单能量X线测定骨密度的初步分析

目的：了解温州地区人群不同年龄组骨质疏松患病率及同年龄组男女骨质疏松患病的差异，强调早期预防治疗老年人及绝经期妇女骨质疏松的重要性，方法：应用单能量X线（SXA）骨密度仪测量246例正常人的右跟骨骨密度，结果：男性大于60岁组较小于60岁组骨密度（BMD）降低明显（P＜0．05）；女性50岁以上组与小于50岁组相比，BMD下降差异有极显性（P＜0．01）；各年龄组男女相比，男性BMD明显高于女性（P＜0．05）。结论：女性骨质疏松症的发病大多以绝经后为主，雌激素在维持骨量方面具有重要的作用。SXA检测的跟骨含95％小梁骨，能较好地确定骨质疏松的风险水平，且其具有价廉、简便，快捷，较准确等特点，故不失为一种较好的临床筛查手段。     

血管内皮生长因子与乳腺癌临床病理因素及预后的关系

目的：探讨血管内皮生长因子在乳腺癌中的表达情况及其与预后的关系。方法：采用免疫组化法对1985年至1986年手术治疗的109例乳腺癌的原发灶进行血管内皮生长因子（VEGF）和微血管密度（MVD）检测，并与临床病理资料进行比较分析。结果：VEGF强表达组淋巴结转移率（52．2％）和病理分级明显高于弱表达且（23．5％，P＜0．05）；随VEGF表达强度的增加，生存率（5年、10年、15年）呈下降趋势，但无明显差异；VEGF与肿瘤大小、绝经状况、雌孕激素受体之间未见相关性。结论：VEGF表达与乳腺癌淋巴结转移和病理分级呈正相关，与预后呈负相关趋势，是估计恶性程度的有用指标，对判断预后有参考价值。     

Quality of life after total mesorectal excision for rectal cancer

BACKGROUND: After total mesorectal excision for rectal cancer, many surgeons try to avoid an abdominoperineal resection (APR) by performing a transanally double stapled low colo-rectal anastomosis (LRA), frequently without a pouch. This policy is mainly based on the assumption that the quality of life after such LRA is higher than after APR. It has been suggested that a better functional outcome and therefore a higher quality of life might be achieved by a colo-anal J-pouch anastomosis (CPA). The aim of this study was to assess quality of life among disease-free survivors after APR, LRA and CPA. METHODS: The charts of 301 consecutive patients who had undergone surgery for cancer in the middle or lower third of the rectum were analysed. Two hundred four patients were eligible for inclusion. The quality of life among these patients was assessed using one generic (EQ-5D) and two disease-specific questionnaires (EORTC QLQ-C30 and EORTC QLQ-CR38). RESULTS: The response rate was 82%. The median follow-up was 31 months. Overall, quality of life was good but CPA patients had better quality of life scores than APR and LRA patients. This difference was not only due to the better functional outcome but also to the lower incidence of disturbed micturition and sexual problems in the CPA group. CONCLUSION: The quality of life after colo-anal J-pouch anastomosis is better than after abdominoperineal resection (APR) and low colo-rectal anastomosis (LRA). The quality of life after APR is similar to that after LRA.     

Detection of glaucomatous damage using multifocal ERG

The first‐order kernel analysis in multifocal electroretinogram (mfERG) using low contrast stimulation is suggested as a way to detect the inner retinal responses in animal studies. In this case report, this protocol is applied to human patients with glaucoma to demonstrate the possibility of using mfERG as a tool to detect glaucomatous damage. Two patients with glaucoma were recruited and had mfERG measurements with the 103‐scaled hexagonal stimulus pattern at low (50 per cent) contrast. Their responses were analysed and compared with those from normal subjects with the mfERG measured under the same condition. In the normal subjects, there were obvious oscillatory components on the ascending and descending limbs of the first‐order kernel response to 50 per cent contrast. In the glaucomatous patients, the oscillatory component on the descending limb was obviously diminished. In addition, this component was significantly diminished in the quadrant with a glaucomatous visual field defect. This suggests that the low‐contrast stimulation condition in mERG measurement may provide a good way to detect glaucomatous damage and this may help in clinical diagnosis of glaucoma.     

膀胱移行细胞癌Mta-1基因与蛋白表达及其临床意义

目的:检测膀胱移行细胞癌(BTCC)中Mta-1mRNA与蛋白表达,分析其与BTCC临床分期、病理分级、转移及复发的关系。方法:原位杂交、免疫组化方法检测42例BTCC组织Mta-1mRNA与蛋白的表达;CD34标记血管内皮细胞,计数肿瘤组织微血管密度(MVD);结合临床病理资料,分析Mta-1与BTCC的侵袭转移、血管生成及复发间的关系。结果:①Mta-1mRNA与蛋白在BTCC中高度表达,其表达阳性率分别为78.6%、73.8%,与正常组织比较差异有统计学意义(P<0.01),且随BTCC临床分期及病理分级的升高而增加,肿瘤复发组高于无复发组,肿瘤转移组高于无转移组(P<0.05)。②经非参数相关分析发现,Mta-1蛋白与Mta-1mR-NA表达呈高度正相关,Rs为0.945,P=0.000;CD34标染的微血管密度(MVD)与Mta-1mRNA与蛋白表达亦呈正相关,相关系数分别为0.712、0.683,P=0.000。结论:①Mta-1在膀胱移行细胞癌中高度表达,并随着肿瘤临床分期和病理分级的升高而增加,与肿瘤的转移及复发密切相关。②Mta-1参与膀胱移行细胞癌的侵袭、转移,可能与促进血管生成有关。     

肱骨近端骨密度的测量及其与年龄和体质量指数的相关性研究

目的 建立一种肱骨近端骨密度(BMD)的测量方法,研究肱骨近端BMD与年龄和体质量指数(BMI)的关系,探讨肱骨近端BMD在预报骨质疏松症的敏感性.方法 选择绝经后健康女性志愿者,使用Hologie DELPHI-A双能X射线骨密度仪及本研究设计的肩部定位器和前臂定位器测虽肱骨近端BMD.研究第一部分包括30名忐愿者,每人连续测量右侧肱骨近端BMD 2次,根据测量结果计算短期精密度RMS SD和RMS CV;第二部分包括92名志愿者,记录其年龄、身高、体重,测量右侧肱骨近端BMD,分析肱骨近端BMD与年龄和BMl的相关性.结果 本研究肱骨近端BMD测量方法的短期精密度:RMS SD=0.011 g/cm2,RMS CV=2.4%.本研究92名志愿者平均(60.2±6.4)岁,平均身高(159.5±5.4)cm,平均体质晕(59.4±7.5)kg,平均BMI 23.3±2.7,平均肱骨近端BMD(0.543±0.083)g/cm2,肱骨近端BMD 同年龄呈负相关,同BMI无显著相关.结论 本研究建立了一种测苗肱骨近端BMD的方法;年龄越人肱骨近端BMD越低;由于BMI对BMD的影响会掩盖骨质的丢失,而非负重区域即肱骨近端会最大程度地减少BMI对BMD的影响程度.     

非依赖型糖尿病全血低切变率粘度值的临床意义

目的:为了探讨非依赖型糖尿病全血低切变率粘度值测定的临床意义。方法:对91例非依赖型糖尿病血液流变学低切率粘度值进行了检测,并对其结果及形成机制进行了分析讨论。结果:91例非依赖型糖尿病低切变率粘度值和对照组相比有显著性差异,p<0．01。结论:非依赖型糖尿病全血低切变率粘度增高,可造成微血管循环障碍,是非依赖型糖尿病易形成心梗、脑梗及其他微血管病的一种重要因素。     

Teriparatide vs. calcitonin in the treatment of Asian postmenopausal women with established osteoporosis

This study compared the clinical efficacy, safety, and tolerability of daily subcutaneous injections of teriparatide and salmon calcitonin in the treatment of postmenopausal women with established osteoporosis in Taiwan. This 6-month, multicenter, randomized, controlled study enrolled 63 women with established osteoporosis. They were randomized to receive either teriparatide 20 μg or calcitonin 100 IU daily in an open-label fashion. Lumber spine, femoral neck, total hip bone mineral density (BMD), and biochemical markers of bone turnover were measured, and adverse events and tolerability were recorded. The results at 6 months showed that patients using teriparatide had larger mean increases in spinal BMD than those who used calcitonin (4.5% vs. 0.1%), but the BMD changes in these two groups at the femoral neck and the total hip were not significant. There were also larger mean increases in bone markers in the teriparatide group than in the calcitonin group (bone specific alkaline phosphatase 142% vs. 37%; osteocalcin 154% vs. 23%). We conclude that teriparatide has more positive effects on bone formation than salmon calcitonin, as shown by the larger increments of lumbar spine BMD and bone formation markers, and caused only mild adverse events and no significant change in liver, kidney or hematological parameters. Compared with the published global results, teriparatide seems to be equally effective and safe to use in this Asian population.     

Bone growth patterns in Chinese children and adolescents: a 6-year follow-up study provides evidence for sexual dimorphism and tracking

Summary We prospectively examined bone growth patterns in 894 children aged 6–17 years at the baseline visit, with a 6-year follow-up. Results show bone “tracking” over a six-year interval and sexual dimorphism of bone attained levels and timing of peak bone growth. Our findings underscore childhood and adolescence as critical periods for building bone and developing gender differences. Introduction Bone growth patterns were prospectively examined in 894 Chinese children (496 males), aged 6–17 yrs, from a population-based twin cohort. Whole-body bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were measured by DEXA at baseline and a 6-yr follow-up. Methods Graphic smoothing plots and generalized estimating equations were used to model bone attained levels, growth, and “tracking”. Results Attained levels of BMC and BA increased curvilinearly with age. Male attained levels were higher than females after age ∼15 yr, but BMD was lower between 13–17 yrs (Tanner stage I to IV). In both genders, peak BMC and BMD growth lagged ∼2 yrs behind peak BA growth, which lagged 2 yrs behind peak height growth. Peak bone growth occurred 1–3 yrs later in males. Over the 6-yr follow-up, all bone measurements “tracked”, but “shifting” across ranks also occurred, and baseline tertile ranking influenced bone growth. Females with early menarche had higher attained levels than females with late menarche at age 12–13 yrs. Conclusion Our findings confirm and expand previous studies on peak bone growth conducted in Caucasian cohorts, particularly sexually dimorphic and maturational effects. The significant “tracking” of bone measurements in this 6-yr follow-up study underscores the importance that osteoporosis prevention should begin in childhood and adolescence. Fengxiu Ouyang and Binyan Wang contributed equally to this article. Source(s) of support: This study is supported in part by grant R01 HD049059, R01 HL0864619 and R01 AR045651 from the National Institute of Health and by the Food Allergy Project.