不同强度跑台运动与雌激素联合作用对实验性骨质疏松大鼠骨量的影响

目的 :将成年SD大鼠去卵巢建立骨质疏松模型 ,探讨不同强度运动与雌激素联合作用对骨质疏松大鼠骨量的影响。方法 :实验动物分基础对照组、正常对照组、阳性对照组、雌激素对照组、中等强度运动组、大强度运动组、中等强度运动 雌激素组和大强度运动 雌激素组。用骨形态计量学方法 ,研究了 8周的不同强度跑台运动 ,以及运动和雌激素结合对大鼠胫骨松质骨骨量的影响。结果 :中等强度运动组骨高转换受到抑制 ,骨量丢失减缓。大强度运动仍为高转换型骨代谢 ,且骨量低于中等强度运动组。两个运动加雌激素组明显抑制了去卵巢后的高骨转换 ,骨量较两个单纯运动组和雌激素对照组增多。结论 :雌激素和运动的结合比单纯用药和单纯运动能起到更好的预防骨丢失的作用     

阿仑膦酸钠对大鼠松质骨和密质骨影响的比较

目的：比较阿仑膦酸钠(固邦，ALN)对去卵巢大鼠胫骨上段和腰椎质松骨及胫骨中段密质骨的影响。方法：3月龄雌性SD大鼠，ALN1mg／(kg&;#183;d)，灌胃给药90d。骨标本行不脱钙骨制片，骨组织形态计量法钡5量。结果：松质骨：OVX组胫骨上段(PTM)和腰椎(LV)质松骨的骨量减少(P&;lt;0．001)，骨结构变差；ALN组PTM，LV骨量增加(P&;lt;0．001)，完全对抗OVX大鼠的骨高转换。密质骨：OVX组胫骨中段(TX)骨量减少(P&;lt;0．05)，骨内膜骨形成和骨吸收增加。ALN组骨量增加(P&;lt;0．05)，骨内膜骨形成减少而骨吸收有减少的趋势。结论：ALN能有效预防OVX后大鼠的骨质疏松，但不同部位有不同的骨转换速度。     

阿仑膦酸钠对大鼠松质骨和密质骨影响的比较

目的:比较阿仑膦酸钠(固邦,ALN)对去卵巢大鼠胫骨上段和腰椎质松骨及胫骨中段密质骨的影响。方法:3月龄雌性SD大鼠,ALN1mg/(kg·d),灌胃给药90d。骨标本行不脱钙骨制片,骨组织形态计量法测量。结果:松质骨:OVX组胫骨上段(PTM)和腰椎(LV)质松骨的骨量减少(P<0.001),骨结构变差;ALN组PTM,LV骨量增加(P<0.001),完全对抗OVX大鼠的骨高转换。密质骨:OVX组胫骨中段(TX)骨量减少(P<0.05),骨内膜骨形成和骨吸收增加。ALN组骨量增加(P<0.05),骨内膜骨形成减少而骨吸收有减少的趋势。结论:ALN能有效预防OVX后大鼠的骨质疏松,但不同部位有不同的骨转换速度。     

运动对生长激素、胰岛素样生长因子-1及骨发育的影响

运动对骨的影响是多方面的，比如运动是影响骨量的主要积极因素。章晓霜等的研究表明，中等强度运动通过主要抑制去卵巢后骨吸收和骨形成，但抑制骨吸收的作用更明显，且增加了骨矿的沉积作用，最终使骨形成大于骨吸收，可减少去卵巢大鼠胫骨骨丢失，减轻骨质疏松的程度。也有研究表明，慢跑、跳舞等运动锻炼可通过抑制骨转换而防治绝经后骨质丢失。同时，运动也是影响骨发育的重要因素之一。生长激素（growth hormone，GH）的主要作用之一是通过生长素介质（somatomedin，SMs）间接刺激软骨生长，在青少年时期促进长骨生长，是众多促生长因子中最关键的因素之一。胰岛素样生长因子-1（insulin-like growth factor，IGF-1）是一种重要的SMs。它们在骨发育过程中发挥着重要的生理作用。运动促进骨生长发育的作用，在很大程度上可能与有运动诱导的GH、IGF-1水平变化有关。     

钙加维生素D预防骨质疏松的实验研究

目的 观察钙加维生素D对卵巢切除大鼠骨密度，骨强度和骨代谢的影响。方法 将40只SD雌性大鼠随机分为4组：假手术组（A），去卵巢组（B），去卵巢并给钙加维生素D组（C）和去卵巢单纯给钙组（D）。实验12周后处死各组大鼠。结果 与B组相比，C组大鼠股骨骨密度最大载荷，骨皮质厚度等明显增加；血清抗酒石酸酸性磷酸酶（TRAP）和骨钙素（OC）明显降低。D组和C组股骨最大应力，弹性载荷，弹性模量等均明显增高。结论 钙加维生素D组在改善骨密度和骨生物力学参数，抑制骨吸收和骨转换方面明显优于单纯补钙组。     

中等强度运动和植物雌激素对大鼠血脂浓度的影响

目的：探讨大豆异黄酮与中等强度运动联合作用对去卵巢大鼠血脂的影响。方法：雌性Wistar大鼠50只,按体质量随机分为假手术组（Sham组）,去卵巢安静组（OVX组）;去卵巢大豆异黄酮组（OVX-IF组）、去卵巢运动组（OVX-EXE组）和去卵巢大豆异黄酮运动组（OVX-EXE-IF组）各10只。OVX-IF组及OVX-IF-EXE组给予大豆异黄酮50mg／kg灌胃,其余3组以等剂量的溶剂灌胃。同时OVX-EXE及OVX-EXE-IF组大鼠进行跑台训练。结果：连续治疗8周后,OVX组TC和LDL显著高于Sham组,HDL低于Sham组（P〈0.05）;与OVX组比较,OVX-IF组和OVX-EXE-IF组TC、LDI,显著降低,HDL增加（均P〈0.05）。各组大鼠间TG的浓度无差异。结论：大豆异黄酮能改善去卵巢大鼠血脂水平。     

运动对去卵巢大鼠骨组织形态计量学的影响

目的评价运动对去卵巢大鼠骨组织形态计量学的影响。方法46只SD大鼠随机分为正常对照组(A组)、去卵巢手术组(B组)、雌激素对照组(C组)、运动组(D组)。A组行假手术,其余各组行双侧卵巢切除术,术后3 个月开始为期3 个月的治疗。C组用尼尔雌醇治疗,D组按要求进行运动。治疗结束后对胫骨作骨组织形态计量学分析。结果D组的骨小梁面积、骨小梁面积百分数、骨小梁周长、骨小梁数目明显高于B组,且在行卵巢切除术各组中骨小梁分离度、单位骨小梁面积破骨细胞数、每毫米破骨细胞数最低,荧光周长百分数、矿化沉积率、骨形成率最大。结论运动能增加去卵巢大鼠骨的骨量,具有促进骨形成和抑制骨吸收的双重作用。     

钙加维生素D预防骨质疏松的实验研究

目的观察钙加维生素D对卵巢切除大鼠骨密度、骨强度和骨代谢的影响。方法将40只SD雌性大鼠随机分为4组:假手术组(A),去卵巢组(B),去卵巢并给钙加维生素D组(C)和去卵巢单纯给钙组(D)。实验12周后处死各组大鼠。结果与B组相比,C组大鼠股骨骨密度最大载荷、骨皮质厚度等明显增加;血清抗酒石酸酸性磷酸酶(TRAP)和骨钙素(OC)明显降低。D组和C组股骨最大应力、弹性载荷、弹性模量等均明显增高。结论钙加维生素D组在改善骨密度和骨生物力学参数、抑制骨吸收和骨转换方面明显优于单纯补钙组。     

中等强度运动对去卵巢大鼠骨量及cGMP-PKG Ⅱ-EnaC通路的影响

目的:通过中等强度跑台运动干预,探讨运动经cGMP-PKGⅡ-ENaC通路对去卵巢大鼠骨量的影响效应,为阐明有氧运动对骨量的影响及机制提供实验依据。方法:3月龄雌性SD大鼠随机分为10组:BC(基础对照组)、SHAM4、8、12(假手术4、8、12周)组;OVX4、8、12(去卵巢对照4、8、12周)组;OVX+T4、8、12(去卵巢+运动4、8、12周)组。运动组采用跑台训练,坡度5°,5d/w。以DXA测定大鼠全身骨密度(bone mineral density,BMD);以ELISA测定血清环鸟苷酸(cyclic guanosine monophosphate,cGMP)含量;以Western blot和实时PCR法分别测定cGMP依赖性蛋白激酶GⅡ(cGMP dependent protein kinase,PKGⅡ)和ENa C-γ的蛋白及mRNA表达量。结果:运动组大鼠BMD呈现出随运动时间增长而增加态势,OVX+T 12组BMD显著高于同期OVX组(P0.01),OVX+T 8和12虽仍低于同期SHAM组,但无显著性差异。与同期OVX组比较,OVX+T8、12组cGMP血清水平、股骨PKGⅡmRNA、ENaC-γ mRNA表达均显著增加(P0.05),但仍均低于同期SHAM组。与同期OVX组比较,OVX+T4、12组PKGⅡ蛋白表达显著增加(P0.05),但仍低于同期SHAM组(P均0.01),运动组PKGⅡ蛋白降低程度显著减缓。OVX+T4、8、12组ENaC-γ蛋白表达均显著高于同期OVX组(P均0.01),但仍低于同期SHAM组(P0.05—0.01),降低程度显著减缓。结论:中等强度跑台运动干预能增加去卵巢大鼠cGMP浓度,同时上调骨PKGⅡ、ENa C-γ蛋白及mRNA的表达;中等强度跑台运动能够有效地增加去卵巢大鼠骨密度;运动增加去卵巢大鼠骨量的机制与c GMP-PKGⅡ-ENaC通路激活密切相关。     

雌激素受体调节剂联合游泳运动干预去卵巢大鼠骨生化指标的变化

背景:研究发现运动和雌激素联合作用对去卵巢大鼠松质骨骨量的丢失有预防作用,但有关运动与选择性雌激素受体调节剂联合作用对骨代谢的影响方面的研究较少.目的:通过对去卵巢大鼠血液生化指标的比较,探讨游泳运动与选择性雌激素受体调节剂联合作用对去卵巢大鼠骨代谢的影响.方法:将50只雌性SD大鼠随机分为5组:假手术组仅手术不切除卵巢,其余各组去卵巢造模,运动组、药物组及运动+药物组分别在去卵巢的基础上进行游泳训练和(或)灌胃选择性雌激素受体调节剂雷洛昔芬.8周后,比较各组大鼠血液生化指标的变化.结果与结论:卵巢摘除的早期对大鼠进行运动干预可抑制大鼠体质量的快速增加.与模型组比较,运动组、药物组、运动+药物组大鼠血磷及碱性磷酸酶水平明显升高(P＜0.05或P＜0.01),血清抗酒石酸酸性磷酸酶水平显著降低(P＜0.05),均以运动+药物组效果最明显,但各组间血钙水平差异无显著性意义(P＞0.05).说明游泳运动和(或)选择性雌激素受体调节剂均可在一定程度上改善骨代谢的血液生化指标,延缓骨丢失,抑制高转换型骨代谢率,以选择性雌激素受体调节剂和运动联合作用效果最佳.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.