Total body calcium in patients with inflammatory bowel disease: a longitudinal study.

1. Serial measurements of total body calcium have been made by prompt gamma-neutron activation analysis in 13 patients with inflammatory bowel disease over a mean period of 23 months. Changes in spinal trabecular bone mineral density and radial shaft bone mineral content were also assessed by using quantitative computed tomography and single photon absorptiometry, respectively. 2. The mean annual decreases (95% confidence intervals) were: total body calcium, 7.8% (-12.0 to -3.7%; P less than 0.001); spinal trabecular bone mineral density, 2.5% (-5.0 to +0.1%; 0.05 less than P less than 0.1), radial bone mineral content, 2.1% (-3.4 to -0.8%; P less than 0.01). 3. No significant correlations were found between rates of change of the three variables. However, there were significant positive correlations between the baseline values for total body calcium and radial bone mineral content (r = 0.638, P less than 0.05), spinal bone mineral density and radial bone mineral content (r = 0.854, P less than 0.01), and total body calcium and spinal bone mineral density (r = 0.876, P less than 0.001). 4. These results demonstrate rapid decreases in total body calcium in patients with inflammatory bowel disease which, in conjunction with the significant decrease in radial shaft bone mineral content, indicate increased rates of cortical bone loss. Whilst values for bone mass at different skeletal sites showed positive correlations within individuals, no relationship was found between the rates of change in bone mass at these sites. 5. The rapid bone loss observed in some subjects emphasizes the importance of early detection of osteoporosis by bone densitometry and the need for effective prophylactic measures to be established in this group of patients.     

Primary hyperparathyroidism: evaluated by 47Calcium kinetics, calcium balance and serum bone-Gla-protein

Combined 47Calcium kinetic and calcium balance studies with correction for dermal calcium loss were performed in thirteen patients with primary hyperparathyroidism (PHP), in whom serum bone-Gla-protein (S-BGP) was measured, and in ten matched controls. Dietary calcium was normal in PHP but both net (7.9 +/- 1.4 mmol Ca day-1 in PHP v. 3.5 +/- 0.9 mmol Ca day-1 in normals (mean +/- SE] and true (11.1 +/- 1.6 v. 6.8 +/- 0.9 mmol Ca day-1) intestinal absorbed calcium were enhanced (P less than 0.05). The renal calcium excretion (10.9 +/- 0.8 v. 5.1 +/- 0.4 mmol Ca day-1, P less than 0.001) and the dermal calcium loss (2.5 +/- 0.3 v. 1.5 +/- 0.1 mmol Ca day-1, P less than 0.02) were increased in PHP. Both patients and controls were in a negative calcium balance (P less than 0.01 and P less than 0.001, respectively) without any difference between the groups (P greater than 0.10). Mineralization (12.0 +/- 1.7 v. 4.8 +/- 0.8 mmol Ca day-1, P less than 0.02) and resorption rates (17.6 +/- 2.5 v. 7.9 +/- 0.6 mmol Ca day-1, P less than 0.02) were increased in PHP and S-BGP correlated positively to both variables (r = 0.64, P less than 0.05 and r = 0.62, P less than 0.05, respectively). Serum immunoreactive parathyroid hormone correlated positively to serum calcium (r = 0.69, P less than 0.01) but not to the calcium kinetic data.     

The effect of weight loss, operation and parenteral nutrition on fat clearance in patients with colorectal cancer

1. Fractional fat clearance rate (K2) in 21 patients with colorectal cancer was studied using the intravenous fat tolerance test. 2. K2 showed a negative correlation with weight change (r = -0.736, P less than 0.001) with the tumour in situ. 3. Fourteen patients were retested 12 weeks after curative resection of their tumours. Eight of the fourteen patients had raised K2 values pre-operatively; in all these the K2 values were reduced post-operatively (pre-operative median 3.94%/min, range 2.63-7.20%/min, post-operative median 2.31%/min, range 1.57-5.36%/min, P less than 0.01 by Wilcoxon's signed rank test). A high pre-operative K2 value was associated with a large reduction in K2 post-operatively (r = -0.844, P less than 0.001). 4. Seven patients with relatively high K2 values received a pre-operative course of intravenous nutrition after which K2 values were significantly reduced (pre-feeding median 7.20%/min, range 4.72-12.12%/min, post-feeding median 4.44%/min, range 2.17-6.83%/min, P less than 0.05).     

Assessment of vitamin D and calcium status in healthy adult Austrians

BACKGROUND: Because there is reason to assume that also in Austria calcium and vitamin D malnutrition is wide-spread, we initiated a comprehensive study on calcium and vitamin D status in relation to bone health in a large group of the normal adult population. SUBJECTS AND METHODS: We assessed dietary calcium and vitamin D intake, serum concentrations of Ca2+, phosphate, alkaline phosphatase, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), follicle-stimulating hormone (FSH), sex hormones and bone mineral density (BMD) by double-energy X-ray absorptiometry at five different skeletal sites in 648 females and 400 males (age 21-76 years). RESULTS: Mean daily intake of vitamin D (101 IU, range 0.2-320) and calcium (569 mg, range 40-2170) was significantly less than the respective recommended dietary allowances. Two hundred and seventy-one (26%) individuals had hypovitaminosis D with serum 25(OH)D < 12 ng mL(-1), while serum Ca2+ was less than normal in 82 (7.8%) subjects. Multiple regression analysis revealed significant correlations between mean calcium intake and BMD in the femoral region in the men (r = 0.13, P < 0.05) though not in the women. No consistent data could be obtained for associations between BMD and vitamin D status, except for 25(OH)D and BMD at the spine in the men (r = 0.10, P < 0.05). 25(OH)D correlated negatively (P < 0.05) with age in the women (r = -0.11) and with PTH in the women (r = -0.11) and men (r = -0.16). Inversely, a significant (P < 0.001) age-related increase in PTH was observed in both sexes (men, r = 0.19; women, r = 0.14). CONCLUSIONS: Prevalence of hypovitaminosis D in adult Austrians is an imminent risk for development of secondary hyperparathyroidism with advancing age, and requires timely correction of nutritional deficits.     

部分小肠微创切除在绞窄性腹股沟疝患者中的应用研究

目的探讨腹腔镜部分小肠切除术联合开放式无张力疝修补对绞窄性腹股沟疝患者的应用研究。方法选取2008年1月-2015年12月于该院收治的98例绞窄性腹股沟疝患者作为研究对象,根据手术方案分为微创组(n=41,腹腔镜部分小肠切除术联合开放式无张力疝修补术)和开腹组(n=57,开放式小肠切除术联合Bassini修补术)。比较两组术前基线资料、手术时间、术后并发症、术后住院天数、生存状况和疝复发率。结果两组术前基线资料比较,差异均无统计学意义(P0.05),具有可比性。微创组的术后慢性疼痛不适的发生率、复发率均明显低于开腹组,差异均有统计学意义(P0.05)。两组的手术时间、切口感染、腹股沟淤血或血肿发生率、术后住院天数和围手术期死亡率等资料比较,差异均无统计学意义(P0.05)。结论对绞窄性腹股沟疝患者而言,腹腔镜部分小肠切除术联合开放式无张力疝修补术不仅能充分利用无张力补片修补的优点,并避免了肠管切除对补片的污染,降低了感染和复发风险,值得临床推广应用。     

复发-缓解型多发性硬化与复发型视神经脊髓炎脑深部灰质核团铁沉积的ESWAN对比定量分析

目的用3.0T MR 3D增强型T2*加权血管成像(ESWAN)相位图测量复发-缓解型多发性硬化(RRMS)与复发型视神经脊髓炎(RNMO)患者脑深部灰质核团的铁含量。方法选取RRMS患者50例(RRMS组)、RNMO患者50例(RNMO组)和年龄、性别相匹配的50名健康志愿者(对照组)行常规MR ESWAN扫描。以上3组分别分为20～39岁和40～59岁两个亚组,测量双侧苍白球(GP)、壳核(PUT)、尾状核头(HCN)、丘脑(THA)、黑质(SN)、红核(RN)及齿状核(DN)的平均相位值(MPVs),比较3个研究组间上述核团MPV在同年龄亚组间的差异。结果 RRMS患者20～39岁组双侧SN与同年龄对照组(左:t=-5.04,P<0.01;右:t=-2.82,P=0.02)和RNMO组(左:t=-4.79,P<0.01;右:t=-3.27,P=0.01)差异有统计学意义(P<0.05);同年龄RNMO患者脑深部核团MPVs均低于对照组,但差异均无统计学意义(P>0.05)。RRMS患者双侧HCN(左:r=-0.42,P=0.01;右:r=-0.43,P=0.01)和双侧DN(左:r=-0.42,P=0.02;右:r=-0.36,P=0.04)的MPV与病程呈负相关,但其扩展残疾状态量表评分与脑深部核团MPV未见明显相关性(P>0.05);RNMO患者脑深部各核团MPV与病程之间亦未见明显相关性(P>0.05)。结论 ESWAN相位图可量化评价脑铁含量;探讨上述两种病变深部灰质核团铁沉积的变化有助于理解脑深部灰质核团的病理改变。     

低位直肠癌腹腔镜与开腹根治术的疗效比较

目的:比较低位直肠癌腹腔镜与开腹根治术的临床疗效.方法:回顾分析广东省人民医院2006年6月至2008年12月收治的101例低位直肠癌患者的临床资料.结果:根据随机数字表进行分组,52例接受腹腔镜手术,49例接受传统开腹手术.腹腔镜手术组中2例(3.8％)中转开腹手术.腹腔镜手术组术中出血量为(90±40) mL,明显少于开腹手术组的(270±140)mL (P=0.023).腹腔镜手术组48 h肛门排气的患者占46.2％(24/52),明显高于开腹手术组的18.4％(9/49)(P=0.003).开腹手术组需要使用止痛药止痛的患者占55.1％(27/49),明显高于腹腔镜手术组的17.3％(9/52)(P=0.000).腹腔镜手术组平均总住院时间为(8.7±5.5)d,明显短于开腹手术组(12.5±7.3)d(P=0.028).两组其他临床病理因素(性别、年龄、收获淋巴结的数目、TNM分期和术后并发症的发生率)的差异无统计学意义(P＞0.05).结论:腹腔镜低位直肠癌根治术较开腹手术具有术中出血少、术后痛苦少和恢复快等优点,同时能达到根治的要求.     

Intraplatelet serotonin in patients with diabetes mellitus and peripheral vascular disease

Intraplatelet serotonin (5-HT) content was determined in 23 patients with type I (insulin-dependent) diabetes mellitus (IDDM), 23 patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM), 29 patients with peripheral vascular disease (PVD) and 34 age-matched normal subjects. Intraplatelet 5-HT content in normal subjects showed an age-related decline (r = -0.45; P less than 0.008), as has been previously demonstrated. The median 5-HT content in platelets of the young normal subjects was 4.36 (range: 3.62-6.79) nmol 10(-9) platelets, while that in the elderly normal subjects was 3.87 (range: 2.8-6.0) nmol 10(-9) platelets and that in young + elderly subjects was 4.05 (range: 2.8-6.8) nmol 10(-9) platelets. The median intraplatelet 5-HT content was significantly lower (P less than 0.002) in IDDM patients: 3.0 (range 1.3-6.3), NIDDM patients: 2.5 (range 1.7-5.8), PVD patients: 2.42 (range 0.94-4.98) nmol 10(-9) platelets than that in all young + elderly healthy subjects. The presence of hypertension in DM patients caused a small but significant (P less than 0.05) decrease in intraplatelet 5-HT content, whilst its presence had no effect in PVD patients. In a smaller study, it was established that NIDDM and PVD patients have significantly (P less than 0.002) greater plasma 5-HT concentrations than controls. Insulin-dependent diabetes mellitus patients had greater plasma 5-HT concentrations but this did not achieve statistical significance despite a 66% increment in its value.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metabolic balance studies of mineral supplementation in osteoporosis.

1. We studied the effect of mineral supplementation and its duration in osteoporosis by analysing the calcium and phosphorus balances of 49 treated osteoporotic patients whose median length of calcium treatment was 19 weeks with a range of 8 days to over 4 years. Forty-four studies satisfied statistical criteria of reproducibility and included 35 women (10 also receiving oestrogen replacement therapy) and nine men. 2. Mean calcium balance was positive in women taking calcium supplements alone, +1.9 +/- 2.5 mmol daily (P less than 0.002), and was significantly more positive (P less than 0.05) in women also taking oestrogens, +4.2 +/- 2.1 mmol daily. Calcium balance was not significantly positive in men. 3. Calcium balance correlated negatively with duration of supplementation, but significantly, only when duration of supplementation was expressed logarithmically (r = -0.401, P less than 0.01) giving the regression equation y = 4.2-1.6 log x, where y = calcium balance in mol/day and x = duration of supplementation in weeks. Theoretical net calcium retention, without allowance for dermal loss, could be calculated by integration. 4. Mean phosphorus balance was significantly positive in both groups of women and in the whole population. Although its correlation with duration of supplementation did not reach statistical significance (P less than 0.1), the ratio of the regression slopes for calcium and phosphorus, 1.5:1, corresponded to their molar ratio in bone. 5. These statistics are, we believe, the first to describe an exponential decline in calcium balance during mineral treatment of osteoporosis, but they firmly suggest that such treatment, with or without oestrogen therapy, conveys temporary benefit.     

Calcium and magnesium in essential hypertension

1. Because disturbances of calcium metabolism have been described in hypertension, measurements of plasma and serum concentrations of ionized calcium, total calcium, magnesium and renin were made in 38 patients with essential hypertension and age- and sex-matched control subjects. Urinary excretion of calcium, magnesium and sodium was also determined. 2. The mean serum concentration of ionized calcium was 1.23 +/- 0.04 (SD) mmol/l in the hypertensive group and 1.21 +/- 0.03 mmol/l in controls, and results were similar after correction for pH. There was a weak positive correlation between serum ionized calcium (pH 7.4) and systolic pressure (r = 0.26, P less than 0.02), but no correlation with plasma renin concentration. 3. Although the difference between serum total calcium concentration in the hypertensive (2.29 +/- 0.09 mmol/l) and control (2.26 +/- 0.07 mmol/l) subjects was not significant, there was a significant correlation between total calcium and systolic pressure (r = 0.23, P less than 0.05) which was maintained after correction for other variables. 4. There were no differences in plasma concentrations of parathyroid hormone or 1,25-dihydroxycholecalciferol between hypertensive and control subjects. 5. The hypertensive group showed higher urinary excretion of calcium (5.9 +/- 3.0 mmol/24 h) than controls (4.6 +/- 1.7 mmol/24 h), but the difference was not maintained after correction for sodium excretion. 6. Serum concentrations of magnesium were similar in the two groups, but urinary excretion of magnesium was significantly lower in hypertensive (3.7 +/- 1.3 mmol/24 h) than control (4.5 +/- 1.6 mmol/24 h) subjects and there was an inverse correlation between magnesium excretion and blood pressure (r = 0.3-0.35, P less than 0.01).     

腹腔镜下根治术对结直肠癌患者胃肠功能、氧化应激及免疫功能的影响

目的探讨腹腔镜下根治术对结直肠癌患者胃肠功能、氧化应激及免疫功能影响。 方法前瞻性研究选择2018年1月至2020年12月邢台市人民医院收治的结直肠癌患者113例,依据随机数字表法随机分为腹腔镜组57例与开腹组56例。腹腔镜组实施腹腔镜下结直肠癌根治术治疗,开腹组实施开腹结直肠癌根治术治疗。记录2组围术期指标（包括术中出血量、手术时间和住院时间）,术后胃肠功能恢复情况,术后并发症情况;术前、术后24 h和术后72 h胃肠激素（胃泌素和胃动素）、氧化应激［超氧化物歧化酶（SOD）和丙二醛（MDA）］和免疫功能［免疫球蛋白A（IgA）、免疫球蛋白G（IgG）和免疫球蛋白M（IgM）］变化。 结果腹腔镜组术中出血量少于开腹组,手术时间和住院时间短于开腹组（P＜0.05）。腹腔镜组排气时间和进食时间短于开腹组（P＜0.05）。腹腔镜组术后并发症少于开腹组（P＜0.05）。腹腔镜组术后24 h和术后72 h患者胃泌素和胃动素水平高于开腹组（P＜0.05）。腹腔镜组术后24 h和术后72 h患者SOD水平高于开腹组,而MDA水平低于开腹组（P＜0.05）。腹腔镜组术后24 h和术后72 h患者IgA、IgG和IgM水平高于开腹组（P＜0.05）。 结论腹腔镜下根治术可促进结直肠癌患者胃肠功能恢复,术后并发症少,及对患者氧化应激和免疫功能影响小。     

Cholesterol enrichment increases basal and agonist-stimulated calcium influx in rat vascular smooth muscle cells.

The effect of cholesterol enrichment on vascular smooth muscle cell (VSMC) calcium homeostasis was studied by evaluating calcium uptake, efflux, and intracellular content in cultured VSMC derived from the rat pulmonary artery. Incubation of VSMC with liposomes consisting of free cholesterol (FC) and phospholipid (2:1 molar ratio, 1 mg FC/ml medium) for 24 h resulted in a 69 +/- 19% increase (P less than 0.01; n = 10) in FC which was associated with a 73 +/- 11% increase (P less than 0.005; n = 10) in intracellular calcium content as assessed by isotopic equilibrium with 45Ca2+ and a 65 +/- 11% increase (P less than 0.024; n = 3) as assessed by atomic absorption spectroscopy. Cholesterol enrichment caused a marked increase in the unidirectional calcium uptake rate from 0.026 +/- 0.03 to 0.158 +/- 0.022 nmol calcium/s per mg protein (P less than 0.01; n = 3), but had no effect on calcium efflux. Nifedipine (1 microM) reduced (P less than 0.05; n = 6) the effect of cholesterol enrichment on unidirectional calcium uptake by 78 +/- 16%; and verapamil (10 microM), diltiazem (1 microM), and nifedipine (1 microM) each significantly inhibited the effect of cholesterol enrichment on intracellular calcium accumulation. Exposure of cholesterol-enriched VSMC to cholesterol-poor liposomes for 24 h returned both FC and calcium contents to control levels. Serum- and serotonin-stimulated calcium uptakes were potentiated 3.7- and 1.7-fold, respectively, in cholesterol-enriched VSMC, whereas endothelin, vasopressin, and thrombin-stimulated calcium uptakes were not affected. We conclude that VSMC FC content plays a role in regulating cellular calcium homeostasis, both under basal conditions and in response to selected agonists.     

Relationship of lipoprotein(a) to variables of coagulation and fibrinolysis in a healthy population.

In the Prospective Cardiovascular Münster (PROCAM) study, serum lipoprotein(a) [Lp(a)] and its relationship to pro- and anticoagulatory as well as fibrinolytic indices were determined in a large group of employees: 864 men (m) and 373 women (f), ages 16-65 years. Univariate statistical analysis showed Lp(a) concentration to be associated with fibrinogen concentrations in both sexes (m: r = 0.08, P less than 0.05; f: r = 0.20, P less than 0.001), but not with euglobulin fibrinolysis activity, tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), or the split products of cross-linked fibrin (d-dimer). In women only, Lp(a) was significantly correlated with antithrombin III (r = 0.15, P less than 0.01) and Protein C (r = 0.17, P less than 0.01). Further sex-related differences were seen in the relationship between Lp(a) and age (m: r = 0.05; f: r = 0.23, P less than 0.001) and body mass index (m: r = 0.01; f: r = 0.19, P less than 0.001), primarily as a consequence of remarkable differences of Lp(a) concentrations between postmenopausal (mean = 79.4 mg/L) and premenopausal women (mean = 51.5 mg/L, P = 0.001). Multiple-regression analysis demonstrated a significant negative correlation of Lp(a) to PAI-1 (m: beta = -0.12, P less than 0.01; f: beta = -0.14, P less than 0.05) and a positive correlation to cholesterol (m: beta = 0.18, P less than 0.001; f: beta = 0.17, P less than 0.01) and systolic blood pressure (m: beta = 0.08, P less than 0.05; f: beta = 0.11, P less than 0.05).     

Impaired insulin-stimulated muscle glycogen synthase activation in vivo in man is related to low fasting glycogen synthase phosphatase activity.

Insulin-mediated glycogen synthase activity in skeletal muscle correlates with the rate of insulin-mediated glycogen deposition and is reduced in human subjects with insulin resistance. To assess the role of glycogen synthase phosphatase as a possible mediator of reduced glycogen synthase activity, we studied 30 Southwestern American Indians with a broad range of insulin action in vivo. Percutaneous biopsies of the vastus lateralis muscle were performed before and during a 440-min euglycemic clamp at plasma insulin concentrations of 89 +/- 5 and 1,470 +/- 49 microU/ml (mean +/- SEM); simultaneous glucose oxidation was determined by indirect calorimetry. After insulin stimulation, glycogen synthase activity was correlated with the total and nonoxidative glucose disposal at both low (r = 0.73, P less than 0.0001; r = 0.68, P less than 0.0001) and high (r = 0.75, P less than 0.0001; r = 0.74, P less than 0.0001) plasma insulin concentrations. Fasting muscle glycogen synthase phosphatase activity was correlated with both total and nonoxidative glucose disposal rates at the low (r = 0.48, P less than 0.005; r = 0.41, P less than 0.05) and high (r = 0.47, P less than 0.05; r = 0.43, P less than 0.05) plasma insulin concentrations. In addition, fasting glycogen synthase phosphatase activity was correlated with glycogen synthase activity after low- (r = 0.47, P less than 0.05) and high- (r = 0.50, P less than 0.01) dose insulin stimulations. These data suggest that the decreased insulin-stimulated glucose disposal and reduced glycogen synthase activation observed in insulin resistance could be secondary to a low fasting glycogen synthase phosphatase activity.     

Eel calcitonin suppresses plasma human calcitonin levels in medullary carcinoma of the thyroid

The effects of synthetic [Asu1,7]-eel calcitonin (0.5 MRC unit/kg body weight intravenously for 30 min) on circulating levels of human calcitonin, calcium and gastrin were investigated in five patients with medullary carcinoma of the thyroid. Blood samples were obtained before and 15, 30, 60, 90, 120 and 180 min after commencement of infusion of [Asu1,7]-eel calcitonin. Plasma levels of human calcitonin were measured by radioimmunoassay. Cross-reactivity with [Asu1,7]-eel calcitonin in this assay was negligible. On infusion of [Asu1,7]-eel calcitonin, the mean plasma level of human calcitonin decreased significantly to 71.0 +/- 8.7% of the basal level (mean +/- SEM, P less than 0.05) after 30 min and 68.4 +/- 25.4% of the basal level (P less than 0.05) after 60 min. The serum calcium level also decreased significantly, but lagged behind the decrease of human calcitonin, being 95.1 +/- 0.7% of the basal level (P less than 0.01) at 120 min and 94.8 +/- 0.6% of the basal level (P less than 0.02) at 180 min. The mean plasma gastrin level did not change significantly on infusion of [Asu1,7]-eel calcitonin. In pooled data for all times, the percentage change in human calcitonin was not significantly correlated with either the percentage change in calcium (r = -0.25, P greater than 0.1) or the percentage change in gastrin (r = -0.38, P greater than 0.1).     

尿毒症患者血管钙化相关因素的分析

目的 探讨尿毒症患者血管钙化发生的相关因素.方法 85例尿毒症患者,均行颈总动脉B超检查及胎球蛋白A、血磷、血钙、C-反应蛋白等检测.结果 有血管钙化的尿毒症患者胎球蛋白A水平明显低于无钙化者[(2.34±0.95)μg/L与(3.79±1.19)μg/L,t=5.94,P＜0.01],而血磷、钙磷乘积及C-反应蛋白水平高于非钙化组[血磷:(1.97±0.23)mmol/L与(1.80±0.33)mmol/L,t=2.05,P＜0.05;钙磷乘积:(50.04±6.61)mg~2/dl~2与(44.84±9.75)mg~2/dl~2,t=2.05,P＜0.05;C-反应蛋白:(33.45±25.11)mmol/L与(20.65±13.43)mmol/L,t=2.03,P＜0.05].相关性分析显示胎球蛋白A水平与C-反应蛋白(r=-0.43,P＜0.01)、血钙磷乘积(r=-0.32,P＜0.01)、血白蛋白(r=0.37,P＜0.05)及血磷(r=-0.36,P＜0.05)相关.结论 高血磷、钙磷乘积升高和微炎症状态是尿毒症患者血管钙化的危险因素,血胎球蛋白A水平降低导致尿毒症患者血管钙化,补充外源性胎球蛋白A可能成为一种预防血管钙化的有效手段.     

Relationship between fractional calcium absorption and gastric emptying

Abstract. The relationship between calcium absorption and gastric emptying and the precision of measurement of fractional calcium absorption using a single isotope technique were evaluated in 14 normal postmenopausal women (age range 61–72 years). On two occasions separated by between 5 and 15 days, each subject was given 250 mL water containing 0.2 MBq of ⁴⁵Ca in 20 mg of calcium carrier as the chloride, 20 mg kg^-1 paracetamol and 9 MBq of ^99mTc sulphur colloid. Venous blood samples were taken at -2, 15, 30, 45, 60, 90, 120, 150 and 180 min after consumption of the drink, and gastric emptying (GE) was monitored with a gamma camera. Fractional calcium absorption in the first hour (α₆) was calculated from the blood samples obtained at 15, 30, 45, 60, 90 and 120 min. An absorption rate was also derived from the 60 min sample using only a calibration curve (α₁). There were close correlations between radiocalcium absorption on the two study days ( r = 0.89, P < 0.001 for both α₁ and α₆) and between α₁ and α₆ ( r = 0.93, P < 0.001). Plasma paracetamol concentrations at 15 min were directly related to the early phase of GE ( r = 0.42, P < 0.05). In contrast, calcium absorption was inversely related to GE ( r — 0.45, P < 0.05). We conclude that radiocalcium absorption is not greatly influenced by gastric emptying rate and that the single blood sample procedure has similar precision to the six-blood sample test.     

Estimation of bone turnover evaluated by 47Ca-kinetics. Efficiency of serum bone gamma-carboxyglutamic acid-containing protein, serum alkaline phosphatase, and urinary hydroxyproline excretion.

Bone gamma-carboxyglutamic acid-containing (Gla) protein (BGP, osteocalcin) is a noncollagenous protein of bone present in plasma and removed by the kidney. Plasma BGP has been shown to be elevated in patients with certain bone diseases. The present study evaluates serum BGP (S-BGP), serum alkaline phosphatase (S-AP), and urinary hydroxyproline excretion (U-OHP) in diseases with differing bone turnover rates, and compares the accuracy of these measurements for estimating bone mineralization (m) and resorption (r) rates. S-BGP, S-AP, U-OHP, and creatinine clearance (Clcr) were measured in patients with primary hyperparathyroidism (n = 13), hyperthyroidism (n = 6), and hypothyroidism (n = 6). Bone mineralization and resorption rates were calculated from a 7-d combined calcium balance and 47Ca turnover study. A highly significant correlation (r = 0.69, P less than 0.001) was found between S-BGP and m. Multiple regression analysis disclosed a partial correlation between S-BGP and m when Clcr was taken into account (r = 0.82, P less than 0.001), and between S-BGP and Clcr when m was taken into account (r = -0.62, P less than 0.005). In accordance with this, a stronger correlation (r = 0.89, P less than 0.0001) was found between S-BGP X Clcr and m than between S-BGP and m. A less significant correlation was found between S-AP and m (r = 0.45, P less than 0.05). Furthermore, U-OHP showed a highly significant positive correlation to r (r = 0.78, P less than 0.001). Thus, in the studied disorders of calcium metabolism, individual serum levels of BGP depend on both mineralization rate and renal function. Serum levels of BGP corrected for alterations in renal function are superior to uncorrected S-BGP and to S-AP levels in the estimation of bone mineralization rates.     

预防性末端回肠双腔造口患者应用顺行结肠灌洗的效果

目的评价预防性末端回肠双腔造口患者应用顺行结肠灌洗法后的肠道准备效率及患者舒适度。方法将80例低位直肠癌经腹前切除＋末端回肠双腔造口术的病例随机分成顺行灌洗组（40例）和传统灌肠组（40例）,比较两种方法灌肠后,患者的主观感受、灌肠时间和肠道清洁度。结果顺行灌洗组患者的主观感受好于传统灌肠组,且该组的灌肠时间少于传统灌肠组,差异有统计学意义（P〈0.05）;顺行灌洗组患者的肠道清洁度明显优于传统灌洗组,差异有统计学意义（P〈0.05）。结论自造口顺行结肠灌洗法是预防性双腔造口患者肠道准备的理想方式。     

Effect of MKC-733, a 5-HT receptor partial agonist, on bowel motility and symptoms in subjects with constipation: an exploratory study

BACKGROUND: MKC-733, a 5-HT(3) receptor partial agonist, is a novel enteroprokinetic compound. OBJECTIVE: The aim of this study was to explore the effects of MKC-733 on bowel motility and symptoms in a small group of subjects with constipation. Tolerability was also examined. METHODS: The study was conducted in a single-blind and dose-escalation manner on 14 male and female subjects with constipation aged 22-67 years. After a 1 week run-in period, subjects were treated with placebo (b.i.d.) for 1 week, and 0.2 and 0.5 mg of MKC-733 (b.i.d.) for 2 weeks sequentially. Geometric mean and per cent elimination of surrogate markers of bowel motility were measured by a radio-opaque marker technique at the end of each treatment period. They were analysed on the whole group and subgroups with low (n = 6) and high (n = 8) bowel motility based upon the geometric mean value after placebo treatment. Subjects kept diaries of their bowel habits and gastrointestinal symptoms. RESULTS: Percent elimination increased after treatment with 0.5 mg MKC-733 compared with placebo treatment in the whole group (70.4 +/- 33.5% vs. 47.1 +/- 36.6%, mean +/- SD, P < 0.05). In the low bowel motility group, both geometric mean and percent elimination increased after treatment with 0.5 mg MKC-733 compared with placebo (7.1 +/- 0.9 vs. 5.9 +/- 0.5, P < 0.05; 60.0 +/- 35.8% vs. 13.3 +/- 19.4%, P < 0.05). Stool frequency increased after the first-week treatment with MKC-733 compared with placebo (P < 0.05). Numbers of sensation of incomplete evacuation and gastrointestinal symptoms decreased to half and less after the treatment with MKC-733. No serious adverse effect was noted. CONCLUSION: Multiple doses of 0.5 mg MKC-733 improve bowel motility, which was clearly demonstrated in the subjects with decreased bowel motility. MKC-733 at the doses studied might be effective in increasing stool frequency and reduce gastrointestinal symptoms related to constipation. MKC-733 was well tolerated. Further studies will be needed to clarify efficacy and safety of MKC-733 on a larger population.