding rhythm in theophyllinized rats in terms of functional destruction of circadian regulation in the hypothalamus which modulate the production of chemical determinants of food intake.     

Rapid steady-state analysis of blood-brain glucose transfer in rat

A new kinetic analysis of blood-brain glucose transport is described, based on a steady-state model that takes account of cerebral blood flow, mean capillary glucose concentration, and cerebral metabolic rate. The maximal rate (T_max) and half-saturation constant (K_m) of glucose transport from blood to brain were determined in rats by measuring the rate of blood-to-brain glucose transfer at different blood glucose concentrations. Each determination lasted 20 seconds. For whole-brain, T_max and K_m averaged 258±33 (S.E.) μmol (100 g)^-1 min^-1 and 5.9±1.6 (S.E.) mmol 1^-1, respectively. The regional variations were insignificant. The new approach permits kinetic parameters to be measured locally in brain in rapidly changing functional states.     

急性胰腺炎患者空腹高血糖发生率及其危险因素分析

目的:回顾性分析急性胰腺炎(AP)患者空腹高血糖发生率及其危险因素。方法:收集2018-01—2018-12武汉大学人民医院胰腺外科133例AP且无糖尿病(DM)病史的住院患者病历资料,按照不同性别、年龄、AP临床分型、病因、CT指数评分(CISI)等分组,χ2检验分析各组临床因素与空腹高血糖(FPG≥6.1mmol/L)发生率的关系,多因素二元logistic回归分析空腹高血糖独立危险因素。结果:AP临床分型(χ2=5.494,P=0.019)和CTSI(χ2=6.236,P=0.013)与AP患者空腹高血糖相关(P<0.05)。CTSI≥6分(P=0.015,OR=2.920,95%Cl=1.234—6.905)为AP患者空腹高血糖的独立危险因素(P<0.05)。结论:临床分型中重症+重症及CTSI≥6分的AP患者易发生空腹高血糖,尤其CTSI≥6分是AP后空腹高血糖的独立危险因素,临床应高度关注。     

住院精神分裂症病人高血糖症的调查

目的 :探讨精神分裂症病人高血糖症的发生与抗精神病药物治疗以及其他因素的关系。方法 :收集精神分裂症住院患者的临床资料 ,对精神分裂症患者出现的高血糖症与不同抗精神病药物治疗、糖尿病家族史、性别、年龄、患病病程等进行单因素和多因素分析。结果 :987例病人中有高血糖症者 3 5例。统计分析表明 ,血糖升高与精神分裂症总病程以及抗精神病药使用的时间的长短有关 ,也可能与患者年龄和性别因素有关 ,但与使用药物种类、糖尿病家族史以及体重变化等因素无密切关系。结论 :初步分析提示慢性病程、长期接受抗精神病药物治疗是精神分裂症病人高血糖症发生的危险因素。     

Nitric oxide mediates intestinal hyperaemic responses to intraluminal bile-oleate

It has long been recognized that intestinal blood flow increases at mealtimes. Mesenteric hyperaemia is also evoked by activation of sensory peptidergic nerves. Our studies explored the possible role of endogenous nitric oxide (NO) in the rat intestinal vasodilator response to luminal instillation of an oleic acid plus bile mixture before and after acute intrajejunal instillation of capsaicin and after chronic pretreatment with capsaicin. In anaesthetized rats we measured jejunal blood flow (BF) with an ultrasonic Doppler flowmeter and systemic arterial pressure (AP) with a pressure transducer. Intestinal perfusion with 80 mM oleic acid in bile increased BF by 98±12%. Instillation of 4 mg of capsaicin into the jejunal lumen initially increased BF by 42±9% but was followed by vasoconstriction. Inhibition of NO synthase with 25 mg/kg i.v. N-nitro-L-arginine (L-NNA) decreased BF by 27±5% and increased AP by 37±11%. After treatment with L-NNA and after acute and chronic administration of capsaicin, the bile-oleate-induced maximal increases in BF above control levels were 42±7%, 65±12%, and 58±8%, respectively. The observed inhibitory effect of L-NNA on the intestinal hyperaemic response to the bile-oleate mixture was reversed by pretreatment with L-arginine (100 mg/kg i.V.). In capsaicin pretreated rats the subsequent bile-oleate-induced hyperaemia was reduced in magnitude but the inhibitory effects of L-NNA were proportionately the same as in animals not receiving capsaicin. These findings support the hypothesis that NO is involved with bile-oleate-induced mesenteric hyperaemia.