中医药防治老年骨质疏松研究进展

骨质疏松症是中老年人的常见疾病,中医在该病防治方面主要从以下几方面分型:(1)肾主骨理论:肾为先天之本,肾主藏精,主骨生髓,与生殖、内分泌、性腺系统密切相关,肾的生理作用与骨的旺、盛、平、衰有极大的相关性。骨痿其标在骨,其本在肾。(2)脾肾相关论:脾为后天之本,主运化水谷精微。脾气散精,上输于肺,下归于肾,脾肾相互促进,相互依存,常有脾肾同病之说。脾肾虚弱是骨质疏松症的主要病理变化。(3)血瘀论:骨质疏松症患者脏腑功能失调,经气不利,影响气血运行,导致经络气血运行不畅,不通则痛,故常出现疼痛、功能障碍。血瘀可致气血运行障碍,营养物质不能濡养脏腑、骨骼,引起脾肾俱虚而加重骨质疏松症。(4)肝郁论:肝藏血主筋,肾藏精主骨,肝肾同下焦,精血可以互化,肝郁气滞,郁而化火,易灼伤肝阴而致肝阴不足,肝阴血亏虚,无以生精养骨,终致骨痿。因此临床用药灵活多变,但不出补肾壮骨、健脾益气、活血通脉、以及疏肝解郁的治疗大法。     

Tissue response to bioabsorbable self-reinforced polylevolactide and polyglycolide pins implanted intra-articularly and directly into the bone on different levels

Self-reinforced poly-l-lactide (SR-PLLA) and self-reinforced polyglycolide (SR-PGA) pins were implanted intra-articularly and directly into the bone of the distal femur of rats at three levels: above, on the same level, and under the surface. For the controls only channels were drilled, or the controls were not operated at all. The follow-up times were 3, 6, and 12 weeks for SR-PGA and 3, 6, 12, and 24 weeks for SR-PLLA. The macroscopic appearance and histologically the villus reaction, the mononuclear phagocytosis and giant cells, the neutrophils, the lymphocytes, the plasma cells, the eosinophils, and the mast cells were analyzed. In the histologic analysis, the most favorable implantation depth was found to be under the surface where the contact between the implants and bone was best, and the orifice was covered with new trabecular bone at 3 weeks. This was especially seen in intra-articular implantation. In general, the tissue responses were mild, and could also be explained in the statistical analysis by a normal postoperative tissue response and faster biodegradation of PGA. Received: 21 August 1997     

胫骨远端骨折应用交锁髓内钉固定时远端不同锁定钉状态的有限元分析

目的 探究胫骨远端骨折应用交锁髓内钉固定时远端不同锁定钉状态的稳定性及其生物力学特性。方法 选择一名健康成年男性的胫骨CT Dicom数据,应用mimics、geomagic和solidworks软件构建胫骨、髓内钉、锁定钉的3D模型,然后按照髓内钉远端不同锁定状态分为试验组（两枚横向锁定钉和一枚纵向锁定钉）和对照组（两枚横向锁定钉）,分别给予轴向、侧向和扭转方向的不同大小的载荷,以模拟正常人体胫骨和内固定系统在不同受力情况下的应力和位移分布情况。结果 试验组和对照组的应力分布没有明显差异,二者都集中在骨-螺钉结合部位,但试验组在轴向、侧向和扭转方向的不同大小的载荷下的最大等效应力均略低于对照组,在轴向300、600、900 N载荷下,试验组的最大等效应力为24.84、49.68、74.52 MPa,对照组的为27.80、55.51、83.27 MPa;在扭转2、4、6 N/m的载荷下,试验组的最大等效应力为144.87、290.92、431.80 MPa,对照组为146.01、292.03、434.80 MPa;在侧向300、600、900 N载荷下,试验组的最大等效应力为209.79、419.58、629.37 MPa,对照组为210.47、420.94、631.41 MPa。在形变位移方面,两组的内固定系统都没有发生明显形变,且试验组的最大位移均略小于对照组。在轴向300、600、900 N载荷下,试验组的最大位移为0.022 9、0.045 8、0.068 7 mm,对照组的为0.024 1、0.048 1、0.072 3 mm;在扭转2、4、6 N/m的载荷下,试验组的最大位移为0.217 8、0.428 8、0.597 8 mm,对照组为0.218 5、0.436 9、0.607 2 mm;在侧向300、600、900 N载荷下,试验组的最大位移为0.949 2、1.898 5、2.847 7 mm,对照组为0.952 5、1.905 0、2.857 6 mm。结论 通过应力和位移对比分析,在使用髓内钉固定胫骨远端骨折时,髓内钉远端固定两枚横向锁定钉已经提供了足够的稳定性,与使用三枚锁定钉相比,两枚锁定钉能减少额外的手术时间和不必要的辐射暴露。在实际情况中还需要手术医生结合临床的具体情况为病人选择最合适的手术方案。     

Forehead lifting: state of the art

Forehead lifting serves to restore a more youthful appearance as well as a more functional and aesthetically pleasing brow position. The purpose of this review is to describe the pertinent anatomy and forehead aesthetics, then to discuss the patient evaluation, surgical approaches, complications, and nonsurgical adjuncts. Anatomic features reviewed include the layers of the forehead and scalp, blood supply, innervation, musculature, and the temporal branch of the facial nerve anatomy. Forehead aesthetics described include the aging process, with its contributing factors and consequences, and the ideal brow position in women and men. Key aspects of the patient evaluation include assessment of skin type; ptosis; hairline, brow, and lid position; symmetry; and bony contours. Pertinent past medical/surgical history as well as family history are reviewed, and the need for ophthalmology evaluation is discussed. Surgical indications and approaches, including direct, coronal, mid-forehead, endoscopic, and trans-blepharoplasty, are reviewed. The advantages and disadvantages of each approach are discussed and techniques briefly described. Complications are mentioned, and the article concludes with a review of nonsurgical adjuncts.     

Phytoplankton abundance, dominance and coexistence in an eutrophic reservoir in the state of Pernambuco, Northeast Brazil

The present study reports the phytoplankton abundance, dominance and co-existence relationships in the eutrophic Carpina reservoir, Pernambuco, Brazil. Sampling was carried out at six different depths bimonthly at a single reservoir spanning two climatic periods: dry season (January, September, and November 2006) and rainy season (March, May, and July 2006). Density, abundance, dominance, specific diversity and equitability of the community were determined, along with chlorophyll a, and physical and chemical variables of the environment. Eight species were considered abundant, and their densities corresponded to more than 90% of the total phytoplankton community quantified. Cyanobacteria represented more than 80% of this density. Cylindrospermopsis raciborskii was the only dominant taxon in the dry season, and was co-dominant in the rainy season. C. raciborskii, Planktothrix agardhii and Geitlerinema amphibium had the greatest densities and lowest vertical variation coefficients. The statistical analysis indicated relationships with vertical and seasonal variations in the phytoplankton community and the following variables: total dissolved solids, water temperature, electrical conductivity and pH. The changes in the environmental variables were discrete and regulated by the establishment of precipitation however, they were able to promote vertical and seasonal instability in the structure of the phytoplankton community.     

异体手移植的手术设计与操作

目的 探讨异体手移植的手术设计与技术操作要点。方法 2例右手缺失病人行异体手移植,参照自体断腕再植的基本程序,依次受区准备、供手准备、移植手组织重建。骨骼再接平面位于桡尺骨离桡骨关节面2.5cm～3cm处,桡骨阶梯状截骨、螺钉固定,尺骨平面截骨、三棱针或钢板内固定;先缝合屈侧深肌腱,吻合尺、桡动脉后静脉放血,再吻合头、贵要静脉,缝合屈侧浅肌腱及伸侧肌腱,吻合神经,缝合皮肤。术后抗免疫排斥、抗感染、抗凝、抗血管痉挛。结果 手术时间分别为7h52min、9h10min,供手缺血时间6h、ah 19min。病例一移植手血循环良好;病例二术后3小时静脉危象,经手术恢复血循环。现术后8个月移植手存活良好,无免疫排斥反应发生,手握持功能及手部感觉已恢复,手内在肌功能部分恢复。结论 异体手移植的手术设计重点依据手缺失残端位置确定受一供体手移植平面,组织重建的顺序为骨骼、深肌腱、动脉、静脉、浅肌腱、神经和皮肤。     

双能X线骨密度仪精密度和准确度的研究

目的：通过测量长、短期精密度和短期准确度对双能X线吸收法（ dual－energy X－ray absorptiometry ,DXA）骨密度仪进行质量控制。方法①长期精密度：对质量保证（Quality Assurance,QA）模块连续1年的测试数据进行统计分析,分别计算其高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的变异系数（ coefficient of variation ,CV）;②短期精密度：取连续25天的QA模块测试数据,计算高、中、低骨密度平均值和标准差（standard deviation,SD）,制作Shewhart质控图。另外选取30名志愿者,分别测量L1－4椎体,双侧股骨颈、大粗隆、Ward＇s三角、全髋关节的骨密度（bone mineral density,BMD）值,计算均方根变异系数（ root mean square of the CV ,RMS－CV）;③短期准确度：取连续25天的QA模块测试数据,计算高、中、低骨密度的准确度。结果①长期精密度：QA模块测量高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的CV分别为0．37％、0．37％、0．41％、0．43％、0．47％、0．12％;②短期精密度：连续25天QA模块测试数据均符合Shewhart 法则;30例受试者L1－4椎体,双侧股骨颈、大粗隆、Ward＇s 三角、全髋关节各测量部位的RMS－CV 分别为1．3％、0．8％、0．9％、1．2％、1．3％、1．5％、1．6％、0．6％、0．6％;③短期准确度：连续25天QA模块测试数据的高、中、低骨密度的准确度分别为－0．07％、0．10％、0．60％。结论进行长、短期精密度和准确度测试能反映双能X线吸收骨密度仪的一致性和可靠性,可有效提高骨质疏松的流行病学研究、诊断、治疗、药物试验研究的可信度。     

Enteral nutrition in HPB surgery: past and future

Perioperative nutrition has, during the past century, been transformed from a tool to provide calorie and nitrogen support to a tool to boost the immune system and increase resistance to complications. Despite all the progress in medicine and surgery, perioperative morbidity, the rate of infections, thrombosis, and the development of serosal adhesions has remained the same as long as can be judged, or at least during the past 80 years. Most prone to develop complications are persons above the age of 65 and persons with depressed immunity. About 80% of the immune system is localized in the gastrointestinal tract, which offers great opportunities for modulation through enteral nutrition. As the stomach has a tendency to develop postoperative paralysis, tube feeding is often necessary. In 1918, Andresen demonstrated the advantages of enteral nutrition, which already started on the operating table. Mulholland and colleagues and Rhoads and co-workers demonstrated, during the 1940s, certain advantages of enteral tube feeding. Also, the works by Alexander, Fischer, and Ryan, and their co-workers supported the value of early enteral feeding, and suggested enteral feeding as an effective tool to boost the immune system. It was, however, works published in the early 1990s, by Moore and colleagues and by Kudsk and colleagues, which made surgeons more aware of the advantages of early enteral nutrition. Surgery in the hepatobiliary pancreatic field is known to have a high rate of complications. Uninterrupted perioperative nutrition, i.e., nutrition during the night before, during surgery, and immediately after, offers a strong tool to prevent complications. It is essential that the nutrition also provides food for the colon, e.g., fiber and healthy bacteria (probiotics) to ferment the fiber and boost the immune system. Received: February 19, 2002 / Accepted: March 8, 2002 Offprint requests to: S. Bengmark     

The brain: functional divisions

The incompletely separated cerebral hemispheres consist of a thin outer folded cortex of grey matter containing organized neuronal cell bodies and interneurons. Some of the surface convolutions subserve particular sensory or motor functions. Incoming afferent and projected efferent fibres constitute the underlying white matter, which connects different parts of each hemisphere, the hemispheres to each other and (as the corona radiata) to subcortical nuclei, especially components of the deeply-embedded diencephalon and the basal ganglia, and continuing between the latter as the internal capsule to and from the cerebellum and brainstem. Divisions of the diencephalon, the deeper part of the embryonic forebrain, include the epithalamus (pineal gland), the thalamus (connected extensively with the cortex), the subthalamus and the hypothalamus (involved in the autonomic nervous system, limbic system and neuro-endocrine system). The brainstem, consisting of the midbrain, pons and medulla, allows passage of many ascending and descending nerve fibre tracts between the brain and spinal cord, carrying sensory information from and allowing movement of the limbs and trunk. It is also the site of many of the cranial nerve nuclei, through which the brain innervates the head region. It houses the centres controlling vital aspects related to respiration, cardiovascular function and consciousness levels. The cerebellum also has a cortex of grey matter, tightly convoluted into folia, and containing layered neuronal cell bodies projecting laterally and, as underlying white matter, to a collection of deep nuclei. Fibres run to and from the cerebellar nuclei in a series of peduncles to the midbrain, pons and medulla, and allow the cerebellum to coordinate movement at an unconscious level.     

腹膜粘连的细胞机制研究进展

腹膜粘连（PA）是由手术、腹膜炎症、腹膜透析等引起的腹腔内受损组织和器官间的异常纤维性粘连带，其中手术是引发PA的主要原因。PA可引起不孕、肠梗阻、肠穿孔等临床并发症，二次松解手术为主要治疗方案，但易复发且存在多种并发症风险。近年来开发出一系列用于PA预防与治疗的药物和屏障材料，但防治效果尚不满意。抗PA药物会增加出血的风险，并抑制正常免疫功能，屏障材料虽然一定程度上缓解了PA进展，但因其不能持久覆盖腹膜损伤部位、降解不彻底等问题，不能达到抗PA的理想效果。因此在PA防治上需要新的突破。近期的研究表明PA是一系列事件综合作用的结果，包括血管损伤、血小板聚集、凝血级联反应、纤维蛋白沉积等过程，最终纤维蛋白和细胞外基质沉积形成粘连带，后期形成收缩性瘢痕并引发临床症状，上述事件中，参与PA的各种细胞发挥了关键作用。腹膜微环境中分布有腹膜间皮细胞（PMC）、中性粒细胞、嗜酸性粒细胞、T淋巴细胞、巨噬细胞、肥大细胞等。生理条件下，这些细胞成分对腹膜微环境的动态稳定具有重要意义。当细菌和异物侵入腹膜腔时，纤维蛋白和炎性细胞随腹腔液渗出以限制、清除并吸收异物，最终纤维蛋白被吸收，腹膜损伤正常愈合。病...     

Temporal and spatial changes in element distribution in bone and cartilage

Background  Bone and cartilage act as reservoirs for a number of elements, and the perturbation of these elements is suggested to contribute to various diseases. Even so, little is known about their respective temporal and spatial distribution. Methods  Three knee joints of three mice on the first day after birth, three knee joints of 3-week-old mice, and three knee joints of 20-week-old mice were prepared. We performed element mapping in the bone and cartilage of normal mouse knee joints. We measured element distribution in articular cartilage, trabecular bone, cortical bone, joint cartilage, growth plates, and joint cavities using energy dispersive X-ray spectrometry. Results  The analysis revealed the following: (1) The main elements in articular cartilage of 1-day-old mice were Na, O, P, S, and Ca; and those in bone were Na, O, P, S, K, Ca, and Mg. (2) The main elements in the growth plate of 3-week-old mice were Na, N, O, P, S, Cl, K, and Ca; those in joint cartilage were Na, O, P, S, Cl, and K; and those in bone were Na, O, P, Ca, and Mg. (3) The main elements in the growth plate of 20-week-old mice were Na, O, P, S, Cl, K, and Ca; and those in bone were Na, O, P, S, K, Ca, and Mg. After corrections were made for the Na ratios of these elements, we investigated the temporal and spatial changes in the distribution of each element. On the first day after birth, a spatial change was seen in the growth plate cartilage: the more the cartilage matured toward hypertrophy, the more S and Ca it contained. Temporal changes in element distribution in the growth plate cartilage, articular cartilage, and bone were observed. Growth plate cartilage of the older mice contained more S and Ca than that of the younger mice. Bone of the older mice contained more Ca and Mg than that of the younger mice. Spatial changes in element distribution in the cortical bone were also seen; that is, the more the cortical bone matured toward diaphysis, the more Mg and the less S it contained. In contrast, no temporal or spatial changes in element distribution were observed in the joint space. No significant temporal or spatial changes in the distribution of P, Cl, or K were seen. Conclusions  These results suggest that element mapping may be useful for identifying the age and maturity of different skeletal tissues. In particular, it may help distinguish between immature cartilage and mature cartilage based on the Ca and S contents.     

糖尿病合并骨质疏松的中医研究进展

随着全球老龄化进程，糖尿病合并骨质疏松在慢性疾病中发病率显著升高，其最常见的并发症之一骨折严重降低患者生活质量。现代医学治疗具有经济负担重、缺少前瞻性研究的缺点，而中医药治疗具有不良反应小、依从性高及价格适中等优点，具有临床多途径、多靶点治疗糖尿病合并骨质疏松的独特优势。近年来中医药有关其研究越来越多，在治疗上注重滋补肝肾，重视补阴药及活血药的运用，许多研究者结合现代医学的检验、检查指标证明了中药的疗效，而从单味药、药对或是复方着手的许多实验研究又证明其疗效通路机制，除此之外，针灸推拿等中医特色治疗也有改善糖代谢及骨代谢的作用。笔者从糖尿病合并骨质疏松的病因病机、辩证分析、治法、实验研究、临床研究及中医特色疗法等方面进行综合论述，深入认识糖尿病合并骨质疏松，能为其治疗提供一定的理论依据及临床参考。     

From the lumen to the laparoscope

Throughout the ages, the issues that have defined the management of disease processes have been particularly exemplified in the gastrointestinal tract. The use of gas lamps and candles with reflectors by Bozzini, Segalas, Cruise, and Fisher (19th century) allowed for some ingress into both the upper and lower gastrointestinal tract. Von Mikulicz, Leiter, Nitze, Kelling, and Jacobaeus contributed to the development of rigid instruments that could be used endoscopically or laparoscopically. Endoscopic efforts were amplified and extended by Rosenheim, Sternberg, Wolf, and, finally, Schindler, who not only introduced novel lens systems but also for the most part overcame the problems of flexibility and illumination. Bernheim, Ruddock, Veress, and Palmer made significant technical and clinical contributions to abdominal cavity exploration. The subsequent application of Hopkins and Kapany's work on optics, and the development by Hirschowitz and Curtiss of the flexible fiber optic endoscope, enabled the design of instruments that would allow the appropriate illumination and vision of both the farthest reaches of the bowel as well as the interior of the abdomen. Thus, the same endoscopic instruments coupled with a surgical interest in diagnostic laparotomy allowed for the evolution of minimally invasive surgery along a similar timescale. The cycle whereby diagnostic laparotomy in the early part of the century was supplanted by endoscopy and laparoscopy has now attained full circle whereby laparoscopy has evolved from a diagnostic procedure into one with major therapeutic applications and is perceived as the state-of-the-art technique for a wide variety of operations, including appendectomy, cholecystectomy, hernia repair, fundoplication, splenectomy, colectomy, and gastrointestinal anastomoses.     

Health Content Analysis of Organ Donation and Transplantation News on Turkish Television Channels and in Turkish Print Media

The media affects individuals' behaviors, especially by means of news and advertisements. In this study, we evaluated health content of organ donation and transplantation news in the printed media and on television programs for a 1-year period in Turkey. We examined 2449 news items in 230 newspapers and magazines; 1179 news programs on 45 television channels, all concerning organ donation and transplantation. The news obtained from the Media Pursuit Center were transferred to an electronic file to evaluate the format and content of the news. Nine variables were examined about the scope and the formal characteristics of the news: the publication name, its type, the province, the date, the headline, the title length, the presence of a photograph, or its kind, the news size, and the page number. In the content analysis of the news, we also examined 9 variables: the topic, the message of the headline, the property of the words in the title, the identification of photographs in the news, the age, gender of actors in the news, as well as donor or recipient. In a summary, print media and television channels, failed to show sufficient information about organ donation and transplantation. The percentage of news about organ donation and transplantation was small and mostly negative items in the media. On television channels, sufficient place was not given to organ donation and transplantation. The news in printed media and on television channels was not about motivated or altruistic behavior. The pattern of organ donation and transplantation news is important in terms of perception and comment by the public. Furthermore it directly affects the perception of the news by the reader.     

围绝经期女性骨密度特点分析

目的总结并分析围绝经期女性腰椎1-4、股骨颈及髋关节部位的骨密度(bone mineral density,BMD)及其临床特点。方法收集2017年12月至2018年6月在我院住院部住院并进行双能X线吸收法骨密度检测的183例围绝经期女性,分别测定其腰椎1-4总体BMD、左侧股骨颈及左髋关节全部BMD,同时分析比较年龄、体质量指数(body mass index,BMI)与骨质疏松的关系。结果 183例患者中,检出骨质疏松39例(21. 3%),其中腰椎1-4、左股骨颈和左髋关节BMD各检出骨质疏松33例(18. 0%)、20例(10. 9%)、13例(7. 1%)。腰椎总体骨质情况与股骨颈、髋关节检查结果相符的各有129例(70. 5%)、119例(65. 0%),股骨颈总体骨质情况与髋关节检查结果相符的有137例(74. 9%)。在骨质疏松组、骨量减少组和骨量正常组,同一组病人腰椎1-4骨密度左髋关节骨密度左侧股骨颈骨密度,组间差异均有统计学意义。年龄、BMI与骨质疏松的发生均相关。骨质疏松与年龄呈正相关,与BMI、腰椎1-4总BMD、左股骨颈BMD、左髋关节BMD负相关,腰椎1-4 BMD与骨质疏松相关程度最高。结论腰椎整体骨密度呈现虚假升高趋势,腰椎1-4 BMD诊断骨质疏松的敏感性和特异性分别为84. 6%、100%,股骨颈分别为51. 3%、100%,髋关节分别为33. 3%、100%;年龄增长、BMI偏低会增加围绝经期妇女罹患骨质疏松的风险。     

The haemodynamics of human septic shock

In the time it has taken medicine to develop the techniques to describe the circulatory changes of severe infections, both pattern and process have been profoundly influenced by the use of intravenous fluids, vasopressors, antibiotics, steroids, mechanical ventilation and haemoflltration. Constant features of severe sepsis include a reduction in peripheral vascular tone on both the arterial and venous sides of the circulation, a defect in oxygen utilisation resulting in lactic acidosis, and varying degrees of myocardial dysfunction. These events have a temporal progression, the precise pattern observed depending on the tempo of the infection, the influence of therapeutic manoeuvres, the age and comorbidities of the patient, and the time the observations are made in the course of events. Early sepsis is accompanied by a decrease in systemic vascular resistance and a metabolic acidosis. The clinical picture includes fever, tachycardia, tachypnoea, respiratory alkalosis and an increased cardiac output with warm, dry peripheries and a bounding pulse. Advanced sepsis involves varying degrees of venous and myocardial contractile failure, and is characterised by progressive acidaemia, respiratory failure and marked sympathetic adrenergic activation. In the absence of vigorous fluid resuscitation, the cardiac output is decreased and the patients are cold, clammy peripherally shut down, and frequently confused, obtunded or comatose. In infections with a silent primary focus (predominantly involving Gram-negative organisms), this stage is frequently the first to attract the attention of attending staff. Late sepsis is characterised by profound acidaemia, vascular hypo-responsiveness, multiple organ failure and death.     

Melanoma of palms, soles, and nail-beds.

The clinical and histological characteristics of palmar, plantar, and subungual melanomas treated in the division of plastic surgery of Helsinki University Hospital between 1970 and 1984 were analysed. The peak incidence was during the seventh decade of life, and the mean delay between the onset of symptoms and the diagnosis was one year. The delay was as much the fault of the physician as of the patient. The observed and relative five-year-survival rates for all 31 patients were 60% and 67%, and the 10-year-survival rates 39% and 49%, respectively. There were 15 cases of the acral lentiginous subtype, and the observed and relative five-year-survival rates were 65% and 71%, and the 10-year-survival rates 48% and 64%, respectively. For the nodular melanomas (n = 11) the survival rates were 53% and 60%, and 39% and 53%, respectively. For the three superficial spreading melanomas they were 50% and 52%, and 25% and 28%, respectively. Microstaging criteria (Breslow and Clark) were both good prognostic indicators. The series was too small for multivariate analysis.