2型糖尿病患者血糖波动与糖尿病视网膜病变的相关性分析

目的:探讨2型糖尿病(T2DM)患者血糖波动与糖尿病视网膜病变(DR)的关系.方法:T2DM患者进行眼底照相或眼底荧光造影,根据DR程度分为糖尿病背景期视网膜病变(BDR)组、糖尿病增殖期视网膜病变(PDR)组、无视网膜病变(NDR)组,记录年龄、性别、体重指数、病程、测量血压、糖化血红蛋白、空腹胰岛素、餐后2h胰岛素、空腹C-肽、餐后2hC-肽、血脂指标.选取三组中上述基线指标具有可比性的病例共106例(BDR组38例,PDR组35例,NDR组33例)纳入观察.采用动态血糖监测系统(CGMS)连续监测患者血糖72 h.结果:各组间平均血糖水平(MBG)、血糖标准差(SDBG)、平均血糖波动幅度(MAGE)及血糖波动最大幅度(LAGE)相比较有统计学差异(P＜0.05).Spearman相关分析显示,糖尿病视网膜病变(DR)与MBG、SDBG、MAGE及LAGE呈正相关(P＜0.05).校正MBG后,糖尿病视网膜病变(DR)与SDBG、MAGE及LAGE的相关系数分别为0.297、0.396、0.284(P＜0.01).结论:血糖波动与糖尿病视网膜病变(DR)的发生发展有关,应尽早干预.     

胃癌合并糖尿病患者术后强化血糖控制的疗效分析

目的:探讨胃癌合并糖尿病患者术后强化血糖控制的临床疗效及其对预后的影响。方法:根据不同血糖控制方法,将96例胃癌合并糖尿病术后患者分为强化血糖控制组50例(血糖控制在4.4-6.1mol/L)和对照组46例(血糖控制在6.1~11.1mol/L)。监测患者术后1、3、7天的空腹血糖(FBG)、空腹胰岛素定量(FINS)、及C反应蛋白(CRP)水平,并计算胰岛素抵抗指数(HOMA-IR),比较分析两组术后恢复情况及并发症发生情况。结果:术后1、3、7天,强化血糖控制组FBG、lnHOMA-IR及CRP水平均显著低于对照组,差异有统计学意义(P<0.05);术后1天两组间FINS水平差异无统计学意义(P>0.05),而术后3、7天,二者之间差异有统计学意义(P<0.05);强化血糖控制组术后发热时间、排气时间、抗生素使用时间与对照组相比明显缩短,差异有统计学意义(P>0.05);强化血糖控制组术后并发症的发生率2.0%,显著低于对照组13.0%,差异有统计学意义(P<0.05)。结论:强化血糖控制可改善胃癌合并糖尿病患者术后胰岛素抵抗,减轻术后的炎性反应,降低术后并发症,改善患者预后。     

胃癌合并糖尿病患者术后强化血糖控制的疗效分析

目的：探讨胃癌合并糖尿病患者术后强化血糖控制的临床疗效及其对预后的影响。方法：根据不同血糖控制方法,将96例胃癌合并糖尿病术后患者分为强化血糖控制组50例（血糖控制在4.4-6.1mol/L）和对照组46例（血糖控制在6.1~11.1mol/L）。监测患者术后1、3、7天的空腹血糖（FBG）、空腹胰岛素定量（FINS）、及C反应蛋白（CRP）水平,并计算胰岛素抵抗指数（HOMA-IR）,比较分析两组术后恢复情况及并发症发生情况。结果：术后1、3、7天,强化血糖控制组FBG、lnHOMA-IR及CRP水平均显著低于对照组,差异有统计学意义（P〈0.05）;术后1天两组间FINS水平差异无统计学意义（P〉0.05）,而术后3、7天,二者之间差异有统计学意义（P〈0.05）;强化血糖控制组术后发热时间、排气时间、抗生素使用时间与对照组相比明显缩短,差异有统计学意义（P〉0.05）;强化血糖控制组术后并发症的发生率2.0%,显著低于对照组13.0%,差异有统计学意义（P〈0.05）。结论：强化血糖控制可改善胃癌合并糖尿病患者术后胰岛素抵抗,减轻术后的炎性反应,降低术后并发症,改善患者预后。     

胰岛素泵可降低糖尿病患儿血清的HMGB1水平

为了探讨胰岛素泵治疗对儿童糖尿病患者血清人高迁移率族蛋白B1 (human high mobility group protein B1, HMGB1)水平的影响,本研究选择1型糖尿病(type 1 diabetes mellitus, T1DM)患儿64例,随机分为胰岛素泵治疗组(观察组)和多次注射胰岛素治疗组(对照组),比较两组糖尿病患儿的空腹血糖(fasting blood glucose, FBG)以及餐后2 h血糖(2 h FBG)、血糖达标时间以及胰岛素用量以及治疗前后的糖化血红蛋白(HbAlc)、C肽和HMGB1水平。结果显示,与对照组比较,观察组的FBG以及2h FBG、血糖达标时间以及胰岛素用量均明显低于对照组,差异均存在统计学意义(p0.05)。与对照组糖尿病患儿治疗后的结果比较,观察组的HbA1c水平明显降低,C肽含量明显升高,差异均存在统计学意义(p0.05)。本研究还发现与对照组糖尿病患儿治疗后的结果比较,观察组治疗后的HMGB1水平明显降低,差异均存在统计学意义(p0.05)。本研究研究结论初步表明,胰岛素泵治疗对儿童糖尿病的改善作用可能与其降低HMGB1水平有关。     

2型糖尿病患者血清Irisin水平与胰岛素抵抗的相关性研究

目的:探讨2型糖尿病患者血清Irision水平和胰岛素抵抗的相关性及其影响因素。方法:2型糖尿病患者50例,纳入健康人群30例为对照组。采用酶联免疫吸附法测定研究对象血清Irisin水平;同时测定糖尿病患者C肽、胰岛素抵抗指数、糖化血红蛋白水平。采用多元回归分析分析影响血清Irisin水平的因子。结果:病例组和对照组间BMI、腰围、血清Irisin、低密度脂蛋白间差异有统计学意义(p0.05)。血清Irisin水平和BMI、腰围、低密度脂蛋白、糖化血红蛋白、胰岛素抵抗指数、糖尿病病程呈负相关(r=-0.73,-0.68,-0.56,-079,-0.65,-0.73,均P0.05)。血清Irisin水平和C肽成正相关(r=0.62,P0.05)。胰岛素抵抗指数、糖尿病病程是影响血清Irisin水平的独立负影响因子。结论:糖尿病患者血清Irisin水平明显降低,和糖尿病患者胰岛素抵抗和病程密切相关。     

2型糖尿病视网膜病变与胰岛素抵抗及β细胞功能的关系

目的:探讨新疆汉族2型糖尿病视网膜病变(DR)与胰岛素抵抗(IR)及β细胞功能的关系.方法:免散瞳眼底照相行眼底筛查我院内分泌科住院病人及体检正常人群258例,正常人(NC)83例、糖尿痛无视网膜病变(NDR)60例、糖尿病视网膜病变(DR)115例.测定其空腹血糖(FBG)、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR指数)、β细胞功能指数(HOMA-β指数),并测定其临床一般资料,记录身高、体重等.结果:NDR组、DR组HOMA-IR指数、HOMA-β指数明显高于NC组,差异有统计学意义(p<0.05),但NDR组与DR组相比,HOMA-IR指数、HOMA-β指数差异无统计学意义(p>0.05).2型糖尿病视网膜病变与FBG、FINS、HOMA.IR、HOMA-β呈正相关(p<0.01).多元Logistie回归分析显示病程、吸烟史、TG、Tc、尿微量白蛋白(UAE)、糖化血红蛋白(HbAlc)、血尿酸(SUA)、收缩压(SBP)HOMA-IR、HOMA-β为DR的危险因素.校正这些因素后DR仍与UAE、SUA、SBP、HOMA-IR、HOMA-β相关.结论:DR的发生与发展除了与病程、脂代谢紊乱、吸烟有关外,还与IR、β细胞功能、UAE及SUA等有关.     

甘精胰岛素联用瑞格列奈治疗初诊2型糖尿病的疗效研究

目的:通过甘精胰岛素联用瑞格列奈与预混人工合成胰岛素(诺和灵30R)治疗初诊2型糖尿病患者的比较,探讨其疗效与安全性.方法:将初诊2型糖尿病患者随机分为甘精胰岛素+瑞格列奈组(A组)和诺和灵30R组(B组),根据血糖情况调整用药剂量.治疗12周后,比较两组的空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、体重指数(BMI)和低血糖发生率.结果:A组低血糖事件明显少于B组,在餐后2小时血糖方面也优于B组,差异有统计学意义(P<0.05);在空腹血糖、HbA1c和BMI方面差异无统计学意义(p0.05).结论:甘精胰岛素与瑞格列奈联用对于初诊2型糖尿病患者,其血糖控制满意,餐后血糖更加平稳,低血糖发生率低,是一种针对初诊2型糖尿病患者安全、有效、方便的治疗方案.     

大剂量胰岛素联合西格列汀对老年2 型糖尿病患者的疗效

目的:研究大剂量胰岛素联合西格列汀对老年2型糖尿病患者的疗效。方法:选择2012年1月~2015年12月在我院进行诊治的老年2型糖尿病患者82例,随机分为两组,观察组采用大剂量胰岛素联合西格列汀治疗,对照组采用大剂量胰岛素治疗,两组均治疗3个月。比较两组治疗前后的甘油三酯、总胆固醇、低密度脂蛋白和高密度脂蛋白水平,餐后2 h血糖、空腹血糖、糖化血红蛋白,胰岛素抵抗指数、胰岛素分泌指数、每日胰岛素总量和低血糖发生次数。结果:对照组治疗前后的血脂水平无明显差异(P0.05),观察组治疗后的甘油三酯、总胆固醇和低密度脂蛋白明显降低(P0.05),高密度脂蛋白明显升高(P0.05);治疗后,两组的餐后2 h血糖、空腹血糖、糖化血红蛋白均明显降低(P0.05),且观察组降低更为明显(P0.05);对照组治疗前后的胰岛素抵抗指数、胰岛素分泌指数和每日胰岛素总量均无明显差异(P0.05),观察组治疗后的胰岛素抵抗指数和每日胰岛素总量均明显降低(P0.05),胰岛素分泌指数明显升高(P0.05);两组治疗前后低血糖发生次数和身体质量指数均无明显差异(P0.05)。结论:大剂量胰岛素联合西格列汀能有效控制老年2型糖尿病患者的血糖水平,改善胰岛β细胞功能,减少胰岛素用量,是一种安全有效的治疗方法。     

醋甲唑胺治疗2 型糖尿病的临床疗效及安全性观察

目的:评价青光眼治疗药物醋甲唑胺用于2型糖尿病治疗的有效性及安全性。方法:选择我院2型糖尿病初诊患者64例,随机分为两组,其中醋甲唑胺治疗组32例,对照药物二甲双胍32例。观察并比较两组患者治疗前后血糖及糖化血红蛋白水平变化,以及肝肾功能、血尿常规等安全性指标。结果:与治疗前比较,两组患者治疗后糖化血红蛋白水平均下降,差异具有统计学意义(P0.05);但治疗后两组间糖化血红蛋白水平比较,差异无统计学意义(P0.05);两组治疗前后肝功肾功等生化指标之间比较,差异无统计学意义(P0.05);两组用药安全性比较,差异无统计学意义(P0.05)。结论:醋甲唑胺与二甲双胍具有相似的降血糖疗效,可作为新的治疗糖尿病的二线药物选择性使用。     

地特胰岛素与NPH胰岛素治疗口服降糖药控制不佳的2型糖尿病 临床比较研究

目的:观察口服降糖药控制不佳的2型糖尿病患者分别加用地特胰岛素和NPH胰岛素治疗24周的有效性和安全性。方法:63例口服降糖药物控制不佳(HbA1c>7%)的2型糖尿病患者随机加用地特胰岛素或鱼精蛋白锌(NPH)胰岛素作为基础胰岛素,每日1次治疗24周,比较两组治疗前后糖化血红蛋白、体重、血脂的变化及低血糖的发生率。结果:两组的糖化血红蛋白、空腹血糖与基线比较均有显著下降,治疗后组间无差异。与NPH胰岛素组比较地特胰岛素组体重增加明显减少,差异有统计学意义。地特胰岛素组治疗期间全部低血糖次数较NPH胰岛素组减少54.69%(P<0.01)。结论:地特胰岛素与NPH胰岛素相比,在有效控制血糖的同时可降低低血糖发生风险,而且有减少体重增加的优势。     

Adaptive computer control of anesthesia in humans

This paper presents an efficient computer control technique for regulation of anesthesia in humans. The anesthetic used is propofol and the objective is to control the degree of hypnosis of the patient. The paper describes the basic hardware/software setup of the system and the closed-loop methodologies. The bispectral index (BIS) is considered as the feedback signal. The control methods proposed here are based in the use of proportional integral controllers with dead-time compensation to avoid undesirable oscillations in the BIS signal during the process. The compensation is based on the Smith predictor. To guarantee the applicability of the method to different patients, an adaptive module to tune the compensator is developed. Some real and simulated results are presented in this work to attest the efficiency of the methods used.     

试论现代公立医院内控制度

本文着重分析了现代公立医院内控制度的定义、内控环境以及如何建立现代公立医院内控制度,对加强医院经营管理有一定借鉴作用。     

Biological tools for control of larval stages of malaria vectors – a review

The two main interventions presently being deployed for control of malaria vectors, that is, long-lasting insecticide-treated bed nets (LLINs) and indoor residual spraying (IRS) involve the use of chemical insecticides and target adult mosquitoes. Meanwhile, the potential of larval control is increasingly being acknowledged for the reduction of insecticide-resistant and/or exophagic Anopheles populations. Larval control has proven to be cost-effective and ideal for localities where mosquito-breeding sites are well defined and approachable. Utilising biological control tools to control anopheline larvae can lower the problem of resistance development, a common feature of chemical control. Fortunately, there are many options of biological larval control tools. Besides their direct impact on mortality, the effects of these tools can reach beyond the larval stage. Anopheline adults that develop from larvae exposed to biological control tools, such as entomopathogenic fungi, show reduced longevity, fecundity and susceptibility to Plasmodium infections. Combining two or more larval control tools can increase their efficacy against anopheline larvae. However, despite the identification of larval control potential in the laboratory, and in few cases in the field, many potential biological control tools have not been utilised to their fullest extent. This review provides an overview of the existing and potential biological larval control options for malaria vectors and discusses the advantages and requirements to develop them for malaria vector control.     

Impact of different densities of Neohydronomus affinis (Coleoptera:Curculionidae) on Pistia stratiotes (Araceae) under laboratory conditions

In Senegal, a laboratory study was conducted in 2005 to ascertain the effect that different numbers of the host-specific weevil Neohydronomus affinis Hustache (Coleoptera: Curculionidae) per plant had on selected plant growth parameters of its target weed, water lettuce Pistia stratiotes Linnaeus (Araceae). Compared to the control, the weevil caused a significant reduction in all parameters measured, except for daughter plant production. There were no significant differences in impact on the plant between the three different densities of weevil (one, two and three pairs per plant). Under laboratory conditions one pair per plant is deemed sufficient to effect complete control of water lettuce over a six-week period.     

Absolute and relational control of a sequential auditory discrimination by pigeons (Columba livia)

Recent evidence indicates that pigeons can readily learn visual discriminations based on both absolute and relational stimulus factors. To examine how these two types of control function in their non-dominant auditory modality, we tested four pigeons in a go/no-go sequential auditory discrimination in which both absolute and relational cues were redundantly available. In this task, sequences of different sounds created from one set of pitches were reinforced, while different sequences created from another set of pitches and any same sequences made from either set of pitches were not. Across three experiments, we independently varied the relative discriminability of the absolute and relational components. The pigeons were consistently and primarily controlled by the absolute fundamental pitch of our notes in all of the experiments, although this was influenced by the range and arrangement of the pitches used in each set. A majority of the pigeons also demonstrated relational control when this component was made more salient. The more robust control exhibited by absolute factors is consistent with the comparative hypothesis that birds in general may have a well-developed aptitude for processing absolute pitch in many auditory settings. The relational control is consistent with our recent evidence of same/different auditory learning by pigeons.     

Susceptibility of nymphs and adults of Diaphorina citri to the entomophathogenic fungus Hirsutella citriformis

The susceptibility of nymphs and adults of Diaphorina citri to infection by Hirsutella citriformis was evaluated. We also studied the ability of adult D. citri that had been contaminated with fungal conidia to transmit infection to nymphs. Diaphorina citri nymphs were more susceptible than adults. Adults were not able to transmit conidia to nymphs and cause infection.     

Microbial control of plant-parasitic nematodes: a five-party interaction

Plant-parasitic nematodes cause significant economic losses to a wide variety of crops. Chemical control is a widely used option for plant-parasitic nematode management. However, chemical nematicides are now being reappraised in respect of environmental hazard, high costs, limited availability in many developing countries or their diminished effectiveness following repeated applications. This review presents progress made in the field of microbial antagonists of plant-parasitic nematodes, including nematophagous fungi, endophytic fungi, actinomycetes and bacteria. A wide variety of microorganisms are capable of repelling, inhibiting or killing plant-parasitic nematodes, but the commercialisation of these microorganisms lags far behind their resource investigation. One limiting factor is their inconsistent performance in the field. No matter how well suited a nematode antagonist is to a target nematode in a laboratory test, rational management decision can be made only by analysing the interactions naturally occurring among “host plant–nematode target–soil–microbial control agent (MCA)–environment”. As we begin to develop a better understanding of the complex interactions, microbial control of nematodes will be more fine-tuned. Multidisciplinary collaboration and integration of biological control with other control methods will␣also contribute to more successful control practices.     

Altered control of submaximal bite force during bruxism in humans

The control of bite force during varying submaximal loads was examined in patients suffering from bruxism compared to healthy humans not showing these symptoms. The subjects raised a bar (preload) with their incisor teeth and held it between their upper and lower incisors using the minimal bite force required to keep the bar in a horizontal position. Further loading was added during the preload phase. A sham load was also used. Depending on the session, the teeth were loaded by the experimenter or the subject and in one session the subject did not see the load (no visual feedback). The bite force was measured continuously using a calibrated force transducer. In all the subjects, the bite force increased with increasing load. Following the addition of the load, the level of the tonic bite force was reached rapidly with no marked overshoot. The patients with bruxism used significantly higher bite forces to hold the submaximal loads compared to the control subjects. In the control subjects, the holding forces for each submaximal load were identical in the men and the women and were independent of subject maximal bite force. Sham loading evoked no marked responses in biting force. Whether the subject or the experimenter added the load or whether the subject had visual feedback or not were not significant factors in determining the level of bite force. The results indicated that the patients with bruxism used excessively large biting forces for each given submaximal load. This study showed no evidence that the inappropriate control of bite force by patients with bruxism was due to an abnormality in the higher cortical circuits that regulates the function of trigeminal motoneurons in the brainstem. This was shown by a lack of abnormality in coordination of voluntary hand movement with biting force, a lack of abnormal anticipation response to a sham load and a lack of any effect of visual feedback. The results were in line with the hypothesis that afferent input from oral (periodontal or masticatory muscle) tissues does not provide an appropriate control of motor command in bruxism.     

Fermentation media and production of exotoxin by three varieties of Bacillus thuringiensis

The insecticidal activities of the exotoxin produced by three varieties of Bacillus thuringiensis grown in six fermentation media were determined by testing the supernatants against larvae of the house fly, Musca domestica, and the black cutworm, Agrotis ipsilon. The activities of the exotoxins from the isolates varied when they were grown in the same medium and also when they were grown in different media. When an isolate of B. thuringiensis var. thuringiensis, and of var. tolworthi were grown in proflo broth, the supernatants produced were more toxic to house fly than to black cutworm larvae, indicating the presence of more than one exotoxin. Autoclaving the supernatants for 15 and 30 min further demonstrated the presence of several exotoxins.     

Assessment of a field trial using the DD-136 strain of Neoaplectana sp. for the control of Scolytus scolytus

Under the prevailing field conditions, a single application of the DD-136 strain of Neoaplectana sp. at the dosage used was insufficient to decrease the overwintering population of Scolytus scolytus in logs.