青年男性血清25羟维生素D、PTH水平与区域骨密度的关系

目的 调查广州地区青年男性维生素D、PTH状态及其与区域骨密度之间的关系.方法 随机选取2011年5月-2012年8月在广州军区广州总医院门诊部体检的60名广州青年男性志愿受试者,年龄18～44岁.评估血清25(OH)D、PTH水平,并分析血清25(OH)D、PTH与骨转换指标和区域骨密度(BMD)的相关性.结果 46.7％的青年男性血清25(OH)D水平＞30 ng/mL,53.3％低于30 ng/mL,5％低于20 ng/mL.血清25(OH)D水平与年龄分布无统计学差异(P＞0.05).双变量分析显示血清25(OH)D水平与PTH负相关(r=-0.264,P=0.042),与β-Crosslaps负相关(r=-0.257,P=0.047).血清25(OH)D水平、PTH与L1-4以及单个腰椎L1、L2、L3、L4的BMD无相关性.股骨大转子BMD与血清25(OH)D正相关(r=0.271,P=0.040),校正年龄、BMI和骨生化指标后,正相关性更加明显(r =0.319,P=0.020).多元线性回归分析显示BMI、ALP与全腰、L1、L3、L4椎BMD相关,BMI、PINP与L2椎BMD相关,BMI、25(OH)D与全髋、大转子BMD相关.结论 青年男性广泛存在血清25(OH)D不足状态,血清25(OH)D水平与股骨大转子BMD明显正相关,适当补充维生素D和钙剂,对维持大转子区域的骨量至关重要.     

绝经后女性血清硒水平与骨质疏松骨密度和骨代谢指标相关性研究

目的探索血清硒水平与绝经后妇女骨代谢指标以及腰椎和髋部骨密度之间相关性。方法检测156例正常骨密度和162例骨质疏松症的血清硒、25-羟基维生素D、PTH、骨钙素、PINP、CTX和NTX/Cr等指标水平。腰椎和股骨颈的BMD通过双能X线吸收法测量。探索了血清硒水平与骨密度的关系。结果骨质疏松症女性的血清硒水平低于正常骨密度的女性(P0.05)。在骨质疏松症妇女中,血清硒水平与年龄、绝经年限、BMI、PTH、骨钙素、PINP、CTX和NTX/Cr水平呈负相关,与25-羟基维生素D水平呈正相关。在正常骨密度组,血清硒水平与这些参数均未发现明显的相关性。调整年龄和BMI后,腰椎和股骨颈骨密度与血清硒及25-羟基维生素D水平呈显著正相关,与绝经年限、PTH、骨钙素、PINP、CTX和NTX/Cr呈负相关。对年龄和BMI进行调整后,进行多元回归分析以确定BMD的预测因子,血清硒和PINP、CTX是腰椎和股骨颈骨密度的显著预测因子。结论绝经后女性患者血清硒水平降低与腰椎和股骨颈骨密度降低密切有关。     

中国男性和女性血清25羟维生素D水平与年龄、性别和骨密度之间的关系

目的观察血清25羟维生素D[25(OH)D]水平与广州地区成人年龄、性别和骨密度的关系。方法本横断面研究随机抽取了188名女性和122名男性,年龄为17~88岁的广州地区居民。采用双能X线(DXA)骨密度仪测量腰椎和股骨颈的骨密度,电化学发光免疫分析法测定血清中25(OH)D、甲状旁腺激素(parathyroid hormone,PTH)、Ⅰ型原胶原N-端前肽(procollagen type IN-terminal propeptide,PINP)、β-胶原特殊序列(β-crosslaps,β-CTX)。血清25(OH)D水平分为四个亚组:严重缺乏(10 ng/m L),缺少(10~20 ng/m L),不足(20~30 ng/m L),充分(≥30 ng/m L)。结果受试者平均年龄为(47.39±19.32)岁。女性的血清25(OH)D水平(25.35±6.59)ng/m L明显低于男性(27.25±7.94)ng/m L,P0.05。男性25(OH)D严重缺乏(10 ng/m L)的比例为1.6%,女性为0;男性25(OH)D缺少(10~20 ng/m L)的比例为22.9%,女性为20.5%;男性25(OH)D不足(20~30 ng/m L)的比例为65.6%,女性为73.4%。男性血清25(OH)D水平与年龄呈负相关(r=0.249,P0.01),而在女性中二者没有相关性(r=0.130,P0.05)。血清25(OH)D水平与老年妇女(分别为r=0.382,P0.01;r=0.384,P0.01)、青年男性(分别为r=0.332,P0.05;r=0.260,P0.05)腰椎和股骨颈的骨密度呈正相关。当校正年龄因素后,血清25(OH)D水平与老年妇女的腰椎、股骨颈骨密度之间仍存在相关性(分别为r=0.325,P0.05;r=0.323,P0.05)。但年龄校正后的血清25(OH)D水平与年轻男性的腰椎骨密度呈正相关(r=0.278,P0.05),与股骨颈骨密度没有相关性(r=0.165,P0.05)。校正年龄后的血清25(OH)D水平与中青年妇女和中老年男性腰椎和股骨颈骨密度无相关性。无论是否校正年龄,血清PTH水平和其他骨代谢指标均与受试者的血清25(OH)D水平无相关性。结论有超过2/3的广州居民存在维生素D不足。血清25(OH)D水平是老年女性和青年男性骨密度的重要生化标志物。     

血清神经肽Y水平与绝经后妇女骨密度相关性研究

目的探讨血清神经肽Y(NPY)水平与绝经后妇女骨密度(BMD)的相关性。方法纳入在我院门诊就诊的绝经后妇女。测量血清钙、磷、白蛋白、甲状旁腺激素(parathyroid hormone,PTH)、促甲状腺激素(thyrotropin,TSH)、25-OH维生素D和NPY浓度。根据骨密度检测结果将受试者分为3组,分别为BMD值:正常(n=66)、骨量减少(n=63)和骨质疏松症(n=63)。根据血清NPY水平,受试者也被分为3组:低NPY(n=30)、正常NPY(n=126)和高NPY(n=36)。结果骨密度正常、骨质疏松、骨质疏松症患者血清NPY、PTH和年龄水平差异有显著统计学意义(P<0.05)。对于不同的NPY水平,各组腰椎、股骨总、股骨颈、转子、股骨转子间和Ward’s三角BMD值有显著差异(P<0.05)。相关性分析显示血清NPY水平与患者年龄、BMI呈现显著正相关(P<0.05),与不同部位的BMD值之间均有显著负相关性(P<0.05)。结论血清NPY水平与患者年龄、体重指数或任何部位测量的BMD值之间有相关性。     

IL-33与绝经后骨质疏松女性骨密度和骨代谢指标相关性研究

目的 探索血清白细胞介素-33(IL-33)与绝经后骨质疏松女性骨密度和骨代谢指标相关性。方法 采用酶联免疫吸附法测定50例绝经后骨质疏松患者和50例正常绝经后妇女血清IL-33水平。采用双能X线骨密度仪(DXA)测量患者和对照组的骨密度(BMD)。检测维生素D、钙、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)水平,以及1型胶原C末端肽(CTX)和1型前胶原N端前肽(P1NP)等骨转换指标。结果 在绝经后骨质疏松症女性中,IL-33水平显著低于健康对照组[(3.53±2.45) pg/mL vs (13.72±5.39) pg/mL,P=0.007];Spearman相关分析表明血清IL-33水平与年龄、BMI、PTH、CTX和P1NP水平呈负相关,与腰椎BMD和股骨颈BMD呈正相关。多元回归分析表明,年龄、BMI、腰椎BMD、PTH、股骨颈BMD和血清CTX和P1NP水平是骨质疏松症患者血清IL-33水平降低的独立预测因子。结论 血清IL-33降低是绝经后骨质疏松患者股骨颈和腰椎骨密度降低和骨转换增速的危险因素。     

绝经后妇女血维生素B12、叶酸水平与骨密度相关性的初步研究

目的探讨绝经后妇女血维生素B12、叶酸水平与骨密度的相关性。方法应用双能X线骨密度仪测定受试者腰椎及股骨骨密度,按1994年WHO标准将其分为3组,即骨质疏松组、骨量减少组及骨量正常组;采取空腹静脉血进行维生素B12、叶酸的集中检测;并分别进行维生素B12、叶酸与不同部位骨密度的相关性分析。结果①骨质疏松组的血维生素B12的水平(512.55±209.85)pg/ml,低于骨量减少组(551.29±237.71)pg/ml和骨量正常组(565.71±189.03)pg/ml。②骨质疏松组的血叶酸的水平(11.27±6.04)pg/ml,低于骨量减少组(13.18±6.14)pg/ml和骨量正常组(11.9±3.73)pg/ml。③绝经后妇女血维生素B12的水平与全髋BMD呈正相关(r=0.25,P<0.01),与股骨颈BMD呈正相关(r=0.212,P<0.05),与股骨干BMD呈正相关(r=0.257,P<0.01),与股骨大转子BMD呈正相关(r=0.239,P<0.05);血维生素B12的水平与L1~L4BMD无相关性(r=0.141,P>0.05)。④绝经后妇女血叶酸的水平与全髋BMD、股骨颈BMD、股骨干BMD、股骨大转子BMD和L1~L4BMD均无相关(r分别为0.005,0.021,0.017,-0.021和0.078,P>0.05)。结论绝经后妇女血维生素B12的水平的缺乏可能是骨质疏松发生的一个重要风险因素,叶酸的缺乏并非骨质疏松发生的风险因素。     

绝经后2型糖尿病患者骨硬化蛋白、PINP、CTX与骨密度相关性研究

目的比较绝经后2型糖尿病患者骨质疏松组、低骨量组、骨量正常组血清骨硬化蛋白(sclerostin,SO)水平,探讨SO与Ⅰ型前胶原氨基末端(N端)前肽(procollagen typeⅠN-terminal propetide,PINP)、Ⅰ型胶原C端肽(typeⅠcollagen carboxyterminal peptide,CTX)、骨密度(bone mineral density,BMD)的关系。方法比较绝经后2型糖尿病患者骨质疏松症组、低骨量组、骨量正常组3组间年龄、绝经年限、糖尿病病程、体重指数、股骨颈及平均腰椎BMD、空腹血糖、糖化血红蛋白、25-(OH)D3、SO、PINP、CTX各指标的差异,并做SO与上述指标的单因素相关性分析和多元线性回归分析。结果 (1)骨质疏松症组年龄、绝经年限显著高于低骨量组、骨量正常组(P均=0.000),低骨量组明显高于骨量正常组(P=0.009、0.002);(2)绝经后2型糖尿病患者中25-(OH)D3缺乏113例(90.4%);(3)骨质疏松症组SO、PINP水平显著高于低骨量组、骨量正常组(P=0.000),低骨量组SO水平明显高于骨量正常组(P=0.045);(4)SO与PINP、年龄、绝经年限正相关(r=0.978、0.194、0.205),与股骨颈BMD、平均腰椎BMD、体重指数负相关(r=-0.518、-0.349、-0.249),多元线性回归分析显示SO与PINP呈正相关(β=7.015,P=0.000)、与股骨颈BMD呈负相关(β=-11.245,P=0.023)。结论 (1)绝经后2型糖尿病合并骨质疏松者SO水平明显增高,与PINP水平呈显著正相关,与股骨颈BMD呈显著负相关;(2)25(OH)D3在绝经后2型糖尿病患者中普遍缺乏。     

绝经后妇女血清催乳素水平与骨代谢指标及骨密度相关性研究

目的评价绝经后妇女血清催乳素水平与骨代谢指标及骨密度相关性。方法 161名健康的绝经后妇女参加了该横断面研究。获得空腹静脉血样用于骨代谢指标和激素水平的评估。人体测量参数包括体重指数(BMI)和腰臀比(WHR)。使用DXA检测股骨颈(FN)和腰椎(LS)部位的BMD。结果本研究共纳入161名绝经后妇女,平均年龄(59.7±6.1)岁,平均绝经时间为(8.0±1.3)岁,血清催乳素为(54.98±6.15)μg/L; Spearman相关分析卵巢体积与年龄、YSM、FSH、PTH、LH、OC和CTX呈正相关; BMI、LS BMD、FN BMD、雌二醇、睾酮和25羟基维生素D呈负相关,与其他混杂因素无关。多元回归分析表明年龄、BMI、YSM、LS BMD、FN BMD、FSH、LH、雌二醇、OC和CTX是绝经后妇女催乳素升高的独立预测因子。结论绝经后妇女催乳素升高和雌激素水平降低、骨密度下降和骨转换加速密切相关。     

血清视黄醇与绝经后妇女骨密度和骨代谢指标的相关 性研究

目的探讨血清视黄醇水平与绝经后妇女骨密度和骨代谢指标的相关性。方法对154例绝经后骨质疏松症妇女( 55岁)进行横断面研究,采用双能X线骨密度仪检测所有患者的骨密度(bone mineral density, BMD),同时检测患者的血清视黄醇、骨钙素、甲状旁腺素、碱性磷酸酶、钙和磷的水平,分析其相关性。结果 Spearman分析显示患者视黄醇水平与腰椎BMD (r=-0.161,P0.05)、股骨颈BMD (r=-0.181,P0.05)、碱性磷酸酶(r=0.109;P0.05)、磷(r=-0.109;P0.05)及生育时限(r=0.157;P0.05)呈正相关。经过多变量调整后,仍然发现血清视黄醇与腰椎(r=-0.209;P0.05)和股骨颈(r=-0.324,P0.05)的BMD呈负相关。结论血清视黄醇水平升高与低骨量的风险增加有关,因此,维生素A可能是骨质疏松症的危险因素之一。     

老年男性血清维生素D水平状况及其与甲状旁腺激素的相关性研究

目的 探讨老年男性血清维生素D水平及其与甲状旁腺素及骨代谢指标的相关性。方法 收集2010年9月至2013 年9月在上海瑞金医院老年病科病房住院及门诊患者895例,平均年龄为76岁。测定其血清25-羟基维生素D[25(OH)D]、血钙（Ca)、血磷(P)、甲状旁腺激素（PTH),1型胶原分子N-端前肽（PINP)及β-1型胶原C端肽（β-CTX)水平。根据血清25 (OH) D水平将患者分为维生素D严重缺乏组（<25 nmol/L)、维生素D缺乏组（25~50 nmol/L)、维生素D不足组（50 ~75 nmol/L)和维生素D充足组（>75 nmol/L)。结果（1)895例老年男性患者年龄60 ~99岁,平均年龄76岁。血清25( OH) D 平均值为(43. 52 ±21. 97) nmol/L。维生素D缺乏者（≤50nmol/L)为592人(67% ),维生素D不足者（50 ~ 75 nmol/L)为223 人(25%)。维生素D缺乏或不足者高达92%,维生素D充足者（>75 nmol/L)仅为80人(8%)。（2)不同年龄段血清25- (OH) D的比较显示,血清25-(OH) D水平随增龄而逐渐降低。60 ~69岁组25-(OH) D值最高,为（46. 27 ± 20. 76) nmol/L,与 其它各组比较差异均有统计学意义(P <0. 05)。相关分析表明,血清25-(OH)D与年龄呈负相关（相关系数r =-0.088,P = 0. 008)。（3)甲状旁腺素（PTH)的平均水平为（55. 74 ±29. 06) pg/mL。相关分析显示,25-(OH)D与PTH、PINP、β-CTX均呈负相关（r值分别为-0.209、-0. 109、-0. 122,P 均 <0.05)。血25-(OH)D 与 Ca 呈正相关（r = 0. 206,P <0.001)。血 25-(OH) D与BMI、P均无相关性（P均>0.05)。结论 老年男性存在严重的维生素D缺乏或不足。血25-(OH) D与PTH、年龄、 PINP、β-CTX均呈负相关。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.