色素上皮源性因子在心脑血管疾病伴发糖尿病中的检测意义

本研究检测了心血管疾病患者中的血清色素上皮源性因子(PEDF)水平,观察其表达水平在心脑血管疾病中与其他伴发疾病的关系,即与吸烟、体重、高血压、蛋白尿、糖尿病等指标进行深入分析.发现PEDF的水平与糖尿病发病呈正相关;进一步的研究发现将重组人PEDF刺激培养的胰岛细胞,发现胰岛细胞分泌胰岛素功能受损,提示心血管疾病中,检测患者血液中的PEDF表达量可起到预测糖尿病发生,并提示胰岛细胞功能异常的作用.     

回顾胰岛素发现之启示

胰岛素的发现经历了漫长的历史.胰岛素的发现不仅改变了糖尿病患者的命运,亦改变了糖尿病学史.     

吡格列酮降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的研究

研究吡格列酮对胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的影响,探讨其作用机制.选择60例接受冠脉支架植入并发胰岛素抵抗非糖尿病患者,随机分为吡格列酮组和对照组.吡格列酮组在常规治疗基础上给予6个月吡格列酮15mg/d.结果显示吡格列酮组支架内再狭窄率明显降低(P＜0.05),血清hsCRP、瘦素和ET-1水平显著降低和血清脂联素水平显著升高(P＜0.05),管腔狭窄面积与血清脂联素呈显著负相关,与胰岛素抵抗指数、瘦素、内皮素、C反应蛋白水平呈显著正相关.因此,吡格列酮能降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄,加强了支架的保护作用.     

内质网应激和胰岛素抵抗

2型糖尿病的发病机制主要涉及胰岛素抵抗.近年来研究表明内质网应激可诱导胰岛素抵抗的形成,并使与改善胰岛素受体敏感性相关的内质网应激标志物分子氧调节蛋白150和转录因子X盒结合蛋白-1表达增强,表明内质网应激对细胞具有双重作用,一方面可诱导胰岛素抵抗,另一方面激发对应激的适应反应.     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间.即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理.我们则采用小剂量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的荆量.结果,有部分患者完全摆脱了胰岛素.我们对糖尿病的再认识是建立在对多脏器活检的基础之上.我们的活检结果表明,糖尿病肾病存在着免疫损伤.糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果.我们尝试用小剂量的免疫抑制剂环孢茵素A(25 mg bid)治疗糖尿病眼底出血,取得了不错的疗效,也证实糖屎病眼底病变是一种血管炎,与自身免疫痛变有关.其他的器官还包括垂体、大脑的血管、糖尿痛足、冠心痛、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿痛,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积.这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在.为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病.应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效.唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红索升高,而也有一部分患者总胆红素不升高.     

心理性胰岛素抵抗及应对策略

糖尿病易导致严重的慢性并发症,已成为影响人们生活质量的一种常见疾病.早期应用胰岛素是使2型糖尿病患者血糖得到良好控制、减少并发症发生的有效手段.但许多患者不愿接受或延迟胰岛素治疗.本文旨在探讨胰岛素应用过程中患者及医护人员存在的心理障碍,即心理性胰岛素抵抗,并进一步阐述其应对策略.     

导言:代谢手术治疗2型糖尿病:一项任重而道远的工作

正代谢手术目前业已成为治疗2型糖尿病(T2DM)的选择之一,被广大糖尿病患者及医护人员所接受,它与胰岛素的发现同样具有划时代意义,将对糖尿病患者产生深远影响。虽然代谢手术对糖尿病患者的受益是显而易见的,但目前仍有一些重要的问题亟待解决。(1)代谢手术的降糖机理仍不十分明确,尤其肠-胰岛素轴所涉及的几种激素的作用及机理有待进一步明确。既往认为,代谢手术对糖尿病的治疗效果来自于体重下降,脂肪组织减少,胰岛素抵抗减轻所带来的血糖降低。但     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区.通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性.     

将糖化血红蛋白控制在7.0%以下是否更安全

2008年一项针对2型糖尿病强化血糖控制对心血管病变研究(ACCORD)发现,对于病程在10年左右,30%存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖"正常化",即糖化血红蛋白(AIC)<6.0%并没有减少糖尿病全因死亡.人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜.中华医学会糖尿病学分会也在今年重新修订了其<中国2型糖尿病防治指南>的AIC控制目标,AIC目标由原来的6.5%提高到7.0%.那么这一改变对2型糖尿病患者来讲到底有多大意义呢?ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡串并没有随之减少.因此,需要重新检视2型糖尿病防治策略.     

肥胖致心肌脂毒性的机制的研究进展

肥胖是体内脂质过度沉积的一种状态,其不仅可引起糖脂代谢紊乱、胰岛素抵抗,从而继发糖尿病、高血压、冠心病等疾病,而且当脂质水平超过脂肪细胞的储存容量及出现胰岛素抵抗时,血液中游离脂肪酸含量会随之升高,进而可引起脂质在心脏的异位沉积.沉积于心肌细胞的脂质可进一步通过神经酰胺、内质网应激等机制影响心肌细胞的结构和功能,最终导致心力衰竭的发生.但肥胖所致心肌脂毒性具体机制不明,本文就肥胖所致心肌脂毒性可能机制做一综述.     

2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平。对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生。本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析。     

THE AMBIVALENCE TOWARD MEN INVENTORY

We present a measure, the Ambivalence toward Men Inventory (AMI), that differentiates between women's hostile and benevolent prejudices and stereotypes about men. The Hostility toward Men (HM) and Benevolence toward Men (BM) subscales of the AMI tap conventional attitudes toward men that have opposing valences. Each subscale assesses subfactors concerning men's power, gender differentiation, and heterosexuality. Three studies with predominately White, male and female participants (two with undergraduates and one with a community sample) establish the factor structure, reliability, convergent validity, and predictive validity of the AMI. The AMI was strongly related to its sister scale, the Ambivalent Sexism Inventory (Glick & Fiske, 1996) and to two established scales of attitudes toward men (Downs & Engleson, 1982; Iazzo, 1983). Only the AMI, however, successfully distinguished between subjectively positive and subjectively negative beliefs about men. A copy of the 20-item AMI is provided as a tool for further exploration of women's ambivalence toward men.     

Research Notes

Abstract

The purpose of the present study was to conduct a preliminary criterion validity assessment of the Athletic Motivation Inventory (AMI). Subjects were 649 ice hockey players who were eligible for the National Hockey League (NHL) entry draft. Each player was rated for the dependent measure, psychological strength, by at least one of three NHL scouts from one team. This criterion measure was based on the observation of on-ice play. The data were analyzed using three independent multiple regression analyses, one for each scout, with the eleven AMI subscales as predictor variables. The results show that less than four percent of the variance in scout ratings was accounted for by AMI scores. The data are interpreted as showing that on-ice behaviors inferred by NHL scouts to represent psychological strength have little relationship to what the AMI measures. Finally, the data are discussed for their relevance to current NHL entry draft screening procedures and to future validity research.     

多囊卵巢综合征与代谢综合征

高胰岛素血症和高雄激素血症是多囊卵巢综合征（PCOS）的两大基本特征,共同参与了PCOS的发生与发展,胰岛素抵抗是连接PCOS和MS的纽带。本文阐述了PCOS和MS的相互重叠、PCOS产生胰岛素抵抗的机制、胰岛素抵抗对PCOS的作用。指出早期识别PCOS,有利于及时纠正、阻断其内分泌紊乱,防止MS的发生。提高胰岛素敏感性的治疗措施包括生活方式调整和药物治疗,生活方式的调整主要是控制饮食、运动和改变生活方式,包括戒烟、戒酒;药物治疗主要是使用二甲双胍和噻唑烷二酮类药物,其他药物如右旋肌醇、N-乙酰半胱氨酸、生长抑素类似物、α糖苷酶抑制剂、内腓肽受体抑制剂也具有增强胰岛素敏感性的作用。     

Stress-Induced Cardiomyopathy and Psychological Wellbeing 1 Year After an Acute Event

Stress cardiomyopathy (SCM) typically presents similar symptoms to acute myocardial infarction (AMI). However, these symptoms differ when it comes to a transient and completely reversible myocardial dysfunction, which is frequently precipitated by acute stressful events, occurring in the absence of plaque rupture and coronary thrombosis. The purpose of this study was to investigate health-related quality of life (HRQL) and emotional burden subsequent to cardiac events in SCM patients. Thirty-seven SCM patients were compared with 37 matched AMI patients. All selected patients were assessed for HRQL and psychological distress at baseline and 1-year after the acute event. After controlling for covariates, scores on the Psychological General Well Being Index indicated that depressed mood had increased in both groups, but the increase for SCM patients was greater than for AMI patients. The AMI group displayed greater decreases than the SCM in physical quality of life and in total cardiac-related health quality of life. The percentage of patients with psychological distress increased significantly more in the SCM group than in the AMI group, and it made no difference whether the triggering event was emotional or physical. Our results suggest that, despite the more favorable medical prognosis of SCM patients, their cardiac condition being transient and resolving completely in few weeks, the psychological impact associated with their condition is more negative 1 year later than in the case of AMI patients whose medical prognosis is less favorable, and this difference is independent of type of trigger event.     

急性心肌梗死发病年轻化的因果分析

越来越多的中青年人因急性心肌梗死住院甚至猝死,其发病具有原因和结果的必然联系。过劳、不良生活习惯、吸烟、大量饮酒等原因都会使冠状动脉内斑块形成或冠状动脉痉挛而诱发急性心肌梗死。患者及医务工作者都应针对病因及发病机制积极治疗并有效预防,从而提高全民的心血管健康水平。     

A competence framework for artificial intelligence research

ABSTRACT

While over the last few decades AI research has largely focused on building tools and applications, recent technological developments have prompted a resurgence of interest in building a genuinely intelligent artificial agent – one that has a mind in the same sense that humans and animals do. In this paper, I offer a theoretical and methodological framework for this project of investigating “artificial minded intelligence” (AMI) that can help to unify existing approaches and provide new avenues for research. I first outline three desiderata that a framework for AMI research should satisfy. In Section 1, I further motivate the desiderata as well as the need for a new framework. Section 2 develops a general methodological approach, the “generative methodology,” and Section 3 develops a version of this methodology, the “Competence Framework for AI research” (CFAI).     

Adapted motivational interviewing for women with binge eating disorder: a randomized controlled trial

In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms.     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区。通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性。     

急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.