新疆维吾尔族2型糖尿病家系成员体质量指数与糖代谢、血脂、血压的关系

目的：分析新疆维吾尔族2型糖尿病家系成员体质量指数与糖代谢、血压、血脂的关系，借以探讨家系成员体质量指数的适宜切点。 方法：抽取新疆和田地区维吾尔族2型糖尿病家系21个，16岁以上家系成员365人，按体质量指数分为6组，比较各组血糖、胰岛素抵抗、血压及血脂的情况。非条件Logistic回归分析不同体质量指数切点作为独立因素与2型糖尿病的相关联系。 结果：365例成员纳入结果分析。①随体质量指数水平的升高，服糖后2h血糖、空腹及服糖后2h胰岛素、收缩压和舒张压、总胆固醇、三酰甘油、稳态模式胰岛素抵抗指数均呈上升趋势，各体质量指数组间比较差异有显著性意义（P〈0．001）。②体质量指数〈23kg／m^2的两组，空腹血糖和服糖后2h血糖分别为（5．93&;#177;2．97）mmoL／L和（7．75&;#177;6．02）mmol/L．接近空腹血糖及糖耐量异常标准。⑧体质量指数≥25kg／m^2和体质量指数≥27kg／m^2时，分别出现空腹糖耐量受损和糖耐量异常。④非条件Logistic回归分析显示体质量指数≥23kg／m^2，糖代谢异常OR=2．05,P=0．0477暴露组归因危险百分比为51．22％。 结论：随体质量指数增高，新疆维吾尔族2型糖尿病家系成员的血糖、血脂、血压增高，体质量指数≥23kg／m^2后，糖代谢异常的危险性增加。     

育龄期多囊卵巢综合征患者的糖代谢异常和胰岛素抵抗

目的探讨育龄期多囊卵巢综合征（PCOS）患者的糖代谢异常和胰岛素抵抗。方法选择育龄期PCOS患者168例,分为肥胖PCOS组78例和非肥胖PCOS组90例,正常对照组100例,对比临床表现及检测内分泌激素、空腹血糖、空腹胰岛素、服糖后2h血糖及2h胰岛素。结果育龄期PCOS患者的月经周期、多毛、痤疮、B超提示卵巢增大、卵巢多囊性改变、有不孕史与对照组比较,差异均有显著性（P〈0．05）,育龄期PCOS组的血清LH、T与对照组比较,差异有显著性（P〈0．05）。育龄期肥胖P-COS组的空腹血糖、服糖后2h血糖、空腹胰岛素、服糖后2h胰岛素与对照组比较,差异均有显著性（P〈0．05）。结论早期出现月经稀发、BMI升高的患者是否存在PCOS,值得重视。育龄期PCOS患者尤其肥胖型要高度重视糖代谢异常及胰岛素抵抗,以决定是否采取干预措施,避免出现远期并发症而对PCOS患者造成健康威胁。     

多囊卵巢综合征不孕症患者胰岛素抵抗及糖代谢异常分析

目的：分析多囊卵巢综合征（PCOS）不孕症患者胰岛素抵抗（IR）及糖代谢异常的发生情况。方法比较48例PCOS不孕症患者及36名非PCOS的正常女性的胰岛素抵抗及糖代谢异常的发生情况。对照组测定空腹胰岛素（FINS）及空腹血糖（FPG）,计算稳态模型评估的胰岛素抵抗指数（HOMA-IR）。 PCOS组分为肥胖（OB-PCOS）及非肥胖（NOB-PCOS）组,均行口服葡萄糖耐量试验（OGTT）及同步胰岛素释放试验（IRT）。结果 PCOS组FINS[（15．53±6.78对9．21±5.10）mIU/L]及HOMA-IR（3.28±2.30对1.85±1.22,P＜0．01）均高于对照组,其中OB-PCOS组FINS[（16.73±9.84对8.39±3.75）mIU/L]及HOMA-IR（3.43±2.17对2．02±1.56,P＜0．01）高于NOB-PCOS组。 PCOS肥胖组中发生糖尿病1例,其中FINS及HOMA-R均升高,糖耐量受损（IGT）患者4例,4例患者FINS 和HOMA-IR均升高。结论PCOS不孕症患者普遍存在IR,肥胖型患者较非肥胖患者更常见、更严重,其中部分PCOS患者已发生糖代谢异常。     

糖耐量低减患者红细胞胰岛素酶活性与胰岛素抵抗

背景：糖耐量低减发病主要与遗传和环境因素有关，环境因素包括摄入热量过多和肥胖等。胰岛素抵抗是其主要发病机制之一。目的：探讨糖耐量低减患者的红细胞胰岛素酶活性(erythrocyles insulinase actlvity，EIA)与胰岛素抵抗的关系，为运动改善糖耐量低减患者的胰岛素抵抗提供理论支持。设计：以IGT患者为研究对象，以正常糖耐量的成年人为对照组的观察对比研究。单位：一所军医大学医院的内分泌科。对象：本研究于2001—01／2003—04在第一军医大学南方医院内分泌科完成。随机抽取住院和门诊的糖耐量低减患者50例，男26例，女24例，年龄(52&;#177;7)岁。纳入标准：符合WHO1999年口服葡萄糖耐量实验(OGTT)的糖耐量低减诊断标准，心、肝、肾功能和血常规均在正常范围，且未使用任何抗糖尿病药物者。排除标准：患肝脏、肾脏疾患、感染、恶性肿瘤、冠心病、脑血管意外和结缔组织疾病者。根据是否合并空腹血糖异常将糖耐量低减患者分为合并空腹血糖异常的糖耐量低减1组，共20例，男9例，女11例；单纯餐后高血糖未合并空腹血糖异常的糖耐量低减2组，共30例，男17例，女13例。20例正常糖耐量的成年人作为对照组，男女各10例，年龄(48&;#177;12)岁。方法：用放射酶分析法检测所有研究对象的EIA，同时检测患者的血糖、血清胰岛素和糖基化血红蛋白，并计算稳态模型胰岛素抵抗指数(Homeostasis Model Analysis-insuIin resistance index，HOMA-IR)以评价机体的胰岛素敏感性。主要观察指标：各组EIA水平和HOMAIR指数的差异和相互关系。结果：糖耐量低减患者的EIA、血清空腹胰岛素和HOMA-IR指数显著高于对照组(P&;lt;0．01或P&;lt;0．05)；糖耐量低减1组患者的EIA和HOMA-IR显著高于糖耐量低减2组(P&;lt;0．01)；直线回归分析表明，糖耐量低减患者的EIA与血清空腹胰岛素、糖基化血红蛋白、HOMA-IR指数呈显著正相关(P&;lt;0．01)。结论：糖耐量低减患者的红细胞胰岛素酶降解速度显著高于正常人，并与其胰岛素抵抗的发生、发展有密切相关性。     

老年冠心病患者糖代谢异常及胰岛素抵抗调查

目的对既往未诊断糖尿病（DM）的住院老年冠心病患者进行糖代谢及胰岛素抵抗情况的调查,并对不同糖代谢状况患者的糖化血红蛋白（HbA1c）和24 h尿蛋白定量进行比较分析,为以后的临床干预打下基础。方法 356例老年冠心病患者,年龄均在60岁以上,空腹抽血查空腹血糖、胰岛素、HbA1c。行简化糖耐量试验（OGTT）,查餐后2 h血糖。留24 h尿进行尿蛋白定量。根据2003年美国糖尿病协会（ADA）标准判断患者的糖代谢状况,计算糖代谢异常者的比率。对不同糖代谢状况的患者进行血糖、胰岛素、HbA1c和24 h尿蛋白量比较。结果 356例既往未诊断DM的老年冠心病病人中,新发现DM 26例,占总观察数的7.3%,发现糖调节受损（IGR）61例,总的糖代谢异常发生率达25.0%。不同糖代谢状态的病人其空腹血糖和餐后2 h血糖的水平存在明显差异（P〈0.05或P〈0.01）。正常糖代谢（NG）组空腹胰岛素低于IGR组和DM组,同时胰岛素抵抗指数（HOMA-IR）也低于其他两组,而β细胞功能指数（HOMAβ）则高于糖代谢异常组（P〈0.01）。而DM组的空腹胰岛素水平、HOMA-IR、HOMAβ也和IGR组比较差异有统计学意义（P〈0.01）。糖代谢正常的老年冠心病患者的HbA1c和另两组的患者比较差异有统计学意义（P〈0.01）,而IGR组和DM组患者也有差别（P〈0.05）。24 h尿蛋白量在3组间比较差异有统计学意义（P〈0.01）。结论在老年冠心病患者中有较高的糖代谢异常发生率。糖代谢异常患者的胰岛素抵抗也较糖代谢正常的患者明显,HOMAβ下降。部分病人的高血糖状态已持续较长时间,有些患者已有早期肾功能的改变。     

瑞格列奈改善2型糖尿病患者胰岛β细胞功能的临床观察

目的：观察瑞格列奈对2型糖尿病患者胰岛β细胞功能的影响。方法：选择58例初诊未经降糖药物治疗的2型糖尿病患者．口服瑞格列奈（诺和龙）0．5～1.0mg／次，3次／d．共16周。测定治疗前后空腹血糖，餐后2h血糖，糖化血红蛋白及空腹血清胰岛素、计算胰岛β细胞功能指数及胰岛素抵抗指数。结果：58例经瑞格列奈治疗的患者其空腹血糖、餐后2h血糖、糖化血红蛋白均降低（P〈0.05）．空腹胰岛素水平亦略有降低．胰岛β细胞功能指数明显增加，胰岛素抵抗指数明显下降（P〈0.05）。结论：瑞格列奈可显著降低血糖．改善2型糖尿病患者胰岛β细胞功能，缓解胰岛素抵抗。     

罗格列酮对糖耐量异常干预的临床研究

目的观察罗格列酮对糖耐量异常患者的治疗效果。方法比较119例糖耐量异常患者在饮食加运动控制的基础上口服罗格列酮和安慰剂干预治疗，经治疗1年后，检测空腹血糖（FPG）及葡萄糖耐量试验（OGTT）后2h血糖（2hPG），总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白（HDL）、胰岛素抵抗指数、空腹胰岛素（FINS）和OGTT后2h胰岛素（PINS）水平的变化。结果罗格列酮组和安慰剂组治疗前糖耐量比较差异无统计学意义（P〉0．05）。罗格列酮组与安慰剂组相比FPG、2HPG、TC、TG、LDL、FINS、PINS及糖尿病发病率均明显下降，HDL—C升高。结论罗格列酮能够降低糖耐量异常（IGT）人群糖尿病的发病率，在调节血脂、减轻胰岛素抵抗的同时，可使糖耐量异常明显改善。     

精神分裂症患者餐后2小时血糖筛查的意义

目的了解精神分裂症患者餐后2h血糖的变化，筛查糖代谢异常的检出率。方法对308例精神分裂症女性患者采用葡萄糖氧化酶法测定空腹血糖、餐后2h血糖、口服葡萄糖耐量试验。结果糖代谢异常64例（20．8％），其中空腹血糖异常17例（26．6％），餐后2h血糖异常52例（81．3％），空腹血糖与餐后2h血糖同时异常9例（14．1％），口服葡萄糖耐量试验异常4例（6．3％）。结论单纯空腹血糖检查可能导致大量的漏诊，同时测定餐后2h血糖可提高糖代谢异常检出率。     

老年高血压患者糖代谢异常及胰岛素敏感性调查

目的了解老年高血压住院患者糖代谢异常及胰岛素抵抗的存在情况,为临床干预提供参考。方法住院老年高血压患者465例,既往未诊断糖尿病,分60～74岁组和75岁以上组进行统计比较。行空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹胰岛素（FINS）、餐后2h胰岛素（2hINS）检查,并计算出胰岛素敏感性指数（ISI、2hISI）,统计新发现的糖尿病数、糖调节受损数,以及总的糖代谢异常发生率。结果465例老年高血压患者中,新发现糖尿病23例（占4．95％）,糖调节受损98例（占21．08％）,总的糖代谢异常率26．03％。糖代谢正常组、糖调节受损组和糖尿病组之间的FPG、2hPG、FINS、2hINS、ISI、2hISI,经统计学比较,除糖调节受损组和糖尿病组之间的FPG差异为P〈0．05外,均为P〈0．01。60～74岁组的糖代谢异常发生率明显高于75岁以上组（P〈0．01）。结论在既往未诊断糖尿病的老年高血压患者中,有约1／4的患者存在糖代谢异常,尤以年龄低的老年人更为明显。在临床中对这类患者进行及时的检测诊断与干预,对预防严重并发症的发生具有重要意义。     

糖耐量及胰岛素水平在多囊卵巢综合征中的临床意义

目的探讨多囊卵巢综合征(PCOS)患者糖代谢和胰岛素分泌的特征。方法比较84例PCOS患者组和30例对照组的糖耐量及胰岛素水平。结果体重指数(BMl)<25的PCOS患者与对照组比较,空腹和口服葡萄糖后,1小时、2小和3小时的血糖均无显著性差异(P>0.05),胰岛素水平均显著升高(p<0.05)。BMI≥25的PCOS患者空腹及口服葡萄糖后1小时、2小时和3小时的血糖和胰岛素水平均显著高于对照组和BMI<25的PCOS患者(p<0.05)。结论BMI>25的PCOS患者更易出现糖代谢异常,肥胖可能促进胰岛素抵抗形成。检测糖耐量及胰岛素水平可用于指导PCOS患者的治疗。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.