目的:降低糖尿病大范围筛查的医疗成本,减轻血糖检测对患者心身的伤害,同时为高风险糖尿病人群提供一种无创、准确、高效、经济的糖尿病检测方法.方法:采用残差注意力卷积神经网络对糖尿病受试者面部图像进行有监督的机器学习,预测受试者未来糖尿病的发病风险;为评估该方法的应用效果,本实验招募了384例糖尿病受试者和137例血糖正常的健康志愿者,比较残差注意力网络与其他卷积神经网络的糖尿病无创检测性能.结果:采用56层残差注意力网络构建的糖尿病无创检测模型在实验中表现出的预测能力最强,准确率高达94.28％,特异性为92.94％,F1值达95.88％.结论:该预测模型检测方法耗时短、成本低且支持大范围筛查及远程诊疗,具有较强的糖尿病检测能力.

Objective:To explore the recurrence and death outcomes of the patients with diabetic foot for 5 year follow-up after ulcer healing, and analyze the risk factors.Methods:A prospective cohort study was conducted in 317 patients with diabetic foot and ulcer healing who were hospitalized in the Department of Diabetic Foot Disease of Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2013 to December 2014. The ulcer recurrence and death of patients after 5 years of continuous follow-up were recorded, and binary logistic regression and Cox proportional hazard regression models were used to analyze risk factors, respectively.Results:Follow-up was completed in 292 of 317 patients (follow-up rate of 92.1%). The 5-year cumulative recurrence rate in follow-up patients was 71.2% (208/292), the recurrence rate of the same site was 29.8% (62/208), multiple recurrence rate was 41.3% (86/208), the highest recurrence rate was 32.7% in the forefoot area (68/208), and the ulcer recurrence rate of the 122 patients with osteomyelitis was 73.8% (90/122). The cumulative five-year mortality rate was 39.7% (116/292). The mortality rate of patients with recurrence was higher than that of patients without recurrence [44.2% (92/208) vs 28.6% (24/84), P<0.05]. Multivariate analysis showed that age, osteomyelitis, foot care behavior, caregiver reaction, glycated hemoglobin A 1c, limb extremity arterial disease (LEAD) stage, and end-stage renal disease were independent influencing factors for ulcer recurrence in patients with diabetic foot ( P<0.05). Bathel index, caregiver reaction, glycated hemoglobin A 1c, LEAD stage, end-stage renal disease, and cardiac events were independent influencing factors of death ( P<0.05). Conclusions:The risk factors of ulcer recurrence are mainly age, osteomyelitis and foot care behavior. The risk factors for death are Bathel index and cardiac events. Moreover, caregiver reaction, glycated hemoglobin A 1c, LEAD stage Ⅳ, kidney disease stage 5 are the risk factors of both ulcer recurrence and death.

胰岛素作用于中枢神经系统可发挥对能量、葡萄糖代谢平衡以及认知记忆等的调节作用,而中枢胰岛素作用缺陷可能导致能量代谢失衡、高血糖、肥胖等不良后果.因此,如何加强胰岛素在中枢的作用和纠正中枢胰岛素抵抗将成为代谢性疾病治疗的一个新的研究方向.

Objective:To observe the chemotactic effects of vascular endothelial growth factor(VEGF) on macrophages and the effects of β2-glycoprotein Ⅰ(β2-GP) on the migration of macrophage induced by VEGF through RAW 264.7 incubation, and to discuss the possible mechanisms.Methods:RAW 264.7 cells were incubated and divided into five groups: control group, VEGF group, VEGF+ β2-GP group, VEGF+ SB203580 (p38 inhibitor) group, β2-GP group. Transwell cell migration assay was used to observe the chemotaxis of the cells in response to VEGF, and the effect of β2-GP on the macrophage migration induced by VEGF. ELISA was used to detect the excretion of monocyte chemotactic proteins-1 (MCP-1), interleukin-8(IL-8) and mitochondrial intermediate peptidase-1β (MIP-1β). Western blotting was used to detect the expression of vascular endothelial growth factor receptor 1 (VEGFR1) and activation of p38 mitogen-activated protein kinase (MAPK) signal transduction pathways.Results:(1)Compared with control group, the number of macrophage migration in VEGF group increased( t=22.089, P<0.05). Compared with VEGF group, the macrophage migration in VEGF+ β2-GP group and VEGF+ SB203580 group was significantly reduced ( t=22.687, 63.625, all P<0.05). (2)Compared with control group, the secretion of macrophage chemokines MCP-1, IL-8 and MIP-1 increased in VEGF group ( t=3.339, 11.140, 2.254, all P<0.05), and the secretion of the three chemokines induced by inhibiting VEGF decreased in VEGF+ β2-GP group and VEGF+ SB203580 group ( t=3.148, 2.402, 2.798, 6.754, 4.459, 5.528, all P<0.05). (3)Compared with control group, VEGFR1 expression and p38MAPK pathway phosphorylation were increased in VEGF group ( t=5.161, P<0.05), while VEGFR1 expression and p38MAPK pathway phosphorylation were decreased in VEGF+ β2-GP group ( t=4.965, P<0.05). Conclusions:VEGF can induce the migration of macrophages and secretion of chemokines MCP-1, IL-8 and MIP-1β through the increase of VEGFR1 on the macrophages and activate the p38MAPK transduction pathway; β2-GP can inhibit the expression of VEGFR1 and partially inhibit the phosphorylation of p38MAPK, thereby inhibiting VEGF-induced migration of macrophage and secretion of chemokine.

目的 分析成人肥胖患者的血清25羟维生素D3[25-(OH)D3]与糖脂代谢指标的相关性.方法 采用标准体质指数(BMI)法,筛选单纯性肥胖成人40例,并设置40例同年龄区间、性别的健康非肥胖成人作为正常对照组,检测各组25-(OH)D3水平以及糖脂代谢指标水平.结果 与正常对照组相比,肥胖组患者血清25-(OH)D3水平明显低于正常组,差异有统计学意义(P<0.05).肥胖组空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)出现不同程度上升,高密度脂蛋白胆固醇(HDL-C)呈一定程度下降,且血清25(OH)D3水平与BMI、FPG、FINS、HOMA-IR、TC、TG、LDL-C呈负相关,与HDL-C呈正相关(P<0.05),与腰围(WC)及HbA1c无明显相关性(P>0.05);肥胖组TG、FPG对血清维生素D水平具有显著负向预测作用.结论 与体质指数正常者相比,成人肥胖患者25-(OH)D3水平显著降低,且与FPG、FINS、TC、TG等糖脂代谢参数指标存在显著关联,提示血清25羟维生素D3水平可能在成人肥胖患者糖脂代谢中发挥一定作用.

糖尿病肾病(DN)是糖尿病(DM)慢性并发症之一,是DM微血管病变在肾脏中的表现,是影响DM患者死亡率的独立因素.其发病的相关因素包括糖脂代谢紊乱、血流动力学改变以及氧化应激等,而以巨噬细胞浸润为代表的持续低水平炎症在DN的发生发展过程中持续存在,巨噬细胞可以通过产生多种细胞因子以及进一步募集巨噬细胞,加速疾病进展[1].本文就巨噬细胞在DN发生发展中的作用、相关机制以及潜在治疗方案等作一综述.

许多糖尿病患者长期注射胰岛素后,注射部位的皮下会出现增厚的“橡皮样”病变,质地硬,或呈疤痕样改变.有些病变不易被肉眼观察到,患者可以自己触诊,正常的部位捏起皮肤较薄,而发生皮下脂肪增生的部位则相反. 已经出现皮下脂肪增生的患者每次就诊时,医护人员应对其注射部位进行检查.每个注射部位至少每年检查一次(儿童患者最好每次就诊时都检查).病变组织恢复正常通常需要数月至数年,所以在此之前,不要在此部位进行注射.

糖尿病性皮肤病 也称胫前色素斑,为发生于胫骨(即小腿靠内侧的长骨)前的淡棕色萎缩性色素沉着斑,是糖尿病特征性皮肤损伤,也是糖尿病最常见的皮肤病变,约占糖尿病患者的50％.男性多于女性.早期表现为不规则的圆形、卵圆形、境界清楚的表浅暗红色丘疹,水疱或紫癜,以后渐次形成褐色萎缩斑.数目不等,双侧都可发生,但不对称.

Objective To explore the repair method for refractory diabetic wound. Methods A total of 206 patients with refractory diabetic foot ulcers were treated with proper surgical treatments.Results Of all, 106 patients were treated by skin flap (51.5 % ), with one stage wound healing rate of 85.8%; 122 patients were repaired with split-thickness skin graft ( 59.2% ), with survival rate of the graft for 79.5%. Simple toe amputation was made in 34 patients (46 toes). The high level amputation was performed in 56 patients (27.2%). Of all, 132 patients were followed up for 6-18 months, which showed that ulcer recurred in 12 patients (9.1%). Conclusion Timely and effective treatment as well as flap and skin graft repair could reduce high level amputation rate of diabetic foot ulcer and promote the quality of life.

Objective To explore the effect of diabetes mellitus (DM) on biological behavior of epidermal keratinocyte in rats. Methods A total of 40 Sprague-Dawley rats were randomized into control group and streptozotocin (STZ) -induced diabetes group. Of each group, 10 rats were implemented with deep partial-thickness scalding. The re-epithelialization rate was observed at the 3rd, 7th, 14th and 21th post-burn day. Histological characteristics and thickness of epidermal tissue in both groups were observed. The adhesion rate, cell cycles, apoptosis rate and migration ability of keratinocyte were measured. The accumulation of advanced glycosylation end products (AGEs) of epidermal tissue was observed. Results The percentages of re-epithelialized area at the 7th, 14th and 21th post-burn day were much lower in DM group than in control group (P<0.05). In DM group, the epidermal thickness was reduced obviously with obscure multilayered epithelium and less amount of prickle cells; The adhesion rates of 12, 24 h after culturing keratinocyte and the percentage of G2/M phase cells were lower in DM group than in control group (P<0.05). However, apoptosis rate of keratinocyte was higher, the amount of migration cell was significantly less in DM group than in control group (both P<0.05). There were lots of AGEs accumulated in epidermal tissue in DM group, while there were hardly AGEs in control group. Conclusions Re-epithelization blocked exists on non-healing wound in DM rats, which is related with the impaired keratinocyte biological behavior. A large of AGEs accumulate in the epidermal tissue of DM rats, which may be a important reason to inhibit keratinocyte function in diabetic environment.

Objective To investigate distribution and antibiotic resistance of pathogens isolated from the patients with diabetic foot infection(DFI) wounds in Tianjin Metabolic Hospital. Methods A retrospective study was carried out on the distribution and resistance rates of 478 bacteria strains isolated from the wounds of 408 DFI from Jan 2005 to Dec 2007. Results Gram-positive bacteria (54.8%), gram-negative bacteria(42.1%)and fungi(3.1%)were prevalent in the DFI. During the three years, the detection rate of Staphylococcus aureus (SA) was increasing (P0.01), Pseudomonas aeruginosa was decreasing(all P0.01). Antibiotic-resistant pathogens consistently decreased during the years (P 0.01). The detection rate of multidrug-resistant pathogens, including 42 methicillin-resistant SA(MRSA) strains, was high. Conclusions Opportunistic pathogens are predominant in DFI. Multidrug resistance is a common phenomenon. It is important to survey pathogens and their antibiotic resistance in DFI.

OBJECTIVE:To explore the impact of advanced glycosylation end products (AGE)-modified human serum albumin (AGE-HSA) on keratinocyte migration and the mechanism thereof.METHODS:AGE-HSA was prepared in vitro. Epidermal keratinocytes from Sprague-Dawley rats' back were cultured and treated with AGE-HSA of the terminal concentrations of 0, 30, 60, 90, 120, and 150 microg/ml for 1, 3, 5, and 7 days respectively. MTT method was used to detect the keratinocyte adhesion rate, expressed by absorbance. Keratinocyte migration ability was assessed by scratch wound healing assay and Transwell assay. Expression of integrin alpha3 was determined by flow cytometry. Scanning electron and inverted microscopes were used to observe the pseudopodium and microfilament of the keratinocytes. Immunofluorescence staining was used to detect the form of F-actin in the cells.RESULTS:The adhesion rates of the keratinocyte cultured with AGE-HSA for 12 and 24 hours were (0.112 +/- 0.022) and (0.173 +/- 0.012) respectively, both significantly lower than those of the control group [(0.122 +/- 0.004) and (0.267 +/- 0.024) respectively, both P < 0.05)]. Scratch wound healing assay showed that the amount of migrating cells in the AGE-HSA group was (7 +/- 4)/HP, significantly less than that of the control group [(61 +/- 11)/HP, P < 0.05)], and Transwell assay showed that the amount of migrating cells in the AGE-HSA group was (72 +/- 18)/HP, significantly less than that of the control group [(288 +/- 52)/HP, P < 0.05]. The expression rate of keratinocyte integrin alpha3 in the AGE-HSA group was (3.2 +/- 1.2)%, significantly lower than that in the control group [(36.6 +/- 11.2)%, P < 0.05]. The spreading of cell body, and the formation of pseudopodium and microfilament of the AGE-HSA group were all depressed in comparison with the control group.CONCLUSION:Keratinocyte migration is inhibited by AGE accumulation in high glucose condition. The mechanism may be the abnormality in the integrin inside-out signaling pathway and AGE-RAGE signaling pathway.

目的探讨糖尿病条件下大鼠创面愈合过程中角质形成细胞迁移功能受损的可能机制。方法选用 SD 大鼠6只,取背部表皮进行角质形成细胞培养;制作并鉴定糖基化基质模型;评价糖基化基质对正常大鼠角质形成细胞迁移功能的影响;测定糖基化基质对正常大鼠角质形成细胞粘附功能、培养12,24 h 黏附形态、伪足形成、微丝表达、整合素表达的影响。结果糖基化层黏连蛋白对细胞迁移较对照组有明显抑制(P<0.05);对细胞贴壁率无明显影响(P>0.05),但抑制了细胞的伸展及伪足的伸出,干扰了微丝的聚集,降低了整合素的表达(P<0.05)。结论正常大鼠皮肤角质形成细胞在糖基化基质上出现迁移功能受阻,这可能是与整合素信号传导出现障碍,引起整合素、肌动蛋白表达减少和微丝形成,从而引起丝状伪足和板状伪足形成减少有关。

糖尿病足感染(DFI)是糖尿病(DM)患者常见住院和截肢的原因[1].因此确定感染致病茵并合理选用抗生素在DFI治疗中至关重要.目前从足部伤口获取病原菌标本的方法包括:拭子,刮除术,组织活检,细针抽吸活检2-3.有研究认为组织活检是确定DFI病原体的金指标4.

近年来,糖尿病足溃疡(DFU)感染发生率逐年增加,成为糖尿病(DM)患者致残、致死的主要原因.应用抗生素治疗DFU感染明显降低了患者的病死率及截趾率.但过早停用抗生素可能引起感染的加重或复发,而抗生素应用时间过长易造成细菌耐药的产生,加重药物不良反应对机体的损害.因此,明确DFU感染停用抗生素的时机,对于指导临床治疗有着重要的意义.

OBJECTIVE:249 diabetic patients with deep foot infection were retrospectively studied. Their clinical features and effective factors related to wound healing were analyzed.METHODS:249 patients team (physician, surgeon and diabetes-specific nurse) were divided into 3 groups. Group A: patients healed without amputation (n = 107), group B: patients healed after amputation (n = 114), and group C: patients didn't heal after amputation. All patients' clinical features, lab examinations and foot wound features were compared.RESULTS:The group A patient were (59 +/- 12) years old, significantly younger than the group B (67 +/- 11, P < 0.01). Hypersensitive C reactive protein (hs-CRP, 18 +/- 5 mg/L) and plasma albumin (32 +/- 7 g/L) of group A were significantly higher than those of group B (13 +/- 5 mg/L and 29 +/- 5 g/L, respectively, P < 0.01). The duration of diabetes mellitus of group B (17 +/- 11) year was significantly longer than that of group A (10 +/- 6 year, P < 0.05). The possibility of probing bone, purulent secretion, necrosis, bone exposure, cacosmia, edema and critical limb ischemia of group B were more frequent (P < 0.01 or P < 0.05) compared to group A. The age of group B (67 +/- 11) are younger than that of group C (72 +/- 9, P < 0.05). In group B, temperature (38.1 +/- 1.1) degrees C, white blood cell (WBC) count (10 +/- 3) x 10(9)/L and hs-CRP (13 +/- 5) mg/L were higher than those of group C (37.4 +/- 0.8 degrees C, 8 +/- 2 x 10(9)/L and 7 +/- 6 mg/L, respectively, all P < 0.05). Critical limb ischemia of group B (37%) was more frequent than that of group A (7%, P < 0.05), but less frequent than that of group C (77%, P < 0.01). hs-CRP and plasma albumin were protective factors for wound healing. Age, the possibility of probing bone, purulent secretion, necrosis, bone exposure, cacosmia, edema and critical limb ischemia were risk factors for wound healing.CONCLUSION:diabetic patients with deep foot infection are difficult to be diagnosed in early stage since they often have no significant clinical syndrome such as fever, redness, swelling and pain, and their WBC count does not increase. Though multidisciplinary team manages these patients, more than half of them need amputation. Wound healing in the patients is related to multiple factors, including age, duration of diabetes mellitus, hs-CRP, plasma albumin, WBC count, level of limb ischemia and wound features.

Aim: In wound microenvironment, many cells could generate active oxygen and other free radicles. In this paper, we investigate the gate the mechanism and effect of oxidative stress on the biological behavior of dermal fibroblasts of normal rats. Methods: The experiment was performed in Shanghai Burn Institute from September 2005 to March 2006. 1 The back skin was harvested from the male SD rats of clean grade and 200-220 g (Shanghai Animal Experiment Institute, Chinese Academy of Sciences), and digested to separate epidermis and dermis, then cut into pieces of 0.1 cm × 0.2 cm, and cultured in DMEM containing 0.10 volume fraction fetal bovine serum (FBS) in incubator with 0.05 volume fraction CO2 at 37 °C. The medium was changed twice a week. About 7 to 10 days later, the fibroblasts gradually moved out of dermis, and proliferated massively. When the primary culture mixed together, the film was digested with 0.05% pancreatic enzyme-EDTA and terminated digestion with DMEM containing 0.01 volume fraction FBS, centrifuged, subpackage and passaged by 1:3. The fibroblast in log phase growth were cultured for 24 hours and incubated with 20, 50, 100, and 150 μmol/L H2O2 (in Hanks' balanced salt solution), at the same time, the blank control group (with no H2O2) and the zero alignment group (only Hank' s fluid with no cell) were set up. 2 Cell survival was observed with MTT; cell apoptosis with flow cytometry; reactive oxygen species (ROS) was detected by fluorescent probe of DCFH-DA, and malonaldehyde (MDA) by lipid peroxidate test box. Results: 1 With the increasing of H2O2, cell survival was gradually decreased, and the absorbance value of each H2O2 group was lower than that of control group (P < 0.01). 2 Compared with that in control group, cell apoptosis did not change obviously in 20 μmol/L H2O2 group, while abundant apoptotic dermal fibroblasts were observed in 100 μmol/L H2O2 group (F =47.78, P < 0.01). 3 ROS was more produced in 20 and 100 μmol/L H2O2 groups compared with that in control group (F =166.557, P < 0.01, P < 0.01). 4 Compared with that in control group, the content of MDA in 20 μmol/L H2O2 group did not change, while the content of MDA in 100 μmol/L H2O2 group was increased (F =5.756, P < 0.01). Conclusion: Oxidative stress results in decrease in survival, and increase in apoptosis of dermal fibroblasts of rats. Anti-oxidation therapy provides a treating approach for refractory wound.

Aim: To discuss therapy effect of diabetic wound by recombinant human epidermal growth factor (rhEGF) combined with basic fibroblast growth factor (bFGF). Methods: Twenty-nine cases with diabetic wound were selected from the center of Burn and Plastic Rehabilitation, Guangxi Medical University between May 2001 and March 2005. They all signed the consents voluntarily. These patients were randomly divided into 4 groups: rhEGF combined bFGF (E+F group 7 cases), rhEGF (E group 8 cases), bFGF (F group 6 cases) and saline (saline group 8 cases). Fasting sugar of all cases were controlled below 11.1 mmol/L before dealing with the wound, infection in the wound site treated by antibiotic, pathologic granulation tissues scraped. RhEGF and bFGF were sprayed over the wound by 1 500 IU per time and 720 AU per time in the E and F group, respectively. The rhEGF was sprayed over the wound for 1 500 IU per time in the E group. The bFGF was sprayed over the wound for 720 AU per time in the F group. The wound of saline group was wiped by saline. All wounds were bind up and dressing was replaced every other day. The wound-healing rate and granulation tissues in the wound site were both observed for 3, 7 and 14 days after treatment. Results: All the 29 patients with diabetic foot were involved in the result analysis. 1 Compared with each group during different time post-treatment: On the 3rd day after treatment, the wound healing rates between every two groups were similar (P > 0.05); On the 7th day, it was higher in the E+F group and E group as compared with the saline group (P<0.05). On the 14th day after treatment, it increased significantly in the E+F group, E group and F group as compared with the saline group (21.67±1.53)%, (33.50±1.56)%. (28.77±1.50)% (23.73±1.20)% (P < 0.01 or 0.05), and the increase in the E+F group was the most obviously. 2 General observational condition of granulation tissues growth at different time after treatment: On the 3rd day and 7th day after treatment, the growth was similar in every group (P > 0.05). On the 14th day, the granulation tissues of the E+F group grew better than that of the E group, F group and the saline group (P < 0.05). Conclusion: There is a cooperation effect of rhEGF combined with bFGF in diabetic wound therapy.

肠系膜上动脉压迫综合征是严重烧伤患者较少见的并发症,我院于1995年1月-2005年7月共收治5例,报告如下.

OBJECTIVE To summarize the clinical management of abdominal compartment syndrome (ACS) in burn patients with severe burn injury. METHODS Twelve serious burn patients with abdominal compartment syndrome hospitalized in our center from January 2001 to April 2005 were enrolled in the study. Among them 3 patients were treated with conservative method, 4 with escharectomy of abdominal wall, 5 with laparotomy for decompression. The clinical results were analyzed statistically. Bladder pressure, central venous pressure, systolic blood pressure and arterial blood oxygen partial pressure (PaO2 ) were measured and compared before and after operation. RESULTS Among these 12 patients, 5 died with the overall mortality of 41.67%. But only 3 died among 9 patients undergone operation. Most of patients were oliguric,with abnormal bladder pressure, central venous pressure, and systolic blood pressure 24 hours before operation. But these parameters were significantly improved after operation ( P <0. 01). CONCLUSION Early abdominal escharectomy and timely abdominal decompression are vital for the management of ACS in burn patients.