雌激素干预吸烟骨质疏松大鼠种植体周围的骨沉积

背景：骨质疏松、吸烟可致口腔种植失败率显著增高。 目的：观察雌激素对吸烟骨质疏松大鼠种植体周围骨沉积的影响。 方法：50只雌性大鼠均分为5组：除假手术组外,卵巢去势组、卵巢去势+雌激素组、卵巢去势+吸烟组、卵巢去势+吸烟+雌激素组均制备卵巢去势模型,去势术后后两组持续熏烟24周。去势术后12周,在大鼠右侧胫骨近骺端植入钛种植体,种植后对卵巢去势+雌激素组和卵巢去势+吸烟+雌激素组肌注雌激素。实验24周时行动物活体骨密度测量及X射线观察,处死动物采集标本行种植体骨硬组织切片观察。 结果与结论：骨密度及X射线观察结果显示,雌激素可提高种植体周围骨沉积。硬组织切片观察结果显示,卵巢去势+雌激素组种植体骨包绕范围基本形成骨结合,松质骨区结合骨板与周围骨小梁相连。卵巢去势+吸烟+雌激素组种植体周围结合骨板较卵巢去势+吸烟组明显增厚,骨板周围小梁骨增多。提示雌激素可在一定程度上提高吸烟骨质疏松大鼠种植体周围骨沉积,促进种植体骨结合。     

钛种植体表面改性策略及对骨整合的影响

背景：纯钛因具有优良的生物相容性、机械性能和与骨组织相近的弹性模量等被广泛应用于口腔种植领域。 目的：综述近年来钛金属种植体材料表面物理改性、化学改性和生物化学改性策略的研究进展。 方法：以“titanium,implant,surface modification,osseointegration”为检索词,检索PubMed数据库,以“钛,种植体,表面改性,骨整合”为检索词,检索中国知网数据库,限定时间范围为2007年1月至2013年2月。文献检索语种为英文和中文。纳入内容与钛种植体表面改性方法及其对骨整合影响密切相关的文献,排除重复文献。 结果与结论：计算机初检得到199篇文献,根据纳入排除标准,对其中76篇文献进行分析。钛种植体本身是生物惰性材料,通过表面改性对钛金属表面进行活化处理,使之具有生物功能性,与骨组织形成早期骨整合,是国内外口腔种植材料研究的热点问题。物理改性、化学改性和生物化学改性可缩短钛种植体种植周期,获得早期骨整合和更高的结合强度。今后的发展趋势是将多种改性方法有机结合,从分子水平深入研究钛金属材料表面与机体细胞和组织之间的界面分子作用机制,完善种植体的表面改性技术,实现种植体和骨组织的早期和更加稳定的骨整合。     

降钙素促进骨质疏松骨床中植入体的骨整合

背景：降钙素具有提高骨量、骨质量,降低骨折发生的效果。 目的：评价鲑鱼降钙素对羟基磷灰石植入体骨整合的影响,及其在治疗骨质疏松症同时促进植入体生物学固定的能力。 方法：将SD大鼠随机分为假手术+羟基磷灰石棒组、卵巢切除+羟基磷灰石棒组、卵巢切除+降钙素+羟基磷灰石棒组,后2组建立绝经后骨质疏松动物模型。建模后分别在3组大鼠的胫骨平台处开孔植入多孔羟基磷灰石假体,卵巢切除+降钙素+羟基磷灰石棒组大鼠皮下注射鲑鱼降钙素12周。 结果与结论：卵巢切除后,大鼠的腰椎骨密度降低,而持续皮下注射鲑鱼降钙素后,大鼠的腰椎骨密度逐渐改善。应用降钙素处理后的大鼠,其骨结合率较卵巢切除+羟基磷灰石棒组提高了22.0%(P < 0.05)。结果证实,全身给予鲑鱼降钙素能提高骨质疏松大鼠骨床和植入体周围骨量、促进主体骨-植入体的骨整合。     

杜仲醇提取物对兔下颌牵张成骨的影响

背景：目前牵张成骨由于治疗周期长、并发症较多成为临床广泛运用的瓶颈,不能满足临床推广需要。 目的：以兔下颌骨牵张动物模型为实验平台,观察全身运用杜仲醇提取物对牵张新骨再生的影响。 方法：24只新西兰大白兔随机均分为对照组及实验组,建立兔下颌单侧牵张模型,牵张速率为每12 h 1 mm。在牵张期2次/d,实验组及对照组分别予以灌胃杜仲醇提取物及等量生理盐水,牵张结束后6周处死动物收集标本行成骨检测。 结果与结论：两组动物牵张间隙内均可观察到新骨生成。牵张成骨结束后6周下颌骨CT图像显示实验组兔牵张间隙舌侧骨皮质生成良好,颊侧骨皮质连续,牵张间隙可见均匀骨质生成桥接;下颌骨核素扫描显示实验组兔下颌骨牵张间隙表现为核浓集,强度明显强于对照组;X射线显示实验组牵张间隙完全桥接,新生成骨质密度均匀,可见上下侧骨皮质形成良好;Micro-CT图像显示实验组骨皮质部分形成较好,骨小梁分布较为均匀,骨小梁明显较对照组粗壮,对照组部分区域仍有囊性变;Micro-CT微结构参数检测显示实验组骨体积分数、骨小梁厚度、骨小梁数量和连接密度均显著高于对照组;组织学观察显示与对照组比较,实验组牵张间隙中有较为成熟的束状骨,骨小梁方向较为规律。实验结果显示全身运用杜仲醇提取物可有效促进兔下颌快速骨牵张的新骨再生。     

锌对钛种植体骨融合的影响

背景：前期的研究结果表明,补锌能够提高种植体的骨愈合率以及固位强度。 目的：观察锌对种植体骨界面组织形态的影响。 方法：纳入成年雄性家兔40只,双侧胫骨近心端各置入1枚钛种植体,建立钛种植体动物模型,分为补锌组和对照组。补锌组动物肌注10 g/L硫酸锌,4 mg/kg,1次/d;对照组给予同剂量生理盐水。分别于术后1,2,4,8,12周处死动物,利用显微镜及扫描电镜观察种植体-骨界面组织形态。 结果与结论：补锌能够在钛种植体置入后1~4周内加速种植体-骨界面的新骨形成,促进种植体骨愈合。提示种植体置入后适量地补锌能够促进新骨形成,提高骨愈合的速度和质量。     

强骨康疏胶囊对去卵巢骨质疏松大鼠骨细微结构及骨代谢的影响

目的:观察强骨康疏胶囊对去卵巢骨质疏松大鼠的骨密度、OPG及RANKL蛋白表达、骨组织形态计量学参数及骨组织细微结构的影响。方法:制备去卵巢骨质疏松大鼠模型后,分组:正常对照组、模型空白组、中药低剂量预防组、中药高剂量预防组、雌激素预防组。给药1月后,检测各组股骨骨密度值,显微镜下观察股骨骨小梁的结构变化,并检测骨组织形态计量学参数。采用免疫组织化学染色法检测大鼠股骨OPG及RANKL蛋白表达。结果:模型空白组大鼠股骨骨密度减少,骨小梁厚度、面积、面积百分数均减少,骨小梁间距增大,股骨OPG蛋白平均光密度值显著降低,RANKL蛋白平均光密度值明显增高;雌激素预防组、中药低剂量组、中药高剂量组对上述指标均有明显改善。结论:强骨康疏胶囊能有效提高骨量,维持骨小梁立体空间结构,改善大鼠股骨远端松质骨的显微结构,能够提高骨OPG蛋白表达及抑制RANKL蛋白表达。     

质子泵抑制剂治疗上消化道出血对痛风复发的影响

目的 通过观察上消化道出血的痛风患者使用质子泵抑制剂（PPI）治疗前后临床症状及尿酸的变化,以探讨PPI治疗上消化道出血对痛风复发的影响。方法 选择我院上消化道出血合并原发性痛风患者37例为痛风组,同期37例上消化道出血且无痛风患者为对照组。两组患者在使用PPI前后分别监测尿酸、体温、关节肿痛等指标,并对相关指标进行统计学分析。结果 痛风组使用PPI后血尿酸较用药前升高（49.24±111.49）μmol/L,差异有统计学意义（P＜0.05）;对照组PPI使用后血尿酸较用药前升高（2.89±47.87）μmol/L,但差异无统计学意义（P＞0.05）。痛风组用药前后尿酸变化差值大于对照组,差异有统计学意义（P＜0.05）。使用PPI治疗后,痛风组64.86%出现非感染性发热,75.68%出现新发关节疼痛,患者疼痛评分较用药前增加（P＜0.001）,而对照组患者未出现关节痛及发热病例。结论 上消化道出血的痛风患者使用PPI可能诱发或加重痛风疾病的活动。     

骨挤压对种植体初期稳定性的影响

背景：种植体的初期稳定性是影响种植体成败的关键因素,提高种植体在骨质不佳的植入床中的初期稳定性可以提高种植体的成功率。 目的：通过建立体外松质骨的骨块模型,模拟临床牙种植体植入,采用骨挤压术和传统备洞术在新鲜离体骨块上植入种植体,观察不同种植方法对种植体初期稳定性的影响。 方法：从新鲜的猪肩胛嵴处截取骨段,制成10 mm×10 mm×10 mm的新鲜立方形骨块(12块),固定后用骨挤压术和传统备洞术植入相同规格相同型号的BEGO种植体,分别记录种植体初期稳定性,并对观察结果进行t检验分析。 结果与结论：与传统备洞技术相比,在种植手术中采用骨挤压方法获得的种植体初期稳定性较高(P < 0.05)。提示骨挤压技术可以为种植体提供更好的初期稳定性。     

电刺激与运动联合干预绝经后骨质疏松模型大鼠骨代谢及血清学指标的改变

背景：电刺激与运动皆能对去势大鼠骨代谢产生良好影响,但关于电刺激和运动联合干预去势大鼠至今少有报道。 目的：观察适宜健骨运动处方与电刺激联合干预对绝经后骨质疏松的影响。 方法：将大鼠随机分为假手术组,骨质疏松模型组,运动组,电刺激组和运动+电刺激组,后4组建立骨质疏松大鼠模型并进行相应的干预。 结果与结论：干预后60 d,与骨质疏松模型组比较,运动结合电刺激组骨钙素浓度增高(P < 0.05),运动组、电刺激组、运动结合电刺激组抗酒石酸盐酸性磷酸酶活性低(P < 0.01),雌二醇水平显著升高(P < 0.05)。结果证实,运动处方结合低频电刺激联合作用能够更好地促进骨质疏松模型大鼠骨形成和抑制骨吸收,减少破骨细胞分泌和阻止骨丢失。 关键词：电刺激;运动;骨质疏松;骨代谢;骨组织构建 doi:10.3969/j.issn.1673-8225.2012.07.004     

复方丹参对高脂大鼠模型骨形态计量学参数的影响

背景：复方丹参对抗泼尼松性大鼠的骨丢失具有抑制骨吸收作用,但对高脂血症所致的骨质疏松症效果如何未见报道。 目的：通过骨形态计量学观察复方丹参对大鼠胫骨和腰椎骨丢失的防治作用。 方法：用脂肪乳剂建立高脂血症骨丢失大鼠模型,30只SD大鼠随机数字表法分为3组,正常对照组、高脂乳剂组、复方丹参组,分别给予生理盐水、高脂乳剂、高脂乳剂和复方丹参,连续16周。 结果与结论：与高脂乳剂组相比,复方丹参可使高脂大鼠胆固醇明显降低和高密度脂蛋白胆固醇明显升高,可以有效改善高脂乳剂导致的脂质代谢紊乱。复方丹参组的骨小梁面积百分数、骨小梁数量、成骨细胞贴壁长度百分率均增加(P < 0.05),而骨小梁分离度、每毫米破骨细胞数、破骨细胞贴壁长度百分率均减少(P < 0.01),反映骨形成及骨矿化的指标变化不明显;胫骨中段的皮质骨面积百分数增加(P < 0.01),骨髓腔面积百分数减少(P < 0.01),骨内外膜的形成和矿化均无明显变化;腰椎松质骨的骨小梁面积百分数、骨小梁数量、骨小梁宽度增加(P < 0.05)、而骨小梁分离度减少(P < 0.01)。提示长期高脂乳剂灌胃会导致大鼠骨量丢失,复方丹参能有效对抗高脂大鼠胫骨上段、中段骨、第5腰椎的骨丢失。     

The effect of oxytocin on osseointegration of titanium implant in ovariectomized rats

Introduction: Oxytocin (OT) was reported to control differentiation of human mesenchymal stem cells and reverse osteoporosis (OP). This study investigated the effect of systematical treatment of OT on implant osseointegration in ovariectomized (OVX) rats. Material and methods: Twenty female rats received bilateral ovariectomy. Twelve weeks later, all animals were randomly assigned to control or experimental group. Each rat received two implants at the distal femoral metaphysis. From the first postoperative day, rats in experiment group received subcutaneous injection of OT (1 mg/kg · d), while animals in control group received vehicle. Twelve weeks after implantation, specimens containing implants were harvested and evaluated by histology, micro-CT, and push-out test. Tibiae were also harvested to evaluate the effect of OT on intact bone tissue of OVX rats. Results: Compared with control, OT treatment increased the relative bone volume surrounding the implant by 2.2 times, the percent implant osseointegration by 0.62 times, and the maximum push-out force by 2.25 times. Increased bone mass was also observed in histological sections of distal femur with implant and intact bone tissue of the proximal tibiae. Conclusion: Systemic administration of OT promoted peri-implant bone healing and osseointegration of titanium implant and recovered the negative effects of OP in undisturbed bone tissue partially.     

质子泵抑制剂预防非甾体类抗炎药相关性胃病的研究进展

2006年9月美国食品及药物管理局(Food and Drug Adminstration,FDA)公告指出:非甾体类抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)基本都是潜在的心血管风险和消化道出血风险.     

Long-term proton pump inhibitor use is a risk factor for mortality in patients hospitalized for COVID-19

Background and aimThe aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is a risk factor for intubation requirement and mortality in patients hospitalized for COVID-19.Materials and methods In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeksResultsThe study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026–1.068), current smoking (HR: 2.590, 95% CI: 1.334–5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06–2.41) were found to be independent risk factors for mortalityConclusionThe results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.     

Influence of hypergastrinemia secondary to long-term proton pump inhibitor treatment on ECL cell tumorigenesis in human gastric mucosa

Proton pump inhibitor (PPI) therapy causes hypergastrinemia, which could promote the development and progression of neuroendocrine tumors (NETs). Concerns have been raised about the safety of long-term PPI use due to a possible increased risk of NETs. This study aimed to investigate the association between hypergastrinemia and the risk of NETs. Twenty outpatients presenting with serum gastrin levels greater than 400 pg/mL after long-term PPI treatment were registered in this study. Immunohistochemical analyses for chromogranin A (CgA), Ki67, gastrin and CCK/B gastrin receptor (CCKBR) were performed, and positive cell numbers were counted. There were no NET or gastric epithelial neoplasia cases observed among any of the 20 patients examined throughout the PPI treatment period. Histologically, ECL cell hyperplasia were shown in all patients. However, no relationship was found between serum gastrin levels and the number of CgA positive ECL cells. There was also no relationship between serum gastrin levels and the proportion of Ki67 positive cells or the density of CCKBR positive cells. The data indicate no relationship may exist between NETs and hypergastrinemia secondary to PPI treatment in patients having no, or mild, atrophic gastritis.     

聚醚醚酮内植物骨整合改性的研究进展

聚醚醚酮（PEEK）材料因有着诸多优点而在骨缺损修复等医学领域得到越来越多的关注和应用,同时对于克服其生物惰性,提高其骨整合性能的改性研究成为热点。本文通过查阅国内外关于PEEK材料骨整合改性的相关文献,综述了近年来对骨科植入物PEEK材料进行改性以提高其骨整合性能的相关研究现状,并重点从改性原理的角度进行总结。     

Anaphylaxis due to proton pump inhibitors: current understanding and important clinical considerations

Introduction: Proton pump inhibitors (PPIs) are one of the most prescribed drug classes. PPIs are remarkably safe, with minimal side effects, most of which are related to drug’s pharmacokinetic interaction profiles. However, hypersensitivity reactions can occur and anaphylactic reactions to PPIs have been described.

Areas covered: A literature search in PubMed was performed to review the evaluation and management of anaphylaxis to PPIs. Clinicians should have a high level of suspicion and a drug allergy workup should be carried out by allergists, in a proper facility. Skin tests with PPIs are the only accurate methods to identify the culprit drug; they are also quite specific to solve cross-reactivity problems among drugs of this group.

Expert commentary: A label of hypersensitivity to the whole group is generally not correct and tolerance to PPI with negative skin tests should be established with a negative oral challenge test. When an alternative drug among the whole group cannot be found, anti-H2 can be prescribed or a PPI desensitization protocol can be applied.     

白细胞介素1β对破骨细胞空泡型质子泵活性与胞内酸化的影响

目的:通过体外实验研究白细胞介素1β(IL-1β)对破骨细胞空泡型质子泵与细胞内pH值的影响,以探讨IL-1β促进破骨细胞骨吸收的机制。方法:骨髓单核巨噬细胞经过诱导成为破骨细胞后,予以0.1、0.3和0.5μg/L的IL-1β干预48 h,检测破骨细胞空泡型质子泵mRNA和蛋白的表达以及IL-1β对破骨细胞胞内酸化的影响,观察空泡型质子泵活性的改变与破骨细胞骨吸收功能的变化。结果:研究结果提示破骨细胞经IL-1β干预48 h后,空泡型质子泵的表达与活性均显著增加,并且细胞内pH值下降。破骨细胞与含有IL-1β的细胞培养液共同孵育后,其骨吸收能力增强,培养液中IL-1β的浓度越高,该作用越趋明显。结论:IL-1β可能是通过上调空泡型质子泵的表达与酶的活性,促进氢离子的产生和(或)转运,引发破骨细胞骨吸收活动增加,最终导致骨质破坏,由此参与骨关节炎症性疾病的发生。     

Effect of zinc ions on improving implant fixation in osteoporotic bone

Abstract

The application of titanium (Ti) and its alloys in tooth restoration and joint replacement for aged patients with unfavorable conditions is gaining popularity. Therefore, strategies aiming at improving the fixation of Ti-based implants are worth investigating. This study was designed to observe whether modification of Ti implants by zinc (Zn) could enhance the fixation capability in osteoporotic bone. Two kinds of implants, hydroxyapatite (HA) coated Ti and Zn-incorporated HA (ZnHA) coated Ti, were inserted into the femoral metaphysis longitudinally in ovariectomized (OVX) rats. Specimens were harvested and subjected to double fluorescence labeling examination at week 6 after surgery. At week 12, samples were evaluated with histomorphometry, micro-CT (μCT) analysis and biomechanical test. Compared to the HA coated implants, ZnHA coating improved mineral apposition rate (MAR) of peri-implant bone, which was revealed by double fluorescence labeling; bone area ratio (BA) and bone-to-implant contact (BIC) were also higher for the latter group by histomorphometry. μCT images suggested that more bone mass was formed around the ZnHA coated implants as compared to the HA coated implants. Biomechanical push-out test showed that the ZnHA coated implants demonstrated higher strength of osseointegration than the HA group. The current study suggested that Zn ions could enhance bone formation and improve implant fixation in OVX rats.