糖尿病性下肢缺血性血管病的外科治疗

目的：探讨糖尿病性下肢缺血性血管病的治疗方法.方法：对24例Ⅰ型糖尿病患者合并下肢动脉缺血性疾病的39条肢体体进行了手术,其中动脉旁路手术31例,占79%.对3例患者进行了下肢截肢处理.结果：接受动脉旁路手术的患者出院时动脉血流均保持通畅.一例51岁男性患者四肢肿胀、变黑,经治疗无效死亡.结论：糖尿病性缺血性血管病可以通过外科手术治疗.如下肢远端动脉旁路移植、腔内血管成型术等.外科治疗的方法正在探讨阶段,研究方法不断进展.外科治疗不仅可以挽救肢体或降低截肢平面,而且可为足部创面的愈合提供较好的营养环境,有利于创面的愈合和提高生活质量.     

Exploring the role of the immune response in preventing antibiotic resistance

For many bacterial infections, drug resistant mutants are likely present by the time antibiotic treatment starts. Nevertheless, such infections are often successfully cleared. It is commonly assumed that this is due to the combined action of drug and immune response, the latter facilitating clearance of the resistant population. However, most studies of drug resistance emergence during antibiotic treatment focus almost exclusively on the dynamics of bacteria and the drug and neglect the contribution of immune defenses. Here, we develop and analyze several mathematical models that explicitly include an immune response. We consider different types of immune responses and investigate how each impacts the emergence of resistance. We show that an immune response that retains its strength despite a strong drug-induced decline of bacteria numbers considerably reduces the emergence of resistance, narrows the mutant selection window, and mitigates the effects of non-adherence to treatment. Additionally, we show that compared to an immune response that kills bacteria at a constant rate, one that trades reduced killing at high bacterial load for increased killing at low bacterial load is sometimes preferable. We discuss the predictions and hypotheses derived from this study and how they can be tested experimentally.     

Static recipient cells as reservoirs of antibiotic resistance during antibiotic therapy

How does taking the full course of antibiotics prevent antibiotic resistant bacteria establishing in patients? We address this question by testing the possibility that horizontal/lateral gene transfer (HGT) is critical for the accumulation of the antibiotic-resistance phenotype while bacteria are under antibiotic stress. Most antibiotics prevent bacterial reproduction, some by preventing de novo gene expression. Nevertheless, in some cases and at some concentrations, the effects of most antibiotics on gene expression may not be irreversible. If the stress is removed before the bacteria are cleared from the patients by normal turnover, gene expression restarts, converting the residual population to phenotypic resistance. Using mathematical models we investigate how static recipients of resistance genes carried by plasmids accumulate resistance genes, and how specifically an environment cycling between presence and absence of the antibiotic uniquely favors the evolution of horizontally mobile resistance genes. We found that the presence of static recipients can substantially increase the persistence of the plasmid and that this effect is most pronounced when the cost of carriage of the plasmid decreases the cell's growth rate by as much as a half or more. In addition, plasmid persistence can be enhanced even when conjugation rates are as low as half the rate required for the plasmid to persist as a parasite on its own.     

糖尿病足感染的细菌学调查及耐药性分析

目的 了解临床糖尿病足患者感染的细菌分布及耐药性分析.方法 2009年至2010年,共调查135例糖尿病足患者.结果 检出细菌株数为107株,其中革兰阳性菌44株,占41.1％;革兰阴性菌57株,占53.3％;真菌6株,占5.6％.需氧菌感染80例,检出率59.3％.以金葡菌、链球菌、变形杆菌和大肠埃希菌为主要感染菌.金黄色葡萄球菌的耐药率明显低于其他葡萄球菌.大肠埃希菌治疗以亚胺培南首选,也可选用β-内酰胺类加酶抑制剂.结论 检出革兰阴性菌57株,革兰阳性菌44株,应根据药敏情况合理应用抗菌素.     

糖尿病患者无乳链球菌尿路感染临床表现及药物敏感性分析

目的了解糖尿病患者无乳链球菌尿路感染的临床表现及耐药状况,为临床用药提供依据。方法回顾性分析温州医学院附属第一医院2003年至2005年糖尿病患者继发尿路感染的临床特点及耐药情况。结果280例送检尿培养的住院糖尿病患者致病菌阳性有169例,共检出无乳链球菌25株,其中女性23例,男性2例。药敏结果显示无乳链球菌对氨曲南、林可霉素、复方新诺明、红霉素、阿米卡星的耐药率高达50%以上,而对头孢唑啉、万古霉素的耐药率为0%,对替考拉宁、青霉素、氨苄西林的耐药率为5.88%、7.69%、10%。结论糖尿病患者无乳链球菌引起尿路感染应引起注意,临床医生需根据药敏结果合理选用抗生素。     

医院感染不动杆菌和肠球菌的分离及耐药性调查分析

目的了解医院感染不动杆菌和肠球菌的分离及耐药情况,为临床合理用药提供依据。方法采用回顾性资料,对医院2008年9月至2010年12月,从临床送检标本中分离到的不动杆菌和肠球菌及其药敏结果进行统计分析。结果从临床标本中分离到191株不动杆菌和319株肠球菌,不动杆菌主要来源是痰液,达77.50%,肠球菌主要来源是尿液、痰液,分别为31.70%和28.8%。不动杆菌对亚胺培南耐药率最低,为10.3%,对头孢噻肟耐药率最高,为7 2.0%,而其余各种抗生素耐药率均处于47%～60%,肠球菌对万古霉素耐药率最低,为2.0%,耐药率最高是四环素为63.9%,对高浓度的庆大霉素和链霉素耐药率分别是52.8%和39.4%。结论医院感染不动杆菌和肠球菌的分离及耐药性高,且呈多重耐药,临床要关注。     

Zinc and copper in the serum of diabetic patients

The Zn/Cu ratio was examined in the serum of three groups of persons: healthy volunteers, diabetic patients on diabetic diet (NIDDM), and diabetic patients on diabetic diet and insulin (IDDM). Zinc, copper, the Zn/Cu serum ratio, and the blood glucose level were determined during fasting and 2 h after breakfast. Zn and Cu serum levels in NIDDM and IDDM patients were decreased. The Zn/Cu ratio was higher in both groups of diabetic patients. These changes in the Zn and Cu levels as well as in the Zn/Cu ratio were not related to chronic diabetic complications.     

Shinrin-yoku (forest-air bathing and walking) effectively decreases blood glucose levels in diabetic patients

 The influence of ”shinrin-yoku” (forest-air bathing and walking) on blood glucose levels in diabetic patients was examined. Eighty-seven (29 male and 58 female) non-insulin-dependent diabetic patients [61 (SEM 1) years old] participated in the present study. Shinrin-yoku was performed nine times over a period of 6 years. The patients were divided into two parties. They then walked in the forest for 3 km or 6 km according to their physical ability and/or the existence of diabetic complications. The mean blood glucose level after forest walking changed from 179 (SEM 4) mg · 100 ml^–1 to 108 (SEM 2) mg · 100 ml^–1 (P<0.0001). The level of glycated haemoglobin A_1c also decreased from 6.9 (SEM 0.2)% (before the first shinrin-yoku) to 6.5 (SEM 0.1)% (after the last shinrin-yoku; P<0.05). Blood glucose values declined by 74 (SEM 9) mg · 100 ml^–1 and 70 (SEM 4) mg · 100 ml^–1 after short- and long-distance walking respectively. There was no significant difference between these values. Since the forest environment causes changes in hormonal secretion and autonomic nervous functions, it is presumed that, in addition to the increased calorie consumption and improved insulin sensitivity, walking in a forest environment has other beneficial effects in decreasing blood glucose levels. Received: 9 July 1997/Accepted: 20 October 1997     

Sodium molybdate improves the phagocytic function in alloxan-induced diabetic rats

Diabetes mellitus is a disease, which virtually affects all the systems in the body including the immune system. Bacterial infections are important causes of increased morbidity and mortality in diabetic patients. In the present study, we assessed the effect of molybdate on immune responses of diabetic rats. The phagocytic potency and nitroblue tetrazolium dye reduction capacity were found to be considerably lowered whereas soluble immune complex formation enhanced significantly in diabetic rats when compared with control rats. From our findings, it is suggested that dietary intake of molybdate may have a vital role in enhancing immune functions during diabetic mellitus.     

Oral glycine administration attenuates diabetic complications in streptozotocin-induced diabetic rats

Diabetes mellitus is a disease characterized by impaired glucose metabolism that leads to retinopathy, brain micro-infarcts and other complications. We have previously shown that oral glycine administration to diabetic rats inhibits non-enzymatic glycation of hemoglobin and diminishes renal damage. In this work, we evaluated the capacity of the amino acid glycine (1% w/v, 130 mM) to attenuate diabetic complications in streptozotocin (STZ)-induced diabetic Wistar rats and compared them with non-treated or taurine-treated (0.5% w/v, 40 mM) diabetic rats. Glycine-treated diabetic rats showed an important diminution in the percentage of animals with opacity in lens and microaneurysms in the eyes. Interestingly, there was a diminished expression of O-acetyl sialic acid in brain vessels compared with untreated diabetic rats (P<0.05). Additionally, peripheral blood mononuclear cells isolated from glycine-treated diabetic rats showed a better proliferative response to PHA or ConA than those obtained from non-treated diabetic rats (P<0.05). Glycine-treated rats had a less intense corporal weight loss in comparison with non-treated animals. Our results suggest that administration of glycine attenuates the diabetic complications in the STZ-induced diabetic rat model, probably due to inhibition of the non-enzymatic glycation process.     

Thermal stress and diabetic complications

Activities of erythrocyte aldose reductase were compared in 34 normal subjects, 45 diabetic patients, and nine young men following immersion in water at 25, 39, and 42° C. Mean basal enzyme activity was 1.11 (SEM 0.12) U/g Hb and 2.07 (SEM 0.14) U/g Hb in normal controls and diabetic patients, respectively (P<0.0001). Activities of the enzyme showed a good correlation with hemaglobin A₁ (HbA₁) concentrations (P<0.01) but not with fasting plasma glucose concentrations. After immersion at 42° C for 10 min, enzyme activity was increased by 37.6% (P<0.01); however, the activity decreased by 52.2% (P<0.005) after immersion for 10 min at 39° C and by 47.0% (P<0.05) at 25° C. These changes suggest that heat stress might aggravate diabetic complications, and body exposure to hot environmental conditions is not recommended for diabetic patients.     

Protection of inactivated influenza virus vaccine against lethal influenza virus infection in diabetic mice

Influenza virus infection frequently causes complications and some excess mortality in the patients with diabetes. Vaccination is an effective measure to prevent influenza virus infection. In this paper, antibody response and protection against influenza virus infection induced by vaccination were studied in mouse model of diabetes. Healthy and diabetic BALB/c mice were immunized once or twice with inactivated influenza virus vaccine at various dosages. Four weeks after the first immunization or 1 week after the second immunization, the mice were challenged with influenza virus at a lethal dose. The result showed that the antibody responses in diabetic mice were inhibited. Immunization once with high dose or twice with low dose of vaccine provided full protection against lethal influenza virus challenge in diabetic mice, however, in healthy mice, immunization only once with low dose provided a full protection.     

Balneotherapy and platelet glutathione metabolism in type II diabetic patients

Effects of balneotherapy on platelet glutathione metabolism were investigated in 12 type II (non-insulin-dependent) diabetic patients. Levels of the reduced form of glutathione (GSH) on admission were well correlated with those of fasting plasma glucose (FPG;r=0.692,P<0.02). After 4 weeks of balneotherapy, the mean level of GSH showed no changes; however, in well-controlled patients (FPG <150 mg/dl), the level increased (P<0.01) and in poorly controlled patients (FPG >150 mg/dl), the value decreased (P<0.05). There was a negative correlation between glutathione peroxidase (GPX) activities and the levels of FPG (r=–0.430,P<0.05). After balneotherapy, the activity increased in 5 patients, decreased in 3 patients and showed no changes (alteration within ±3%) in all the other patients. From these findings in diabetic patients we concluded: (1) platelet GSH synthesis appeared to be induced in response to oxidative stress; (2) lowered GPX activities indicated that the antioxidative defense system was impaired; and (3) platelet glutathione metabolism was partially improved by 4 weeks balneotherapy, an effect thought to be dependent on the control status of plasma glucose levels. It is suggested that balneotherapy is beneficial for patients whose platelet antioxidative defense system is damaged, such as those with diabetes mellitus and coronary heart disease.     

青少年食蟹猴糖尿病模型的肝脏病理生理学研究

目的通过对胰岛素用量不足条件下链脲佐菌素诱导的青少年食蟹猴1型糖尿病模型肝脏病理生理学的研究,探讨长期高血糖所致青少年食蟹猴肝损伤特点及机制。方法通过静脉注射68 mg/kg的链脲佐菌素,诱导4只3岁的食蟹猴成为1型糖尿病模型,然后经长期的血糖监测和静脉糖耐量实验来评价该模型的可靠性及稳定性,造模4年后,对模型猴进行血生化、PAS染色、苏丹III染色及普通病理和超微病理等指标的检测,另外选取4只健康与模型猴年龄匹配的猴作为正常对照组,同时进行相应的检测。结果与正常对照组比较,糖尿病猴血清学检测指标中总胆汁酸、尿素氮、谷丙转氨酶、谷草转氨酶、胆碱酯酶、乳酸脱氢酶、总胆固醇、甘油三酯和低密度脂蛋白胆固醇明显升高。组织化学染色结果显示,与正常猴比较,糖尿病猴中央静脉区肝实质细胞肿胀,肝细胞PAS染色（糖原染色）加深,苏丹Ⅲ染色（脂肪染色）阳性细胞增多;电镜结果显示糖尿病猴肝细胞内胞质糖原颗粒增多;线粒体电子密度显著增高,结构不清;窦周隙内含有大量脂滴的肝星状细胞明显增多。结论在长期胰岛素用量不足血糖控制不理想的条件下,青少年食蟹猴1型糖尿病模型肝脏特异性的病理改变是肝糖原贮积和含有大量脂滴的肝星状细胞增生,这些病理改变与非酒精性脂肪肝病的病变特点存在显著不同,但其机制目前尚不清楚。     

Direction of aminoacylated transfer RNAs into antibiotic synthesis and peptidoglycan-mediated antibiotic resistance

Prokaryotic aminoacylated-transfer RNAs often need to be efficiently segregated between translation and other cellular biosynthetic pathways. Many clinically relevant bacteria, including Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa direct some aminoacylated-tRNA species into peptidoglycan biosynthesis and/or membrane phospholipid modification. Subsequent indirect peptidoglycan cross-linkage or change in membrane permeability is often a prerequisite for high-level antibiotic resistance. In Streptomycetes, aminoacylated-tRNA species are used for antibiotic synthesis as well as antibiotic resistance. The direction of coding aminoacylated-tRNA molecules away from translation and into antibiotic resistance and synthesis pathways are discussed in this review.     

Ovine ruminal and abomasal zygomycosis

Thirty of four hundred lambs developed diarrhoea subsequent to broad-spectrum antibiotic therapy initiated because of apathy and weight loss after start of fattening. At necropsy mycotic rumenitis and abomasitis was diagnosed in one lamb. Especially intense an antibiotic therapy seems to have contributed to the fungal infection.

The aetiological diagnosis was accomplished by indirect immunofluorescence staining of fungi in tissue sections. A strong and uniform reaction was obtained with heterologously absorbed anti-Absidia corymbifera hyperimmune rabbit antiserum, whereas no reactivity was seen when heterologously absorbed hyperimmune rabbit antisera towards Aspergillus spp. and Candida spp. were applied. Thus, the infective agent was identified as a zygomycete, probably Absidia corymbifera, also a common cause of mycosis in the stomachs of cattle treated intensively with antibiotics.     

The relationship between short-term antibiotic treatments and fatigue in healthy individuals

Antibiotic treatment tends sometimes to result in sensations of fatigue and decreased physical performance. The effects of antibiotics were therefore studied in 50 healthy, male trainees, aged 18–25 years, assigned in a random, double-blind fashion to one of the following treatments: tetracycline, ampicillin, trimethoprim/sulphamethoxazole, placebo I and placebo II. Duration of treatment was five times the half-life of each agent and the placebo was matched accordingly. Muscle enzyme activity (serum glutamine oxaloacetate transaminase, lactate dehydrogenase, creatine phosphokinase), maximal aerobic capacity ( O_2max), muscle strength (MS), and rating of subjective sensation of fatigue were assessed prior to and upon conclusion of treatment. Compared to pretreatment values, plasma enzymes activity was elevated in all five groups (P<0.005). No differences in O_2max or in MS were found among the subjects treated with either one of the antibiotics or those given a placebo. A significant difference in O_2max was found between the groups treated for 1 day (antibiotic and placebo) and the groups treated for 3 days (antibiotic and placebo) (P<0.0001). The rating of subjective sensation was not affected by any of the agents. We concluded that in healthy individuals, a short-term antibiotic treatment had no deleterious effect on aerobic capacity or on muscle strength and was not associated with subjective side effects. The time interval between the two maximal tests could, however, have affected the aerobic capacity. Physiological disturbances associated with a sensation of fatigue following a longer period of antibiotics cannot be excluded.     

循证医学理念对麻醉科医生的启迪

循证医学(EBM)是近年来迅速兴起的一门临床医学,其理论和方法已渗透到医疗决策和临床实践的各个方面.本文分析了麻醉领域运用EBM的必要性,每个麻醉医生必须具备EBM知识.EBM以令人信服的临床证据,带来了麻醉学实践革命性的改变.麻醉医生不仅要有丰富的临床经验和技能,同时要利用最佳的证据来指导麻醉实践,并充分尊重患者的意愿和价值观.     

Hypoglycaemic, antioxidative and nephroprotective effects of taurine in alloxan diabetic rabbits

The therapeutic potential of taurine was investigated under diabetic conditions. Alloxan diabetic rabbits were treated daily for three weeks with 1% taurine in drinking water. The following parameters were measured: 1) serum glucose, urea, creatinine and hydroxyl free radical (HFR) levels; 2) blood glutathione redox state; 3) urine albumin concentration; 4) hepatic and renal HFR levels, GSH/GSSG ratios and the activities of catalase, superoxide dismutase and the enzymes of glutathione metabolism; 5) renal NADPH oxidase activity; 6) the rates of renal and hepatic gluconeogenesis. Histological studies of kidneys were also performed. Taurine administration to diabetic rabbits resulted in 30% decrease in serum glucose level and the normalisation of diabetes-elevated rate of renal gluconeogenesis. It also decreased serum urea and creatinine concentrations, attenuated diabetes-evoked decline in GSH/GSSG ratio and abolished hydroxyl free radicals accumulation in serum, liver and kidney cortex. Animals treated with taurine exhibited elevated activities of hepatic gamma-glutamylcysteine syntetase and renal glutathione reductase and catalase. Moreover, taurine treatment evoked the normalisation of diabetes-stimulated activity of renal NADPH oxidase and attenuated both albuminuria and glomerulopathy characteristic of diabetes. In view of these data, it is concluded that: 1) diminished rate of renal gluconeogenesis seems to contribute to hypoglycaemic effect of taurine; 2) taurine-induced increase in the activities of catalase and the enzymes of glutathione metabolism is of importance for antioxidative action of this amino acid and 3) taurine nephroprotective properties might result from diminished renal NADPH oxidase activity. Thus, taurine seems to be beneficial for the therapy of both diabetes and diabetic nephropathy.