老年性骨质疏松症患者腰椎及髋关节骨矿含量及骨钙 素变化相关性分析

目的研究并分析老年性骨质疏松症患者不同年龄组腰椎及髋关节骨矿含量及其骨钙素相关性。方法选取2011年 3月-2012年3月在我院收治人院确诊的患者86例。应用X线骨密度检测仪检测其腰椎及髋关节骨矿含量,放免法检测其 骨钙素。应用SPSS13.0对比研究骨质疏松症患者腰椎及髋关节骨矿含量与骨钙素变化相关性分析。结果86例骨质疏松 症患者随着年龄的增长腰椎及髋关节骨矿含量呈下降的趋势,而血清骨钙素水平相对增高（P <0. 05),差异有统计学意义。 Person相关分析结果显示：血清骨钙素与腰椎及髋关节骨密度呈负相关(P < 0. 05),结论血清骨钙素在早期诊断骨质疏松 症有一''定的临床意义     

骨碎补总黄酮（强骨胶囊）治疗绝经后骨质疏松症大鼠实验的系统评价

目的 评价骨碎补总黄酮（强骨胶囊）治疗绝经后骨质疏松症大鼠实验的有效性及安全性,探索骨碎补总黄酮（强骨胶囊）在绝经后骨质疏松症治疗领域的创新应用与安全使用。方法 计算机检索国内外7个常用数据库,筛选骨碎补总黄酮（强骨胶囊）治疗绝经后骨质疏松症大鼠的随机对照试验;采用SYRCLE动物实验偏倚风险评估工具评价纳入文献研究,RevMan5.3软件进行Meta分析。结果 经过初筛和严格评价,纳入12个研究,共246例样本,纳入文献质量普遍偏低。Meta分析结果显示,骨碎补总黄酮（强骨胶囊）有助于提高大鼠腰椎（WMD=0.03,95％CI 0.02～0.04,P＜0.001）、股骨（WMD=0.03,95％CI 0.02～0.03,P＜0.001）骨密度,以及血清骨钙素（osteocalcin,BGP）、碱性磷酸酶（alkaline phosphatase,ALP）、CTX水平,但对大鼠血清钙、血清磷水平的作用及量效关系,仍需更多动物实验加以探索与验证。安全性方面纳入文献中均未报告。结论 骨碎补总黄酮（强骨胶囊）可在一定程度上提高绝经后骨质疏松症大鼠骨密度水平及部分骨代谢血液指标。但考虑到纳入研究在方法学质量和报告质量的局限性,本研究所得结论仍需进一步深入研究予以证实和深化。     

体重指数联合腰椎和股骨平均骨密度测量推算全身骨质含量的研究

目的 分析体重及体重指数与腰椎、股骨平均骨密度和骨矿含量之间的相关关系、比较腰椎、股骨骨密度和骨矿含量值的差异,探讨腰椎、股骨平均骨密度和体重与骨矿含量之间的关系.方法 选取2009年1月到2011年1月来我院进行治疗的166被确诊为骨量减少、骨质疏松症患者,比较L2、L3、L4骨密度及骨矿含量之间的差值,分析L2、L3、L4的平均骨密度和骨矿含量与体重及体重指数之间的相关性关系.结果 3组骨矿含量值与骨密度值两两比较差异显著(P<0.05).腰椎、股骨平均BMC与体重之间呈现出明显的正相关关系(P<0.01),而BMD与体重之间无明显的相关性(P>0.05).结论 三组骨矿含量与骨密度之间存在明显的差异,其中腰椎、股骨平均骨密度和骨矿含量与体重及体重指数之间存在着明显的相关关系,体重在一定程度上会增加骨量,因此保持适当的体重对预防骨质疏松症的发生有重要的临床意义和价值.     

离子导入骨碎补总黄酮对骨质疏松症患者腰椎骨密度影响临床研究

目的：离子导入骨碎补总黄酮对骨质疏松症患者腰椎骨密度及临床评价标准的影响。方法选取2011年3月-2012年3月来我院进行治疗并确诊的120例骨质疏松症患者,随机将其分为治疗组与对照组两组,每组60人,治疗组选择离子导入骨碎补总黄酮进行治疗,对照组选用口服药物治疗。应用疼痛视觉模拟评分法及腰椎骨密度检测法对骨质疏松症患者进行评价,在治疗3个月之后收集并分析骨质疏松症患者各组疼痛视觉模拟评分及腰椎骨密度及其变化,对比并进行临床分析。结果在经过3月的治疗后,离子导入骨碎补总黄酮患者的总有效率达到93.1％,对照组患者的有效率为61.3％,两组对比治疗效果差异有统计学意义。结论离子导入骨碎补总黄酮治疗骨质疏松症对于缓解骨质疏松症患者腰腿疼痛及提高腰椎骨密度有明显的疗效,因此应在临床实践中加以运用并推广,促进骨质疏松症患者的早日康复。     

74例老年骨质疏松患者应用鲑鱼降钙素联合阿仑膦酸钠治疗的疗效观察

目的　评估联合应用鲑鱼降钙素与阿仑膦酸钠治疗缓解老年性骨质疏松症患者骨关节疼痛及血清骨钙素(BGP)、降钙素(CT)及骨密度(BMD)水平的变化。方法 联合应用鲑鱼降钙素和阿仑膦酸钠治疗本院收治的74例老年性骨质疏松症患者,给予鲑鱼降钙素50IU肌肉注射,隔日1次,连续使用15次后改为口服阿仑膦酸钠1粒/周,共经6个月治疗,采用数字模拟评分法(VAS)比较治疗前、后全身骨关节疼痛程度,治疗前、后骨钙素、降钙素及第2～第4腰椎(L2-4 )、股骨颈、Ward区骨密度水平的变化,并进行统计学分析。结果 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症患者6个月后,对缓解骨关节疼痛症状疗效良好,治疗前与治疗后比较差异显著(P<0.01);治疗前后骨密度、血清骨钙素和降钙素水平均有显著差异（P<0.05）。结论 鲑鱼降钙素联合阿仑膦酸钠治疗老年性骨质疏松症使血清降钙素的水平明显升高,骨钙素水平明显降低,能显著减轻患者骨关节疼痛,改善症状,并增加骨密度,对老年性骨质疏松症有明显的疗效。     

特立帕肽治疗原发性骨质疏松症的短期疗效观察

目的：观察特立帕肽（ Teriparatide ）治疗原发性骨质疏松症的短期疗效和安全性。方法采用自身前后对照临床研究,纳入2011年12月-2012年12月在解放军第309医院骨内科住院的原发性骨质疏松症患者共10名,所有患者在每天口服补充元素钙600 mg和活性维生素D 0.25μg的同时,分别接受特立帕肽治疗,疗程6个月,具体用法为每日皮下注射特立帕肽20μg。所有患者均于用药前、用药后3、6个月采用双能X线吸收法（DEXA）测定腰椎（L2-4）、股骨颈、Ward’s区和大粗隆骨密度（BMD）,用酶联免疫吸附法（ELISA）测定血清骨钙素（sOC）、骨碱性磷酸酶（sBAP）和Ⅰ型胶原交联C端肽（sCTX）水平。观察患者治疗前后骨密度和骨标志物的变化并进行对比分析,记录患者的不良事件。结果10名患者均完成全疗程治疗。治疗3个月时,腰椎（L2-4）、股骨颈、Ward’s区和大粗隆骨密度改善不明显（P＞0.05）,血清骨钙素（sOC）和骨碱性磷酸酶（sBAP）较治疗前明显升高（P＜0.05）。治疗6个月时,腰椎（L2-4）骨密度较治疗前明显增高（P＜0.05）,而股骨颈、Ward’s区和大粗隆骨密度改善不明显（P＞0.05）。血清骨钙素（sOC）和骨碱性磷酸酶（sBAP）呈持续升高趋势（P＜0.05）,Ⅰ型胶原交联C端肽（sCTX）较治疗前略升高,但差异无统计学意义（P＞0.05）。治疗期间不良事件的发生情况：头晕发生2例,恶心发生1例,上述情况均较轻微,没有给予特殊处理即自行缓解。结论特立帕肽能在3个月内改善患者的骨代谢状况（促进骨形成）,6个月内有效增加原发性骨质疏松症患者的腰椎骨密度,适用于绝经后及老年性骨质疏松症患者的治疗。     

补肾壮骨冲剂治疗310例骨质疏松症患者5年观察

目的观察5年补肾壮骨冲剂治疗老年性骨质疏松症的疗效,以期了解中医药治疗老年性骨质疏松症远期效果。方法于1997-07～2004-07选择2家医院门诊的老年性骨质疏松症患者310例为研究对象,其中治疗组174例,空白对照组136例,治疗组口服补肾壮骨冲剂,空白对照组只接受对症治疗。采用丹麦产1100A单光子骨密度仪,测量非优势左前臂尺、桡骨。计算出前臂骨矿含量和骨密度。结果①治疗6个月后两组骨矿含量和骨密度结果比较:治疗组骨矿含量、骨密度均明显高于治疗前(P<0.01),空白对照组骨矿含量、骨密度均低于入组时(P<0.01),组间比较差异具有显著性(P<0.01);②骨折发生率:治疗组低于空白对照组,差异有显著性意义(P<0.01)。结论补肾壮骨冲剂长期服用能明显提高及稳定老年性骨质疏松症患者骨矿含量、骨密度水平,降低新骨折率。     

补肾壮骨中成药对绝经后骨质疏松症治疗机理初探

目的 观察补肾壮骨中成药对绝经后骨质疏松症的疗效,初步探索补肾壮骨中成药治疗绝经后骨质疏松症的作用机制.方法:134例患者随机分为钙剂+活性维生素D治疗组(对照组)及补肾壮骨中成药+钙剂+活性维生素D治疗组(中成药治疗组)两组治疗1年.在第0月、第3月、第6月留取清晨空腹2 h尿检测尿钙/肌酐(Ca/Cr)、尿I型胶原交联C末端肽/肌酐(CTX-I/Cr),第0月、第12月检测骨密度.结果:经治疗1年后,所有患者第0月、第3月、第6月尿Ca/Cr均无明显差异.但中成药治疗组在第3月时尿CTX-I/Cr明显降低(P＜0.01),第12月股骨颈骨密度较基线显著提高(P＜0.01),与对照组第12月股骨颈骨密度比较有显著差异(P＜0.01);腰椎1-4骨密度较基线无明显变化(P＞0.05).尿CTX-I/Cr的变化与股骨颈骨密度的变化呈明显负相关(P＜0.05).而对照组尿CTX-I/Cr、股骨颈/腰椎1-4骨密度变化均无统计学意义.结论:补肾壮骨中成药可以通过填补肾精,滋补肝肾等作用,降低骨吸收,提高骨密度,发挥对绝经后骨质疏松症的治疗作用.其机制可能与抑制破骨细胞骨吸收功能和促进其凋亡有关.     

骨碎补总黄酮联合鲑鱼降钙素在慢性阻塞性肺疾病合并骨质疏松症中的疗效

目的研究老年慢性阻塞性肺疾病(COPD)合并骨质疏松症患者应用骨碎补总黄酮联合鲑鱼降钙素对患者的影响。方法 98名COPD合并骨质疏松症患者随机分为两组即治疗组(n=49)、和对照组(n=49)。对照组的患者给予鲑鱼降钙素治疗,治疗组的患者给予骨碎补总黄酮联合鲑鱼降钙素治疗,为期6个月。检测两组患者治疗前后腰椎1-4 (L_(1-4))和股骨颈骨密度改变,VAS评分及ODI评分改善情况,血清转化生长因子-β1(TGF-β1)和白细胞介素17(IL-17)水平改变以及骨代谢指标抗酒石酸酸性磷酸酶(TRACP)和骨碱性磷酸酶(ALP)水平的改变。同时观察治疗期间两组患者出现的药物不良反应情况。结果治疗后6个月后,治疗组腰椎1-4 (L_(1-4))和股骨颈骨密度均显著高于同时期对照组和治疗前(P0. 05);治疗6个月后,治疗组的VAS评分、ODI评分均显著低于对照组同期和治疗前(P0. 05);治疗后6个月后,治疗组TGF-β1和ALP水平显著高于对照组和治疗前,而IL-17及TRACP水平明显低于对照组和治疗前(P0. 05);两组药品不良反应发生率比较差异无统计学意义(P0. 05)。结论骨碎补总黄酮联合鲑鱼降钙素提升COPD患者骨密度,改善骨代谢状态和降低细胞因子水平,可以安全有效防治老年COPD合并骨质疏松症。     

骨碎补总黄酮的活血化瘀作用及对实验性微循环障碍和骨质疏松症的影响

目的观察骨碎补总黄酮胶囊对大鼠的活血化瘀作用及对实验性微循环障碍、实验性骨质疏松症的影响.方法利用盐酸肾上腺素注射液造成大鼠"血瘀"模型,观察骨碎补总黄酮对大鼠血液黏度、红细胞功能、血小板聚集、粘附等血液流变学指标和大鼠肠系膜微循环的影响,利用维甲酸造成大鼠实验性骨质疏松症模型,观察骨碎补总黄酮对大鼠骨密度的影响.结果实验表明骨碎补总黄酮胶囊具有降低大鼠血液黏度、抑制血小板聚集的作用,与对照组比较差异有显著性(P＜0.01).骨碎补总黄酮对肾上腺素造成大鼠微动脉收缩具有抑制作用,并抑制微动脉血流的减慢,使血流状态得到改善;并提高大鼠的骨密度含量,提高大鼠的血钙浓度.结论骨碎补总黄酮具有一定的活血化瘀、抑制血小板聚集的作用;并能促进微循环的血流,对肾上腺素引起的微循环障碍有良好的预防和改善的作用;具有升高大鼠的骨密度和提高血钙含量的作用.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes

BACKGROUND: Smoking is associated with surgical wound infections, impaired wound healing, and tissue-destructive disorders. The mechanisms are largely unknown, but changes in the function and activity of inflammatory cells may be involved. METHODS: Seventy healthy volunteers (54 smokers and 16 never smokers) were included. The smokers were studied while they smoked and after 20 days of abstinence. After the first 10 days of abstinence, they were randomized to double-blind treatment with transdermal nicotine patch 25 mg per day or placebo. Venous blood neutrophils and monocytes were sampled and isolated. In 22 randomly selected smokers and in all never smokers, the oxidative burst and chemotaxis were determined by a chemiluminescence response assay and a modified Boyden chamber technique, respectively. Stimulants were opsonized zymosan, formyl-Met-Leu-Phe, and zymosan-activated serum. RESULTS: The neutrophil and monocyte oxidative burst was 50% and 68% lower, respectively, in smokers compared to never smokers (P < .05). Neutrophil chemotaxis was 93% higher in smokers (P < .05). Monocyte chemotaxis was lower in smokers compared to never smokers (P < .05). After 20 days of abstinence, neutrophil oxidative burst increased to the level of never smokers (P < .05); monocyte oxidative burst increased by 50% (P < .05). Chemotaxis was only marginally affected. The changes induced by abstinence were less pronounced in the transdermal nicotine patch group compared to the placebo group. CONCLUSIONS: Smoking attenuates the oxidative burst of inflammatory cells and increases chemotaxis. Three weeks of abstinence normalize the oxidative burst, but affect chemotaxis only marginally.