早期高蛋白饮食对肾移植切口愈合的影响

收集慢性肾功能衰竭终末期肾移植后食欲改善，肾功恢复正常患者66例，随机分为两组，治疗组35例，对照组31例。于术后第5天分别进行人体测量，各种参数及化验指标经统计学处理无显著差异。两组均经术后4天禁食，流汁，半流汁饮食过渡。此后，治疗组选用优质蛋白占65％，且含铁、硒、锌及维生素C丰富的高蛋白饮食，而对照组采用优质蛋白为主的普食，经8天治疗，比较两组切口愈合情况。结果治疗组切口愈合明显优于对照组（P＜0．05），而对血肌酐无明显影响。     

壮筋续骨汤对骨折大鼠血清BMP和NPY水平的影响

目的研究壮筋续骨汤对大鼠股骨骨折后血清骨形态发生蛋白（BMP）与神经肽Y（NPY）水平影响,探讨其促进骨折愈合的作用机制。方法成年健康雄性wiScar大鼠50只,用线锯在股骨中段切断股骨制备骨折模型,应用壮筋续骨汤水煎液灌胃治疗。解剖观察大度骨折局部与和情况。酶联免疫吸附试验检测血清BMP7及NPY水平。结果骨折伤后7天,骨折断端主要为纤维肉芽组织,14天为纤维性骨痂组织。治疗后7天,骨折断端由纤维性骨痂形成,14天已有软骨性骨痂和骨性骨痂形成。大鼠血清BMP7和NPY水平在骨折术后14天均显著高于骨折术后7天,P〈0．05。模型组血清BMP7和NPY水平均显著高于假手术组。P〈0．05;治疗组血清BMP7和NPY水平均显著高于模型组,P〈0．05。结论壮筋续骨汤可能通过提高血清BMP7和NPY的含量而促进骨折愈合。     

Dietary energy density and diet variety as predictors of outcome in anorexia nervosa

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, and the rate of relapse is estimated to be as high as 50%. Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients. OBJECTIVE: The objective of the study was to determine whether diet energy density and diet variety in recently weight-restored women with AN predict outcome. DESIGN: After gaining weight to a body mass index (BMI; in kg/m(2)) of > or = 20, 47 hospitalized women completed 4-d food records, from which a mean diet energy density score (DEDS) and a mean diet variety score (DVS) were calculated. Outcome was determined at study end by using modified Morgan-Russell criteria, and it was dichotomized as "treatment success" or "treatment failure." Data were analyzed by using Student's t test. A logistic regression model was constructed to evaluate the effects of DEDS, DVS, and caloric intake on outcome. RESULTS: Groups did not differ significantly in mean measures of age, admission and weight-restored BMI, or caloric intake. However, DEDS and DVS were significantly higher in the success group than in the failure group. The success and failure groups were followed for a mean of 240 and 170 d, respectively. In the logistic regression model, DEDS (P = 0.016) and DVS (P = 0.048) but not caloric intake (P = 0.585) significantly predicted outcome. CONCLUSION: In recently weight-restored women with AN, lower DEDS and DVS but not caloric intake were associated with poor outcome.     

大鼠脑损伤对股骨骨折骨痂中CGRP和PDGF表达的影响

目的研究大鼠脑损伤股骨骨折骨痂中降钙素基因相关肽(CGRP)和血小板衍生生长因子(PDGF)的表达规律。方法成年健康雄性Wistar大鼠90只,随机分为脑外伤合并骨折组、单纯骨折组和假手术组各30只。HE染色观察骨痂的结构变化,免疫组化染色检测骨痂中CGRP和PDGF表达。结果脑外伤合并骨折组骨折愈合速度较单纯骨折组快,骨痂中CGRP阳性表达出现早,7d达高峰,维持时间长,21d才开始下降;PDGF于14d达高峰,维持21d下降。结论颅脑损伤后,骨折骨痂中CGRP和PDGF表达出现时间早,表达强度高,维持时间长,可加快骨折愈合过程。     

脊髓损伤对股骨骨折骨痂中VIP和NGF表达的影响

目的观察大鼠脊髓损伤对股骨骨折骨痂中血管活性肠肽(VIP)和神经生长因子(NGF)表达的影响。方法将健康雌性Wistar大鼠32只随机分为单纯股骨骨折组和股骨骨折并脊髓损伤组,每组16只,每组再分为骨折后1、4、7、14d亚组,每个亚组4只。应用物体自由坠落打击法建立脊髓损伤大鼠模型,免疫组织化学技术检测骨痂中VIP和NGF的表达水平。结果单纯骨折组表现为典型的骨折愈合过程,骨痂内纤维母细胞及成骨细胞内VIP和NGF阳性表达相对较弱。骨折并脊髓损伤组早期形成大量纤维骨痂和软骨骨痂,VIP和NGF强阳性表达,VIP和NGF表达达高峰。结论合并脊髓损伤的股骨骨折部位愈合较快,VIP和NGF表达明显增强,提示VIP和NGF具有促进骨折愈合的作用。     

Effects of catabolic stress in acute and chronic renal failure

The degree of catabolism was studied in a group of seven patients with postsurgical acute renal failure, and net protein catabolism of 43.1 to 927 g/day. In 70% of a group of 30 patients with stable chronic renal failure receiving and 18 g high biological value protein diet, urea synthesis was equivalent to what could be accounted for by the protein content of the food. This equivalence was not found in studies in both adults and children who were treated for catabolic chronic renal failure. Data obtained show the superiority of feeding essential amino acids with an adequated caloric supply. The need for studies aimed at adapting the uremic patient to protein depletive mechanisms is strongly stressed.     

Chronic ethanol consumption results in deficient bone repair in rats

There is evidence that ethanol inhibits osteoblast function and that chronic ethanol consumption induces systemic bone loss and increases the risk of fracture in humans. The purpose of the present study was to determine whether chronic ethanol consumption also compromises the healing of injured bone. Male Sprague-Dawley rats, 8-10 weeks old, were placed into four feeding groups: group A received ethanol (36% of calories) as part of a liquid diet; group B was pair-fed to group A and received an isocaloric control diet containing maltodextrin; group C was fed the AIN-93M standard semi-purified liquid diet ad libitum; group D was fed the same ethanol diet as group A before bone injury, but after surgery (see below) these rats were given isocaloric control diet ad libitum. After 6 weeks on their respective diets, a bone repair model was surgically created at the midshaft in both fibulae of each rat. Seven weeks after injury the animals were euthanized and bone healing was evaluated by determining rigidity of the fibula by three-point bending, flexural modulus of the repair tissue and mineral content of the repair tissue. Rigidity of fibula in ethanol-fed rats and their pair-fed controls (groups A and B) were respectively 48 and 47% lower than in group C. Flexural modulus of the repair tissue in ethanol-fed rats had a 55% (P = 0.046) deficiency compared with their pair-fed controls. The mineral contents in groups A and B were respectively 16 and 13% lower than in group C. There were no significant differences in the results between groups C and D. Thus, the outcome of bone repair in ethanol-fed rats was deficient compared with rats receiving a standard maintenance diet. The repair tissue in ethanol-fed rats was mechanically inferior to that in pair-fed controls. This deficiency could not be attributed to the reduced food consumption of these animals. On the other hand, the restoration of normal bone healing in group D cannot be attributed solely to the cessation of ethanol feeding after bone injury because of the increased food consumption during this period.     

外固定器加微创植骨在治疗胫骨骨折不愈合、延迟愈合中的应用

目的为提高临床治愈率,了解外固定器加微创植骨在治疗胫骨骨折不愈合、延迟愈合中的应用价值。方法选择2009年1月～2010年12月两年期间某科就诊的23例胫骨骨折不愈合的患者。回顾术后治疗效果、并发症及随访情况。结果 23例患者住院时间平均为(21±4)d,CR拍片显示骨痂出现时间平均为(8.7±3.2)周,骨折愈合时间平均为(6.7±3.4)月。Johner-Wruhs功能分级法评定患肢情况:优良(excellent)占56.5%,良好(good)占34.8%,一般(fair)占8.7%,无差级(poor)者。术后1年内随访情况:骨折部位均愈合良好,无严重并发症等情况发生。结论外固定器加微创植骨治疗胫骨骨折不愈合、延迟愈合,安全有效,值得临床推广。     

The effect of metal copper on fracture healing in chicken

OBJECTIVE: To observe the effect of copper on bone fracture healing. METHODS: 160 growing chickens aged 70 days were fed in 32 cages, each consisting of five. The fracture with 1 approximately 2 mm defects at the bilateral radius of wings was created by osteotomy. The chickens were divided into four groups, 40 each. Every morning, chickens of the first group, served as controls, were fed orally 0.8% Na-CMC solution (sodium carboxymethyl cellulose), those of the other three groups were fed with copper-Na-CMC suspension (copper powder suspended in 0.8% Na-CMC) with different doses of 20, 40 and 80 mg Cu/kg body weight. Each group was sacrificed 14, 21, 28 and 35 days postoperatively. Liver was taken for analysis of Cu and Zn. Both radius were removed by dissection. CT was performed quantitatively for the ment of the gray values of the callus. The biomechanical properties of the healing radius were analyzed by a three point bending test. Afterwards, the contents of calcium, magnesium, phosphorus, copper, zinc, iron and hydroxyproline in the callus were determined. RESULTS: The gray values of the callus increased along with the increase of copper dose and the duration of observation. 21 and 35 days after operation, the gray values of the callus were significantly higher in the high-Cu group than in the controls respectively (909 +/- 220 vs. 597 +/- 155; 973 +/- 100 vs. 763 +/- 179 HU, P < 0.05). The level of calcium and magnesium in the callus 35 days after operation was much higher in the mid and high Cu groups than in the controls respectively (Ca: 177 +/- 26.7, 176 +/- 20.5 and 137 +/- 34.7 mg/g; Mg: 2.98 +/- 0.57, 3.06 +/- 0.46 and 2.43 +/- 0.53 mg/g P < 0.05). The contents of hydroxyproline in the callus 35 days after operation were significantly higher in the high-Cu group than in the controls (34.23 +/- 1.96 vs. 32.17 +/- 1.93 mg/g respectively). The biomechanical properties of the repaired radius had a better improvement tendency in the three Cu-fed groups than in the controls. CONCLUSION: Copper is helpful in fracture healing; however, the effect of copper on fracture healing needs further study.     

The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation

Interfragmentary movement (IFM) at the fracture site plays an important role in fracture healing, particularly during its early stage, via influencing the mechanical microenvironment of mesenchymal stem cells within the fracture callus. However, the effect of changes in IFM resulting from the changes in the configuration of locking plate fixation on cell differentiation has not yet been fully understood. In this study, mechanical experiments on surrogate tibia specimens, manufactured from specially formulated polyurethane, were conducted to investigate changes in IFM of fractures under various locking plate fixation configurations and loading magnitudes. The effect of the observed IFM on callus cell differentiation was then further studied using computational simulation. We found that during the early stage, cell differentiation in the fracture callus is highly influenced by fracture gap size and IFM, which in turn, is highly sensitive to locking plate fixation configuration. The computational model predicted that a small gap size (e.g. 1 mm) under a relatively flexible configuration of locking plate fixation (larger bone-plate distances and working lengths) could experience excessive strain and fluid flow within the fracture site, resulting in excessive fibrous tissue differentiation and delayed healing. By contrast, a relatively flexible configuration of locking plate fixation was predicted to improve cartilaginous callus formation and bone healing for a relatively larger gap size (e.g. 3 mm). If further confirmed by animal and human studies, the research outcome of this paper may have implications for orthopaedic surgeons in optimising the application of locking plate fixations for fractures in clinical practice.     

Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients

AIMS: To determine whether a specific high-protein enteral formula with a similar caloric percentage of fat and carbohydrates achieves greater control over glycemic levels and reduces insulin requirements in hyperglycemic critically ill patients when compared to a control high-protein enteral formula. DESIGN: A prospective, randomized, controlled, single-blind trial in two University Hospital Intensive Care Units in Spain. METHODS: We enrolled 50 patients with diabetes mellitus or stress hyperglycemia with basal glycemia > or =160 mg/dl and indication for enteral nutrition > or =5 days. Patients with severe kidney failure, liver failure or obesity were excluded from the study. In the first 48 h of admission, after randomization, 26 patients received the study diet and 24 patients received the control diet. The variables were monitored for 14 days. The Harris-Benedict formula with a fixed stress factor of 1.2 was used to calculate caloric needs. Insulin was administered by continuous infusion. An intention-to-treat analysis was performed. RESULTS: On admission, there were no differences between the study and control group in plasma glucose levels (mg/dl) (190.9+/-45 vs 210.3+/-63) and capillary glucose levels (mg/dl) (226.1+/-73 vs 213.8+/-67). After the feeding trial, there were differences between the study and control group in plasma glucose levels (mg/dl) (176.8+/-44 vs 222.8+/-47, P=0.001), capillary glucose levels (mg/dl) (163.1+/-45 vs 216.4+/-56, P=0.001), insulin requirements/day (IU) 8.73 (2.3-27.5) vs 30.2 (21.5-57.1) (P=0.001), insulin/received carbohydrates (UI/g) 0.07 (0.02-0.22) vs 0.18 (0.11-0.35) (P=0.02) and insulin/received carbohydrates/kg 0.98 (0.26-3.59) vs 2.13 (1.44-4.58) (P=0.04). These differences remain in a day-to-day comparison. There were no differences in the analytical tests, or in digestive or infectious complications. Intensive Care Unit length of stay, mechanical ventilation and mortality were similar in both groups. CONCLUSIONS: Hyperglycemic critically ill patients fed with a high-protein diet with a similar caloric percentage of fat and carbohydrates show a significant reduction in plasma glucose levels, capillary glucose levels and insulin requirements in comparison to patients on a conventional high-protein diet. This better glycemic control do not modify Intensive Care Unit length of stay, infectious complications, mechanical ventilation and mortality.     

Efficacy of diet and exercise in the reduction of serum cholesterol and triglyceride in free-living adult males.

Young males with levels of serum cholesterol or triglyceride in the upper quartile of the distribution for volunteers tested, participated in a program designed to determine the effect of diet and exercise on serum lipids. Dietary modifications involved caloric restriction superimposed on either the National Institutes of Health (NIH) recommendations for type II or IV hyperlipoproteinemia, as appropriate, or superimposed on a fat-controlled regimen in which fat of an unspecified nature was restricted to 30% of total calories. Participants with elevated levels of cholesterol responded significantly better when instructed in the diet meeting NIH criteria, 21% change in cholesterol, than when instructed in a diet controlled in fat, 11% change in cholesterol. For those with elevated levels of triglyceride, the NIH type IV diet was no more effective at the end of 6 months than the diet controlled in fat where caloric restriction was a part of both dietary regimens. The mean change in triglyceride for this group was 32%. Those with elevated levels of both cholesterol and triglyceride were less amenable to change than those with a single hyperlipidemia. For some diagnostic types, the results were suggestive of a beneficial effect of exercise in addition to diet in accelerating or maintaining reductions in serum lipids.     

纤维粘连蛋白在骨质疏松骨折愈合过程中的动态表达及中药对其的调控作用

目的探讨纤维粘连蛋白在骨质疏松骨折愈合过程中的动态表达及骨康中药对其的调控作用。方法 60只健康未生育4月龄SPF级SD雌性大鼠,随机均分为空白组、骨质疏松组、骨质疏松+中药组。去势造骨质疏松模型并造股骨干中段闭合性骨折,术后第1、2、4、6、8周每组处死4只大鼠,取骨痂组织,行RT-PCR和Western Blotting检测。结果正常组及中药组术后两周FNmRNA的术后两周达到峰值,显著高于与其它周的FNmRNA表达(P<0.05);骨松组在术后第6周达到峰值,显著高于与其它周的FNmRNA表达(P<0.05);骨松组的FNmRNA的表达峰值较其余两组有显著统计学差异(P<0.05)。结论 FN在骨质疏松骨折骨痂钙化的延迟过程中起到一定的作用;骨康方可能是通过调整FN蛋白的表达促进其愈合。     

壮筋续骨汤促进骨折愈合的实验研究

目的 研究壮筋续骨汤促进大鼠股骨骨折愈合的作用.方法 成年健康雄性Wistar大鼠50只,用线锯在股骨中段切断股骨制备骨折模型,应用壮筋续骨汤水煎液灌胃治疗.X线观察骨折愈合情况,苏木精-伊红染色观察骨折愈合的病理变化.结果 治疗后7天,大鼠局部肿胀消失;X线片示纤维性骨痂开始形成,骨折线模糊;HE染色示骨折端断成纤维细胞和成骨细胞增多.治疗后14天,大鼠患肢活动逐渐恢复;X现示骨折处显示纤维性骨痂和钙盐沉积,骨折线消失;HE染色示骨折端有大量纤维性骨痂,软骨性骨痂和骨性骨痂,趋于愈合.结论 壮筋续骨汤能促进实验性大鼠骨折愈合.     

成肌细胞介导的hIGF-1基因转移促骨折愈合实验研究

目的观察携带外源人胰岛素样生长因子-1(insulin-like growth factor-1,hIGF-1)基因的成肌细胞体内局部注射对小鼠胫骨骨折愈合的影响。方法将42只8周龄雄性C57小鼠随机分成两组,建立左胫骨骨折的动物模型。分别在实验组和对照组骨折周围肌肉组织中多点注射0.3ml转基因成肌细胞悬液和等量生理盐水,术后于第2、3、4周每组各处死7只,行HE染色,观察形成骨痂面积的大小和组成成分的变化;术后第2、4周免疫组织化学染色分析外源性细胞在体内有无存活并表达hIGF-1;术后2、4周行X线摄片以观察骨折愈合情况并采用透射电镜观察骨痂生长情况。结果各实验组转基因成肌细胞BrdU免疫组化染色阳性;各实验组hIGF-1免疫组化染色阳性;所有实验组外骨痂中小梁骨占骨痂总面积的百分比均高于对照组,其中第3、4周经F检验两组的差异具有显著性(p<0.05);X线显示第4周实验组有较多骨痂形成,经秩和检验与对照组有显著差异(p<0.05);电镜显示实验组骨生成细胞的数量、活跃程度和胶原纤维的数量、分布均优于对照组。结论局部注射转hIGF-1基因的成肌细胞对小鼠胫骨骨折愈合有一定的促进作用。     

High protein enteral feedings: a means of achieving positive nitrogen balance in head injured patients

In an attempt to improve early enteral nitrogen replacement, nitrogen status was compared in two groups of head injured patients receiving enteral regimens of 38 to 51 kcal/kg/day with different protein concentrations. Eleven control patients received 1.5 g protein/kg/day and 10 study patients received 2.2 g protein/kg/day. Daily nitrogen excretion, corrected nitrogen balance, blood urea nitrogen changes, and enteral formula tolerance were compared between groups over a 10-day period. Those receiving 2.2 g protein/kg/day had significantly higher daily and cumulative nitrogen balances despite their higher nitrogen excretion levels. Over 10 days, the study group retained 9.2 g nitrogen. By comparison, the control group sustained a cumulative loss of 31.2 g nitrogen over 10 days, despite a mean intake of 109 g protein/day. In both groups, full strength, full rate feedings were not possible until day 10 postinjury. These data indicate that once enteral formulas are tolerated high nitrogen regimens are required to achieve positive nitrogen balance in acute severe head injury patients.     

Protein restriction during lactation alters the autonomic nervous system control on glucose-induced insulin secretion in adult rats

Involvement of autonomic nervous system (ANS) neurotransmitters on insulin secretion in rats submitted to protein malnutrition during lactation was studied. During the first 2/3 of lactation, mothers received a 4% protein diet (LP). Control group received normal diet (23% protein) (NP). After protein restriction, mothers received normal diets. At 81 days rats were submitted to intravenous glucose tolerance tests (ivGTT). Plasma glucose and insulin concentration (PIC) were measured. Glucose-induced insulin secretion (GIIS) was tested in pancreatic islets. Fasting normoglycemia and hypoinsulinemia were observed in LP rats. Glucose intolerance and low PIC in LP group were detected during ivGTT. Acetylcholine (Ach) or blockage of alpha-adrenoceptors induced high PIC increment in LP rats; atropine or stimulation of alpha-adrenoceptors did not change PIC. Insulin secretion of LP rat islets showed low glucose and carbachol responses. Epinephrine-inhibited GIIS in both islet groups. Hypoinsulinemia observed in lactation-malnourished rats might be caused by alterations in GIIS regulation, including ANS modulation.     

Malnutrition during brain growth spurt alters the effect of fluoxetine on aggressive behavior in adult rats

Malnutrition effect during the suckling period on aggressive behavior was investigated in adult rats treated and not treated with fluoxetine, a selective serotonin reuptake inhibitor. Sixty-four Wistar male rats were allocated in two groups, according to their mothers' diet during lactation. The well-nourished group was fed by mothers receiving a 23% protein diet; the malnourished one by mothers receiving a 8% protein diet. Following weaning, all rats received the 23% protein diet. On the 90th day after birth, each nutritional group was divided into two subgroups, one receiving a single daily injection of fluoxetine (10 mg/kg) and the other of a saline solution (0.9% NaCl) for 14 days. Treatment with Fluoxetine reduced aggressive response in well-nourished but not in malnourished rats. These findings suggest that the serotoninergic system was affected by malnutrition during the critical period of brain development, and persisted even after a long period of nutritional recovery.     

Protein restriction during lactation alters the autonomic nervous system control on glucose-induced insulin secretion in adult rats

Involvement of autonomic nervous system (ANS) neurotransmitters on insulin secretion in rats submitted to protein malnutrition during lactation was studied. During the first 2/3 of lactation, mothers received a 4% protein diet (LP). Control group received normal diet (23% protein) (NP). After protein restriction, mothers received normal diets. At 81 days rats were submitted to intravenous glucose tolerance tests (ivGTT). Plasma glucose and insulin concentration (PIC) were measured. Glucose-induced insulin secretion (GIIS) was tested in pancreatic islets. Fasting normoglycemia and hypoinsulinemia were observed in LP rats. Glucose intolerance and low PIC in LP group were detected during ivGTT. Acetylcholine (Ach) or blockage of α-adrenoceptors induced high PIC increment in LP rats; atropine or stimulation of α-adrenoceptors did not change PIC. Insulin secretion of LP rat islets showed low glucose and carbachol responses. Epinephrine-inhibited GIIS in both islet groups. Hypoinsulinemia observed in lactation-malnourished rats might be caused by alterations in GIIS regulation, including ANS modulation.     

兔骨折合并脑外伤模型血清对鼠骨折愈合影响的实验研究

目的在鼠单纯骨折模型中应用兔骨折合并脑外伤模型血清,分析其骨折愈合过程。方法制备免骨折合并脑外伤模型8只．并制备兔骨折合并脑外伤模型动物不同时段血清（实验血清）,分术后1w、2w、3w、4w分别保存,冻干处理;从2只健康兔动脉血制备血清（阴性对照血清）,冻干处理;制备鼠单纯股骨干骨折模型72只,骨折行克氏针髓内固定;将单纯股骨干骨折模型鼠随机分成3组。即实验组、阴性对照组和空白对照组,每组24只,据鼠与兔体表面积比计算血清用量,实验组在术后1天（第1周）、8天（第2周）、15天（第3周）、22天（第4周）分别臀肌内注射相应时段实验血清,阴性对照组对应时间肌注阴性对照血清。空白对照组不予任何处理：每组术后1w、2w、3w、4w处死6只鼠,x线摄片比较各组骨折固定术后1w、2w、3w、4w骨折愈合情况。软件分析骨痂形成情况。结果术后2w、3w、4w实验组较对照组骨折处骨痂形成明显加速．骨痂灰度明显致密。结论肌注相应时段兔骨折合并脑外伤模型血清,能明显加速鼠单纯骨折模型的骨折愈合。