广西南宁市区绝经后女性骨质疏松症流行情况及相关因素研究

目的了解广西南宁市绝经后女性骨质疏松症的患病情况及相关影响因素,为进一步预防干预提供理论依据。方法选取我院健康体检的216名绝经后女性作为研究对象,测定髋部及第1~4腰椎的骨密度,同时进行问卷调查。结果骨质疏松、骨量减少及骨量正常分别占38.89%、43.06%、18.05%,随着年龄增加,骨质疏松患病率明显升高(χ2=17.56,P=0.000);骨质疏松组年龄、体重指数(body mass index,BMI)、绝经年限、足月妊娠次数、户外活动次数、每次运动时间、活动程度、奶制品摄入及钙剂摄入情况与另外两组比较,差异均有统计学意义(P0.05),Logistics多因素回归分析表明,年龄、绝经年限与骨质疏松症呈正相关(OR=3.419,P=0.000;OR=2.569,P=0.016);而BMI、运动次数、饮牛奶及钙剂摄入与其呈负相关性(OR=0.517,P=0.000;OR=0.684,P=0.024;OR=0.589,P=0.021;OR=0.266,P=0.000)。结论广西南宁市区绝经后女性骨质疏松及骨量减少患病率高。BMI增高、运动次数多、饮牛奶及钙剂摄入是其保护因素,应加强宣教,从而预防和延缓骨质疏松的发生。     

新乡市部分社区人群骨质疏松症流行病学调查及相关影响因素Logistic 回归分析

目的了解新乡市部分社区人群骨质疏松症(osteoporosis,OP)的患病情况及相关影响因素,为OP的社区干预提供基础资料。方法应用HOLOGIC公司生产的Sahara定量超声骨密度检测仪测量新乡市部分社区4280名人群右侧跟骨骨密度。通过对受试者进行调查问卷,测量身高、体重、体重指数(BMI),是否服用糖皮质激素及其他影响骨代谢的药物等。单因素Logistic分析,有统计学意义者(P0.1)进一步行二分类Logistic回归分析,计算OR值及其95%置信区间。结果 1 OP总患病率为11.7%,男性8.4%,女性16.3%,OP及低骨量发生率随年龄增加呈上升趋势,同年龄组女性较男性更易发生OP及低骨量;2在男性,单因素分析显示年龄、文化程度、饮酒、咖啡、日饮用牛奶量、BMI、固定锻炼、OP家族史等与OP患病可能相关(P0.1)。二分类Logistic回归分析显示增龄、OP家族史、饮酒为OP可能为危险因素;高文化程度、稳定日牛奶饮用、固定锻炼为OP的可能保护性因素;3在女性,单因素分析显示年龄、文化程度、日饮牛奶量、咖啡、BMI、固定锻炼、绝经年龄及年限是OP的可能影响因子(P0.1);二分类Logistic回归分析显示增龄、绝经状态及BMI是OP的可能危险因素;晚绝经、每日稳定牛奶饮用及锻炼为其可能保护性因素。结论新乡市部分社区OP骨质疏松症的发生随着增龄而增加,女性更为明显。影响男性OP的主要危险因素为家族史和增龄及饮酒;在女性是增龄、绝经及BMI。饮用牛奶和规律锻炼是OP可能保护性因素。在社区一级预防中加强宣教,控制可能导致OP的不良因素,预防和延缓骨质疏松症的发生。     

中老年女性原发性骨质疏松症危险因素

骨质疏松症是中老年人,尤其是绝经后妇女的一种常见病、多发病,给社会和家庭带来了沉重的经济和生活负担。其危险因素有很多方面,部分是不可控制的,而部分是可以控制的,包括钙摄入、维生素D摄入、蛋白质摄入、吸烟、饮酒、饮用咖啡、体育锻炼等。国外对这些危险因素研究地较多较全面,而国内研究较少,对危险因素也研究地不够全面。本文采用文献综述法,对中老年女性原发骨质疏松的相关危险因素的研究现状进行分析和总结,探讨中老年女性原发性骨质疏松症相关危险因素研究现状;提出了研究骨质疏松危险因素的意义。     

血清铁蛋白水平与骨密度的相关性研究

目的分析绝经后女性及50岁以上男性不同骨量人群血清铁蛋白的差异,探讨血清铁蛋白水平与骨密度的相关性。 方法选择2018年9月至2019年2月期间于河北医科大学第三医院就诊,接受双能X线骨密度测量仪（DEXA）检测骨密度（BMD）的绝经后女性（131例）及50岁以上男性（65例）患者（共196例）,根据BMD分为骨量正常组（46例）、骨量减少组（68例）和骨质疏松组（82例）。收集上述患者的临床资料,检测相关生化指标,并测定血清铁蛋白水平,评估血清铁蛋白与骨密度的相关性。 结果（1）与骨量正常组[99.50（91.55,128.51）ng/ml]和骨量减少组[103.36（93.26,113.46）ng/ml]相比,骨质疏松组血清铁蛋白水平明显增高[（174.25（160.85,210.42）ng/ml）（χ²=100.573,P=0.000）。（2）血清铁蛋白水平与髋部、腰椎骨密度均呈负相关,（髋部r=-0.487,P<0.05;腰椎r=-0.531,P<0.05）。（3）体重为骨质疏松症的保护因素（r=0.049,P<0.05）,血清铁蛋白为骨质疏松症的危险因素（r=-0.018,P<0.05）。 结论血清铁蛋白水平增高是骨质疏松症的危险因素,在骨质疏松症的发生中可能起重要作用。     

鄂西北地区正常人群骨质疏松危险因素的相关研究

目的研究鄂西北地区正常人群骨质疏松的危险因素。方法在2013年4月-2014年8月期间,随机选择鄂西北地区的正常人840例进行研究,测定骨密度并判断骨质疏松情况;设计调查表对骨质疏松的相关因素进行调查。结果 840名入组者中存在骨质疏松124例;骨质疏松者和非骨质疏松者的性别、年龄、文化程度、体质指数、吸烟情况、每周运动次数、每日静坐时间、每日奶制品摄入量、每日豆制品摄入量、每日蔬菜摄入情况比较,差异有统计学意义(t/x~2=5.102~33.192,P0.05,P0.01);女性、高龄、体质指数低、吸烟、每日静坐时间久是发生骨质疏松的危险因素(β=0.872~1.331,OR=1.984~3.192,95%CI=1.423~4.039,Wald X2=10.498~14.661,P0.05),文化程度高、每周运动次数多以及奶制品、豆制品、蔬菜摄入多是发生骨质疏松的保护因素(β=-1.029~-1.383,OR=0.204~0.274,95%CI=0.103~0.348,Wald X2=9.202~15.685,P0.05)。结论骨质疏松的危险因素包括女性、高龄、体质指数低、吸烟、每日静坐时间久,保护因素包括文化程度高、每周运动次数多以及奶制品、豆制品、蔬菜摄入多。     

吸烟、饮酒、喝绿茶等生活习惯对老年人骨质疏松的影响

目的 分析吸烟、饮酒、喝绿茶等生活习惯对老年人骨质疏松的影响。方法 选取2012年9月到2013年5月在天津武警后勤学院附属医院老年门诊就诊的老年人群728例,使用双能骨密度仪进行骨密度测定，同时，自行设计调查表收集资料，有效问卷703例,其中将确诊的303例骨质疏松老年人群作为病例组,未发生骨质疏松400例的老年人群作为对照组进行研究。结果 吸烟、饮酒、喝绿茶等生活习惯对老年人骨质疏松的影响：1单因素分析结果显示：吸烟、吸烟年数、饮酒、饮酒量、喝绿茶、喝咖啡与老年人骨质疏松的发生有关，差异有统计学意义（P＜0.05），饮酒类型与饮酒年数与老年人骨质疏松的发生无关，差异无统计学意义（P＞0.05）；2多因素Logistic回归分析结果显示：吸烟、喝绿茶与老年骨质疏松发生有关（P＜0.05）。结论 老年人骨质疏松的发生情况与吸烟与否、喝茶与否有关，吸烟是老年人骨质疏松的危险因素，喝绿茶是老年人骨质疏松的保护因素。     

绝经后女性骨折风险与肌源性因子及骨代谢指标的相关性研究

目的 探讨绝经后女性肌源性因子及骨代谢指标与骨质疏松性骨折风险的相关性。方法 研究南京中医药大学无锡附院2021年6月至2022年6月门诊绝经后女性患者215例，根据纳排标准筛选出184例，其中绝经后骨质疏松88例，骨量减少65例，正常骨量31例。收集基线资料、肌骨代谢指标（碱性磷酸酶（ALP）、I型原胶原氨基端前肽（PINP）、鸢尾素（irisin）及肌肉抑制素（MSTN）等）及BMD，应用FRAX评估软件来评估骨折风险。控制年龄、骨量、FRAX风险等级比较肌骨代谢指标、体质指数（BMI）及体表面积（BS）的差异，并对绝经后女性骨折风险和各指标进行相关性分析；多重线性回归分析骨折风险概率与相关变量间的关系。结果 不同年龄组间BMD、PMOF及PHF差异存在统计学意义（P<0.05）；不同骨量组间BMI、BS、ALP、PMOF及PHF差异存在统计学意义（P<0.05）；FRAX不同风险组年龄、BS、BMD、Ca、ALP、PINP、irisin及MSTN之间差异存在统计学意义（P<0.05）；相关性分析显示FRAX骨折概率与年龄、PINP、MSTN成正相关（P<0.05）,与BMI、BS、BMD及irisin成负相关（P<0.05），二元Logistic回归分析显示年龄、PINP与irisin是骨折风险的重要相关因素。结论 基于适合亚洲人群的FRAX干预阈值研究，绝经后女性年龄、PINP与irisin是骨折风险评估的敏感因素，这对优化骨质疏松骨折风险模型有重要意义。     

潍坊地区骨密度异常患病率调查及影响因素分析

目的 了解潍坊地区体检人群骨密度异常（低骨量及骨质疏松）发病情况及影响因素，为该地区低骨量和骨质疏松的防治提供依据。方法 用DXA骨密度仪对潍坊地区2010—2021年15 180例50岁及以上男性和绝经后女性体检人群进行骨密度（BMD）测量及问卷调查，排除骨代谢性疾病，分析性别、年龄、体质指数、骨折史、家族骨折史、生育数、行经年数、绝经年龄、烟龄、长期饮酒、饮浓茶、喝牛奶、运动、服用钙片、常服维生素D（VitD）等因素对骨密度异常的影响。结果 ①本研究总体人群BMD异常率为42.22 %，其中OP率为15.68 %。男、女BMD异常（25.21 %、58.62 %）和OP发生率（6.07 %、24.95 %）。男性及绝经后女性各年龄段BMD异常及OP患病率整体随年龄增长而上升，且各年龄段男性患病率均低于绝经后女性，其差异有统计学意义。其中男性BMD异常率最高的70~79岁年龄段（32.96 %），OP患病率最高的是≥80岁组（13.61 %）；女性BMD异常率及OP率最高的均为≥80岁组，分别为77.47 %及43.96 %。②对于≥50岁的男性，体质指数、常运动是BMD异常的保护性因素；骨折史、烟龄、常服钙片则是其危险因素。体质指数、家族骨折史与T值呈正相关，烟龄、常服VitD、常饮酒与之呈负相关（P＜0.05）。③对于绝经后女性，体质指数、绝经年龄、行经年数、常喝牛奶是BMD异常的保护性因素，年龄、骨折史、生育数则为危险因素。体质指数、行经年数、绝经年龄、常喝奶与T值有正相关关系，年龄、骨折史、生育数与之呈负相关（P＜0.01）。结论 潍坊地区体检人群低骨量和骨质疏松的患病率低于全国水平，年龄、性别、生活习惯、饮食习惯、女性月经和生育情况、骨折史和家族骨折史等因素对骨密度变化有一定影响。     

重庆市区中老年人跟骨定量超声测定分析

目的通过对重庆市区中老年人进行跟骨定量超声测定,分析重庆市区中老年人骨质疏松现状,为该病的防治提供依据和借鉴。方法采用SONOST2000型定量超声仪对855例中老年人右跟骨宽波段超声衰减(BUA)、超声速度(SOS)、骨量指数(BQI)、T值(T-Score)进行检测。结果受检中老年人群骨质疏松发生率约为41．1％,其中女性(58．4％)明显高于男性(33．9％, P<0．01);随着年龄增长,骨质疏松发生率明显增高(P=0．001);女性各项跟骨定量超声测定参数均显著低于老年男性(P<0．01);各项参数随年龄增长而显著减低(BUA:P=0．04,其余P< 0．01)。结论增龄和女性是老年人骨质疏松的重要危险因素,跟骨定量超声检测可以作为骨质疏松人群防治的有效筛选手段。     

浙江地区人群11926例跟骨骨密度研究

目的 探讨浙江地区人群骨量的分布规律和骨质疏松的患病情况.方法 采用美国进口Dove3000骨密度测量仪对11926例浙江居民的跟骨骨量进行测定,按年龄分成14组,SPSS10.0统计软件对各组数据进行处理.结果 浙江地区人群骨量约在25～35岁达到峰值,50岁开始随年龄的增加而逐年减少;20岁后男性骨密度明显高于女性(P＜0.01),女性骨量的丢失速率明显快于男性;女性绝经1～3年骨量开始快速丢失,约10年后趋缓;骨质疏松的患病率与年龄的变化呈正相关(r=0.99),女性患病率明显高于男性(P＜0.01).结论 浙江地区人群骨量25～35岁达到峰值,50岁后随年龄的增加而逐年减少;女性骨量低于男性,50岁后骨量丢失的速率明显快于男性;女性骨量丢失与绝经时间密切相关.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.