901例社区2型糖尿病血瘀证的影响因素研究

目的 了解血瘀证在社区2型糖尿病患者中的分布及其相关影响因素。 方法 以社区901例2型糖尿病患者为研究对象,采集其相关临床信息并进行中医辨证分析,采用单因素分析和Logistic回归分析考察血瘀证的影响因素。 结果 901例2型糖尿病患者中,单纯血瘀脉络证165例,阴虚热盛证、湿热困脾证、气阴两虚证、阴阳两虚证分别为137、135、334、130例,分别兼夹血瘀证55、57、200、101例,各证型兼夹血瘀证的比例明显不同（P<0.05）。单因素分析结果显示,年龄、病程、高血压并发症、收缩压、体质量、体型是血瘀证的影响因素,舒张压、血脂水平不是血瘀证的影响因素;二项分类Logistic回归分析结果显示,年龄、高血压并发症、收缩压是血瘀证的影响因素。 结论 血瘀证是社区2型糖尿病患者的主要证型,年龄越大,具有高血压并发症,收缩压较高者易于出现血瘀证,尚不能认为病程、体质量和体型是2型糖尿病血瘀证的影响因素。     

Hyperosmolarity Induces Armanni‐Ebstein‐like Renal Tubular Epithelial Swelling and Cytoplasmic Vacuolization

Armanni–Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni–Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni–Ebstein lesions. However, although morphological changes similar to Armanni–Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid–Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni–Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein‐like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states.     

Armanni–Ebstein Lesions in Terminal Hyperglycemia

Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.     

Lived reality and the multiplicity of norms: a critical tribute to George Canguilhem

Canguilhem considered the lived reality of a disease that makes a person visit a doctor with clinical complaints as more important than the deviance that may be detected in the laboratory. He also insisted that doing medicine is a technique mobilized to improve life rather than an assemblage of neutral scientific facts. But these two ways of insisting on lived reality have different consequences. In line with the second, I present various ways in which clinical normality and laboratory normality are handled in current day medical practice. I consider where that leaves the first approach of setting standards. The multiplicity of normalities detected raises the question of how the various medical normalitiesrelate. For if they hang together coherently, medicine, by normalizing, might actively help to order the society of which it forms a part. But what if the various medical normalities contradict each other and inform different orders?     

丹蛭降糖胶囊对2型糖尿病患者B细胞功能的影响

目的:观察纯中药制剂丹蛭降糖胶囊对2型糖尿病患者B细胞功能的影响,探讨中医药在治疗2型糖尿病及延缓其进程中的作用。方法:62例2型糖尿病患者随机分成两组,治疗组32例服用丹蛭降糖胶囊,对照组30例服用马来酸罗格列酮,疗程为2个月,以胰岛素敏感指数及Ho-ma模型公式评估各组B细胞功能。结果:两组中医证候积分及B细胞功能均有改善,且治疗组明显优于对照组(P<0.05,P<0.01)。结论:丹蛭降糖胶囊具有降低血糖,改善高胰岛素血症,提高2型糖尿病患者胰岛素敏感性,改善胰岛素抵抗的作用。     

Formal and informal governance networks: Diabetes care in Australia and India

The concept of networks has gained interest in public administration and management. They address concerns such as the coordination of multiple actors within the policy process. Networks take both formal and informal forms. As the integration of formal and informal networks in public service delivery is gaining traction, this paper uses the example of diabetes care in Australia and India to provide an analytical framework to examine one of the ways such integration of networks take place. Diabetes, a chronic long‐term disease, poses to be a global problem with a high rate of diagnosis with implications for public health expenditure. A multi‐disciplinary team, which comprises both formal and informal categories, is required to manage diabetes. This paper highlights the integration of networks in diabetes care in different institutional and cultural settings. For such form of integration of networks to work, collaboration among the various actors is important. Lessons learnt from diabetes care will be relevant for other long‐term chronic conditions to help reduce the human resource and financial burden. The analytical framework developed based on the example of diabetes care will provide useful lessons for examining the mechanics and dynamics of the integration between formal and informal networks in the field of public administration and management.     

How Useful is Basal Renal Tubular Epithelial Cell Vacuolization as a Marker for Significant Hyperglycemia at Autopsy?

Basal vacuolization of renal tubular epithelial cells (so-called Armanni-Ebstein phenomenon) has been attributed to hyperglycemia causing accumulation of cytoplasmic glycogen. Review of 34 autopsy cases with significant hyperglycemia (vitreous glucose ≥ 15 mmol/L/270 mg/dL) was undertaken to determine whether there was any significant association between the degree of hyperglycemia and the severity of this morphological change (graded as 0, 1+, 2+, and 3+). No association was demonstrated. Review of the subgroup of 14 cases with terminal hyperglycemia without ketoacidosis was then undertaken to assess the effect of hyperglycemia in isolation on renal tubular epithelial cells. Vitreous glucose levels in these 14 cases ranged from 17 to 49.7 mmol/L (306-894.6 mg/dL) with a mean of 26.25 mmol/L (472.5 mg/dL) and β-hydroxybutyrate levels ranged from 0.02 to 2.55 mmol/L (0.36-45.9 mg/dL) with a mean 0.79 mmol/L (14.22 mg/dL). Not one of the latter cases displayed basal vacuolization. No relationship between basal vacuolization of renal tubular epithelial cells at autopsy and terminal hyperglycemia could, therefore, be demonstrated.     

Renal Tubular Epithelial Vacuoles—A Marker for Both Hyperlipidemia and Ketoacidosis at Autopsy

Review of 15 cases of nephrotic syndrome found that eight had significant hyperlipidemia with serum cholesterol levels ranging between 10.59 and 18.60 mmol/L (mean 12.88) and serum triglyceride levels between 2.30 and 9.92 mmol/L (mean 4.58); all of these cases displayed basal lipid vacuolization. Seven of the 15 study cases had normal–mild hyperlipidemia with serum cholesterol levels ranging between 4.71 and 7.54 mmol/L (mean 6.02) and serum triglyceride levels between 0.65 and 4.1 mmol/L (mean 1.57). Six of the seven cases had basal lipid vacuoles (86%). Of these, five cases were hyperlipidemic and one case had borderline hyperlipidemia with a serum cholesterol level of 4.71 mmol/L. Although hyperlipidemia was associated with renal tubular epithelial vacuolization, the vacuoles appeared morphologically different to those found in ketoacidosis. This study has shown that while hyperlipidemia in isolation may result in basal lipid vacuolization within renal tubular epithelial cells, the phenotype differs from that observed in ketoacidosis.     

耳针辅助治疗社区气阴两虚型2型糖尿50例

目的 观察耳针辅助治疗气阴两虚型2型糖尿病的临床疗效。〖JP2〗方法 将100例气阴两虚型2型糖尿病患者随机分为对照组和干预组,每组50例,对照组给予饮食和运动指导及降糖药口服,干预组辅以耳针治疗,疗程12周。治疗前后分别观察两组中医证候积分、空腹血糖（fasting plasma glucose,FPG）、餐后2 h血糖（2-hour postprandial glucose,2hPG）、糖化血红蛋白A1c（hemoglobin A1c,HbA1c）、三酰甘油（triacylglycerol,TG）、总胆固醇（total cholesterol,TC）、低密度脂蛋白（low-density lipoprotein）、体质量。〖JP〗结果 干预组中医证候疗效显著优于对照组;治疗12周末,干预组中医证候积分、FPG、2hPG、HbA1c、TC、TG、LDL均较治疗前显著降低（P<0.01）,而对照组上述指标与治疗前比较,差异均无统计学意义（P>0.05）。结论 耳针辅助治疗能明显改善糖尿病患者气阴两虚证候,调节血糖和血脂,减轻体质量。     

中药穴位注射治疗2型糖尿病周围神经病变临床观察

目的 观察中药穴位注射治疗2型糖尿病周围神经病变的临床疗效。方法 将70例2型糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）患者随机分为对照组和治疗组,每组35例。在糖尿病常规治疗基础上,对照组加用弥可保治疗,治疗组在对照组基础上加用红花注射液穴位注射。治疗前、治疗4周后分别进行密西根州糖尿病周围神经病评分（Michigan diabetic neuropathy score,MDNS）。结果 治疗4周后,治疗组临床疗效优于对照组,差异有统计学意义（P＜0.05）。两组患者治疗后MDNS评分和症状、体征评分均较治疗前明显减少（P＜0.05）;两组MDNS评分和症状、体征评分差值比较,差异均有统计学意义（P＜0.05）。结论 中药穴位注射可以显著减少DPN患者MDNS评分和症状、体征评分,提高生活质量。