阿伦膦酸盐治疗绝经后骨质疏松症疗效观察

目的 评价阿伦膦酸盐对绝经后骨质疏松症的临床疗效及安全性。方法 32名绝经后骨质疏松妇女口服阿伦膦酸盐 10mg/d,为期半年。结果 治疗前后各年龄组骨密度 (BMD)明显上升,与年龄呈正相关,椎体压缩性骨折楔形指数平均增加 8.8％。该药物副作用 轻微,治疗前后骨生化指标、血生化、血常规和尿常规均无变化,不需终止治疗。结论 阿伦膦酸盐能有效增加骨密度,缓解骨痛,降低骨折发生率,药物安全性好。     

绝经女性骨质疏松的运动干预

目的:通过大量文献研究,阐述运动预防绝经后骨质疏松的依据和影响运动疗效的因素,对女子骨质疏松实施运动干预提供参考性建议。资料来源:运用计算机检索“中国期刊全文数据库”1994-01/2004-04期间相关文献,检索词为“骨质疏松”、“绝经后骨质疏松”、“骨密度”,“运动”等。资料选择:对资料进行初审,选择关于绝经后骨质疏松的运动干预方面的文献。并查找全文,然后筛除重复研究。资料提炼:共收集到19篇关于绝经后骨质疏松的运动干预方面的文献,他们的实验都针对绝经期妇女采用运动疗法,通过骨密度测量来评价运动干预对预防骨质疏松的效果。资料综合:运动干预是预防女子绝经后骨质疏松的最积极办法。运动的最佳方式是力量训练、快走、健身跑、游泳等中等强度有氧运动;运动干预时间至少在一年以上;运动干预的敏感年龄是绝经后最初几年;运动干预效果与女子体成分、瘦体质量等呈高度相关。测量仪器及测量的部位的选择会影响运动干预效果的评价。结论:长期从事有氧运动是绝经后女子骨质疏松干预的最积极疗法,但其疗效受许多因素影响。     

阿伦膦酸盐治疗绝经后骨质疏松症疗效观察

目的 评价阿伦膦酸盐对绝经后骨质疏松症的临床疗效的安全性。方法 ３２名绝经后骨质疏松妇女口服阿伦膦酸盐１０ｍｇ／ｄ,为期半年。结果 治疗前后各年龄组骨密度（ＢＭＤ）明显上升,与年龄呈正相关,椎体压缩性骨折楔形指数平均增加８．８％。该药物副作用轻微,治疗前后骨生化指标、血生化、血常规和尿常规均无变化,不需终止治疗。结论 阿伦膦酸盐能有效增加骨密度,缓解骨痛,降低骨折发生率,药物安全性好。     

运动疗法治疗绝经后妇女骨质疏松症的荟萃分析

背景:运动疗法对预防绝经后妇女骨丢失的价值尚存在争议.目的:评价运动疗法治疗绝经后妇女骨质疏松症的疗效.方法:计算机检索PubMed,Embase,Cochrane Library,CBM,CNKI,VIP数据库关于运动疗法治疗绝经后妇女骨质疏松症的随机对照试验.纳入健康的绝经后妇女,种族、国籍、地域不限,年龄在50～70岁之间.排除合并有基础疾病的患者.采用Cochrane协作组提供的Revman 5.0软件进行统计分析.临床评价指标包括骨矿物质密度和骨折发生率.结果与结论:共纳入9篇随机对照试验,Meta分析结果显示:与常规治疗比较,运动疗法联合常规治疗可明显提高绝经后妇女骨矿物质密度[WMD=0.96,95%CI (0.47,1.44),P < 0.05],但对其骨折发生率影响不明显(P > 0.05).提示运动疗法可以增加绝经后妇女骨质疏松症的骨矿物质密度,但并不能减低骨折的发生率.     

运动疗法治疗绝经后妇女骨质疏松症的荟萃分析

背景：运动疗法对预防绝经后妇女骨丢失的价值尚存在争议。目的：评价运动疗法治疗绝经后妇女骨质疏松症的疗效。方法：计算机检索PubMed,Embase,Cochrane Library,CBM,CNKI,VIP数据库关于运动疗法治疗绝经后妇女骨质疏松症的随机对照试验。纳入健康的绝经后妇女,种族、国籍、地域不限,年龄在50～70岁之间。排除合并有基础疾病的患者。采用Cochrane协作组提供的Revman5.0软件进行统计分析。临床评价指标包括骨矿物质密度和骨折发生率。结果与结论：共纳入9篇随机对照试验,Meta分析结果显示：与常规治疗比较,运动疗法联合常规治疗可明显提高绝经后妇女骨矿物质密度[WMD=0.96,95%CI（0.47,1.44）,P〈0.05],但对其骨折发生率影响不明显（P〉0.05）。提示运动疗法可以增加绝经后妇女骨质疏松症的骨矿物质密度,但并不能减低骨折的发生率。     

绝经女性骨质疏松的运动干预

目的：通过大量文献研究，阐述运动预防绝经后骨质疏松的依据和影响运动疗效的因素，对女子骨质疏松实施运动干预提供参考性建议。资料来源：运用计算机检索“中国期刊全文数据库”1994—01／2004—04期间相关文献，检索词为“骨质疏松”、“绝经后骨质疏松”、“骨密度”，“运动”等。资料选择：对资料进行初审，选择关于绝经后骨质疏松的运动干预方面的文献。并查找全文，然后筛除重复研究。资料提炼：共收集到19篇关于绝经后骨质疏松的运动干预方面的文献，他们的实验都针对绝经期妇女采用运动疗法，通过骨密度测量来评价运动干预对预防骨质疏松的效果。资料综合：运动干预是预防女子绝经后骨质疏松的最积极办法：运动的最佳方式是力量训练、快走、健身跑、游泳等中等强度有氧运动；运动干预时间至少在一年以上；运动干预的敏感年龄是绝经后最初几年；运动干预效果与女子体成分、瘦体质量等呈高度相关：测量仪器及测量的部位的选择会影响运动干预效果的评价。结论：长期从事有氧运动是绝经后女子骨质疏松干预的最积极疗法，但其疗效受许多因素影响。     

运动锻炼改善绝经后妇女骨密度效果的meta分析

目的:系统评价运动锻炼改善绝经后妇女骨密度的效果,丰富和完善运动健骨的理论成果,并为绝经期女性改善骨骼健康的运动实践提供科学指导和具体方案。方法:计算机检索EBSCOhost、Science Direct、PubMed和Web of Science等各数据库,检索期限均从各数据库建库开始至2017年4月,收集运动锻炼对绝经后妇女骨密度影响的随机对照试验,应用Cochrane偏倚风险评估工具,使用Revman5.3软件对纳入研究进行方法学质量评价,Stata12.0软件进行统计分析。结果:纳入研究文献27篇,文献质量A级15篇,B级12篇。meta分析结果:运动锻炼能有效改善绝经后妇女股骨颈密度(SMD=0.703,95%CI:0.370—1.036),亚组分析发现试验周期12个月、试验对象年龄65、研究文献质量高和有氧联合抗阻训练对提高绝经后妇女股骨颈密度效果较好;运动锻炼能提高绝经后妇女腰椎骨密度(SMD=0.27,95%CI:0.048—0.492),经过meta回归分析、亚组分析并未发现异质性来源,发现试验周期12个月、运动时间≥60min、一周3次和有氧联合抗阻训练改善绝经后妇女腰椎骨密度效果较好。结论:运动锻炼能有效改善绝经后妇女股骨颈和腰椎骨密度,且对股骨颈密度的改善效果更好;改善股骨颈和腰椎骨密度最优运动方式均包含有氧和抗阻运动;通过meta回归分析、亚组分析探索各研究之间的异质性来源,敏感性分析检验结果的稳定性,本meta分析结果稳定、可靠。     

Th17和IL-17对绝经后妇女骨质疏松发病的影响

目的探讨辅助性T细胞17(Th17)和白介素-17(IL-17)对绝经后妇女骨质疏松发病的影响。方法收集2012年6月至2015年8月来该院就诊的绝经后骨质疏松的患者68例为试验组,同时选取同时期来该院体检的绝经后骨质正常的68例为对照组,分别通过流式细胞仪及酶联免疫吸附测定法(ELISA法)来检测两组研究对象外周血中Th17细胞的水平及IL-17蛋白的水平,然后用统计学方法来分析绝经后骨质疏松患者的血清钙及骨密质与患者外周血中IL-17水平的关系。结果绝经后妇女骨质疏松患者外周血中Th17细胞的比例及IL-17蛋白的水平均明显高于对照组;绝经后妇女骨质疏松患者骨密度BMD值及血清钙的水平均明显低于对照组;绝经后妇女骨质疏松患者血清中IL-17与血清钙及骨密度均呈负相关性。结论 Th17和IL17能明显提升绝经后女性发生骨质疏松的概率,对绝经后外周血中Th17细胞的水平及IL-17蛋白的水平高的患者在临床工作中要警惕骨质疏松的发生。     

β-Crosslaps和PINP在绝经后妇女骨质疏松诊断中的效能评价

目的评价β胶原特殊序列(β-Crosslaps)和总骨[型前胶原N端肽(PINP)在老年妇女骨质疏松诊断中的灵敏性、特异性及准确性。方法 69例50～70岁绝经后妇女应用双能X线骨密度仪(DXA)测量腰椎和股骨骨密度(BMD),依据T评分并参照世界卫生组织标准进行诊断。根据有无骨质疏松,将69例妇女分为骨质疏松组(OP组)和健康组。测定所有妇女PINP和β-Crosslaps及雌二醇(E2)水平。采用SPSS13.0软件建立ROC曲线,并计算ROC曲线下面积,评价β-Crosslaps和PINP在老年妇女骨质疏松诊断中的灵敏性、特异性及准确性。结果用β-Crosslaps诊断绝经后老年妇女骨质疏松的最佳分界值为0.995ng/mL,敏感性为78.0%,特异性为82.1%;用PINP诊断绝经后老年妇女骨质疏松的最佳分界值为34.5 ng/mL,敏感性为65.9%,特异性为85.7%。结论β-Crosslaps和PINP在老年妇女骨质疏松诊断中有较好的灵敏性、特异性,是诊断绝经后妇女骨质疏松的较理想指标。ROC曲线下面积比较结果显示,β-Crosslaps比PINP具有更高的诊断准确性。     

激素替代、运动疗法对绝经妇女骨质疏松的防治效果

目的探讨激素替代和运动疗法对绝经妇女骨质疏松防治作用。方法绝经妇女180例随机分为3组,每组各60例。康复组给予有氧运动、结合型雌激素、补钙、调节饮食等综合康复治疗;激素替代组(HRT组)给予结合型雌激素、补钙、调节饮食;对照组给予补钙及调节饮食。结果康复组治疗后骨密度(BMD)比治疗前明显升高(P<0.05);HRT组治疗后BMD稍升高,但无统计学意义(P>0.05);对照组BMD比治疗前反而明显降低(P<0.05)。即治疗以后,康复组BMD比HRT组和对照组显著增高(P<0.05)。HRT组BMD比对照组增高(P<0.05)。结论绝经后妇女单纯补钙、调节饮食不能预防骨质疏松。HRT治疗对于防治绝经后妇女骨质疏松有一定的效果。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.