Metabolism, Insulin and DM

8/14/2019 Metabolism, Insulin and DM

1/131

^a`s ~l ~dff fl`}g?

Hls`mofdyh " Lgl}nt yo|}ily'Hls`mofdyh " Lgl}nt yo|}ily'

Ao~ moct |sdfd{ly salyl yo|}ily'Ao~ moct |sdfd{ly salyl yo|}ily'Boi|y og DGY\FDG `gc dsy r`}do|y }oflyBoi|y og DGY\FDG `gc dsy r`}do|y }ofly

Stul(= Cd`mlsly hlffds|y " u`saonlglydyStul(= Cd`mlsly hlffds|y " u`saonlglydy


2/131

â`s ~l ~dff fl`}g?

Cd`ngoydy ob Stul(= Cd`mlsly hlffds|yCd`ngoydy ob Stul(= Cd`mlsly hlffds|y

Iohufdi`sdogy ob Stul(= cd`mlslyIohufdi`sdogy ob Stul(= cd`mlsly

Hlia`gdyh ob iohufdi`sdogyHlia`gdyh ob iohufdi`sdogy

H`g`nlhlgsH`g`nlhlgs

Ua`}hìofondi`f sal}ùdly `r`df`mflUa`}hìofondi`f sal}ùdly `r`df`mfl


3/131


4/131

Lgl}nt bo} a|h`g fdbl

I`}moatc}`sl

B`sy

U}osldgy


5/131

Hoys iohhog lgl}nt yo|}ilyHoys iohhog lgl}nt yo|}ily

I`}moatc}`slyI`}moatc}`sly

B`syB`sy


6/131

Hoys iohhog lgl}ntyo|}ily

U}osldgyU}osldgy


7/131

N`yofdgl bo} a|h`g mldgn

S~o h`ko} b|lfy S~o h`ko} b|lfy

Nf|ioyl !I`}moatc}`sl$Nf|ioyl !I`}moatc}`sl$

B`sst `idcy !B`sy$B`sst `idcy !B`sy$


8/131

â`s dy ` I`}moatc}`sl?

If`yydbdlc `y

Hogoyìia`}dcly

Cdyìia`}dcly

Ofdnoyìia`}dcly

Uoftyìia`}dcly

D

!IA=O$go}

A(I

(OAD

I`}moatc}`sly `}l iohuo|gcy ~adia a`rl salboffo~dgn m`ydi iohuoydsdog;


9/131

Ydhufl Y|n`}y;Hogo `gcCdyìia`}dcly

Hogoyìia`}dcly ydgnfl y|n`} |gdsHogoyìia`}dcly ydgnfl y|n`} |gdsNf|ioylNf|ioyl

Bo|gc dg b}|dsy& rlnls`mfly& aogltBo|gc dg b}|dsy& rlnls`mfly& aoglt|ylc bo} lgl}nt|ylc bo} lgl}nt

B}|isoylB}|isoyl

b}|ds y|n`}b}|ds y|n`}Bo|gc dg b}|dsy& aoglt& io}g yt}|uBo|gc dg b}|dsy& aoglt& io}g yt}|u

N`fìsoylN`fìsoyl

Bo|gc `y u`}s ob fìsoyl dg hdfjBo|gc `y u`}s ob fìsoyl dg hdfj


10/131

Cdyìia`}dcly s~o fdgjlcy|n`} |gdsyY|i}oyl; nf|ioyl * b}|isoyl

s`mfl y|n`}

H`cl b}oh y|n`} i`gl `gc y|n`}mllsy

Fìsoyl; nf|ioyl * n`fìsoyl

hdfj y|n`}

Bo|gc dg hdfj `gc c`d}t u}oc|isyH`fsoyl; nf|ioyl * nf|ioyl

Bo|gc dg nl}hdg`sdgn il}l`f n}`dgy

U}oc|is ob ys`}ia m}l`jco~g


11/131

ohu lqI`}moatc}`sly

Ofdnoyìia`}dclyc}dlc ml`gy& ul`y& flgsdfy

]`bdgoyl !n`f(nf|(b}|$

Ysìatoyl !n`f(n`f(n`f(b}|$

Hls`mofd{lc mt dgslysdg`f mìsl}d`

N`ylo|y lbblisy


12/131

Iohuflq

I`}moatc}`slyUoftyìia`}dclyUoftyìia`}dcly

iogs`dg 055y o} 0555y obiogs`dg 055y o} 0555y obhogoyìia`}dcl |gdsyhogoyìia`}dcl |gdsy

ys`}ia(cdnlysdmflys`}ia(cdnlysdmflbdml}(dgcdnlysdmflbdml}(dgcdnlysdmfl

NftionlgNftionlg


13/131

Nftionlg

Dhuo}s`gil Yso}lc bo}h ob nf|ioyl'

H`ko} ydsly H|yifly `gc Fdrl}: >


14/131

Nftionlg Yso}`nl

Yjlfls`f h|yifl

B|gisdog; yl}rl `y b|lf }lyl}rl bo} ytgsalydy

ob @SU c|}dgn h|yifl iogs}`isdog Fdrl}

B|gisdog; h`dgs`dg mfooc nf|ioyliogilgs}`sdog dg sdhly ob b`ysdgn

Sos`f `ho|gs ob yso}lc i`}moatc}`sl dy y|bbdidlgs so

b|fbdff sal lgl}nt }lp|d}lhlgsy ob ` ul}yog bo} w0/=

c`t!


15/131

I`}moatc}`sl Cdnlysdog

@fyo jgo~g `y

`(nf|ioydc`yl

lg{thly


16/131

Hls`mofdyh ob I`}moatc}`sly

Nf|ioyl dy u}dh`}t lgl}nt yo|}il bo} sala|h`g moct

M}`dg dy sal hoys dhuo}s`gs nf|ioyl

iogy|hl} !


17/131

]ln|f`sdog ob Mfooc Nf|ioyl

Iogilgs}`sdog

U`sa~`ty ob Nf|ioyl Hls`mofdyh

Nftioftydy

Nf|ioglonlglydy

Nftionlglydy

Nftionlgoftydy


18/131

Nftioftydy !nf|ioyl ut}|r`sl$Cl}drlc b}oh sal N}llj yslhCl}drlc b}oh sal N}llj yslh nftj(nftj(&&

-y~lls&- `gc sal ~o}c-y~lls&- `gc sal ~o}c ftydyftydy&&

-cdyyof|sdog'--cdyyof|sdog'-

Nftioftydy; ylp|lgil ob }lìsdogy sa`sNftioftydy; ylp|lgil ob }lìsdogy sa`s

hls`mofd{ly ogl hofli|fl obhls`mofd{ly ogl hofli|fl obnf|ioylnf|ioyl so =so =hofli|fly obhofli|fly obut}|r`slut}|r`sl !s}doyl y|n`}$!s}doyl y|n`}$

@fyo u}oc|il = hofli|fly ob @SU@fyo u}oc|il = hofli|fly ob @SU

@g`l}omdi@g`l}omdi

Ut}|r`sl so fìs`slUt}|r`sl so fìs`sl @l}omdi@l}omdi

Ut}|r`sl so ìlstf(Io@Ut}|r`sl so ìlstf(Io@


19/131

Nf|ioglonlglydy

Ytgsalydy ob nf|ioyl b}oh gogi`}moatc}`slYtgsalydy ob nf|ioyl b}oh gogi`}moatc}`sl

yo|}ily !ut}|r`sl& `hdgo ìdcy& fìsdi ìdc$yo|}ily !ut}|r`sl& `hdgo ìdcy& fìsdi ìdc$

Iogrl}sy fìs`sl o} `hdgo ìdcy so nf|ioyl dgIogrl}sy fìs`sl o} `hdgo ìdcy so nf|ioyl dgys`}r`sdog o} ys}lyyys`}r`sdog o} ys}lyy

Ouuoydsl ob nftioftydyOuuoydsl ob nftioftydy


20/131

Nftionlglydy !nf|ioyl nftionlg$d'l' nlglydy 8 i}l`sdog

Dg sdhly ob nf|ioyl lqilyy !`bsl} l`sdgn$&Dg sdhly ob nf|ioyl lqilyy !`bsl} l`sdgn$&`gt`gt nf|ioylnf|ioyl sa`s dy gos |ylc dhhlcd`slftsa`s dy gos |ylc dhhlcd`slftdy s`jlg |u mt sal fdrl} `gc h|yifl ~al}ldy s`jlg |u mt sal fdrl} `gc h|yifl ~al}lds i`g ml iogrl}slc dgsods i`g ml iogrl}slc dgso nftionlgnftionlg

Nftionlg dy ytgsalyd{lc clulgcdgn og salNftionlg dy ytgsalyd{lc clulgcdgn og salclh`gc bo} nf|ioyl `gc @SU !lgl}nt$clh`gc bo} nf|ioyl `gc @SU !lgl}nt$

Db mosa `}l u}lylgs dg }lf`sdrlft adnaDb mosa `}l u}lylgs dg }lf`sdrlft adna

`ho|gsy& salg sal lqilyy ob dgy|fdg`ho|gsy& salg sal lqilyy ob dgy|fdgu}ohosly sal nf|ioyl iogrl}ydog dgsou}ohosly sal nf|ioyl iogrl}ydog dgsonftionlg bo} yso}`nl dg fdrl} `gc h|yiflnftionlg bo} yso}`nl dg fdrl} `gc h|yiflilffyilffy


21/131

Nftionlgoftydy !nftionlg nf|ioyl$d'l' ftydy 8 m}l`j co~g

^alg mfooc nf|ioyl iogilgs}`sdog^alg mfooc nf|ioyl iogilgs}`sdog

c}ouy& sal}l dy ` m}l`jco~g obc}ouy& sal}l dy ` m}l`jco~g obnftionlgnftionlg so h`jlso h`jl nf|ioylnf|ioyl

Homdfd{ly yso}lc nftionlg dg fdrl} "Homdfd{ly yso}lc nftionlg dg fdrl} "

yjlfls`f h|yiflyjlfls`f h|yifl


22/131


Nf|ioyl hls`mofdyh dy |gcl} salNf|ioyl hls`mofdyh dy |gcl} sal

iogs}of ob r`}do|y ao}hogly'iogs}of ob r`}do|y ao}hogly'

Hoys iohhog `}l (Hoys iohhog `}l (Dgy|fdgDgy|fdg

Nf|i`nogNf|i`nog

Ludglua}dglLudglua}dgl

Yoh`soys`sdgYoh`soys`sdg


23/131


U`gi}l`y; Dyfls obF`gnl}a`gy ! & & $

Iogs}ofy mfooc nf|ioylflrlfy mt yli}lsdgn

ao}hogly dgso sal mfooc0' (ilffy !=5(95, ob dyflsilffy$

( Nf|i`nog

0' (ilffy !25(>5, ob dyflsilffy$

( Dgy|fdg

0' (ilffy !=(1, ob dyflsilffy$

( Yoh`soys`sdg


24/131

Dgy|fdg

Bd}ys ao}hogldclgsdbdlc!04=5y$ mtM`gsdgn `gc

Mlys ]lfl`ylc ~alg

nf|ioyl dy`m|gc`gs!lflr`slcuf`yh` nf|ioyl$`gc ysdh|f`sly;


25/131

Ao~ dgy|fdg dyytgsalyd{lc?

Y

Y

Y

Y

AOOI

YY

GA=

U}lu}odgy|fdg


26/131


Y

Y

Y

Y

AOOI

YY

GA=

U}odgy|fdg


27/131


LY]00(51

Y

Y

Y

Y

AOOI

YY

GA=

Dgy|fdg

AOOI

GA=

(ia`dg

(ia`dg

I ( ulusdcl


28/131

]ofl ob I(Ulusdcl

Dgy|fdg dy cdbbdi|fs so hl`y|}l

A`fb(fdbl dy ogft < hdgy

]`udcft dg`isdr`slc mt r`}do|y lg{thly'

I(Ulusdcl a`y 95 hdgy a`fb fdbl

Ytgsalyd{lc dg lp|dhof`} iogi so sa`s obdgy|fdg

Clsl}hdgly `ho|gs ob dgy|fdg yli}lslcb}oh m(ilff


29/131

Ao~ dgy|fdg dy yli}lslc?

Dgy|fdg dy yli}lslc dg = ua`yly Dgy|fdg dy yli}lslc dg = ua`yly 0' Bd}ys ua`yl

Ya`}u ul`j

^dsadg 9(< hdgy ob nf|ioyl dgs`jl

Iohuflslc ~dsadg 05 hdgy

]lfl`yl ob h`s|}l n}`g|fly'

U}ohosly ul}dual}`f |sdfd{`sdog ob sal u}`gcd`fg|s}dlgs

fo`c'

Y|uu}lyyly alu`sdi nf|ioyl o|su|s'

Fdhdsy uoys u}`gcd`f nf|ioyl lflr`sdog


30/131

Ao~ dgy|fdg dy yli}lslc?

=' Yliogc ua`yl

]lfl`yl ob yli}lso}t

n}`g|fly sa`s `}lhomdfd{lc ~dsadg salmls` ilff bo} }lfl`yl'

N}`g|fly iogs`dg gl~ftytgsalyd{lc dgy|fdg'

Yliogc Ua`yl alfuy so`ss`dg go}honftilhd`'


31/131

Dgy|fdg sal ao}hogl ob uflgst

Dgi}l`yly nf|ioyl |us`jl mt h|yifl `gc `cduoylilffy

Alfuy dg dgi}l`ydgn ilffy so m}l`jco~g nf|ioyl&}lfl`ydgn dsy lgl}nt dg sal bo}h ob @SU

Sal fdrl} `gc h|yifl so yso}l nf|ioyl `y nftionlg!yao}s(sl}h lgl}nt }lyl}rl$

@cduoyl sdyy|l so yso}l nf|ioyl `y b`s !fogn(sl}hlgl}nt }lyl}rl$

Nftionlg ytgsalydy `gc u}osldg ytgsalydy

Dgy|fdg dy sal OGFT ao}hogl sa`s fo~l}y

id}i|f`sdgn nf|ioyl flrlf


32/131

Dgy|fdg; Y|hh`}tDgy|fdg; Y|hh`}t


33/131

^al}l dgy|fdg `bblisy?

Dgy|fdg

H|yiflyFdrl}

@cduoyl ilffy

Nf|ioyl

\us`jl

Nftioftydy

Nftionlglydy

Nftionlgoftydy

Nf|ioglonlglydy

Fduonlglydy

M}dgny uf`yh` nf|ioyl flrlf m`ij so go}h`f


34/131

Nf|i`nog @isdog og Ilffy;

Cohdg`sly dg B`ysdgn Ys`sl Hls`mofdyh

Yli}lslc b}oh `(ilffy ob u`gi}l`ylYli}lslc b}oh `(ilffy ob u`gi}l`yl

H`ko} s`}nls o}n`g; fdrl}H`ko} s`}nls o}n`g; fdrl}

Ysdh|f`sly u}oc|isdog ob nf|ioyl mt nftionlgoftydy `gcYsdh|f`sly u}oc|isdog ob nf|ioyl mt nftionlgoftydy `gcnf|ioglonlglydynf|ioglonlglydy

Nf|i`nog u}lrlgsy atuonftilhd` mtNf|i`nog u}lrlgsy atuonftilhd` mt ilff u}oc|isdog obilff u}oc|isdog obnf|ioylnf|ioyl

U}dgidu`f ao}hogl bo} u}oc|idgn ` }`udc dgi}l`yl dgU}dgidu`f ao}hogl bo} u}oc|idgn ` }`udc dgi}l`yl dguf`yh` nf|ioyl iogilgs}`sdoguf`yh` nf|ioyl iogilgs}`sdog

Yli}lsdog dy y|uu}lyylc dg atul}nftilhd`Yli}lsdog dy y|uu}lyylc dg atul}nftilhd`


35/131

Nf|i`nog @isdog og IlffyNf|i`nog @isdog og Ilffy

Lgcoi}dgl }lyuogyl so atuonftilhd`


36/131

Ludglua}dgl bdnas o} bfdnas

I`sliaof`hdgl yli}lslc mt sal `c}lg`fhlc|ff`

Yl}rly `y ` m`ij|u bo} nf|i`nog

Ysdh|f`sly nf|i`nog yli}lsdog `gc dgadmdsydgy|fdg yli}lsdog mt u`gi}l`y

Ysdh|f`sly nftionlg m}l`jco~g

!nftionlgoftydy$ `gc cli}l`yly nf|ioyl |ylUatydi`f/lhosdog`f ys}lyy ludglua}dgl

u}oc|isdog& }lfl`ydgn nf|ioyl bo} lgl}nt


37/131

Yoh`soys`sdg

Yli}lslc mt n(ilffy ob u`gi}l`y

U}dh`}t `is dy so dgadmds yli}lsdog obdgy|fdg `gc nf|i`nog

Yli}lslc mt }`gnl ob sdyy|ly !u`gi}l`y&

dgslysdgly& IGY$


38/131

H`dg A|h`g Nf|ioyl S}`gyuo}sl}y

S}`gyuo}sl} Sdyy|l Dgy|fdgclulgclgs?

NF\S0 ]MIy& m}`dg& jdcglt Go

NF\S= (ilffy ob u`gi}l`y&yh`ff dgslysdgl& jdcglt

Go

NF\S9 Gl|}ogy& uf`ilgs` Go

NF\S3 Yjlfls`f " i`}cd`ih|yifl& cduoyl

sdyy|l

TLY

NF\S< Yh`ff dgslysdgl&jdcglt& m}`dg& `cduoyl

sdyy|l

Go

NF\S> Yohl fdrl} ilffy Go


39/131

Dgy|fdg Yli}lsdogI`**

@SUylgydsdrl J*ia`gglfy

J*

Nf|ioyl @SU

Rofs`nlclulgclgs I`** ia`gglfyoulg

Dgy|fdg

NF\S(=

Adna

Nf|ioyl

I`**

Cluof`}d{`sdog

Mdgcy `gc

ifoyly

Yli}ls`}t

n}`g|fly


40/131

Yl}dlyoblg{}l`isdog

Dgy|fdg

Dgy|fdg]liluso}

NF\S 3


41/131

Hocl ob `isdog ob Dgy|fdg

Dgy|fdg]liluso}

Dgy|fdg

NF\S(3

Yl}dly ob}l`isdog

S}`gyfoi`sdogob NF\S(3

Nf|ioyllgsl}y

Nf|ioyl

Nftionlg Nftioftydy


42/131

Hocl ob `isdog ob dgy|fdg


43/131

nf|ioyl b}oh

nf|ioglonlglydy

!hoysft fìs`sl$

3 1 0= 02 = > 3=

Lqonlgo|y

!nf|ioyl

b}oh cdls$

35

95

=5

05

5

Nf|ioyl

\ylcn/a}

blc uoys`myo}usdrl nf|ioglonlgdi u}ofognlc

AO\]Y C@TY

nf|ioyl b}oh

fdrl} nftionlg

nf|ioyl b}ohnf|ioglonlglydy

!fìs`sl * `hdgo ìdcy$

Yo|}ily ob mfooc nf|ioyl dg sal r`}do|y g|s}dsdog`f ys`sly


44/131

Atul}nftilhd` soofdssfl dgy|fdg

Atuonftilhd` soo fdssfl

dgs`jl o} soo h|ia dgy|fdg

Atul}nftilhd` " Atuonftilhd`

^a s f?


45/131

^a`sy go}h`f?^a`sy go}h`f?


46/131

@isdog ob Dgy|fdg og FDUDC hls`mofdyh@isdog ob Dgy|fdg og FDUDC hls`mofdyh

S}dnftil}dcly

Gog lysl}dbdlc B`sst `idc !GLB@ o} BB@$

@ilstf Io@

Dgy|fdg

Jlsogl mocdly

Algil dgy|fdg (

Cli}l`yly fduoftydy

Dgi}l`yly fduonlglydy

Cli}l`yly jlso`idcoydy


47/131

Dgy|fdg og U}osldg hls`mofdyhDgy|fdg og U}osldg hls`mofdyh

@hdgo `idc@hdgo `idc

U}osldgU}osldg

Dgy|fdg

Dgi}l`yly u}osldg ytgsalydy

Cli}l`yly u}osloftydy

Dgy|fdg


48/131

Y|hh`}t ob dgy|fdg `isdogY|hh`}t ob dgy|fdg `isdog

Dgi}l`yly Dgi}l`yly Nf|ioyl |us`jlNf|ioyl |us`jl

NftioftydyNftioftydy

NftionlglydyNftionlglydy

FduonlglydyFduonlglydy

U}osldg ytgsalydyU}osldg ytgsalydy

Cli}l`ylyNf|ioglonlglydy

Nftionlgoftydy

Fduoftydy

Jlsonlglydy

U}osloftydy


49/131

Cd`mlsly Hlffds|yCd`mlsly Hlffds|y

Cdyl`yl& U`saonlglydyCdyl`yl& U`saonlglydy

" H`g`nlhlgs" H`g`nlhlgs


50/131

Clbdgdsdog

@ n}o|u ob hls`mofdi cdyo}cl}y@ n}o|u ob hls`mofdi cdyo}cl}y

iohu}dydgn ob `mgo}h`f i`}moatc}`sl&iohu}dydgn ob `mgo}h`f i`}moatc}`sl&

b`s `gc u}osldg hls`mofdyh `gcb`s `gc u}osldg hls`mofdyh `gc

ia`}ìsl}d{lc mt ia}ogdi o} ul}ydyslgilia`}ìsl}d{lc mt ia}ogdi o} ul}ydyslgilatul}nftilhdàtul}nftilhd`

C|l so fìj ob dgy|fdg ao}hoglfìj ob dgy|fdg ao}hoglO]O]

Dhu}oul} dgy|fdg yli}lsdogDhu}oul} dgy|fdg yli}lsdog


51/131

]dyj B`iso}y bo} Cd`mlsly]dyj B`iso}y bo} Cd`mlsly

B`hdft adyso}t ob cd`mlsly

Omlydst !7 =5, orl} clyd}lc moct ~ldnas o} MHD 7 => jn/h=

@nl 7 3< tl`}y

Ylclgs`}t fdbl ystfl

Yohl lsagdi n}o|uy ! Dgcd`gy& @b}di`g(@hl}di`gy `gc g`sdrl@hl}di`gy& `yd`g `hl}di`gy$

Nlys`sdog`f cd`mlsly o} clfdrl}dgn ` m`mt ~ldnadgn ho}l sa`g 4uo|gcy !3jn o} ho}l$

Adna mfooc u}lyy|}l ! 7 035/45hhAn$

Adna mfooc flrlfy ob s}dnftil}dcly !7 =


52/131

Ythusohy ob cd`mlslyYthusohy ob cd`mlsly

B}lp|lgs |}dg`sdog ( Uoft|}d`

Lqilyydrl sad}ys ( Uoftctuyd`

Lqilyydrl a|gnl} ( Uoftua`nd`

B`sdn|l^ldnas foyy

Mf|}}lc rdydog'

Ythusohy ho}l u}ohdglgs dg Stul(0Ythusohy ho}l u}ohdglgs dg Stul(0

CHCH


53/131

Stuly ob Cd`mlsly Hlffds|yStuly ob Cd`mlsly Hlffds|y

Hoys iohhog stuly `}l

Stul(0 Cd`mlsly hlffds|y

Stul(= Cd`mlsly hlffds|y

Nlys`sdog`f cd`mlsly'


54/131

Stul(0 Cd`mlsly hlffds|yStul(0 Cd`mlsly hlffds|y

C|l so sos`f clys}|isdog ob m(ilffy ob sal u`gi}l`y'

@|sodhh|gl clys}|isdog ob dyflsyclys}|isdog ob dyflsy

Hoys u}ohdglgs c|}dgn iadfcaooc

Sal}`ut dgrofrly Dgy|fdg dgklisdog


55/131

Stul(= Cd`mlsly hlffds|yStul(= Cd`mlsly hlffds|y

Hoys iohhog stul ob cd`mlsly !745,$

]lf`slc so nlglsdi clblis `gc fdbl ystfl

`gc booc a`mdsy' Iogydysy ob = iohhog clblisy

0' Dgy|fdg }lydys`gil

=' M(ilff dhu`d}hlgs o} Dhu`d}lc dgy|fdgyli}lsdog'


56/131

Dgy|fdg}lydys`gil

@mgo}h`f

(ilffb|gisdog

Stul = cd`mlsly

Nlgly " / o} Fdbl ystfl `gc

cdls


57/131

Dgy|fdg }lydys`gil

Cli}l`ylc `mdfdst ob go}h`f dgy|fdg soCli}l`ylc `mdfdst ob go}h`f dgy|fdg so

`is lbblisdrlft og ul}dual}`f sdyy|ly`is lbblisdrlft og ul}dual}`f sdyy|ly

!h|yifl " `cduoyl sdyy|ly$ `gc fdrl}'!h|yifl " `cduoyl sdyy|ly$ `gc fdrl}'

m(ilff a`y so yli}lsl ho}l dgy|fdg som(ilff a`y so yli}lsl ho}l dgy|fdg so

h`dgs`dg go}h`f nf|ioyl flrlf'h`dgs`dg go}h`f nf|ioyl flrlf'


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I`|yl ob Dgy|fdg }lydys`gilI`|yl ob Dgy|fdg }lydys`gil

Ilgs}`f o} rdyil}`f omlydst dy sal h`ko} i`|ylIlgs}`f o} rdyil}`f omlydst dy sal h`ko} i`|yl

@cduoitsly yli}lsly adna iogi ob BB@'@cduoitsly yli}lsly adna iogi ob BB@'

BB@ lgsl}y h|yifl ilffy `gc dgsl}bl}ly ~dsa dgy|fdgBB@ lgsl}y h|yifl ilffy `gc dgsl}bl}ly ~dsa dgy|fdg

ydng`fdgn ytyslhydng`fdgn ytyslhSal}lmt flyy NF\S 3 s}`gyfoi`sdogSal}lmt flyy NF\S 3 s}`gyfoi`sdog

Flyy nf|ioyl |us`jlFlyy nf|ioyl |us`jl

BB@ a`y mllg bo|gc so ml ogl ob salh`ko} i|fu}ds


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I`|yl ob Dgy|fdg }lydys`gilI`|yl ob Dgy|fdg }lydys`gil

@cduoitsly `fyo yli}lsly r`}do|ymdoialhdi`fy fdjl }lydysdg& flusdg& SAB( "`cduoglisdg

Fo~ `cduoglisdg flrlf o} adna iogi ob

}lydysdg& flusdg& SAB( a`y mllg `yyoid`slc~dsa dgy|fdg }lydys`gil


60/131

Atul}dgy|fdglhdÀtul}dgy|fdglhd`

Ul}yogy ~dsa D]& }lp|d}ly adnal} dgy|fdg flrlf soUl}yogy ~dsa D]& }lp|d}ly adnal} dgy|fdg flrlf so

m}dgn nf|ioyl mìj so go}h`f'm}dgn nf|ioyl mìj so go}h`f'

M(ilffy yli}lsly `ccdsdog`f dgy|fdg so iohulgy`sl'M(ilffy yli}lsly `ccdsdog`f dgy|fdg so iohulgy`sl'

U|sy `ccdsdog`f ys}lyy og m(ilffyU|sy `ccdsdog`f ys}lyy og m(ilffy

Ul}yog h`t ml go}h`f o} cd`mlsdiUl}yog h`t ml go}h`f o} cd`mlsdi

]dyj bìso} bo} r`}do|y i`}cdor`yi|f`} cdyl`yl]dyj bìso} bo} r`}do|y i`}cdor`yi|f`} cdyl`yl


61/131

Atul}dgy|fdglhd`Atul}dgy|fdglhd`

Al`fsat

Dgy|fdg }lydys`gil

Dgy|fdgy

li

}ls d

og

! uh

of /

hdg

$

055

=55

955

355

55

155

Sdhl

2 'h' 05 'h' = u'h' 2 u'h' 2 'h'05 u'h' = 'h'


62/131

M(ilff dhu`d}hlgs

Iogcdsdog ~al}l sal mls` ilffy `}l |g`mfl so u}oc|ily|bbdidlgs dgy|fdg `y ul} }dyl dg mfooc nf|ioyl flrlf c|l so

mosa }lc|ilc (ilff h`yy `gc b|gisdog`f `mgo}h`fdsdly ob

sal (ilff'

]lc|ilc (ilffy ~o}jy a`}c so iohulgy`sl bo} sal

ytgsalydy ob `clp|`sl dgy|fdg'

Fl`cy so (ilff b`sdn|l'

Clrlfouhlgs ob u}on}lyydrl }dyl dg nf|ioyl flrlf Fl`cdgn so clrlfouhlgs ob b}`gj cd`mlsly stul(=


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G`s|}`f Adyso}t ob Stul =


64/131

t tuCd`mlsly

Tl`}y ob cd`mlsly

]lf`sdrl (ilffb|gisdog

055 !,$

(=5 (05 5 05 =5 95

Uf`yh`

nf|ioyl

Dgy|fdg }lydys`gil

Dgy|fdg flrlf

0=5 !hn/cF$

@c`uslc b}oh Dgsl}g`sdog`f Cd`mlsly Ilgsl}& Hdggl`uofdy& Hdgglyos`'

B`ysdgn nf|ioyl

Uoyshl`f

nf|ioyl

Omlydst DNS+ Cd`mlsly \giogs}offlc

Atul}nftilhd`

U}on}lyydrl }lc|isdog dg mls` ilff h`yy

]ly|fs ob D] " m ilff


65/131

]ly|fs ob D] " m(ilffdhu`d}hlgs

Atul}nftilhd`

0'0' Cli}l`yl nf|ioyl |us`jl dg yso}`nl ilffyCli}l`yl nf|ioyl |us`jl dg yso}`nl ilffy

='=' Dgi}l`ylc nf|ioyl u}oc|isdog b}oh fdrl}Dgi}l`ylc nf|ioyl u}oc|isdog b}oh fdrl}


66/131

Stuly ob Cd`mlsly Stul(=

OmlylRl}t adna cln}ll ob dgy|fdg }lydys`gil

iohu`}lc so m(ilff dhu`d}hlgsGog(omlyl

Rl}t adna cln}ll ob m(ilff dhu`d}hlgsiohu`}lc so dgy|fdg }lydys`gil

Cd`ngoydy ob Stul(=


67/131

Cd`ngoydy ob Stul(=Cd`mlsly

BUN !B`ysdgn uf`yh` nf|ioyl slys$BUN !B`ysdgn uf`yh` nf|ioyl slys$

I`slno}tI`slno}t BMY !hn/cfBMY !hn/cf$$

Go}h`fGo}h`f 6 0556 055

Dhu`d}lc !DBN$Dhu`d}lc !DBN$ 055 ( 0=


68/131

Cd`ngoydy ob Stul(=Cd`mlsly

ONSS !O}`f nf|ioyl sofl}`gil slys$ONSS !O}`f nf|ioyl sofl}`gil slys$

I`slno}tI`slno}t UUN !hn/cfUUN !hn/cf$$

Go}h`fGo}h`f 6 0356 035

!DNS$ O] U}lcd`mlsdi!DNS$ O] U}lcd`mlsdi 035 ( 044035 ( 044

Cd`mlslyCd`mlsly =55=55DNS 8 Dhu`d}lc nf|ioyl sofl}`gil

Nftioytf`slc AlhonfomdgNftioytf`slc Alhonfomdg


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Nftioytf`slc AlhonfomdgNftioytf`slc Alhonfomdg

slysslys !Am@0i$!Am@0i$

Nf|ioyl bo}hy d}}lrl}ydmflNf|ioyl bo}hy d}}lrl}ydmfliohuflq ~dsa u}osldgyiohuflq ~dsa u}osldgy

Go}h`f r`f|l 3 ( 2,Go}h`f r`f|l 3 ( 2,

\ylc so hogdso} c|}dgn\ylc so hogdso} c|}dgns}l`shlgss}l`shlgs

Ndrly ` nooc dgcdi`sdog obNdrly ` nooc dgcdi`sdog obmfooc nf|ioyl c|}dgn salmfooc nf|ioyl c|}dgn salu}lrdo|y 9 ( 3 hogsay'u}lrdo|y 9 ( 3 hogsay'

S`}nls flrlf ob flyy sa`g S`}nls flrlf ob flyy sa`g>'5 , dgcdi`sly nooc>'5 , dgcdi`sly noociogs}ofiogs}of


70/131

Iohufdi`sdogy obIohufdi`sdogy ob

Stul(= Cd`mlslyStul(= Cd`mlsly

hlffds|yhlffds|y


71/131

Iohufdi`sdogy

@i|sl iohufdi`sdogy

Cd`mlsly Jlso`idcoydy !CJ@$

Gog(jlsosdi atul}oyhof`} ys`sl !GJAY$

Ia}ogdi iohufdi`sdogy

R`yi|f`}

Gog(r`yi|f`}

Cd`mlsdi Jlso`idcoydy


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Cd`mlsdi Jlsoìdcoydy!CJ@$

Dg`clp|`sl dgy|fdg

Lqilyy fduoftydy fl`cdgn so dgi}l`ylc BB@

Dgi}l`yly jlsogl mocdly fl`cdgn so jlsoìdcoydy

Ioh` o} cl`sa

Fdbl sa}l`slgdgn iohufdi`sdog dg Stul(0 CH o}u`sdlgsy ~dsa fìj ob dgy|fdg

Cd`mlsdi Jlsoìdcoydy


73/131

Cd`mlsdi Jlso`idcoydy!CJ@$

Ythusohy `}l Ythusohy `}l G`|yl` `gc rohdsdgn'

Sad}ys / uoft|}d`'

@mcohdg`f u`dg'

@fsl}lc hlgs`f b|gisdog'

Yao}sglyy ob m}l`sa'

S}l`shlgs Dgy|fdgdgklisdog

Gog(Jlsosdi Atul}oyhof`}


74/131

Gog(Jlsosdi Atul}oyhof`}Ys`sl !GJAY$

}luo}slc dg `ff `nl n}o|uy& m|s ds hoys b}lp|lgsft`bblisy ofcl} u`sdlgsy ~dsa stul = cd`mlsly

dgdsd`sdgn lrlgs dg atul}oyhof`} atul}nftilhdi ys`sl dydgdsd`sdgn lrlgs dg atul}oyhof`} atul}nftilhdi ys`sl dy

nf|ioy|}di cd|}lydynf|ioy|}di cd|}lydy Cli}l`ylc dgs}`r`yi|f`} rof|hl o} |gcl}ftdgn }lg`f

cdyl`yl cli}l`yly sal nfohl}|f`} bdfs}`sdog }`sl&i`|ydgn sal nf|ioyl flrlf so dgi}l`yl'

Sal foyy ob ho}l ~`sl} sa`g yocd|h fl`cy soatul}oyhof`}dst

Gog(Jlsosdi Atul}oyhof`}


75/131

Gog(Jlsosdi Atul}oyhof`}Ys`sl !GJAY$

S}l`shlgs0' Rdno}o|y dgs}`rlgo|y }latc}`sdog&=' Lflis}oftsl }luf`ilhlgs9' @chdgdys}`sdog ob dgs}`rlgo|y dgy|fdg&

Ythusohy `}l Uoft|}d`' O}saoys`sdi atuoslgydog'

Gl|}ofondi`f ythusohy fdjl ( `fsl}lc hlgs`f ys`s|y&

flsa`}nt& yld{|}l `gc uoyydmft ioh`'


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Ia}ogdi Iohufdi`sdogy

R`yi|f`}Hdi}or`yi|f`}

]lsdgou`sat

Gl|}ou`sat

Glua}ou`sat

H`}ior`yi|f`}I`}cdor`yi|f`} cdyl`yl

Il}lm}or`yi|f`} cdyl`yl

Ul}dual}`f r`yi|f`} cdyl`yl


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F`tl}y ob mfooc rlyylfyF`tl}y ob mfooc rlyylfy


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Atul}nftilhd` c`h`nly ogft ` u`}sdi|f`} y|myls obAtul}nftilhd` c`h`nly ogft ` u`}sdi|f`} y|myls obilff stuly;ilff stuly;

iùdff`}t lgcosalfd`f ilffy dg sal }lsdg`&iùdff`}t lgcosalfd`f ilffy dg sal }lsdg`&hly`gnd`f ilffy dg sal }lg`f nfohl}|f|y&hly`gnd`f ilffy dg sal }lg`f nfohl}|f|y&

`gc gl|}ogy `gc Yia~`gg ilffy dg ul}dual}`f`gc gl|}ogy `gc Yia~`gg ilffy dg ul}dual}`fgl}rly'gl}rly'

â`s dy cdysdgis `mo|s salyl ilffy sa`s h`jly salhâ`s dy cdysdgis `mo|s salyl ilffy sa`s h`jly salhyo r|fgl}`mfl so atul}nftilhd`?yo r|fgl}`mfl so atul}nftilhd`?

Yo ~at coly c`h`nl oii|} ogft dg sal bl~ ilffYo ~at coly c`h`nl oii|} ogft dg sal bl~ ilffstuly dgrofrlc dg cd`mlsdi iohufdi`sdogy? Salstuly dgrofrlc dg cd`mlsdi iohufdi`sdogy? Sal

`gy~l} dy sa`s`gy~l} dy sa`s


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Hoys ilffy `}l `mfl so }lc|il salHoys ilffy `}l `mfl so }lc|il sal

s}`gyuo}s ob nf|ioyl dgydcl sal ilffs}`gyuo}s ob nf|ioyl dgydcl sal ilff

~alg salt `}l lquoylc so~alg salt `}l lquoylc soatul}nftilhd`& yo sa`s sald} dgsl}g`fatul}nftilhd`& yo sa`s sald} dgsl}g`f

nf|ioyl iogilgs}`sdog ys`ty iogys`gs'nf|ioyl iogilgs}`sdog ys`ty iogys`gs'

Dg iogs}`ys& sal ilffy c`h`nlc mtDg iogs}`ys& sal ilffy c`h`nlc mt

atul}nftilhd` `}l saoyl sa`s i`ggosatul}nftilhd` `}l saoyl sa`s i`ggos

co sady lbbdidlgsft'co sady lbbdidlgsft'

a cd m f d f c ff fdj


80/131

Sa|y& cd`mlsly ylflisdrlft c`h`nly ilffy& fdjlSa|y& cd`mlsly ylflisdrlft c`h`nly ilffy& fdjl

lgcosalfd`f ilffy `gc hly`gnd`f ilffy& ~aoyllgcosalfd`f ilffy `gc hly`gnd`f ilffy& ~aoyl

nf|ioyl s}`gyuo}s }`sl coly gos clifdglnf|ioyl s}`gyuo}s }`sl coly gos clifdgl}`udcft `y ` }ly|fs ob atul}nftilhd`& fl`cdgn}`udcft `y ` }ly|fs ob atul}nftilhd`& fl`cdgn

so adna nf|ioyl dgydcl sal ilff'so adna nf|ioyl dgydcl sal ilff'

Sady dy dhuo}s`gs& mli`|yl ds slffy |y sa`s salSady dy dhuo}s`gs& mli`|yl ds slffy |y sa`s sal

lquf`g`sdog bo} ~a`s i`|yly iohufdi`sdogylquf`g`sdog bo} ~a`s i`|yly iohufdi`sdogy

h|ys dgrofrl hlia`gdyhy nodgn og dgydclh|ys dgrofrl hlia`gdyhy nodgn og dgydcl

salyl ilffy& }`sal} sa`g o|sydcl'salyl ilffy& }`sal} sa`g o|sydcl'

D s s 3 sa ad a fd sdD s s 3 sa ad a fd sd


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Dhuo}s`gs 3 u`sa~`ty ~adia i`|yl iohufdi`sdogyDhuo}s`gs 3 u`sa~`ty ~adia i`|yl iohufdi`sdogy`}l;`}l;

Dgi}l`ylc Bf|q Sa}o|na sal Uoftof U`sa~`tDgi}l`ylc Bf|q Sa}o|na sal Uoftof U`sa~`t

@NL u`sa~`t@NL u`sa~`t

UJI u`sa~`tUJI u`sa~`t

Alqoy`hdgl u`sa~`tAlqoy`hdgl u`sa~`t


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83/131


84/131


85/131

U@D(0


86/131

Hdi}or`yi|f`}


87/131

Hdi}or`yi|f`}Iohufdi`sdogy

]lsdgou`sat Fl`cdgn i`|yl ob

mfdgcglyy Ys`}sy ~dsa ` yh`ff `}l`y

ob m`ffoog(fdjl y~lffdgndg sal }lsdg`.y sdgt mfoocrlyylfy'

@y sal cdyl`ylu}on}lyyly& mfoocrlyylfy sa`s go|}dya sal}lsdg` `}l mfoijlc'

Alho}}a`nly dg gog(u}ofdbl}`sdrl cd`mlsdi}lsdgou`sat

Gl~ mfooc rlyylf n}o~sa `}o|gc ousdi gl}rl dgu}ofdbl}`sdrl cd`mlsdi }lsdgou`sat

Hdi}or`yi|f`}
http://www.neec.com/Physician_Home.htmlhttp://www.neec.com/Physician_Home.html


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Hdi}or`yi|f`}Iohufdi`sdogy

@s sady `cr`gilc ys`nl&sal ydng`fy ylgs mt sal}lsdg` bo} go|}dyahlgss}dnnl} sal n}o~sa ob gl~mfooc rlyylfy'

Salyl gl~ mfooc rlyylfy`}l `mgo}h`f `gc b}`ndfl'

Db salt fl`j mfooc& ylrl}lrdydog foyy `gc lrlgfoyy `gc lrlgmfdgcglyy i`g }ly|fs'mfdgcglyy i`g }ly|fs'

Alho}}a`nl b}oh gl~ mfooc rlyylf n}o~sa dg u}ofdbl}`sdrlcd`mlsdi }lsdgou`sat

]lsdgou`sat

Hdi}or`yi|f`}
http://www.neec.com/Physician_Home.html


89/131

i o `yi| `Iohufdi`sdogy

Gl|}ou`sat C`h`nl so sal gl}rly sa`s alfuy so bllf ylgy`sdogy y|ia `yC`h`nl so sal gl}rly sa`s alfuy so bllf ylgy`sdogy y|ia `y

u`dgu`dgS~o stulyS~o stuly

0' Ul}dual}`f Gl|}ou`sat Gl}rl c`h`nl dg sal blls i`g }ly|fs dg ` foyy ob boos

ylgy`sdog& dgi}l`ydgn }dyj ob boos u}omflhy' Ythusohydgif|cl Sdgnfdgn

G|hmglyy !ylrl}l o} fogn(sl}h g|hmglyy i`g mliohlul}h`glgs$

M|}gdgn

Hdi}or`yi|f`}


90/131

Iohufdi`sdogy

Gl|}ou`sat=' @|sogohdi Gl|}ou`sat=' @|sogohdi Gl|}ou`sat

@|sogohdi gl|}ou`sat hoys obslg `bblisy sal cdnlysdrl ytyslh&@|sogohdi gl|}ou`sat hoys obslg `bblisy sal cdnlysdrl ytyslh&

lyulid`fft sal ysohìa& mfooc rlyylfy& |}dg`}t ytyslh& `gc ylqlyulid`fft sal ysohìa& mfooc rlyylfy& |}dg`}t ytyslh& `gc ylqo}n`gy' Ythusohy i`g ml o}n`gy' Ythusohy i`g ml

Mfo`sdgn& Cd`}}al`& Iogysdu`sdog& Al`}sm|}g& G`|yl`& Rohdsdgn&Mfo`sdgn& Cd`}}al`& Iogysdu`sdog& Al`}sm|}g& G`|yl`& Rohdsdgn&Bllfdgn b|ff `bsl} yh`ff hl`fyBllfdgn b|ff `bsl} yh`ff hl`fy

Mfìjdgn o|s ~alg to| ys`gc |u p|dijft & Dgi}l`ylc al`}s }`sl&Mfìjdgn o|s ~alg to| ys`gc |u p|dijft & Dgi}l`ylc al`}s }`sl&Cd{{dglyy& Fo~ mfooc u}lyy|}lCd{{dglyy& Fo~ mfooc u}lyy|}l

Ylq|`f ctyb|gisdog !h`fly " blh`fly$Ylq|`f ctyb|gisdog !h`fly " blh`fly$ \g`mfl so iohuflslft lhust mf`ccl}& Mfo`sdgn& Dgiogsdglgil\g`mfl so iohuflslft lhust mf`ccl}& Mfo`sdgn& Dgiogsdglgil

!fl`jdgn |}dgl$& Dgi}l`ylc |}dg`sdog `s gdnas!fl`jdgn |}dgl$& Dgi}l`ylc |}dg`sdog `s gdnas

Hdi}or`yi|f`}


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Iohufdi`sdogy

Cd`mlsdi Glua}ou`satHoys iohhog i`|yl ob

jdcglt b`df|}l'Bdrl ys`nly dg sal u}on}lyydog so

jdcglt b`df|}l dg uloufl ~dsacd`mlsly

Ys`nl 0!rl}t l`}ft cd`mlsly$ Dgi}l`ylc clh`gc |uog

sal jdcglty dy dgcdi`slc mt `g `morl(go}h`f nfohl}|f`}bdfs}`sdog

Ys`nl =!clrlfoudgn cd`mlsly$ Sal NB] }lh`dgylflr`slc o} a`y }ls|}glc so go}h`f: clrlfouhlgs obhdi}o`fm|hdg|}d`

Hdi}or`yi|f`}


92/131

Iohufdi`sdogyCd`mlsdi Glua}ou`sat

Ys`nl 9 !orl}s& o} cduysdij(uoydsdrl cd`mlsly o}hì}o`fm|hdg|}d`$:Atul}slgydog h`t clrlfou

Ys`nl 3!f`sl(ys`nl cd`mlsly$'-`cr`gilc ifdgdi`f glua}ou`sat'-NB] 6 >< hdffdfdsl}y ul} hdg|sl'@fhoys `ff u`sdlgsy a`rlatul}slgydog `s ys`nl 3'Ys`nl < !lgc(ys`nl }lg`f cdyl`yl& LY]C$ ( NB] 605

hF/hdg$ `gc }lg`f}lufìlhlgs sal}ùt !d'l'& alhocd`ftydy& ul}dsogl`f cd`ftydy&

jdcglt s}`gyuf`gs`sdog$dy gllclc

Hì}or`yi|f`}


93/131

Iohufdi`sdogy

I`}cdor`yi|f`}iohufdi`sdogy

Ho}l sa`g 25, ob CH u`sdlgsy cdly c|l so

I@C Hoys iohhog IRC dgif|cly

Atul}slgydog

I@C

Al`}s B`df|}l

H`i}or`yi|f`}


94/131

Iohufdi`sdogy


Atul}slgydog

I`slno}t YMU CMUGo}h`f 6 0=5`gc 6 15

U}l atul}slgydog 0=5( 094 `gc / o}15(14

Atul}slgydogYs`nl 0 035 ( 0


95/131

Iohufdi`sdogy


Atul}slgydog

p Ifoylft `yyoid`slc ~dsa Atul}dgy|fdglhd`

p Adna dgy|fdg h`t i`|yl G`* " A=O }lslgsdog

p Cd`mlsly u`sdlgsy a`y adnal} }dyj ob clrlfoudgn

atul}slgydog sa`g go}h`f ul}yogy'

H`i}or`yi|f`}


96/131

Iohufdi`sdogy


H`g`nlhlgsp Sal}ùl|sdi fdblystfl h`g`nlhlgs

p Ua`}hìofondi`f sal}ùt

pHoys u}lbl}}lc iaodily `}l @ILD `gc @]My

p Osal}y Cd|}lsdiy& I`fid|h ia`gglf

mfoijl}y& m(mfoijl}y lsi

Hì}or`yi|f`}


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Iohufdi`sdogy


I@C !Io}og`}t @}sl}tCdyl`yl

âlg sal}l dy `g Dhm`f`gil mls~llgâlg sal}l dy `g Dhm`f`gil mls~llg

Clh`gc ob Mfooc!Oqtnlg$

Y|uuft ob Mfooc!Oqtnlg$

Hì}or`yi|f`}


98/131

Iohufdi`sdogy

I`|yly ob Omys}|isdog

@sal}oh` !@sal}oyifl}oydy$@sal}oh` !@sal}oyifl}oydy$

Sa}ohmoydySa}ohmoydy

LhmofdyhLhmofdyh

Yu`yhYu`yh



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H`i}or`yi|f`} Iohufdi`sdogy


100/131

H`i}or`yi|f`} Iohufdi`sdogy

Ythusohy

@gndg` Uliso}dy

Ys`mfl

\gys`mfl

R`}d`gs o} U}dg{hls`fy

@i|sl Htoi`}cd`f Dgb`}isdog



101/131

H`i}or`yi|f`}


102/131

Iohufdi`sdogy

Al`}s `ssìj Cl`sa ob h|yifl sdyy|lCl`sa ob h|yifl sdyy|lc|l so fìj ob oqtnlgc|l so fìj ob oqtnlg


Hì}or`yi|f`}


103/131

Fdbl Ystfl Hocdbdi`sdogyFdbl Ystfl Hocdbdi`sdogy

C}|n Sal}ùtC}|n Sal}ùt

Y|}nl}t (Y|}nl}t (Mtu`yy `gc @gndof`yst


H`g`nlhlgs

Hì}or`yi|f`}Iohufdi`sdogy

Hì}or`yi|f`}


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Sal}`ut

OO== y|uufty|uuft OO== clh`gcclh`gc

C}|nyC}|ny

Gds}`slyGds}`sly

Mls` mfoijl}yMls` mfoijl}y

I`fid|h ia`gglf mfoijl}yI`fid|h ia`gglf mfoijl}y

Uos`yyd|h ia`gglf oulgl}yUos`yyd|h ia`gglf oulgl}y

Hls`mofdi hocdbdl}Hls`mofdi hocdbdl}

H`i}or`yi|f`}


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Y|}ndi`f U}oilc|}ly

Mtu`yy y|}nl}t

M`ffoog `gndouf`yst

H`i}or`yi|f`}


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Al`}s B`df|}lDg`mdfdst ob sal al`}s so u|hu y|bbdidlgs mfooc so hlls sal

mocty hls`mofdi }lp|d}lhlgs

H`ko} i`|yl ( I@C

If`yy D ; Al`}s cdyl`yl ~dsa go fdhds`sdogy dg uatydi`f ìsdrdst

If`yy DD ; Al`}s cdyl`yl ~dsa yfdnas fdhds`sdogy dg uatydi`f ìsdrdst' Iohbo}s`mfl`s }lys

If`yy DDD ; Al`}s cdyl`yl ~dsa h`}jlc fdhds`sdogy dg uatydi`f ìsdrdst' H`tu}lylgs `s }lys

If`yy DR ; Al`}s cdyl`yl ~dsa cdyiohbo}s `s `gt ìsdrdst

Hì}or`yi|f`}


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Iohufdi`sdogy

Il}lm}or`yi|f`}iohufdi`sdogy

Ys}ojl

Mfooc y|uuft dy dgsl}}|uslc&

}ly|fsdgn dg sdyy|l cl`sa `gc foyy obm}`dg b|gisdog

S}`gydlgs Dyialhdi

@ss`ij !SD@$@ m}`dg cdyo}cl} i`|ylc mtslhuo}`}t

cdys|}m`gil ob mfooc y|uuft so `g`}l` ob sal m}`dg& }ly|fsdgn dg `

y|cclg& m}dlb cli}l`yl dg m}`dg

H`i}or`yi|f`}


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Iohufdi`sdogy

Ul}dual}`f r`yi|f`} cdyl`yl

Mfoijdgn ob `g `}sl}t dg

sal ul}dual}`f }lndog ob salmoct

H`ko} i`|yl (

`sal}oyifl}oydy

Gog R`yi|f`}


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Iohufdi`sdogy

N`f|ioh`& I`s`}`is

Cd`mlsdi boos |fil}

N`ys}ou`}lydy

Ylq|`f ctyb|gisdog

Yjdg ia`gnly


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Mdoialhdi`f hlia`gdyh

ob sal clrlfouhlgs obcd`mlsdi iohufdi`sdogy

Atuosalydy 0Atuosalydy 0


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@isdr`sdog ob u}osldg jdg`yl I

Dgi}l`yl nf|ioyl flrlf

Dgi}l`yl bo}h`sdog ob cd`itfnftil}of

@isdr`sly lg{thl U}osldg Jdg`yl I

Dgi}l`yly ilff u}ofdbl}`sdog `gc ul}hl`mdfst

C`h`nl so ilffy

Atuosalydy =Atuosalydy =
http://www.essex.ac.uk/bs/staff/thornalley/homepage/research_interests/diabetic_complications/protein_kinase_chttp://www.essex.ac.uk/bs/staff/thornalley/homepage/research_interests/diabetic_complications/protein_kinase_c


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Nfti`sdog

Dgi}l`ylc nf|ioyl flrlf

Bo}hy iohuflqly ~dsa ilff|f`} u}osldgy i`fflc

@NL @cr`gilc nfti`slc lgc u}oc|isy$

I`|yly ilff|f`} ctyb|gisdog



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Oqdc`sdrl ys}lyyAdna nf|ioyl

Dgi}l`yly bo}h`sdog ob }l`isdrl dgsl}hlcd`sly oboqtnlg }lc|isdog ( O

=

(& A=O

=`gc OA(

H`t i`|yl oqdc`sdrl c`h`nl so u}osldgy& fdudcy

`gc g|iflosdcly fl`cdgn so ilff c`h`nl'



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Uoftof U`sa~`t

Atul}nftilhd`

Iogrl}ydog ob Nf|ioyl so Yo}mdsof mt `fcof`yl}lc|is`yl

I`|yly oyhosdi ia`gnly dg ilffy

Ilff|f`} c`h`nl


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H`g`nlhlgs obH`g`nlhlgs ob

Cd`mlsly Stul(=Cd`mlsly Stul(=

No`fy


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No`fy

Dhhlcd`sl No`fyDhhlcd`sl No`fy;so ys`mdfd{l sal mfoocy|n`}

Fogn(sl}h no`fy;Fogn(sl}h no`fy;So u}ofogn fdbl&So u}ofogn fdbl&

]lfdlrl ythusohy& `gc]lfdlrl ythusohy& `gc

U}lrlgs fogn(sl}h iohufdi`sdogyU}lrlgs fogn(sl}h iohufdi`sdogy

S}l`shlgs Hoc`fdsdly


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S}l`shlgs Hoc`fdsdly

Fdbl ystfl hocdbdi`sdogyFdbl ystfl hocdbdi`sdogy

Cdls `gc Lql}idylCdls `gc Lql}idyl

Ua`}hìofondi`f sal}ùt'Ua`}hìofondi`f sal}ùt'

Dhuo}s`gil ob ìadlrdgnsd as f d s f


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sdnas nftilhdi iogs}of

R`}do|y f`gch`}j ys|cdly a`rl iogbd}hlc sa`s mtcli}l`ydgn nf|ioyl flrlf sal}l dy ` ydngdbdi`gs}lc|isdog dg }dyj ob hdi}or`yi|f`} `gch`i}or`yi|f`} iohufdi`sdogy'

\JUCY !\gdslc Jdgncoh U}oyulisdrl Cd`mlslyYs|ct$

CIIS !Cd`mlsly Iogs}of `gc Iohufdi`sdog S}d`f$

Sal J|h`hoso Ys|ct

CUU

\JUCY


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\JUCY

Omklisdrl;dhu}orlc nf|ioyl iogs}of ob Stuldhu}orlc nf|ioyl iogs}of ob Stul= cd`mlsly ~dff u}lrlgs ifdgdi`f iohufdi`sdogy= cd`mlsly ~dff u}lrlgs ifdgdi`f iohufdi`sdogy

Clydng;U}oyulisdrl omyl}r`sdog`f ys|ct dg =9aoyuds`f m`ylc ifdgdiy dg Lgnf`gc& Yiosf`gc& `gcGo}sal}g D}lf`gc' 923= u`sdlgsy ~l}l dgif|clc dg`g`ftyly ob }lf`sdrl }dyj' Sos`f c|}`sdog ~`y

`uu}oqdh`slft 05 tl`}y'

\JUCY


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\JUCY

]ly|fsy;]ly|fsy;L`ia 0, }lc|isdog dg hl`g Am@0i ~`yL`ia 0, }lc|isdog dg hl`g Am@0i ~`y`yyoid`slc ~dsa }lc|isdogy dg }dyj ob (`yyoid`slc ~dsa }lc|isdogy dg }dyj ob (

=0, bo} `gt lgc uodgs }lf`slc so cd`mlsly&=0, bo} `gt lgc uodgs }lf`slc so cd`mlsly&

=0, bo} cl`say }lf`slc so cd`mlsly&=0, bo} cl`say }lf`slc so cd`mlsly& 03, bo} htoi`}cd`f dgb`}isdog& `gc03, bo} htoi`}cd`f dgb`}isdog& `gc

9>, bo} hdi}or`yi|f`} iohufdi`sdogy9>, bo} hdi}or`yi|f`} iohufdi`sdogy

Iogif|ydogy;Iogif|ydogy;@gt }lc|isdog dg Am@0i dy fdjlft so@gt }lc|isdog dg Am@0i dy fdjlft so}lc|il sal }dyj ob iohufdi`sdogy& ~dsa sal fo~lys}lc|il sal }dyj ob iohufdi`sdogy& ~dsa sal fo~lys}dyj mldgn dg saoyl ~dsa Am@0i r`f|ly dg sal go}h`f}dyj mldgn dg saoyl ~dsa Am@0i r`f|ly dg sal go}h`f}`gnl ! 6 2'5,$'}`gnl ! 6 2'5,$'

CIIS


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CIIS

Ifdgdi`f ys|ct iogc|islc b}oh 0419 so 0449 mtsal G`sdog`f Dgysds|sl ob Cd`mlsly `gc Cdnlysdrl`gc Jdcglt Cdyl`yly !GDCCJ$

Dgrofrlc 0&330 rof|gsll}y ~dsa stul 0 cd`mlsly`gc =4 hlcdi`f ilgsl}y dg sal \gdslc Ys`sly `gcI`g`c`' Rof|gsll}y a`c cd`mlsly bo} `s fl`ys 0tl`} m|s go fognl} sa`g 0< tl`}y'

Salt `fyo ~l}l }lp|d}lc so a`rl go& o} ogft l`}ftydngy ob& cd`mlsdi ltl cdyl`yl'

CIIS


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CIIS

Sal ys|ct iohu`}lc sal lbblisy ob s~o s}l`shlgs}lndhlgyys`gc`}c sal}`ut `gc dgslgydrliogs}ofog sal iohufdi`sdogy ob cd`mlsly'

]ly|fs ; Fo~l}dgn mfooc nf|ioyl }lc|ily }dyj

Ltl cdyl`yl !]lsdgou`sat$ ( >2, }lc|ilc }dyj

Jdcglt cdyl`yl !Glua}ou`sat$ (


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| ` o o Y |ct

OMKLISDRLOMKLISDRL So lq`hdgl ~alsal} dgslgydrl nftilhdiSo lq`hdgl ~alsal} dgslgydrl nftilhdiiogs}of io|fc cli}l`yl sal b}lp|lgit o} ylrl}dst ob cd`mlsdiiogs}of io|fc cli}l`yl sal b}lp|lgit o} ylrl}dst ob cd`mlsdihdi}or`yi|f`} iohufdi`sdogy'hdi}or`yi|f`} iohufdi`sdogy'

CLYDNGCLYDNG ( 005 u`sdlgsy ~dsa stul = cd`mlsly !


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t

]LY\FSY sal i|h|f`sdrl ul}ilgs`nly ob~o}ylgdgn dg }lsdgou`sat `gc glua}ou`sat ~l}l

ydngdbdi`gsft fo~l} dg sal HDS n}o|u sa`g dg sal IDSn}o|u'

IOGIF\YDOGY Dgslgydrl nftilhdi iogs}of i`gclf`t sal ogyls `gc u}on}lyydog ob sal l`}ft ys`nly ob

cd`mlsdi hdi}or`yi|f`} iohufdi`sdogy dg K`u`glylu`sdlgsy ~dsa stul = cd`mlsly'

\gdslc Ys`sly Cd`mlsly U}lrlgsdogU}on}`h; ]ly|fsy


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Dgslgydrl FdblystflUf`ilmo Dgsl}rlgsdog Hlsbo}hdg

!g 8 051=$ !g 8 05>4$ !g 8 05>9$

^s foyy; 5'0 jn ^s foyy;


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Dgslgydrl Fdblystfl

Uf`ilmo Dgsl}rlgsdog Hlsbo}hdg!g 8 051=$ !g 8 05>4$ !g 8 05>9$

^s foyy; 5'0 jn ^s foyy;


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Stul(= Cd`mlsly Hlffds|yStul(= Cd`mlsly Hlffds|y

O}`f Atuonftilhdi `nlgsy''Y|fbogtf|}l`y l'n'& Nfdmlgif`hdcl& Nfdif`{dcl&

Nfdud{dcl `gc Nfdhlud}dcl'

Gog(y|fbogtf|}l`y !H`nflsdgdcly$ l'n'&

]lu`nfdgdcl `gc G`slnfdgdcl'

@gsd(atul}nftilhdi `nlgsy' Dgy|fdg ylgydsd{l}y

Mdn|`gdcly l'n'& Hlsbo}hdg'

Sad`{ofdcdglcdogly l'n'& ]oydnfds`{ogl `gc Udonfds`{ogl'

(Nf|ioydc`yl dgadmdso}y l'n'&@i`}moyl&Hdnfdsof'

@gsd ( Cd`mlsdi C}|ny


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@gsd Cd`mlsdi C}|ny

Dgy|fdg `g`fono|lyDgy|fdg `g`fono|ly l'n'& Mordgl& uo}idgl `gca|h`g'

Gl~l} `nlgsyGl~l} `nlgsy @fcof`yl }lc|is`yl dgadmdso}y l'n'& @hdgon|`gdcdgl'

Dgy|fdg hdhlsdi `nlgsy l'n'& R`g`cd|h y`fsy'

Nf|i`nog gs`nogdysy l'n'& 9(`c}lgl}ndi `nogdysy'

Uoslgsd`so}y ob dgy|fdg yli}lsdog l'n'& Nf|i`nog fdjl

ulusdcl `hdcl'

Iohmdg`sdog sal}`ut


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ut

Iohhogft |ylc iohmdg`sdogy `}l;;

Y|fbogtf|}l` `gc hlsbo}hdg

@ nfds`{ogl `gc ` Y|fbogtf|}l` o} dgy|fdgGog( Y\ `gc hlsbo}hdg

Y|fbogtf|}l` `gc dgy|fdg

@gt osal} c}|n hlgsdoglc `morl `gc dgy|fdg

S}dufl Sal}`ut


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u ut

Sal |yl ob ` nfds`{ogl dg iohmdg`sdog ~dsahlsbo}hdg `gc ` y|fbogtf|}l` dg u`sdlgsy

~ao a`rl gos }lyuogclc so hogosal}`uto} ~dsa iohmdg`sdog ob s~o o}`f `nlgsya`rl `fyo mllg `uu}orlc mt BC@'

S}l`shlgs B`df|}l


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U}dh`}t b`df|}lGo }lyuogyl ~dsa ` c}|n ndrlg bo} sal bd}ys

sdhl

Yliogc`}t b`df|}lN}`c|`f foyl ob `isdog ob ` c}|n ~alg

|ylc bo} ` u}ofognlc ul}doc' L'n'&

Y|fbogtf|}l`y'

Metabolism, Insulin and DM

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