补骨脂酚的提取纯化工艺优选及其对骨质疏松症的治疗作用分析

目的:优选补骨脂酚的提取纯化工艺,并考察其对骨质疏松症的治疗作用。方法:使用乙醇回流法提取,经D101型大孔树脂纯化,通过单因素试验优选工艺条件,冷冻干燥后得到补骨脂酚;采用斑马鱼体内试验评价补骨脂酚对骨密度和骨骼发育钙化的影响。结果:优选的工艺条件为加8倍量85%乙醇浸泡过夜,回流提取3次,每次2 h,边搅拌边往补骨脂酚粗提物中加入0.2%氢氧化钠水溶液至完全溶解,过预处理好的D101型大孔树脂柱处理,上样流速1 BV·h~(-1),静置4 h,加水6 BV洗脱,用60%乙醇2 BV洗脱,加95%乙醇4 BV洗脱,收集95%乙醇的洗脱液;制备的补骨脂酚质量分数80%,收率10%。斑马鱼体内活性研究表明补骨脂酚能提高斑马鱼骨质疏松症的骨密度,且能促进正常斑马鱼骨骼发育钙化。结论:此工艺具有绿色环保、操作简便等优点,所得补骨脂酚的纯度和收率均比较理想,可开发成预防或治疗骨质疏松症的药品和食品。     

枸地氯雷他定片联合玉屏风胶囊治疗慢性荨麻疹临床研究

目的 探讨枸地氯雷他定片联合玉屏风胶囊治疗慢性荨麻疹的临床疗效。方法 将40例慢性荨麻疹患者按就诊顺序随机分为治疗组20例和对照组20例。对照组口服枸地氯雷他定片,治疗组在对照组治疗的基础上加用玉屏风胶囊,疗程均为4周;观察两组患者治疗前后症状（风团数目、风团大小、风团发生频率、风团持续时间、瘙痒程度）评分、血清免疫球蛋白E(immunoglobulin E, IgE)水平以及临床疗效。结果 治疗后两组症状评分均较治疗前显著减少（P＜0.05）;治疗组风团持续时间评分、总评分减少程度与对照组比较,差异有统计学意义（P＜0.05）。治疗后两组患者血清IgE水平均较治疗前显著降低(P＜0.05）,治疗组IgE水平降低程度较对照组更为明显（P＜0.05）。两组临床疗效比较,差异有统计学意义（P＜0.05）。结论 在单纯口服枸地氯雷他定片的基础上加用玉屏风胶囊治疗慢性荨麻疹的疗效较好。     

Is lead chelation therapy effective for chronic kidney disease? A meta‐analysis

The heavy metal lead (Pb) is a major environmental and occupational hazard. Epidemiological studies have demonstrated a strong association between lead exposure and the presence of chronic kidney injury. Some studies have suggested that chelation therapy with calcium disodium ethylenediaminetetraacetic acid (calcium disodium EDTA) might help decrease the progression of chronic kidney disease among patients with measurable body lead burdens. However, calcium disodium EDTA chelation in lead exposure is controversial due to the potential for adverse effects such as acute tubular necrosis. Therefore, we investigated the available randomized controlled trials assessing the renoprotective effects of calcium disodium EDTA chelation therapy. Our meta‐analysis shows that calcium disodium EDTA chelation therapy can effectively delay the progression of chronic kidney disease in patients with measurable body lead burdens reflected by increasing the levels of estimated glomerular filtration rate (eGFR) and creatinine clearance rate (Ccr). There appears to be no conclusive evidence that calcium disodium EDTA can decrease proteinuria.     

玉屏风颗粒结合枸地氯雷他定片治疗过敏性鼻炎临床研究

目的 评价玉屏风颗粒结合枸地氯雷他定片治疗过敏性鼻炎的疗效.方法 将符合入选标准的112例过敏性鼻炎患者按就诊顺序随机分为2组,每组56例.对照组口服枸地氯雷他定片,观察组在对照组基础上口服玉屏风颗粒.2组均治疗4周,随访6个月.分别于治疗前后评估中医症状积分,采用化学免疫发光法检测IgE水平,采用ELISA法检测血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)、IL-4、IL-10、白细胞三烯B4(leukotrienes B4,LTB4),评价临床疗效,记录随访期间的复发率.结果 观察组总有效率为94.6%(53/56)、对照组为80.4%(45/56),2组比较差异有统计学意义(Z=-3.254,P<0.01).治疗后,观察组流鼻涕[(1.2±0.1)分比(2.0±0.2)分,t=6.420]、鼻部瘙痒[(1.2±0.3)分比(1.7±0.3)分,t=7.003]、打喷嚏[(0.8±0.1)分比(1.3±0.1)分,t=6.716]、鼻塞[(1.1±0.1)分比(1.6±0.3)分,t=7.256]积分低于对照组(P<0.05);观察组血清IgE[(114.48±9.85)IU/ml比(130.64±10.51)IU/ml,t=6.994]、VCAM-1[(512.56±13.84)μg/L比(624.98±7.06)μg/L,t=7.803]水平低于对照组(P<0.05);观察组血清IL-4[(16.25±1.53)ng/L比(22.38±3.16)ng/L,t=5.458]、IL-10[(15.98±2.43)ng/L比(21.82±1.75)ng/L,t=6.149]、LTB4[(59.14±0.96)ng/L比(67.46±3.04)ng/L,t=5.342]水平低于对照组(P<0.05).随访6个月,观察组复发率为5.66%(3/53)、对照组为26.67%(12/45),2组比较差异有统计学意义(χ2=8.284,P=0.004).结论 玉屏风颗粒结合枸地氯雷他定片可有效改善过敏性鼻炎患者的临床症状,调节免疫功能,减少疾病复发.     

氯膦酸二钠脂质体清除巨噬细胞对小鼠造血干祖细胞归巢过程的影响

目的 探讨清除巨噬细胞对小鼠造血干祖细胞（hematopoietic stem/progenitor cells,HSPC）归巢过程的影响。 方法 免疫磁珠分选获得小鼠HSPC,使用羧基荧光素二醋酸盐琥珀酰亚胺酯（Carboxyfluorescein diacetate succinimide ester,CSFE）染色标记,采用氯膦酸二钠脂质体（clodronate liposomes,Clod）方法建立去除巨噬细胞的小鼠模型,通过流式细胞术检测HSPC移植的归巢效率,通过实时荧光定量逆转录酶链式反应方法和酶联免疫吸附测定方法检测去除巨噬细胞后骨髓微环境中CXCL12、SCF和人血管内皮细胞粘附分子1(vascular adhesion molecule 1,VCAM1)分子mRNA表达水平和蛋白表达水平的变化。 结果 氯膦酸二钠脂质体作用后第24小时和第48小时,小鼠骨髓中CD11b+F4/80+巨噬细胞数量显著减少（P＜0.05）;移植小鼠HSPC后,相较于对照组,去除巨噬细胞组小鼠HSPC归巢效率显著降低（P＜0.05）;同时去除巨噬细胞组小鼠骨髓微环境中CXCL12、SCF的mRNA和蛋白表达量比对照组显著降低（P＜0.05）,而VCAM1表达量无显著变化。 结论 去除巨噬细胞能够显著降低小鼠HSPC归巢效率,该作用可能与去除巨噬细胞后导致的骨髓微环境中CXCL12与SCF含量减少有关。     

Potential Adverse Effect of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) on Bisphosphonate Efficacy: An Exploratory Post Hoc Analysis From a Randomized Controlled Trial of Clodronate

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to have weak but beneficial effects on bone health, including fracture risk, but many epidemiological studies are likely confounded. We explored the relationship between NSAIDs and fracture risk in a post hoc analysis of a well-documented, randomized, placebo-controlled study of the bisphosphonate, clodronate, in which treatment reduced osteoporotic fracture risk by 23%. Concurrent medication use at baseline was used to identify those prescribed oral NSAIDs. Only verified, incident fractures were included in the analysis. A total of 1082 (20.8%) women reported use of NSAIDs at baseline. They were slightly, but significantly, younger (mean 79 versus 80 years, p = 0.004), heavier (mean 66.7 versus 64.7 kg, p < 0.001) than nonusers, with slightly higher femoral neck bone mineral density (FN-BMD, 0.66 versus 0.64 g/cm², p < 0.001). In an adjusted model, NSAID use was associated with a significant increase in osteoporotic fracture risk over the 3-year study period (hazard ratio [HR] 1.27; 95% confidence interval [CI], 1.01–1.62; p = 0.039). However, this increase in risk was not statistically significant in the placebo group (HR 1.11; 95% CI, 0.81–1.52). In women receiving clodronate, the effect of the bisphosphonate to reduce osteoporotic fracture risk was not observed in those receiving NSAIDs (HR 0.95; 95% CI, 0.65–1.41; p = 0.81) in contrast to those not using NSAIDs (HR 0.71; 95% CI, 0.58–0.89; p = 0.002). In a subset with hip BMD repeated at 3 years, BMD loss during clodronate therapy was greater in those women receiving NSAIDs than in nonusers (eg, total hip −2.75% versus −1.27%, p = 0.078; femoral neck −3.06% versus −1.12%, p = 0.028), and was not significantly different from that observed in women receiving placebo. The efficacy of the bisphosphonate, clodronate, to reduce fracture risk was largely negated in those receiving NSAIDs. Although the mechanism is unclear, this clinically significant observation requires exploration in studies of commonly used bisphosphonates. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Hyperintense HCC on hepatobiliary phase images of gadoxetic acid-enhanced MRI: Correlation with clinical and pathological features

Purpose

To retrospectively determine whether the hyperintense hepatocellular carcinomas (HCCs) seen on the hepatobiliary phase of gadoxetic acid-enhanced MR imaging (EOB-MRI) might have different histologic characteristics from usual hypointense HCCs.

Materials and methods

Two hundred three surgically proven HCCs from 192 patients who underwent preoperative EOB-MRI were analyzed. The demographic and histologic characteristics of hyperintense HCCs were compared with usual hypointense HCCs by using the t-test or Fisher's exact test.

Results

By visual assessment, 18 (8.8%) tumors were classified as hyperintense HCCs. Patients with hyperintense HCC were significantly (p < 0.05) older (60.1 vs. 55.2 years) than those with hypointense HCCs. Hyperintense HCCs showed significantly lower rate of microvascular invasion (27.8% vs. 53.5%) and significantly higher rate of peliosis (61.1% vs. 30.8%). Hyperintense HCCs were more frequently expanding type, and none showed infiltrative type or scirrhous histologic pattern.

Conclusions

Hyperintense HCCs seem to have clinical and histologic features that might be related with more favorable outcomes.     

Gd‐EOB‐DTPA‐enhanced MR imaging: Prediction of hepatic fibrosis stages using liver contrast enhancement index and liver‐to‐spleen volumetric ratio

Purpose:

To develop and evaluate a quantitative parameter for staging hepatic fibrosis by contrast enhancement signal intensity and morphological measurements from gadoxetic acid (Gd‐EOB‐DTPA)‐enhanced MR imaging.

Materials and Methods:

MR images were obtained in 93 patients; 75 patients had histopathologically proven hepatic fibrosis and 18 patients who had healthy livers were evaluated. The liver‐to‐muscle signal intensity ratio (SI_post = SIliver/SImuscle), contrast enhancement index (CEI = SIpost/SIpre), and liver‐to‐spleen volumetric ratio (VR = Vliver/Vspleen) were evaluated for staging hepatic fibrosis.

Results:

VR was most strongly correlated with fibrosis stage (7.21; r = ?0.83; P < 0.001). Sensitivity, specificity, and area under the ROC curve demonstrated by linear regression formula generated by VR and CEI in predicting fibrous scores were 100%, 73%, and 0.91, respectively, for the detection of hepatic fibrosis F1 or greater (≥ F1),100%, 87%, and 0.96 for ≥ F2, 74%, 98%, and 0.93 for ≥ F3 and 91%, 100%, and 0.97 for F4.

Conclusion:

The liver‐to‐spleen volumetric ratio and contrast enhancement index were reliable biomarkers for the staging of hepatic fibrosis on Gd‐EOB‐DTPA‐enhanced MR imaging. J. Magn. Reson. Imaging 2012;36:1148–1153. © 2012 Wiley Periodicals, Inc.

     

Prediction of microvascular invasion of hepatocellular carcinoma: usefulness of peritumoral hypointensity seen on gadoxetate disodium-enhanced hepatobiliary phase images

Purpose:

To determine whether peritumoral hypointensity seen on hepatobiliary phase images of preoperative gadoxetate disodium‐enhanced magnetic resonance imaging (EOB‐MRI) is useful for predicting microvascular invasion of hepatocellular carcinoma (HCC).

Materials and Methods:

This study was approved by the Institutional Review Board. In all, 104 HCC masses in 104 patients who had undergone EOB‐MRI and liver surgery within 1 month after EOB‐MRI were evaluated. Two radiologists independently recorded the presence of a peritumoral hypointensity on hepatobiliary phase. Interobserver agreement was assessed and consensus records were used. Tumor size was measured. A chi‐square test and independent t‐test were used for univariate analysis. Multiple logistic regression was performed to determine factors for predicting microvascular invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of peritumoral hypointensity were calculated.

Results:

Sixty HCCs had microvascular invasion and 44 did not. Interobserver agreement in determining peritumoral hypointensity was excellent (κ = 0.83). By univariate analysis, peritumoral hypointensity and tumor size were significant for predicting microvascular invasion of HCC. On multiple logistic regression analysis, only peritumoral hypointensity was significant in predicting microvascular invasion of HCC (P = 0.013). The sensitivity, specificity, PPV, and NPV of peritumoral hypointensity were 38.3%, 93.2%, 88.5%, and 52.6%, respectively.

Conclusion:

Peritumoral hypointensity on the hepatobiliary phase of EOB‐MRI is not sensitive but has high specificity for predicting microvascular invasion of HCC. J. Magn. Reson. Imaging 2012;35:629‐634. © 2011 Wiley Periodicals, Inc.