胰岛素泵治疗2型糖尿病疗效研究

目的观察胰岛素泵连续皮下注射胰岛素(CSII)治疗2型糖尿病、减少低血糖反应、改善生活质量的效果.方法对血糖控制不良,需要住院使用或调整胰岛素治疗的2型糖尿病26例患者,随机分为CSII组(12例)和常规多次皮下注射胰岛素(MSII)组(14例) 进行强化胰岛素治疗.结果两组均达到目标血糖值,但CSII组血糖控制时间显著少于MSII组(P＜0.05),且胰岛素用量少于MSII组,低血糖发生率较低,能较有效地控制黎明现象发生.结论胰岛素泵治疗糖尿病快速、安全、方便,是难治性2型糖尿病患者理想的强化治疗方案.     

胰岛素泵治疗围术期糖尿病疗效观察

目的 观察胰岛素泵治疗围术期糖尿病的临床疗效.方法 围术期2型糖尿病患者(T2DM)随机分为两组,胰岛素泵持续泵入(CSII)和多次皮下注射胰岛素(MSII).结果 CSII组血糖达标时间比MSII组明显短(P<0.01),胰岛素用量较MSII组明显少(P<0.05),且CSII组低血糖发生率低.结论 围术期T2DM患者使用CSII治疗更有效安全.     

短期胰岛素泵强化治疗对新诊断2型糖尿病的临床观察

目的 观察短期应用胰岛素泵强化治疗对新诊断2型糖尿病患者血糖控制的有效性和安全性,及对B细胞功能的影响. 方法 新诊断2型糖尿病79例,随机分为2组,1组用胰岛素泵进行持续皮下胰岛素(诺和锐)输注(CSII组)(40例);另外1组用预混胰岛素(诺和锐30)多次皮下注射(39例)即多次皮下注射胰岛素(MSII组).比较治疗前后血糖、血胰岛素及C肽变化情况及血糖达标时间、胰岛素用量、低血糖事件. 结果 2组均能有效地控制血糖,但CSII组能更快使高血糖状态得以控制,C肽水平较MSII组明显改善(P＜0.05).CSII组较MSII组血糖达标时间更短,胰岛素用量更少,且低血糖事件的发生率显著减少. 结论 短期胰岛素泵强化治疗新诊断的2型糖尿痛患者,具有快速而安全地控制血糖、改善胰岛B细胞功能的优势,是新诊断的2型糖尿病患者一种安全有效的临床治疗方法.     

2型糖尿病患者围手术期胰岛素泵的应用观察

目的 观察2型糖尿病患者围手术期应用胰岛素泵（CSII）和多次皮下注射胰岛素（MSII）的疗效差别。方法 将60例拟行手术治疗的2型糖尿病患者分为CSII组32例，MSII组28例，根据血糖调整胰岛素用量比较两组的血糖变化、胰岛素用量、血糖达标时间、低血糖发生率及术后并发症。结果 CSII组与MSII组在血糖达标时间、低血糖发生率、术后并发症方面比较差异有显著性（P〈0．05）。结论 与MSII组相比，CSII组血糖达标时间缩短，明显减少胰岛素用量，减少低血糖发生率，有效减少术后并发症。     

胰岛素泵联合诺和锐治疗老年2型糖尿病合并脑梗死疗效观察

目的探讨胰岛素泵联合诺和锐治疗老年2型糖尿病合并急性脑梗死的临床疗效。方法 132例老年2型糖尿病合并急性脑梗死的患者,在急性脑梗死常规治疗的基础上,随机分为胰岛素泵联合诺和锐治疗组68例（CSII组）和常规诺和锐多次皮下注射治疗组64例（MSII组）,观察两组治疗后血糖控制情况、血糖达标时间、每日胰岛素用量、低血糖发生率及神经功能的改善情况。结果两组治疗后空腹血糖、三餐后2 h血糖均较治疗前降低（P〈0.01）,CSII组较MSII组在血糖达标时间、胰岛素用量、低血糖发生率及神经功能改善上差异均有统计学意义（P〈0.01）。结论胰岛素泵联合诺和锐治疗老年2型糖尿病合并急性脑梗死既能有效控制血糖,缩短血糖达标时间,减少胰岛素用量,减少低血糖发生,又能改善急性脑梗死的神经功能。     

短期持续胰岛素输注治疗酮症起病的2型糖尿病疗效观察

目的 比较持续皮下胰岛素输注(CSII,胰岛素泵治疗)与多次皮下注射胰岛素(MSII)治疗酮症起病的2型糖尿病患者,观察其降糖效果和对胰岛β细胞功能的影响.方法 对新发的空腹血糖≥11.1 mmol/L,酮体阳性的60例初诊糖尿病患者随机分组.胰岛素泵持续注射胰岛素组(CSII组)30例,多次皮下注射胰岛素组(MSII组)30例.比较两种方法治疗前后血糖、胰岛素用量、血糖达标时间、低血糖发病率;标准馒头餐胰岛素释放试验的胰岛素及C肽、空腹血浆胰岛素及Homaβ等.结果 CSII组在血糖达标时间、胰岛素用量及低血糖发病率上均优于MSII组(P＜0.05).胰岛β细胞功能在治疗后获得显著改善(P＜0.05).结论 对酮症起病的2型糖尿病患者,短期CSII强化治疗具有快速稳定纠正代谢紊乱、控制血糖和显著改善胰岛β细胞功能的作用.     

不同胰岛素强化治疗围手术期2型糖尿病的疗效比较

目的比较胰岛素泵持续皮下输注（CSII）及多次胰岛素皮下注射（MSII）强化治疗围手术期2型糖尿病的疗效。方法将78例围手术期的2型糖尿病患者随机分成两组,CSII组采用CSII治疗,MSII组采用MSII治疗,观察两组治疗后血糖、血糖达标时间、平均住院天数、降糖费用、切口愈合情况、并发症的差异。结果治疗后CSII组餐前血糖较MSII组低,血糖达标时间较MSII组短,平均住院天数、切口感染率及愈合障碍率均低于MSII组（P均〈0.05）,低血糖发生率两组差异无统计学意义,降糖费用CSII组略高于MSII组。结论 CSII治疗2型糖尿病围手术期患者疗效明显优于MSII。     

胰岛素泵在冠状动脉旁路移植术后血糖控制中的应用

目的 探讨冠状动脉旁路移植术后理想的胰岛素输注方式.方法 观察80例冠状动脉旁路移植术后需要胰岛素治疗的2型糖尿病患者,将其分为胰岛素泵连续皮下注射组(CSII组和多次皮下胰岛素注射组(MSII组),每组40例.CSII组采用胰岛素泵连续皮下注射短效胰岛素;MSII组采用多次皮下胰岛素注射,三餐前注射短效胰岛素,晚睡前加注中效胰岛素.结果 两组均可达到相同靶血糖值,CSII组所需治疗时间、胰岛素用量、低血糖发生率明显减少.结论 胰岛素泵连续皮下注射能更有效地模拟生理胰岛素的分泌,更快速、安全、有效地控制血糖,是冠状动脉旁路移植术后血糖控制的理想方式.     

2型糖尿病治疗中胰岛素泵的临床应用价值探析

目的探究胰岛素泵在治疗2型糖尿病患者中的临床应用价值。方法选取该院2014年3月—2015年3月接诊的72例2型糖尿病患者进行研究。按照随机表法,随机平分为两组,CSII组采用持续皮下输注胰岛素,MSII组采用多次皮下输注胰岛素。观察并记录患者血糖达标时间、全天胰岛素用量;治疗前后空腹血糖、餐后2 h血糖及不良反应发生率。结果治疗后,两组患者的空腹血糖均有所下降(t=18.5000、16.0835,P0.05),两组患者的餐后2 h血糖均有所下降(t=17.022 1、16.916 3,P0.05),效果显著;但两组治疗前后的血糖检查结果无明显差异(P0.05)。CSII组患者的空腹和餐后2 h血糖达标时间和全天胰岛素用量均比MSII组患者时间短(P0.05)。CSII组低血糖患者的发生率(2.78%)远低于MSII组(16.67%),两组数据对比差异有统计学意义(χ2=3.956 0,P=0.046 7)。结论胰岛素泵在治疗2型糖尿病中疗效显著,CSII组低血糖患者发生率较少,且血糖达标时间快,胰岛素用量少,明显优于MSII组,值得在治疗中广泛应用。     

胰岛素泵治疗老年2型糖尿病的疗效观察

目的对比应用胰岛素泵(CSII)与多次皮下注射胰岛素(MSII)对血糖控制不佳的老年2型糖尿病(T2DM)患者的治疗效果及安全性。方法将58例老年T2DM患者随机分为CSII组(30例)和MSII组(28例),进行胰岛素治疗。分别检测2组治疗前后的三餐前后及睡前血糖、血糖控制时间、每日胰岛素用量、低血糖发生的次数以及治疗后的糖化血红蛋白(HbA1c)水平并进行统计分析。结果2组均能达到目标血糖值,但CSII组血糖控制达标时间、胰岛素用量及低血糖发生率均明显少于MSII组(P<0.01),CSII治疗后HbA1c水平显著低于MSII组(P<0.01)。结论CSII有效模拟人体生理胰岛素分泌,用于老年T2DM患者能更快、更有效地控制高血糖,减少低血糖的发生率,并且效果能持续较长时间。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.