儿童1型糖尿病骨密度变化及影响因素分析

目的 测定儿童1型糖尿病(T1DM)患者骨密度(BMD),分析探讨骨密度变化的影响因素。方法 选取于2018年1月—2021年6月于我院收治的儿童1型糖尿病患者76例,收集性别、年龄、发病年龄、身高、体重、BMI、病程等基本资料,检测空腹血糖、空腹C肽、糖化血红蛋白(HbA1c)、血碳酸氢根(HCO3-)、血清碱性磷酸酶(ALP),应用双能X线吸收测定法测定骨密度,获取Z值。结果 76例儿童1型糖尿病患者骨密度Z值为-0.93±2.14。HbA1c、病程与骨密度Z值呈负相关,差异具有统计学意义(分别B=-0.334,P<0.001;B=-0.191,P=0.017)。结论 儿童1型糖尿病患者骨密度低于健康儿童,血糖控制不良、病程长是1型糖尿病儿童骨密度减低的危险因素。     

Biomechanical comparison of stemless humeral components in total shoulder arthroplasty

BackgroundThe purpose of this study was to compare initial fixation strength between various stemless and stemmed humeral components and to correlate implant fixation strength with bone mineral density (BMD).MethodsFive humeral stem designs were investigated: Stemless-A (four hollow fins), Stemless-B (central body, three solid fins), Stemless-C (central screw, peripheral rim-fit), Short stem (50 mm), and Standard stem (130 mm). Fifty cadaveric human humerii were obtained and divided into five groups. BMD within the humeral head was determined for all samples. The mean BMD was similar between groups. The 25 samples with the lowest and highest BMDs were categorized as “Low” and “High,” respectively, with a BMD threshold of 0.35 g/cm², creating BMD subgroups. After implantation, each sample underwent a standardized biomechanical testing protocol, with axial loading followed by torsional loading. Sensors attached to the specimen recorded micromotion throughout testing. Axial loading consisted of cyclic loading for 100 cycles at 3 peak forces (220, 520, and 820 N). Torsional loading consisted of 100 cycles of internal/external rotation at 0.1 Hz at 6 peak torques, or until failure (±2.5, 5, 7.5, 10, 12.5, and 15 Nm). Failure was defined as the torque at which any bone fracture, implant detachment from anchor/stem, or an excess of 50° internal/external rotation occurred. Groups and BMD subgroups were compared.ResultsAt maximal axial loading, Stemless-B demonstrated greater micromotion (540 μm) than Stemless-C (192 μm) (P = .003). Stemless-B and Stemless-A (387 μm) also had greater micromotion than Short stem (118 μm, P < .001, P = .03) and Standard stem (85 μm, P < .001, P = .01). When comparing low-BMD samples at maximal axial loading, these differences were accentuated, but comparison of high-BMD samples showed no significant differences between groups. Torsional testing demonstrated that Standard stem failed at greater torque (7.2 Nm) than Stemless-B (2.3 Nm, P < .001), Stemless-A (1.9 Nm, P < .001), and Stemless-C (3.9 Nm, P = .01). When comparing torsional testing results of low-BMD samples, both Standard stem and Short stem failed at greater torque than Stemless-B (P = .02, P = .003) and Stemless-A (P = .03, P = .004) but failed at a similar torque to Stemless-C. Torsional testing of high-BMD samples showed that Standard stem failed at a greater torque than all stemless designs.ConclusionStemless humeral implants should be used with caution in low-BMD settings (<0.35 g/cm²). A central screw and peripheral rim-fit stemless anchor design demonstrated greater fixation strength at low BMD when compared with other designs, while all stemless designs performed similarly at high BMD.Level of evidenceBasic Science Study; Cadaveric Study     

郑州地区孕妇铁营养状况及其影响因素调查

目的 探讨郑州地区孕妇铁营养状况及其影响因素。方法 以2021年4—8月在郑州市某三家医院建立健康档案并进行孕期体检的孕妇作为研究对象进行问卷调查及铁营养状况检测,采用描述流行病学方法对孕妇铁营养状态进行分析,并采用单、多因素分析方法对孕妇铁缺乏状况影响因素进行分析。结果 共有3 258例孕妇参与本次研究,其中妊娠早期989例,占30.36%,妊娠中期1 125例,占34.53%,妊娠晚期1 144例,占35.11%。在3 258名孕妇中,共有773例为铁缺乏,铁缺乏的检出率为23.73%。多因素分析结果显示,年龄≥35岁（OR=2.726）、处于妊娠的中期或晚期（OR=3.037,3.438）、月经初潮年龄<13岁（OR=2.432）、经产妇（OR=3.493）、流产次数≥3次（OR=2.648）、孕前月经量≥100 mL/次（OR=2.420）、文化程度为初中及以上（OR=0.517,0.459）、居住在农村（OR=3.684）、家庭月收入>3 000元及以上（OR=0.601,0.542）、居住房屋装修时间<1年（OR=6.449）、罹患消化系统疾病（OR=4.716）、有营养补齐剂摄入（OR=0.355）是孕妇铁缺乏的影响因素。结论 郑州市孕妇铁缺乏检出率较高,需要尽早给予针对性的干预。部分因素被确定为该地区孕妇人群发生铁元素缺乏的影响因素,可选择性的对其中危险因素给予干预。     

Clinical efficacy of bisphosphonates and monoclonal antibodies on bone mineral density following skeletal fractures

BackgroundBisphosphonates and monoclonal antibodies are drugs primarily developed to inhibit osteoclast-mediated bone resorption and are used to treat an array of skeletal pathologies. Their use is aimed at increasing bone health and therefore reducing fracture risks. The aim of this study was to evaluate the effectiveness of bone protection therapy on improving bone mineral density (BMD) in patients following a fracture.MethodsInclusion criteria consisted of patients who sustained a skeletal fracture and were subsequently commenced on bone protection therapy. Dual-energy X-ray Absorptiometry (DEXA) scans were performed at baseline and following a consented period of drug therapy. Bone health data included T-Scores, Z-Scores, FRAX Major, FRAX Hip and BMD. The clinical effectiveness of four bisphosphonates (alendronate, risedronate, pamidronate and zoledronate) and one monoclonal antibody (denosumab) were evaluated.ResultsA total of 100 patients were included in the study. Overall, bone protection therapy significantly improved Z-score Hip, Z-score Spine, T-score Spine and BMD Spine (p < 0.05). There was a marked difference between drug therapies. Denosumab and zoledronate were associated with the greatest treatment effect size. Alendronate only improved Z-score Spine and Z-score Hip (p < 0.05). Pamidronate and risedronate did not demonstrate any statistically significant improvement across any DEXA parameter.ConclusionOverall, bisphosphonates/monoclonal antibodies confer beneficial effects on bone health as measured by DEXA scans in patients following skeletal fractures. However, the magnitude of improvement varies among the commonly used drugs. Alendronate, zoledronate and denosumab were associated with greatest therapeutic benefit. Bone protection therapy did not improve fracture risk of patients (FRAX scores).     

The increase in bone mineral density by bisphosphonate with active vitamin D analog is associated with the serum calcium level within the reference interval in postmenopausal osteoporosis

Objectives: To examine the factors associated with increase in lumbar spine bone mineral density (LS-BMD) by bisphosphonates (BPs) with active vitamin D analog (aVD).

Methods: Two independent postmenopausal osteoporotic patients treated by BPs with aVD for 24 months (Study 1: n?=?93, Study 2: n?=?99) were retrospectively analyzed.

Results: In Study 1, LS-BMD of the patients significantly increased for 24 m (5.4%, p?r²: 0.088, p?=?.02). While average sCa of the patients was 9.2?mg/dL before treatment, it increased time-dependently to 9.6?mg/dL for 24 m by treatment. As each patient had their LS-BMD five times during the study, there were four instances of %LS-BMD in each patient, resulting in 372 instances of %LS-BMD in Study 1. The smallest Akaike’s information criterion value for the most appropriate cut-off levels of sCa for %LS-BMD by treatment every 6 m was 9.3?mg/dL. The %LS-BMD by treatment for 6 m during 24 m period in patients with sCa ≥9.3?mg/dL (1.5%) was significantly higher than that in patients with sCa <9.3?mg/dL (0.8%, p?=?.038). The results of Study 2 were similar to those of Study 1, confirming the phenomena observed.

Conclusion: sCa was associated with an increased LS-BMD by BPs with aVD.     

Acquired acrodermatitis enteropathica due to zinc‐depleted parenteral nutrition

Well‐known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc‐depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re‐epithelialization of previously denuded skin.