碳酸钙联合阿法骨化醇治疗对2型糖尿病合并骨质疏松患者血钙、磷代谢及骨密度的影响

目的研究阿法骨化醇联合碳酸钙治疗对2型糖尿病(T2DM)合并骨质疏松(OP)患者血钙、磷代谢及骨密度的改善效果。方法160例T2DM合并OP患者按照入院就诊号奇偶数随机均分为研究组和对照组。对照组应用单纯碳酸钙进行治疗,研究组在此基础上联合阿法骨化醇治疗。治疗前后,检测两组血清钙、磷指标、甲状旁腺素及碱性磷酸酶、L1~4骨密度、左股骨颈密度、骨钙素、Ⅰ型胶原C端肽(β-CTX)水平,并且对疗效及不良反应状况进行记录。结果两组治疗前后血清钙、磷水平无显著差异(P>0.05);治疗前,两组甲状旁腺素及碱性磷酸酶水平无显著差异(P>0.05),治疗后,研究组甲状旁腺素及碱性磷酸酶水平均显著降低(P<0.05),对照组甲状旁腺素水平明显降低(P<0.05),但碱性磷酸酶水平无明显改善(P>0.05),且研究组明显低于对照组(P<0.05)。与治疗前比较,研究组L1~4骨密度、左股骨颈密度、骨钙素水平均显著升高(P<0.05),β-CTX水平显著降低(P<0.05);对照组L1~4骨密度、左股骨颈密度、骨钙素及β-CTX水平无显著改变(P>0.05)。研究组疼痛改善总有效率(98.75%)明显高于对照组(27.50%;χ~2=87.236,P=0.000)。两组不良反应发生率无显著性差异(P=0.650)。结论阿法骨化醇联合碳酸钙治疗老年T2DM合并OP患者疗效显著,骨密度改善效果及预后良好。     

阿法骨化醇联合钙剂对老年性骨质疏松患者骨钙素、Ⅰ型胶原C端异构肽水平及骨密度的影响

目的探讨阿法骨化醇联合钙剂对老年性骨质疏松患者骨钙素(BGP)、Ⅰ型胶原C端异构肽(β-CTS)水平及骨密度的影响。方法老年性骨质疏松患者132例随机分为观察组和对照组各66例。对照组单用钙剂治疗,观察组采用阿法骨化醇联合钙剂治疗。对比两组治疗效果及骨密度变化情况。结果观察组总有效率(90. 91%)均显著高于对照组(77. 27%,P0. 05);两组治疗前VAS评分、生活质量评分、L2～3骨密度、股骨颈骨密度及BGP、β-CTS等骨指标对比差异无统计学意义(P0. 05);治疗后观察组VAS评分、生活质量评分及β-CTS水平均显著低于对照组及治疗前,BGP水平、L2～3和股骨颈骨密度均显著高于对照组及治疗前(均P0. 05)。结论阿法骨化醇联合钙剂治疗老年性骨质疏松具有非常好的疗效,对骨密度改善效果显著。     

唑来膦酸联合碳酸钙D3及阿法骨化醇对老年高血压合并骨质疏松患者血清CTX、PINP、OC及炎症因子的影响

目的观察唑来膦酸联合碳酸钙D3及阿法骨化醇对老年高血压合并骨质疏松(OP)患者血清炎症因子及骨转换标志物的影响。方法选择老年高血压合并OP患者110例作为观察对象,随机分为对照组55例及治疗组55例。对照组每日口服碳酸钙D3和阿法骨化醇治疗,治疗组予唑来膦酸联合碳酸钙D3和阿法骨化醇治疗,治疗为期1年。分别检测两组患者治疗前及治疗后的骨密度、血清钙、磷、炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6]、骨转换标记物[Ⅰ型胶原交联C端肽(CTX)、Ⅰ型原胶原N端前肽(PINP)、骨钙素(OC)]的变化,比较两组间差异。观察治疗组使用唑来膦酸后有无严重不良反应。结果治疗组应用唑来膦酸1年后肾功能未见明显损害,亦无其他严重不良反应发生。与对照组相比,治疗组使用唑来膦酸1年后,腰椎(L1～L4)、股骨颈(Neck)、股骨大转子(Torch)的骨密度均显著增加(P0.05),而血CTX及TNF-α、IL-6水平明显下降(P0.05)。结论采用唑来膦酸联合碳酸钙D3及阿法骨化醇治疗高血压合并OP患者,不仅可以有效抑制破骨细胞活性,增加骨密度,而且可以显著降低血清炎症因子水平,是一种安全有效的治疗方法。     

金天格胶囊治疗糖尿病肾病合并骨质疏松症的临床研究

目的评价金天格胶囊（人工虎骨粉）对早期2型糖尿病肾病合并骨质疏松症的临床疗效。方法选择2013年8月—2014年4月来该院诊治的早期2型临床糖尿病肾病合并骨质疏松症56例患者随机分组。对照组78例：口服钙尔奇D片600 mg/d、骨化三醇胶丸0.25ug/d及阿仑膦酸钠片70 mg/周;治疗组78例：对照组的基础上,加用金天格胶囊,3粒/次,3次/d。疗程为24周。比较各组治疗前后临床症状的改善情况及腰椎骨密度。结果两组治疗前后骨密度比较,差异无统计学意义（P〉0.05）;治疗组治疗后临床症状改善明显优于对照组,差异有统计学意义（P〈0.05）。结论金天格胶囊能显著改善糖尿病肾病合并骨质疏松症患者腰背疼痛、腰膝痿弱、步履艰难等症状,亦能促进骨形成,提高骨密度。     

丹杞颗粒联合阿法骨化醇片对老年骨质疏松患者骨强度的影响

目的探讨丹杞颗粒联合阿法骨化醇片对老年骨质疏松患者骨强度的影响。方法100例老年骨质疏松患者应用随机数字表法均为对照组和联合组。对照组给予阿法骨化醇片,联合组给予丹杞颗粒联合阿法骨化醇片进行治疗。比较分析两组治疗后的临床疗效和不良反应发生情况,治疗前后骨密度、骨代谢指标、骨强度。结果联合组治疗后总有效率(98.00%)显著高于对照组(80.00%;P<0.05)。联合组治疗后股骨颈、腰椎正位、Wards三角区骨密度及桡骨远端和胫骨中段部位的超声声速(SOS)显著高于对照组;骨钙素(BGP)、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRACP)-5b水平显著低于对照组(P<0.05)。联合组治疗过程中的总不良反应发生率(4.00%)显著低于对照组(20.00%,P<0.05)。结论应用丹杞颗粒联合阿法骨化醇片对老年骨质疏松患者治疗效果显著,明显提高患者骨密度和骨强度,降低骨代谢指标,且安全性较高。     

金天格胶囊对老年绝经后膝骨关节炎患者血清OPN、MMP-3、IL-1β及TGF-β1水平的影响

目的探讨金天格胶囊对老年绝经后膝骨关节炎患者血清骨桥蛋白(OPN)、基质金属蛋白酶(MMP)-3、白细胞介素(IL)-1β及转化生长因子(TGF)-β1水平的影响。方法 102例老年绝经后膝骨关节炎患者,按随机数字表法分为两组。实验组51例口服金天格胶囊治疗,对照组51例口服盐酸氨基葡萄糖胶囊治疗,两组均治疗6 w。分别于治疗前、治疗4 w、6 w后,采用视觉模拟评分法(VAS)及西安大略和麦玛斯特大学骨关节炎指数可视量表(WOMAC)评分评估患者疼痛、僵硬及关节功能,采用酶联免疫吸附(ELISA)法测定患者血清OPN、MMP-3、IL-1β和TGF-β1水平。结果治疗后两组VAS评分及WOMAC评分均降低,且随着治疗时间的增长两组VAS评分及WOMAC评分持续降低(P<0.05),两组各时间段VAS评分及WOMAC评分比较差异无统计学意义(P>0.05);与治疗前比较,治疗4 w后对照组MMP-3水平显著降低(P<0.05),实验组则无明显变化(P>0.05),两组OPN水平无明显变化(P>0.05),两组IL-1β水平均显著降低,TGF-β1显著升高(P<0.05);与治疗4 w后比较,治疗6 w后实验组OPN和MMP-3水平明显降低(P<0.05),对照组则无明显变化(P>0.05),两组IL-1β水平均显著降低,TGF-β1水平均显著升高(P<0.05);治疗6 w后实验组OPN和MMP-3水平显著低于对照组(P<0.05)。结论金天格胶囊治疗老年绝经后膝骨关节炎患者可以明显改善膝关节功能及僵硬,缓解疼痛,其作用机制可能与破坏OPN与MMP-3联合形成的复合体,降低患者血清OPN、MMP-3水平有关。     

中西医结合治疗原发性骨质疏松的疗效观察

目的探讨阿仑磷酸钠联合金天格胶囊治疗原发性骨质疏松的疗效。方法选取2014年8月~2015年8月我院收治的原发性骨质疏松患者167例作为研究对象,将其随机分为观察组84例和对照组83例。对照组单纯应用阿仑磷酸钠治疗,观察组联合金天格胶囊治疗方法。比较两组的疗效并测定治疗前后骨密度。结果观察组总有效率为95.24%明显高于对照组的77.11%,骨密度恢复明显比对照组高,差异有统计学意义(P0.05)。结论阿仑磷酸钠联合金天格胶囊治疗原发性骨质疏松有较好的疗效,值得推广。     

不同活性维生素D治疗慢性肾脏病——矿物质和骨异常比较

目的骨化三醇和阿法骨化醇是治疗慢性肾脏病—矿物质和骨异常(CKD-MBD)的重要药物,本研究旨在比较两药口服冲击治疗对血液透析患者全段甲状旁腺激素(iPTH)、血钙、血磷影响的特点。方法将36例维持性血液透析患者随机分为骨化三醇组及阿法骨化醇组,比较两组口服冲击治疗前及治疗16周后iPTH、血钙、血磷的变化。结果骨化三醇组和阿法骨化醇组在治疗16周后,iPTH较治疗前分别下降42.5%±9.9%和38.0%±10.5%(P=0.203),iPTH靶目标(150～300 pg/mL)达标率分别是94.4%和88.9%(P=0.55),血钙较治疗前分别上升10.7%±7.9%和5.9%±4.1%(P=0.03),血磷较治疗前分别上升7.1%±5.7%和8.2%±8.4%(P=0.644)。结论骨化三醇与阿法骨化醇口服冲击治疗对血液透析患者CKD-MBD的疗效相当,但阿法骨化醇高钙血症的发生率小于骨化三醇。     

中西医结合治疗骨质疏松型骨折的临床疗效研究

目的研究金天格胶囊治疗骨质疏松型骨折的临床疗效研究。方法研究对象为我院2015年4月~2016年3收治的160例骨质疏松型骨折患者,并随机分为研究组80例和对照组80例。对照组行骨折手术后使用阿伦酸钠治疗,观察组在研究组基础上增加金天格胶囊用药。比较两组的临床研究结果并测定治疗前后骨密度。结果观察组的总有效率为95%明显高于对照组的75%,差异均显著(P0.05)。结论金天格胶囊对骨质疏松型骨折临床恢复有较好的临床疗效,值得各医院临床大力推广。     

中西医结合治疗内分泌失调导致骨质疏松的临床疗效观察

目的研究金天格胶囊联合氨基酸钙治疗内分泌失调导致骨质疏松的临床疗效观察。方法研究对象为我院2014年4月~2015年3收治的160例内分泌失调导致骨质疏松患者,并随机分为研究组80例和对照组80例。对照组单纯应用氨基酸钙治疗,观察组在研究组基础上增加金天格胶囊用药。比较两组的临床研究结果并测定治疗前后骨密度。结果观察组的总有效率为95%明显高于对照组的75%,差异均显著(P0.05)。结论金天格胶囊联合氨基酸钙治疗内分泌失调型骨质疏松有较好的临床疗效,值得临床大力推广。     

Biliary microlithiasis,sludge,crystals,microcrystallization,and usefulness of assessment of nucleation time

BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were"biliary microlithiasis","biliary sludge","bile crystals","cholesterol crystallisation","bile microscopy","microcrystal formation of bile","cholesterol monohydrate crystals","nucleation time of cholesterol","gallstone formation","sphincter of Oddi dysfunction"and"idiopathic pancreatitis".Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.     

Antibacterial activity of cefpodoxime in comparison with cefixime,cefdinir, cefetamet,ceftibuten, loracarbef,cefprozil, BAY 3522, cefuroxime,cefaclor and cefadroxil

Summary The new oral cephalosporins cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten demonstrate enhanced activity against Enterobacteriaceae susceptible to the established compounds as well (e.g. cefuroxime, cefaclor, cefadroxil). In addition, cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten include in their spectrum species hitherto resistant to oral cephalosporins (Proteus vulgaris, Providencia spp.,Yersinia enterocolitica). Besides, the majority of these compounds demonstrate relevant activity (MIC₅₀ equal to or below 2 mg/l) againstEnterobacter spp.,Citrobacter freundii, Serratia spp. andMorganella morganii. Ceftibuten is the most potent oral cephalosporin against most of the Enterobacteriaceae. Non-fermentative bacilli (Acinetobacter spp.,Pseudomonas spp.) remain completely resistant to oral cephalosporins (except someAcinetobacter species against cefdinir andPseudomonas cepacia against ceftibuten). Antistaphylococcal activity for oral cephalosporins is highest for cefdinir followed by BAY 3522, cefprozil, cefuroxime and cefpodoxime. Loracarbef, cefaclor and cefadroxil are about equally active, while the other compounds are only weakly active (cefixime) or inactive (cefetamet, ceftibuten). Enterococci are insensitive to new generation oral cephalosporins as they have been to established compounds. The most active oral cephalosporins against hemolytic streptococci are cefdinir and cefprozil.Streptococcus pneumoniae, Streptococcus milleri andStreptococcus mitior are most susceptible to cefpodoxime, cefdinir, cefuroxime and BAY 3522. Penicillin resistant pneumococci have to be regarded as resistant to all oral cephalosporins. Fastidious pathogens likeHaemophilus spp.,Moraxella catarrhalis andNeisseria gonorrhoeae are more susceptible to cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten than to the other oral cephalosporins. The activity of oral cephalosporins is only weak againstListeria spp.,Helicobacter pylori and anaerobic pathogens (except BAY 3522).Bordetella pertussis remains resistant to all absorbable cephalosporins. Progress in antibacterial activity of oral cephalosporins was mainly achieved by cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten against Enterobacteriaceae and the fastidious pathogens and against staphylococci and the nonenterococcal streptococci by cefdinir, BAY 3522, cefprozil and cefpodoxime.

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Antibakterielle Aktivität von Cefpodoxim im Vergleich mit anderen oralen Cephalosporinen

Zusammenfassung Die neuen oralen Cephalosporine Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten zeigen eine verstärkte Aktivität auch gegen solche Enterobacteriaceae, die gegen etablierte Substanzen empfindlich sind (z.B. Cefuroxim, Cefaclor, Cefadroxil). Zusätzlich schließt das Spektrum von Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten Spezies ein, die gegen die bisherigen oralen Cephalosporine resistent waren (Proteus vulgaris, Providencia spp.,Yersinia enterocolitica). Daneben zeigt die Mehrheit der neuen Substanzen erhöhte Aktivität (MHK₅₀<2 mg/l) gegenEnterobacter spp.,Citrobacter freundii, Serratia spp. undMorganella morganii. Gegen die meisten Enterobacteriaceae ist Ceftibuten das wirksamste orale Cephalosporin. Non-Fermenter (Acinetobacter spp.,Pseudomonas spp.) bleiben gegenüber oralen Cephalosporinen vollständig resistent (mit Ausnahme einigerAcinetobacter-Spezies gegen Cefdinir undPseudomonas cepacia gegen Ceftibuten). Die Antistaphylokokken-Aktivität oraler Cephalosporine ist am höchsten bei Cefdinir, gefolgt von BAY 3522, Cefprozil, Cefuroxim und Cefpodoxim. Loracarbef, Cefaclor und Cefadroxil sind etwa gleich aktiv, während die anderen Substanzen nur schwach aktiv (Cefixim) oder inaktiv sind (Cefetamet, Ceftibuten). Enterokokken sind gegenüber der neuen Generation oraler Cephalosporine ebenso unempfindlich wie gegenüber den etablierten Substanzen. Die aktivsten oralen Cephalosporine gegen hämolysierende Streptokokken sind Cefdinir und Cefprozil.Streptococcus pneumoniae, Streptococcus milleri undStreptococcus mitior sind am empfindlichsten gegen Cefpodoxim, Cefdinir, Cefuroxim und BAY 3522. Penicillin-resistente Pneumokokken müssen als resistent gegenüber allen oralen Cephalosporinen betrachtet werden. Anspruchsvolle Erreger wieHaemophilus spp.,Moraxella catarrhalis undNeisseria gonorrhoeae sind gegen Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten empfindlicher als gegen die anderen oralen Cephalosporine. Die Aktivität oraler Cephalosporine gegenListeria spp.,Helicobacter pylori und Anaerobier (Ausnahme BAY 3522) ist nur schwach.Bordetella pertussis bleibt gegen alle resorbierbaren Cephalosporine resistent. Der Fortschritt in der antibakteriellen Aktivität oraler Cephalosporine wurde gegen Enterobacteriaceae und anspruchsvolle Erreger hauptsächlich durch Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten erlangt, gegen Staphylokokken und Streptokokken (außer Enterokokken) durch Cefdinir, BAY 3522, Cefprozil und Cefpodoxim.

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Supported by Luitpold-Werk, a company of the Sankyo group.     

Electrochemical Recovery and Behaviors of Rare Earth (La,Ce, Pr,Nd, Sm,Eu, Gd,Tb, Dy,Ho, Er,Tm, and Yb) Ions on Ni Sheets

The electrochemical behaviors of rare earth (RE) ions have extensively been studied because of their high potential applications to the reprocessing of used nuclear fuels and RE-containing materials. In the present study, we fully investigated the electrochemical behaviors of RE(III) (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, and Yb) ions over a Ni sheet electrode in 0.1 M NaClO₄ electrolyte solution by cyclic voltammetry between +0.5 and −1.5 V (vs. Ag/AgCl). Amperometry electrodeposition experiments were performed between −1.2 and −0.9 V to recover RE elements over the Ni sheet. The successfully RE-recovered Ni sheets were fully characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and photoluminescence spectroscopy. The newly reported recovery data for RE(III) ions over a metal electrode provide valuable information on the development of the treatment methods of RE elements.     

Clinical trials update: highlights of the scientific sessions of The American College of Cardiology 2002: LIFE,DANAMI 2, MADIT-2, MIRACLE-ICD,OVERTURE, OCTAVE,ENABLE 1 & 2, CHRISTMAS,AFFIRM, RACE,WIZARD, AZACS,REMATCH, BNP trial and HARDBALL

This article continues a series of reports updating recent research developments of particular interest to personnel involved in the treatment and management of patients with heart failure. This is a summary of selected presentations made at the American College of Cardiology 51st Annual Scientific Session held in Atlanta on 17-20 March 2002. Reports of the following clinical studies are included: LIFE, DANAMI 2, MADIT-2, MIRACLE-ICD, OVERTURE, OCTAVE, ENABLE 1 & 2, CHRISTMAS, AFFIRM, RACE, WIZARD, AZACS, REMATCH, BNP trial and HARDBALL.