莫沙必利对糖尿病胆囊排空功能障碍患者临床疗效的观察

目的:探讨糖尿病合并自主神经功能病变胆囊排空功能障碍的变化及发生机制,并观察莫沙必利对胆囊排空功能障碍的疗效方法:B超观察糖尿病合并自主神经病变、莫沙必利后的变化。结果:①糖尿病合并自主神经病变组病人的胆囊体积较糖尿病不合并自主神经病变组及正常明显增大,胆囊最大收缩率明显减低。②莫沙必利治疗后糖尿病合并自主神经病变组的胆囊排空功能较前明显好转。结论糖尿病合并自主神经病变病人胆囊排空障碍与自主神经受损有关,莫沙必利治疗有效。     

胆囊结石的诱因与防范

胆囊结石病因较复杂,家族病史、细菌感染、肠道神经功能障碍、地域、年龄、性别、体重、饮食结构与习惯等,通过影响胆汁内胆固醇饱和、胆固醇结晶形成、胆囊动力异常,诱发胆结石。     

消石利胆散对微创保胆取石后预防胆囊结石复发的研究

目的:观察中药对于保胆取石术后预防结石复发临床治疗效果,总结相关经验,为中医药在微创保胆取石术后临床治疗效果提供参考。试验研究方法:选取于贵阳中医学院第一附属医院外一科成功实行腹腔镜胆囊切开取石术患者60例,随机分成治疗组以及对比组各30例,通过术后复查B超观察有无胆囊结石、胆囊收缩功能、胆囊壁厚度从而对中药消石利胆散疗效和安全性作出评价。结论:中药消石利胆散对于腹腔镜微创保胆取石术后能有效降低结石复发率,对于改善胆囊收缩功能以及胆囊壁厚度有疗效。     

腹腔镜下胆囊切除合并胆总管探查取石术10例疗效体会

随着微创外科的发展,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)已成为治疗胆囊结石的首选方法。(laparoscopic common bile duct exploration,LCBDE)腹腔镜胆总管探查术也越来越多的外科医师用于胆总管结石的治疗。回顾性总结我科从2015年3月至2015年9月一共收治胆囊结石合并胆总管结石10例,在全麻下经腹腔镜胆囊切除同时胆总管切开取石术取得了较满意的疗效。只要在术前选择好合适的患者,在术中掌握好手术方式对身体的侵袭和治疗效果之间的平衡点,腹腔镜下胆囊切除同时胆总管探查术是可行、有效、安全的。     

糖尿病肾病的医学营养治疗

糖尿病肾病是糖屎病最严重的并发症之一,是由于糖尿病糖代谢异常为主因所致的肾小球硬化,并伴尿蛋白含量超过正常,是导致慢生肾衰竭最严重的重要原因.其中糖尿病1型和2型糖尿病患者糖尿病肾病发病率为20%～30% 其发生主要与高血糖有关.同时高血压、脂代谢素乱、肾脏血流动力学改变、遗传等因素在糖尿病肾病的发生发展中也起重要作用.医学营养疗法是治疗和预防糖尿病早期肾病的措施之一.本文就来谈谈糖尿病肾病的医学营养治疗.     

胆心综合征

胆心综合症是以胆囊疾病与冠心病同时并见,且胆病的发作可诱发或加重冠心病为特征的病症. 　　本病常先有……墨菲氏征阳性.现代医学认为由于支配胆道和心脏的神经在脊髓部位有部分交叉,当胆囊或胆道疾病发作时,刺激迷走神经到达脑网状结构,累积后再经迷走神经下行到冠状动脉引起收缩而狭窄,血流量减少,导致心肌缺氧加重,而诱发心绞痛、心肌梗塞、心律失常、心电图异常等一系列表现. 　　……     

胆心综合征

胆心综合症是以胆囊疾病与冠心病同时并见,且胆病的发作可诱发或加重冠心病为特征的病症. 本病常先有……墨菲氏征阳性.现代医学认为由于支配胆道和心脏的神经在脊髓部位有部分交叉,当胆囊或胆道疾病发作时,刺激迷走神经到达脑网状结构,累积后再经迷走神经下行到冠状动脉引起收缩而狭窄,血流量减少,导致心肌缺氧加重,而诱发心绞痛、心肌梗塞、心律失常、心电图异常等一系列表现.     

浅谈农村温室大棚的经营管理

随着经济的发展,各个方面都有了很大的发展,生态对农村建设同样有着很大的影响,农村温室大棚作为生态建设中重要的一环,对新农村建设起到积极的推进作用,对于提高农民生活水平,改善农村生态环境有着积极的促进作用。农村温室大棚的经营和养护管理在很大程度上影响着现代生态城市的发展。     

Visfatin与2型糖尿病的研究进展

visfatin（内脂素）是新近发现的脂肪细胞因子,它可以结合并激活胰岛素受体,模拟胰岛素的作用。从而降低血糖水平,改善胰岛素抵抗。现有研究表明：visfatin可能在2型糖尿痛的发病中扮演重要角色,它的发现为研究糖尿病的发病机制增加了新的内容．可能为糖尿病的治疗提供一个新的靶点.     

小议会计电算化对内部控制制度的影响

电算化的引入对会计体系的发展起到了很大作用.电算化给企业的内部控制制度带来了许多重大影响,使其出现了新特征.怎样在电算化环境下,加强内部控制制度建设是是当前需要认真对待和研究的问题.     

Evaluation of adenosine deaminase activity and lipid peroxidation levels in diabetes mellitus

There was increase in erythrocyte lipid peroxidation and adenosine deaminase (ADA) activity in red blood cells (RBC's), white blood cells (WBC's) and plasma, in 30 patients of confirmed diabetes mellitus, 10 each of insulin dependent diabetes mellitus (IDDM or type I), non-insulin dependent diabetes mellitus (NIDDM or type II) and diabetes with ketoacidosis when compared with 20 healthy individuals (controls). Glycosylated hemoglobin A1c%, plasma free fatty acid (FFA) and glycerol levels were also elevated in all the cases when compared with controls. The increase was more in diabetic ketoacidosis group. Significant positive correlations were seen between erythrocyte lipid peroxidation and ADA activities in RBC's, WBC's and plasma. It is suggested that decreased tissue adenosine levels due to increase in ADA activity, is related to the severity of hyperglycemia and lipid peroxidation in diabetes mellitus.     

Study of lipid peroxide and lipid profile in diabetes mellitus

The study was designed to find out the correlation between lipid peroxidation, lipoprotein levels to severity and complication of diabetes mellitus. Degree of lipid peroxidation was measured in terms of malondialdehyde (MDA) along with lipid profile and blood glucose in diabetes mellitus. It is categorised into insulin dependent diabetes mellitus (IDDM), non insulin dependent diabetes mellitus (NIDDM) and diabetes mellitus(DM) with complication. Total 112 known diabetic patients and 52 non-diabetic controls were studied. These patients were grouped as per the concentration of fasting blood glucose level i.e. controlled, poorly controlled, and uncontrolled group. There are significant increase in the lipid peroxide (MDA) and lipid profile except HDL cholesterol which is decreased, has been found in all groups as compared to controls In NIDDM group lipid peroxidation was markedly increased than IDDM group and it was higher in DM with complications. Other finding observed was that the level of lipid peroxide increased as per the increase in concentration of blood glucose. The increase lipid peroxidation in the hyperglycemic condition may be explained, as the superoxide dismutase enzyme which is antioxidant becomes inactive due the formation of superoxide radical within the cell. Maximum lipid peroxidation leads to the damage of the tissue and organs which results into complication in diabetic patients. High levels of total cholesterol appear due to increased cholesterol synthesis. The triglyceride levels changes according to the glycemic, control. The increase may be due to overproduction of VLDL-TG. It is concluded that good metabolic control of hyperglycemia will prevent in alteration in peroxidation and the lipid metabolism, which may help in good prognosis and preventing manifestation of vascular and secondary complication in diabetes mellitus.     

Endothelial Dysfunction in Type 2 Diabetes Mellitus

Endothelial dysfunction is an imbalance in the production of vasodilator factors and when this balance is disrupted, it predisposes the vasculature towards pro-thrombotic and pro-atherogenic effects. This results in vasoconstriction, leukocyte adherence, platelet activation, mitogenesis, pro-oxidation, impaired coagulation and nitric oxide production, vascular inflammation, atherosclerosis and thrombosis. Endothelial dysfunction is focussed as it is a potential contributor to the pathogenesis of vascular disease in diabetes mellitus. Under physiological conditions, there is a balanced release of endothelial-derived relaxing and contracting factors, but this delicate balance is altered in diabetes mellitus and atherosclerosis, thereby contributing to further progression of vascular and end-organ damage. This review focuses on endothelial dysfunction in atherosclerosis, insulin resistance, metabolic syndrome, oxidative stress associated with diabetes mellitus, markers and genetics that are implicated in endothelial dysfunction.     

Hypomagnesaemia in type-2 diabetes mellitus patients: A study on the status of oxidative and nitrosative stress

This study was undertaken to evaluate the levels of plasma magnesium, lipid peroxides, nitric oxide end products, erythrocyte membrane lipid peroxides, erythrocyte reduced glutathione and erythrocyte superoxide dismutase activity in type-2 diabetes mellitus patients. 60 patients with type-2 diabetes mellitus and 30 healthy control subjects were included in this study. Among 60 type-2 diabetic patients, 30 patients were without complication and 30 patients were with various complications. Decreased levels of plasma magnesium, erythrocyte reduced glutathione and erythrocyte superoxide dismutase activity while increased levels of plasma lipid peroxides, nitric oxide end products and erythrocyte membrane lipid peroxides were observed in patients with type-2 diabetes mellitus. We propose that, under the shadow of hypomagnesaemia, there is excessive production of reactive oxygen species and reactive nitrogen species as reflected by elevated lipid peroxides and nitric oxide end products concomitant with dwindled antioxidants and suggest their association with late complications in type-2 diabetes mellitus.     

Wolfram syndrome — clinical and diagnostic details

Wolfram syndrome, a rare genetic disorder is characterized by juvenile onset diabetes mellitus and optic atrophy. We describe two cases of wolfram syndrome belonging to same family; 25 year old female and her only 15 year old brother. In female, diabetes mellitus and optic atrophy were manifested in 1^st decade, diabetes insipidus in 2^nd decade and hypoacusis at the age of 25 years. Her ophthalmic evaluation revealed bilateral optic atrophy, decreased vision and peripheral constriction of visual field. However she didn’t have any renal dysfunction which is also considered to be one of the features of the syndrome. Though associated psychiatric features are later manifestations of the syndrome she was admitted with alleged suicidal consumption at the age of 25 years. The brother was asymptomatic except for the diabetes mellitus and insipidus.     

MTHFR (Ala 222 Val) polymorphism and AMI in patients with type II diabetes mellitus

The prevalent Ala222Val single nucleotide polymorphism of the MTHFR gene has been shown to be associated with type II diabetes. The objective of the present study was to find out whether there is genetic predisposition for development of acute myocardial infarction in type II diabetes mellitus among South Indian Tamil population. PCR-based restriction enzyme analysis was performed in DNA isolated from 120 acute myocardial infarction patients with diabetes mellitus and 100 non diabetic healthy individuals with no documented cardiovascular diseases. The results indicate that the MTHFR 677TT genotype is absent in both case and controls. The MTHFR 677CT genotype was observed among 32 (26.7 %) cases and 20 (20%) controls and the MTHFR 677CC genotype among 88 (73.3%) cases and 80 (80%) controls. The allelic frequencies were in accordance to Hardy Weinberg equilibrium. There was no statistical difference in genotype distribution between cases and controls. In conclusion, we suggest that the analysis of MTHFR genotyping for C677T polymorphism alone need not be considered to find out whether there is genetic predisposition for development of acute myocardial infarction in type II diabetes mellitus among South Indian Tamil population.     

RBC membrane composition in insulin dependent diabetes mellitus in context of oxidative stress

Glyco-oxidation is considered as a source of permanent, cumulative, oxidative damage to long lived proteins in ageing and in diabetes. Although RBC depends solely on glucose for energy purpose, hyperglycemic state glycosylates hemoglobin, creates oxidative stress and puts the cellular components at risk. In view of this, RBC membrane composition was analyzed in diabetic patients. The results were compared with healthy age and sex matched control groups. When RBC membrane components such as protein, sialic acid, phospholipids and cholesterol were determined in insulin dependent diabetes mellitus, a significant rise in phospholipids and cholesterol and significant fall in sialic acid and protein content was noted. RBC membrane composition showed pronounced alterations in insulin dependent diabetes mellitus. These changes were accompanied by higher levels of lipid peroxidation products like Malondialdehyde.     

Induction of diabetes by Streptozotocin in rats

The objective of this study is to induce experimental diabetes mellitus by Streptozotocin in normal adult Wistar rats via comparison of changes in body weight, consumption of food and water, volume of urine and levels of glucose, insulin and C-peptide in serum, between normal and diabetic rats. Intra-venous injection of 60mg/kg dose of Streptozotocin in adult wistar rats, makes pancreas swell and at last causes degeneration in Langerhans islet beta cells and induces experimental diabetes mellitus in the 2–4 days. Induction of experimental diabetes mellitus is indeed the first step in the plan of purification of pancreatic Langerhans islet cells of normal rats for transplanting under the testis subcutaneous of experimentally induced diabetic rats. Streptozotocin induces one type of diabetes which is similar to diabetes mellitus with non-ketosis hyperglycemia in some animal species. For induction of experimental diabetes in male adult rats weighted 250–300 grams (75–90 days), 60mg/kg of Streptozotocin was injected intravenously. Three days after degeneration of beta cells, diabetes was induced in all animals. The diabetic and normal animals were kept in the metabolic cages separately and their body weight, consumption of food and water, urine volume, the levels of serum glucose, insulin and C-peptide quantities in all animals were measured and then these quantities were compared. For a microscopic study of degeneration of Langerhans islet beta cells of diabetic rats, sampling from pancreas tissue of diabetic and normal rats, staining and comparison between them, were done. Induction of diabetes with Streptozotocin decreases Nicotinamide-adenine dinucleotide (NAD) in pancreas islet beta cells and causes histopathological effects in beta cells which probably intermediates induction of diabetes. In this study, we used Streptozotocin for our experiments in induction of experimental diabetes mellitus. After Induction of diabetes, consumption of food and water, volume of urine and glucose increased in the diabetic animals in comparison with normal animals, but the weight of body and the volume of insulin and C-peptide decreased in the diabetic animals. Sampling and staining of pancreas tissue of diabetic and normal rats showed that the Langerhans islet beta cells of diabetic rats have been clearly degenerated. In three days, Streptozotocin makes pancreas swell and at last causes degeneration in Langerhans islet beta cells and induces experimental diabetes. It also changes normal metabolism in diabetic rats in comparison with normal rats. Consumption of water and food, volume of urine, serum glucose increases in diabetic animals in comparison with normal rats but the levels of serum insulin, C-peptide and body weight decreases.     

Association of Single Nucleotide Polymorphisms of Adiponectin Gene with Type 2 Diabetes Mellitus,and Their Influence on Cardiovascular Risk Markers

Type 2 diabetes mellitus is a genetically heterogeneous condition, characterized by insulin deficiency and/or insulin resistance. The etiology of type 2 diabetes is complex, with involvement of genetic and environmental factors. The adipose tissue protein ‘adiponectin’ is known to increase insulin sensitivity with decreased risk of type 2 diabetes mellitus. The gene for adiponectin is present on chromosome 3q27, the association of number of single nucleotide polymorphisms of adiponectin gene with type 2 diabetes and its complications have been reported. In the present study the two most common SNPs +45T/G & +276G/T, and their association with type 2 diabetes mellitus and cardiovascular markers were studied. The significant difference in genotype frequencies of +45T/G & +276G/T was found in type 2 diabetic patients and controls, with odds ratio of 1.13 & 1.26 respectively. BMI, Fasting blood glucose, fasting insulin, HOMA IR, triglyceride and VLDL cholesterol levels were increased, and HDL cholesterol level was decreased in patients carrier for +45T/G SNP than the wild type. While only decrease in the HDL cholesterol was reported in carriers for SNP +276G/T than the wild type. The logistic regression analysis revealed the positive association of SNP +45T/G with total cholesterol & LDL cholesterol. And negative association of HDL cholesterol was found with SNPs +45T/G and +276G/T. The haplotype analysis shows the alterations in means of biochemical markers in the patients having haplotype (GG) for mutant allele of SNP +45T/G and wild allele for SNP +276G/T.     

浅谈社区糖尿病视网膜病变患者的护理干预

随着现代人们生活水平的提高及饮食结构的改变,以社区为统计单位的糖尿病患病率正在逐年提高。因糖尿病而引起的不可逆性的最严重的并发症糖尿病视网膜病变也呈上升趋势,成为严重影响患者生活、生命质量,给患者及其家属生理、心理带来巨大影响的一种慢性疾病。当前,我国社区卫生服务事业正逐步走向成熟,通过社区卫生服务机构对社区DR患者做好护理干预具有十分重要的现实意义。