OPG及RANKL在儿童先天性胫骨假关节病变骨与骨膜中的表达研究

目的通过免疫组化检测儿童先天性胫骨假关节和胫骨骨折患儿骨与骨膜标本中骨保护素(OPG)、核因子κB受体活化因子配体(RANKL)的表达水平,明确OPG及RANKL在儿童先天性胫骨假关节骨与骨膜中的表达差异,并分析其可能的意义。方法选取2016年1月至2018年2月由湖南省儿童医院收治的17例儿童先天性胫骨假关节(CPT组)和10例胫骨骨折患儿(对照组)作为研究对象。采用SABC法检测先天性胫骨假关节患儿和对照组骨及骨膜中OPG、RANKL的表达,并分析其差异性。结果本研究发现OPG在CPT组(0. 08±0. 03)骨膜中的表达量低于对照组(0. 11±0. 02),差异有统计学意义(t=2. 805,P 0. 01); RANKL在CPT组(0. 24±0. 07)骨膜中的表达量高于对照组(0. 15±0. 04),差异有统计学意义(t=3. 707,P 0. 01); CPT组(2. 37±0. 29)病变胫骨骨膜中RANKL/OPG比值高于对照组(1. 09±0. 16),差异有统计学意义(t=12. 792,P 0. 01)。OPG在CPT组(0. 17±0. 09)胫骨中的表达量低于对照组(0. 26±0. 05),差异有统计学意义(t=2. 895,P 0. 01); RANKL在CPT组胫骨中的表达量(0. 68±0. 13)高于对照组(0. 33±0. 09),差异有统计学意义(t=7.494,P 0. 01); RANKL/OPG比值在CPT组(5. 12±0. 60)胫骨中的表达量高于对照组(1. 12±0. 17),差异有统计学意义(t=25.784,P 0.05)。结论 RANKL/OPG失衡可能是儿童先天性胫骨假关节出现胫骨不愈合和骨吸收的原因之一。     

OPG及RANKL在小儿单纯性骨囊肿与动脉瘤样骨囊肿中的表达研究

目的检测小儿单纯性骨囊肿和动脉瘤样骨囊肿标本中骨保护素(OPG)、核因子-kB受体活化因子配体(RANKL)的表达水平,并与正常骨组织作对照,分析两种蛋白在这两种瘤样病变中的表达是否存在差异及意义。方法共收集小儿单纯性骨囊肿标本31例,动脉瘤样骨囊肿标本23例,正常骨组织标本(对照组)14例。采用免疫组化SABC方法检测单纯性骨囊肿、动脉瘤样骨囊肿和对照组中OPG、RANKL的表达,并分析其差异性。应用Imagepro-Plus 6.0图像处理软件及数据处理软件SPSS17.0对图像及所得数据进行分析。结果在单纯性骨囊肿及动脉瘤样骨囊肿中,OPG的表达量均低于正常骨组织,RANKL的表达量均高于正常骨组织,其中动脉瘤样骨囊肿RANKL的表达量较单纯性骨囊肿更高,差异有统计学意义(P0.05);单纯性骨囊肿的OPG稍高于动脉瘤样骨囊肿,差异无统计学意义(P0.05)。RANKL/OPG比值动脉瘤样骨囊肿单纯性骨囊肿正常组织,差异有统计学意义(P0.05)。结论 RANKL/OPG失衡可能是小儿单纯性骨囊肿和动脉瘤样骨囊肿出现溶骨性破坏的原因之一,动脉瘤样骨囊肿术后相对更高的复发率可能与RANKL的相对高表达有关。     

184例儿童与成人横纹肌肉瘤的比较研究

目的 比较分析儿童与成人横纹肌肉瘤的预后差别及其临床影响因素.方法 回顾性分析天津医科大学肿瘤医院1993年1月至2009年6月间经病理确诊为横纹肌肉瘤且有完整随访资料的184例患者,其中分为儿童组93例(≤18周岁)和成人组91例(＞18周岁).结果 1年、3年、5年生存率儿童组分别为90.3％、62.0％、43.1％,成人组分别为86.8％、35.1％、20.0％.两组间1年生存率差异无统计学意义(P=0.454),但3年(P=0.001)和5年(P=0.007)生存率成人组均低于儿童组,并且Kaplan-Meier生存曲线也提示成人组(中位生存期26.7个月)低于儿童组(中位生存期47.3个月),Log-rank检验两生存曲线差异有统计学意义(P=0.003).多因素分析显示组织学类型、原发部位和术后分组是儿童RMS预后的独立影响因素,组织学类型、原发肿瘤大小和术后分组是成人RMS预后的独立影响因素.x2检验显示儿童组与成人组在组织学类型(胚胎型:77.4％、27.5％；腺泡或多形性:22.6％、72.5％；P=0.000)、原发部位(预后好的部位:40.9％、22.0％；预后不好部位:59.1％、78.0％;P=0.006)和远处转移(无转移:87.1％、73.6％；有转移:12.9％、26.4％；P=0.021)因素的差异具有统计学意义.结论 成人RMS的预后明显差于儿童,组织学类型、原发部位和远处转移的差异是导致这种差别的可能因素.     

破骨细胞和辅助性T细胞

骨免疫学主要研究T细胞和破骨细胞的互相作用.有研究证实,产生白细胞介素17的辅助性T细胞可诱导核因子κB配体受体活化因子在滑膜细胞上表达,并和炎症细胞因子一起刺激破骨细胞分化和骨质吸收的活性.骨免疫学对抗风湿病药物研发和风湿病治疗有重要意义.     

少年儿童抗中性粒细胞胞浆抗体相关原发性系统性血管炎的临床和病理特点

目的 回顾性总结并分析儿童抗中性粒细胞胞浆抗体(ANCA)相关原发性系统性血管炎(AASV)患者的临床和病理特点,并与成人原发AASV患者作比较,以提高对该类疾病的认识。方法 将原发AASV的儿童患者与同期成人原发AASV患者的临床和病理进行比较。结果 儿童组加例,占同期诊断的原发AASV患者的7．87％(20／254),与38例成人住院患者相比,儿童组中女性患者比例显著高于成人组(儿童组80％;成人组50％,P=0．047),二组在疾病组成和ANCA类型方面差异无显著性,均以显微镜下型多血管炎及P-ANCA／抗MPO抗体阳性为主。儿童组高血压出现者显著少于成人组(儿童组20％;成人组61％,P=0．005),二组在肾脏受累,肾外器官受累,实验室检查,肾脏活检病理表现,治疗方案,临床缓解率方面均无显著性差异。结论 儿童原发AASV患者并不罕见,其临床与病理特点与成人原发AASV基本一致,但女性患者更为常见。     

组织因子基因沉默对胎盘早剥人脐静脉内皮细胞的影响

目的 利用RNA干扰技术对胎盘早剥(placental abruption,PA)和正常出生的新生儿脐静脉内皮细胞(human umbilical vein endothelial cell,HUVECs)组织因子(tissue factor,TF)的表达进行干预.方法 收集2008年11月至2010年2月胎盘早剥(placental abruption,PA)产妇分娩胎儿(足月或早产不限)6例的脐带(PA组)及6例同期正常产妇分娩胎儿的脐带(正常对照组).构建RNA干扰TF基因表达载体及RNA 干扰沉默PA胎儿HUVECs TF基因表达.两组分别进行以下处理:(1)空白未干扰对照;(2)假干扰对照;(3) RNA干扰TF基因表达.观察处理后HUVECs在基因沉默前后的mRNA表达、TF蛋白水平免疫荧光检测的变化.结果 将构建的pENTRTM/U6-TF-shRNA转染到正常对照组和PA组,正常对照组HUVECs在转染后TF mRNA水平较空白对照的0.657±0.097下降至0.220±0.030; PA组则由1.323±0.323下降至0.207±0.150.与正常对照组比较,TF mRNA表达在PA组空白对照处理(1.323±0.323 vs0.657±0.097,P=0.023)、假干扰处理(1.057 ±0.178 vs 0.540±0.079,P =0.01)后差异均有统计学意义,而RNA干扰处理后正常对照组和PA组之间TFmRNA的表达差异无统计学意义(0.220 ±0.030 vs 0.207 ±0.150,P＞0.05).在正常对照组及PA组内,各处理间差异均有统计学意义(F=27.657,P=0.001;F=19.299,p=0.002).结论 构建的pENTRTM/U6-TF-shRNA成功转染到HUVECs,显著抑制PA 产妇胎儿HUVECs中TF的表达.     

信号转导子与转录激活子3和缺氧诱导因子-1α在神经母细胞瘤中的表达及其意义

目的检测信号转导子与转录激活子3(STAT3)与缺氧诱导因子-1α(HIF-1α)基因在神经母细胞瘤(NB)中的表达,探讨STAT3 mRNA及HIF-1αmRNA的表达与NB的发生、发展及预后的关系。方法收集30例行手术切除的NB患儿的瘤体组织(研究组)及瘤旁组织(对照组)。其中预后不良型(UFH)20例,预后良好型(FH)10例。应用反转录PCR法,检测STAT3 mRNA、HIF-1αmRNA在瘤体组织及相应的瘤旁组织中的表达情况。结果 STAT3 mRNA水平在对照组、FH组和UFH组的表达分别为0.114±0.002、0.267±0.073、0.529±0.325,3组间比较差异有统计学意义(F=22.00,P=0.001);HIF-1αmRNA水平在对照组、FH组和UFH组的表达分别为0.519±0.251、0.673±0.124、0.779±0.145,3组间比较差异有统计学意义(F=111.82,P=0.001)。且FH组和UFH组STAT3 mRNA和HIF-1αmRNA表达水平分别与对照组比较差异均有统计学意义(Pa<0.05),FH组与UFH组比较差异亦有统计学意义(Pa<0.05)。研究组STAT3 mRNA、HIF-1αmRNA相对表达水平分别为0.530±0.051、0.489±0.032,二者表达呈正相关(r=0.497,P<0.05)。结论 STAT3与HIF-1α在NB中过量表达,NB患者预后较差,STAT3与HIF-1α可相互作用促进肿瘤的发生发展。PCR技术可检测NB中STAT3 mRNA及HIF-1αmRNA表达水平,判断其生物学行为,用于指导临床。     

哮喘患儿血清肿瘤坏死因子α及其可溶性受体Ⅰ和Ⅱ的水平变化及意义

目的 探讨血清肿瘤坏死因子α(TNF-α)、可溶性肿瘤坏死因子受体Ⅰ和Ⅱ(sTNFR-Ⅰ和sTNFR-Ⅱ)在儿童哮喘发病中的作用及意义.方法 采用酶联免疫吸附法检测60例支气管哮喘患儿(急性发作期组及临床缓解期组各30例)和22例健康体检儿童血清中TNF-α、sTNFR-Ⅰ、sTNFR-Ⅱ蛋白浓度水平,比较3组间各因子的水平差异.结果 (1)儿童哮喘急性发作期血清TNF-α水平为(98.87±16.25) ng/'L,明显高于临床缓解期(62.19±15.85) ng/L及正常对照组(44.25±10.44) ng/L(F=94.78,P＜0.05),急性发作期血清sTNFR-Ⅰ和sTNFR-Ⅱ水平分别为(11.14±2.04) μg/L和(11.81±2.14) μg/L,亦分别高于临床缓解期(8.91±1.63) μg/L和(9.36±1.72)μg/L,同时也显著高于正常对照组(5.03±1.18) μg/L和(5.21±1.23) μg/L(F=83.03和87.62,P均＜0.05),且各指标临床缓解期分别高于其正常对照组,差异有统计学意义(P＜0.05).(2)急性发作期血清sTNFR-Ⅰ和sTNFR-Ⅱ水平呈正相关(r=0.908,P＜ 0.05),哮喘临床缓解期血清sTNFR-Ⅰ和sTNFR-Ⅱ水平亦呈正相关(r =0.737,P＜0.05).结论 TNF-α水平可以提示哮喘炎症的轻重及病情程度,sTNFR-Ⅰ和sTNFR-Ⅱ血清浓度水平变化与哮喘的病情及气道炎症程度密切相关.     

缺氧缺血性脑损伤新生大鼠脑神经细胞凋亡及脑组织中Rho GDP解离抑制因子和Bcl-2表达的变化

目的 研究Rho GDP解离抑制因子(Rho GDP dissociation inhibitor 2,RhoGDI2)mRNA 及Bcl-2 mRNA的表达在缺氧缺血性脑损伤(hypoxic-ischemic brain damage,HIBD)中的作用和机制.方法 30只新生7日龄SD大鼠按照完全随机化方法分为假手术组及HIBD 6 h和48 h组,每组10只.采用流式细胞仪检测脑细胞凋亡情况,并用Real-time RT-PCR方法测定脑组织中RhoGDI2和Bcl-2mRNA表达水平.结果 (1)新生大鼠HIBD后48h结扎侧大脑半球脑水肿明显.(2) HIBD6 h出现典型的凋亡细胞峰,细胞凋亡率为(1.40±0.12)％.HIBD 48 h凋亡峰更为明显,细胞凋亡率达到( 15.86±0.98)％.缺氧缺血后与假手术组相比,差异有统计学意义(P＜0.01).(3)假手术组大鼠RhoGDI2和Bcl-2 mRNA表达水平较高(4.12±0.74、2.55±0.65),在HIBD 6 h后二者表达开始下降(3.19±0.77、1.96±0.36),48 h降低更加明显(1.04±0.18、1.06±0.17),与假手术组比较,HIBD各时间点RhoGDI2和Bcl-2 mRNA的表达均明显降低,差异有统计学意义(P＜0.01).(4)缺氧缺m后各时间点RhoGDI2 mRNA的表达和Bcl-2 mRNA的表达呈正相关(r=0.831,P＜0.05).结论 脑缺氧缺血后,随着凋亡的出现,RhoGDI2和Bcl-2 mRNA表达水平降低,提示Rh0GDI2表达失衡可能通过Bcl-2参与新生大鼠HIBD中凋亡的发生.     

神经生长因子及其受体在肛门直肠畸形动物模型直肠末端的表达及意义

目的 观察肛门直肠畸形(ARM)动物模型直肠末端组织中神经生长因子(NGF)及其受体(NGFR)的表达,探讨ARM排便功能障碍的机制.方法 应用免疫组织化学和RT-PCR检测正常与肛门直肠畸形动物胎鼠直肠末端组织中NGF及其高亲和力受体(TrkA)、低亲和力受体(p75NTR)的表达.结果 NGF、TrkA、p75NTR在正常胎鼠直肠末端肠黏膜皱襞及肌层细胞质及细胞核中有大量表达,其平均光密度(IOD值)分别为731.749±232.177,262.815±101.722,134.674±67.127,而在肛门直肠畸形直肠末端表达较少,其平均光密度(IOD值)分别为17.973±74.945,33.145±11.128,113.010±36.468,两组比较,差异均有统计学意义(P＜0.05)；TrkAmRNA、P75NTRmRNA在正常胎鼠直肠末端组织中的相对表达量分别为162.221±104.675,129.778±51.967,在肛门直肠畸形胎鼠中的相对表达量分别为78.973±33.425,87.145±25.812,两组比较,差异有统计学意义(P＜0.05).结论 NGF及其受体TrkA、p75NTR在ARM动物模型直肠末端的表达异常可能是导致其排便功能障碍的原因之一.     

EGFR expression in acquired middle ear cholesteatoma in children and adults

Middle ear cholesteatomas are characterized by the presence of keratinized stratified squamous epithelium inside this cavity. It is considered to be more aggressive in childhood. In normal skin, the epidermal growth factor receptor (EGFR) is expressed in the cytoplasmic membrane of epithelial cells of the basal layer. In contrast, its expression in middle ear cholesteatoma extends to suprabasal layers. The objective of this study is to detect the presence of EGFR in cases of acquired cholesteatoma of the middle ear and correlate the expression of this receptor with patients’ ages. In this cross-sectional study, cholesteatoma samples were collected from 50 patients (35 adults and 15 children) who underwent otological surgery, throughout 1 year of study. These samples were subjected to histological and immunohistochemical assays. Results were submitted to statistical analyses and main findings were: EGFR was present in the parabasal layers in 27 cases and EGFR expression was extended to all layers of the matrix in 17 cases. There were no statistically significant differences in what concerns age-related variances in EGFR expression. The intensity and location of EGFR expression in acquired cholesteatoma of the middle ear confirm the hyperproliferative capacity of keratinocytes.     

Serum levels of osteoprotegerin and receptor activator of nuclear factor -κB ligand in children with early juvenile idiopathic arthritis: a 2-year prospective controlled study

Background  

The clinical relevance of observations of serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor -κB ligand (RANKL) in juvenile idiopathic arthritis (JIA) is not clear. To elucidate the potential role of OPG and RANKL in JIA we determined serum levels of OPG and RANKL in patients with early JIA compared to healthy children, and prospectively explored changes in relation to radiographic score, bone and lean mass, severity of the disease, and treatment.     

肾病综合征患儿血清骨保护素改变及糖皮质激素对其的影响

目的：观察肾病综合征（nephrotic syndrome, NS）患儿骨保护素改变及糖皮质激素治疗对骨保护素的影响,探讨骨保护素在NS骨代谢改变中的应用价值。方法：随机选取NS患儿44例,其中NS初发患儿24例,糖皮质激素治疗减量过程中复发患儿20例,其糖皮质激素累积剂量为28327±5879 mg/m2;23例年龄性别匹配的正常儿童设为对照组。采用酶联免疫吸附法测定血清骨保护素浓度,采用电化学发光免疫法测定血清骨钙素N端中分子片段（骨钙素N-MID）含量。结果：初发NS组血清骨保护素、骨钙素N-MID含量分别为 211±55 ng/L、46±14 ng/mL,均明显低于对照组（分别为470±57 ng/L、73±9 ng/mL）（P<0.05）。NS复发组血清骨保护素、骨钙素N-MID含量均较NS初发组及对照组低,分别为176±42 ng/L、29±10 ng/mL（P<0.05）。结论：NS患儿本身即存在骨代谢异常,大剂量应用糖皮质激素后可进一步加重骨代谢改变,提示NS患儿骨保护素改变受疾病本身及糖皮质激素治疗的双重影响,骨保护素有望成为预测NS患儿骨代谢改变的新型生化指标。     

Are activated T cells regulators of bone metabolism in children with Crohn disease?

OBJECTIVES: To test the hypothesis that circulating activated T cells may release cytokines that decrease bone turnover in children with Crohn disease. STUDY DESIGN: Newly diagnosed Crohn disease and healthy controls of similar age were compared for bone age, bone mineral content and density, markers of bone remodeling, and serum concentration and in vitro T-cell production of receptor activator of nuclear factor kappaB ligand (RANKL), interferon (INF)-gamma, and osteoprotegerin (OPG). RESULTS: Newly diagnosed children with Crohn disease (n=23) had similar bone mineral density (BMD) z-scores and body mass index as the controls (n=40). Biochemical markers of bone remodeling indicated a state of low bone turnover in the Crohn disease patients compared with controls. Serum OPG (pmol/L; mean+/-SD, median) was higher (4.24+/-1.74, 3.98 vs 3.38+/-0.83, 3.41; P<.05), and serum RANKL (pmol/L) was lower in the Crohn disease patients (0.50+/-0.86, 0.28 vs 1.02+/-1.63, 0.49; P<.01), consistent with decreased bone resorption. Activated T cells from Crohn disease patients produced a higher concentration of INF-gamma (ng/microg protein) than those from controls (20.03+/-26.39, 8.70 vs 9.76+/-14.10, 6.17; P<.05). CONCLUSIONS: The newly diagnosed children with Crohn disease exhibited reduced bone remodeling, possibly due to T-cell INF-gamma and OPG.     

Relationships between OPG,RANKL, bone metabolism,and bone mineral density in biliary atresia

Purpose  Osteoprotegerin (OPG) and receptor activator of nuclear factor kappa B ligand (RANKL) have been implicated in osteoclastogenesis. However, the relationship between the OPG–RANKL system and bone status in biliary atresia (BA) has not, as yet, been clarified. Thus, the aim of this study has been to evaluate the relationship between the OPG–RANKL system and bone mineral metabolism in patients with BA. Methods  Fifty patients with BA and 13 healthy controls were investigated. The mean age of BA patients and controls was 7.3 ± 0.6 and 8.0 ± 1.1 years, respectively. Serum levels of OPG, RANKL, osteocalcin, and C-terminal telopeptide of type I collagen (CTX) were measured by sandwich enzyme-linked immunosorbent assay. Bone mineral density (BMD) of the lumbar spine was determined by dual energy X-ray absorptiometry. Results  Biliary atresia patients had significantly elevated serum OPG levels compared with controls (4.0 ± 0.3 vs. 3.0 ± 0.3 pmol/L, P = 0.02) and serum OPG levels in BA patients with jaundice were higher than in those without jaundice (4.6 ± 0.4 vs. 3.6 ± 0.4 pmol/L, P = 0.04). Likewise, serum RANKL levels were significantly higher in BA patients than in controls (2.9 ± 0.2 vs. 1.2 ± 0.7 pmol/L, P = 0.001). In addition, serum RANKL levels were increased in BA patients with jaundice compared to those without jaundice, but this difference was not statistically significant (3.2 ± 0.3 vs. 2.7 ± 0.2 pmol/L, P = 0.2). The serum osteocalcin levels in BA patients were not significantly different from those in the healthy controls, whereas the serum CTX levels were elevated in BA patients compared with the controls (0.4 ± 0.1 vs. 0.2 ± 0.1 ng/mL, P = 0.02). Furthermore, BMD of BA children with jaundice was significantly lower than that of BA children without jaundice (P = 0.0005). BMD of BA patients was inversely correlated with serum levels of OPG (r = −0.452, P < 0.001). Conclusion  Elevated serum OPG levels are associated with reduced BMD and the outcome of BA. The increase of serum OPG in BA patients with severe disease could reflect a compensatory response to bone loss. Presented at the 30th American Society for Bone and Mineral Research (ASBMR) annual meeting, Montreal, Quebec, Canada, 12–16 September 2008.     

Markers of bone metabolism in eugonadal female patients with beta-thalassemia major

Osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) have been recently implicated in the pathogenesis of various types of osteoporosis. The aim of this study was to investigate bone turnover in eugonadal female patients with this disease and characterize the possible role of the OPG/RANKL system in thalassemia-related bone loss. Markers of bone turnover and bone mineral density (BMD) were measured in 16 eugonadal young females with β-thalassemia major and 18 age- and sex-matched healthy controls. Bone turnover was significantly increased in thalassemic patients compared to controls but OPG was significantly higher in healthy subjects. BMD values negatively correlated with urine markers of bone resorption but not with OPG/sRANKL system.     

哮喘患儿呼出气一氧化氮水平与肺功能相关性研究

目的 探讨处于稳定期哮喘患儿呼出气一氧化氮水平(FeNO)与肺功能中第一秒用力呼气容积(FEVl)的相关性.方法 选取2009年2月至2009年7月于中国医科大学附属盛京医院小儿哮喘门诊就诊的5～14岁的稳定期哮喘患儿53例,根据其是否应用吸入糖皮质激素规范化治疗分为激素治疗组和非激素治疗组,分别测定其FeNO水平和肺功能,分析FeNO水平和肺功能在两组患儿之间是否存在统计学差异,并比较两组患儿FeNO水平和肺功能指标是否存在相关性.结果 非激素治疗组患儿FeNO水平明显高于激素治疗组,且差异有显著性(P=0.005).激素治疗组患儿FEV1平均值为(95.152±8.993)%,非激素治疗组患儿FEVl平均值为(91.350±11.690)%,两组差异无显著性(P=0.932).非激素治疗组患儿FeNO水平与FEV1呈显著负相关性(r=-0.465,P=0.039).激素治疗组哮喘患儿FcNO水平与FEV1参数不相关(r=0.058,P=0.747).结论 处于稳定期的哮喘患儿,未应用吸入糖皮质激素规范化治疗时,其FeNO水平明显高于已用激素规范治疗患儿,测定FeNO水平可以作为一项很好的指标来评价哮喘患儿的气道炎症.     

Detection and management of childhood cholesteatoma.

Childhood cholesteatoma is an aggressive disease that demonstrates higher rates of recidivism than its adult counterpart. The priorities in ideal management include total removal, followed by hearing restoration, followed by preserving the ear anatomy. Especially in children, one must endeavor to preserve ear anatomy if it does not jeopardize total removal of cholesteatoma. Absolute indications for CWD surgery include an only-hearing ear, a severely destroyed posterior canal wall, an extremely contracted mastoid, and matrix overlying a semicircular canal fistula. Reasons for staging childhood cholesteatoma include suspected residual disease, uncertainty about total removal of cholesteatoma, severe mucosal disease, and CWU procedures in which the cholesteatoma has diffusely invaded the bone. Adequate long-term follow-up is imperative. Patients and their families should be reminded frequently of the importance of close follow-up because recidivism is frequent. Successful management of cholesteatoma in children does not involve a rigid, "one-way" approach. The surgeon must be flexible and capable of employing the most appropriate procedure for the patient.     

MARKERS OF BONE METABOLISM IN EUGONADAL FEMALE PATIENTS WITH β-THALASSEMIA MAJOR

Osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) have been recently implicated in the pathogenesis of various types of osteoporosis. The aim of this study was to investigate bone turnover in eugonadal female patients with this disease and characterize the possible role of the OPG/RANKL system in thalassemia-related bone loss. Markers of bone turnover and bone mineral density (BMD) were measured in 16 eugonadal young females with β-thalassemia major and 18 age- and sex-matched healthy controls. Bone turnover was significantly increased in thalassemic patients compared to controls but OPG was significantly higher in healthy subjects. BMD values negatively correlated with urine markers of bone resorption but not with OPG/sRANKL system.     

受虐儿童个性特征初步分析

目的探讨受虐儿童的个性特征,以期减少儿童受虐事件发生。方法采用自编一般资料问卷和儿童受虐筛查表、艾森克个性问卷(儿童版),对随机抽取湘潭某工厂子弟中学二年级学生282名施测。结果1年内遭受虐待儿童86名,未曾遭受虐待196名;受虐组N分值(情绪不稳分)高于非受虐组[(55.62±10.60)/(52.65±10.98)],(t=-2.114P=0.035),而受虐组L分值(“掩饰”倾向)低于非受虐组[(42.21±9.87)/(46.04±9.20)],(t=3.184P=0.002),均存在差异显著性;两组男童中受虐组的P分值高于非受虐组[(52.37±11.49)/(48.04±9.97)],(t=-2.227P=0.028),L分值较非受虐组分值低[(41.03±9.18)/(46.18±8.79)](t=3.125P=0.002),均存在显著性差异。两组女童EPQ分值无差异。结论儿童情绪与儿童受虐关系密切,因此培养情绪控制与表达是有望减少儿童受虐的一个干预策略。