Bone Metabolism Discrepancy in Type 2 Diabetes Mellitus Patients With and Without Non-Alcoholic Fatty Liver Disease

To explore the distribution of several bone metabolic indicators in type 2 diabetes patients (T2DM) with and without non-alcoholic fatty liver disease (NAFLD) and to preliminarily evaluate the relationship of bone metabolism with NAFLD in patients with T2DM. The hospitalized patients with T2DM were divided into the group of T2DM complicated with NAFLD and the group of T2DM alone according to the results of ultrasonic diagnosis. The general information and laboratory test data such as bone metabolism indexes of these patients were collected and the differences of the indexes between the 2 groups were compared. Furthermore, the independent influencing factors of NAFLD in patients with T2DM were analyzed. A total of 186 patients were included in the study. Compared with patients with T2DM only, patients with T2DM combined with NAFLD were characterized with younger age (p < 0.001), higher BMI (p = 0.016), ALT (p = 0.001), TG (p = 0.005), HOMA-IR (p = 0.005), and lower HDL-C (p = 0.031). Significant discrepancy of age (OR 1.052, p = 0.001), ALT (OR 0.964, p = 0.047), HOMA-IR (OR 0.801, p = 0.005), and T-PINP (OR 1.022, p = 0.008) was found using multivariate logistic regression model. Significant discrepancy of T-PINP was found in T2DM patients with and without NAFLD. Further studies are needed to explore whether T-PINP could be used as a predictor of fatty liver disease, osteoporosis, and other related complications in patients with T2DM.     

Changes in Bone Marrow Adipose Tissue in Transgender and Gender Non-Conforming Youth Undergoing Pubertal Suppression: A Pilot Study

Pubertal suppression with gonadotropin-releasing hormone (GnRH) agonists in transgender and gender non-conforming (TGNC) youth may affect acquisition of peak bone mass. Bone marrow adipose tissue (BMAT) has an inverse relationship with bone mineral density (BMD). To evaluate the effect of pubertal suppression on BMAT, in this pilot study we prospectively studied TGNC youth undergoing pubertal suppression and cisgender control participants with similar pubertal status over a 12-month period. BMD was measured by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Magnetic Resonance T1 relaxometry (T1-R) and spectroscopy (MRS) were performed to quantify BMAT at the distal femur. We compared the change in BMD, T1-R values, and MRS lipid indices between the two groups. Six TGNC (two assigned female and four assigned male at birth) and three female control participants (mean age 10.9 and 11.7 years, respectively) were enrolled. The mean lumbar spine BMD Z-score declined by 0.29 in the TGNC group, but increased by 0.48 in controls (between-group difference 0.77, 95% CI: 0.05, 1.45). Similar findings were observed with the change in trabecular volumetric BMD at the 3% tibia site (-4.1% in TGNC, +3.2% in controls, between-group difference 7.3%, 95% CI: 0.5%-14%). Distal femur T1 values declined (indicative of increased BMAT) by 7.9% in the TGNC group, but increased by 2.1% in controls (between-group difference 10%, 95% CI: -12.7%, 32.6%). Marrow lipid fraction by MRS increased by 8.4% in the TGNC group, but declined by 0.1% in controls (between-group difference 8.5%, 95% CI: -50.2%, 33.0%). In conclusion, we observed lower bone mass acquisition and greater increases in BMAT indices by MRI and MRS in TGNC youth after 12 months of GnRH agonists compared with control participants. Early changes in BMAT may underlie an alteration in bone mass acquisition with pubertal suppression, including alterations in mesenchymal stem cells within marrow.     

Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis: A Prospective,Randomized Controlled Study

The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis.There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years.A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20–52 years) was followed up for a minimum of 12 months (range: 12–60 months). Patients were randomly divided into 2 groups. Group A (n = 21) was treated by the subscapularis transthoracic approach and group B (n = 22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation.Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb''s angle (P > 0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P > 0.05). The Cobb''s angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed significant postoperative improvement in both groups, with no significant difference between the groups.The subscapularis transthoracic approach and the posterolateral approach with debridement, bone graft fusion, and internal fixation are both sufficient and satisfactory for the surgical treatment of upper thoracic tuberculosis. However, the posterolateral approach is superior to the subscapularis transthoracic approach in terms of surgical trauma, operative time, and kyphosis correction.     

经咽后入路手术治疗Hangman骨折

目的探讨Hangman骨折经咽后入路减压融合内固定的临床疗效。方法对7例Hangman骨折患者行颅骨牵引大致复位后择期手术。全麻下采用高位前方咽后入路显露C2-3椎体，切除C2-3椎间盘组织，充分减压，C2-3椎间植骨钢板内固定。术后颈围保护6～8周。结果7例均获随访，时间4—42个月。患者术后3个月内均获骨性愈合，无一例出现椎体再位移和成角畸形，无伤口感染及其他并发症发生，不全瘫患者均有不同程度恢复。结论C2-3前路减压融合内固定治疗Hangman骨折，内固定疗效确切，并能有效维持理想的复位。     

股骨逆行交锁髓内钉治疗股骨髁部C型骨折

目的探讨股骨逆行交锁髓内钉治疗股骨髁部C型骨折的方法和疗效。方法应用股骨逆行交锁髓内钉治疗股骨髁部C型骨折47例:C1型19例,C2型22例,C3型6例。结果47例随防6～48个月,平均20个月,骨折均愈合,平均愈合时间18周。根据Neer膝关节功能评分标准:优23例,良14例,可8例,差2例,优良率77.72%。结论股骨逆行交锁髓内钉是治疗股骨髁部C1、C2型骨折较理想手术方法,但对C3型骨折疗效欠满意。     

应用足底内侧皮瓣修复足跟部软组织缺损

目的探讨应用足底内侧皮瓣转移修复足跟部软组织缺损的临床疗效。方法应用足底内侧皮瓣转移修复15例深达跟骨的足跟部软组织缺损。结果15例皮瓣移植后均成活,术后随访3~12个月,所有皮瓣外形和感觉均恢复良好。结论足底内侧皮瓣修复足跟部深度软组织缺损效果较好。     

尺骨鹰嘴骨折皮质骨加压螺钉固定的实验研究及临床应用

比较尺骨鹰嘴骨折加压螺钉与常用的4种内固定的强度,为临床选择内固定方法提供实验依据。用22具新鲜尸体肘关节做成横型、斜形和粉碎形鹰嘴骨折模型。用5种内固定后置于MD—10E万能电子力学试验机上,测定骨折处的位移与压力的关系;结果:钢丝内固定强度最小,钩钢板最大。髓内加压螺钉固定欠可靠。横形骨折皮质骨加压螺钉与张力带钢丝比较,统计学上无显著差异(P〉0.05),斜形骨折皮质骨加压螺丝钉强于张力带钢丝(P〈0.01)。粉碎形骨折使用钩钢板尤佳(P〈0.01)。临床应用24例中,22例平均随访14个月。骨折全部愈合,优良率达90.91％;认为皮质骨加压螺丝钉治疗横、斜形尺骨鹰嘴骨折,创伤小,操作简便,固定确切,是一种安全可靠的方法。     

学校人际关系与学生心理健康的相关研究

目的 调查学校人际关系与中小学生心理健康的相关状况，为改善学校人际关系提供依据。方法 采取问卷调查和心理测量相结合的方法，采取整群随机抽取大连地区城乡中小学生731人。结果 中小学生的师生关系困扰程度与学生心理健康水平存在显著的相关性（F=52．65P〈0．001），同学关系困扰程度与学生心理健康水平有非常显著的相关性（F=70．57 P〈0．001）。结论 现实中学校人际关系与中小学生心理健康之间有着显著相关。学校人际关系的困扰程度影响学生的心理健康，师生关系、同学关系的困扰程度随年级的增长而增强，学生心理问题的严重性也显示出随着年级的增长而增强的趋势。