老年男性未来10年主要骨质疏松性骨折和髋部骨折风险独立相关因素的研究

目的寻找老年男性未来10年主要骨质疏松性骨折风险（PMOP）和髋部骨折风险（PHF）的独立相关因素。方法选取2020年1月1日至12月31日在浙江省人民医院体检的60~97岁老年男性555例,进行问卷调查,骨密度、骨代谢标志物、血液生化指标等的测定,通过骨折风险预测工具（FRAX）计算包含股骨颈骨密度的PMOF和PHF,然后运用多元回归分析方法筛选老年男性PMOF和PHF的独立相关因素。结果老年男性PMOF的独立相关因素包括血清I型胶原羧基末端肽交联（CTX）（茁=1.049,P＜0.05）和室外运动（茁=-0.408,P＜0.05）;老年男性PHF的独立相关因素包括血清CTX（茁=1.014,P＜0.01）、室外运动（茁=-0.277,P＜0.05）和慢性阻塞性肺疾病（COPD）（茁=0.243,P＜0.05）。结论老年男性未来10年骨质疏松性骨折风险与骨转换标志物、室外运动和COPD等因素有关,老年男性的骨折风险评估工具有待进一步完善。     

老年女性血清I型胶原羧基端肽独立影响因素的研究

目的寻找老年女性血清I型胶原羧基端肽（CTX）的独立影响因素。方法对212例老年女性进行伴随疾病和生活方式的调查,并进行骨代谢标志物（CTX、甲状旁腺素和25-羟基维生素D）、血液生化等指标的检测,运用多元回归分析方法筛选老年女性血清CTX的独立影响因素。结果老年女性血清CTX的独立影响因素包括血钠（茁=20.879,P＜0.01）、服用钙剂（茁=－100.381,P＜0.01）、室外运动（茁=－42.459,P＜0.05）和总胆固醇（茁=34.696,P＜0.05）。结论坚持低盐饮食、室外运动和服用钙剂,降低血清总胆固醇水平,可能是降低老年女性血清CTX水平的重要方法。     

β-CTX、UA、FGF-23与慢性肾衰竭透析患者矿物质-骨异常的关系

目的研究Ⅰ型胶原羧基端肽β特殊序列（type I collagen carboxy terminal peptide β special sequence,β-CTX）、尿酸（uric acid,UA）、成纤维细胞生长因子23（fibroblast growth factor-23,FGF-23）与慢性肾衰竭透析患者矿物质-骨异常的关系。 方法纳入我院收治的80例慢性肾衰竭透析患者为研究对象,开展回顾性分析。统计患者一般资料,包括年龄、体重指数、原发病、磷结合剂使用情况、透析龄及β-CTX、UA、FGF-23等实验室指标,调查患者矿物质-骨异常发生情况,并采用多因素Logistic回归分析慢性肾衰竭透析患者矿物质-骨异常的独立影响因素,分析β-CTX、UA、FGF-23与慢性肾衰竭透析患者矿物质-骨异常的关系。 结果80例慢性肾衰竭透析患者中存在矿物质-骨异常44例,设为矿物质-骨异常组,非矿物质-骨异常36例,设为非矿物质-骨异常组。矿物质-骨异常组年龄、透析龄、血清白蛋白（serum albumin,SA）、UA、FGF-23均显著高于非矿物质-骨异常组（P＜0.05）,β-CTX显著低于非矿物质-骨异常组（P＜0.05）。多因素Logistic回归分析显示,年龄（OR=1.364,P=0.034）、透析龄（OR=1.534,P＜0.001）、UA（OR=1.502,P=0.165）、β-CTX（OR=1.486,P＜0.001）、FGF-23（OR=1.385,P=0.001）是慢性肾衰竭透析患者矿物质-骨异常的独立影响因素（P＜0.05）。 结论年龄、透析龄、UA、β-CTX、FGF-23是慢性肾衰竭透析患者矿物质-骨异常的独立影响因素,临床应引起重视。     

老年男性室外运动与骨代谢标志物和骨密度的关系

目的探讨老年男性室外运动与骨代谢标志物（BMMs）、骨密度（BMD）的关系。方法对512例老年男性室外运动情况进行调查,根据室外运动情况分为坚持组435例和未坚持组77例。比较两组BMMs和BMD水平的差异。分析老年男性未坚持室外运动的原因。结果与未坚持室外运动老年男性相比,坚持室外运动老年男性的血清I型胶原羧基端肽β特殊序列（CTX）和总I型胶原氨基端前肽（P1NP）水平均较低,血清25-羟基维生素D[25（OH）D]、股骨颈BMD和股骨总髋部BMD水平均较高,差异均有统计学意义（均P＜0.05）。77例未坚持室外运动的老年男性中,最常见的是因腰腿痛、视力不好等原因而难以外出行走,其次是不喜欢运动,第3是喜欢在家上网、看报纸。结论坚持室外运动可能有助于降低老年男性的骨转换水平,提高其血清25（OH）D水平,延缓其髋部骨质丢失。     

老年女性骨质疏松症患者骨转换标志物的变化特征

目的了解老年女性骨质疏松症（OP）患者骨转换标志物（BTMs）的变化特点。方法选择100例未曾接受过抗骨质疏松治疗的老年女性OP患者,检测其BTMs,包括I型胶原羧基端肽β特殊序列(CTX)、总I型胶原氨基端前肽(P1NP)和N端骨钙素（OC）,再分析其数据分布特点及其相关性,并根据不同CTX水平对100例老年女性OP患者进行分级。结果老年女性OP患者血清CTX、P1NP和OC均呈正态分布（均P＞0.05）,且３者之间均呈高度正相关（均P＜0.01）。在100例老年女性OP患者中,低转换、中低转换、中高转换和高转换的人数分别为6、14、21和59例。结论老年女性OP患者血清CTX、P1NP和OC均呈正态分布,80%的老年女性OP患者应尽早接受抗骨吸收治疗。     

高龄男性血清N端骨钙素的独立相关因素探讨

目的探讨高龄男性血清骨钙素的独立相关因素。方法对1429例高龄男性进行一般情况调查,检测骨转换标志物、血生化和性激素等指标,采用多元回归分析方法筛选高龄男性血清骨钙素的独立相关因素。结果高龄男性骨钙素的独立相关因素有甲状旁腺素（茁=0.074,P=0.000）、肌酐（茁=0.049,P=0.000）、癌症（茁=2.431,P=0.000）、BMI（茁=-0.158,P=0.016）、血钠（茁=0.239,P=0.003）、雌二醇（茁=-0.036,P=0.033）和2型糖尿病（茁=-1.044,P=0.036）。结论积极防治癌症和肾功能不全,降低血清甲状旁腺素和血钠水平,维持合理的BMI和雌二醇水平,可能是降低高龄男性血清骨钙素水平的重要方法。     

老年男性服用复方钙剂与骨密度和骨代谢标志物的关系

目的探讨老年男性服用钙和维生素D复方制剂（以下简称复方钙剂）与骨密度、骨代谢标志物(BMMs)的关系。方法对505例老年男性服用复方钙剂的情况进行调查,根据服用复方钙剂情况分为服用组87例和未服用组418例,比较两组老年男性骨密度和BMMs水平的差异,并进一步比较服用复方钙剂不同时间段（7~24个月、25~60个月和61个月以上）老年男性的BMMs水平。结果服用组骨质正常率为46.0%,明显高于未服用组的34.7%,差异有统计学意义（P＜0.05）。与未服用组相比,服用组血清I型胶原羧基端肽β特殊序列（CTX）和甲状旁腺素（PTH）水平较低、25-羟基维生素D［25（OH）D)］水平较高,差异均有统计学意义（均P＜0.01）。服用复方钙剂不同时间段患者之间CTX、PTH和25（OH）D水平比较差异均有统计学意义（均P＜0.05）。结论老年男性长期服用复方钙剂有助于降低其血清CTX和PTH水平,提高其血清25（OH）D水平,进而提高其骨质正常率。     

戒烟对男性2型糖尿病患者骨代谢的影响

目的探讨戒烟对男性2型糖尿病（T2DM）患者骨代谢的影响。方法收集332例男性T2DM患者,其中不吸烟组91例、吸烟组163例及戒烟组78例,并根据戒烟时间和年龄进行分层分析。结果3组间β-胶原特殊序列（β-CTx）、N-端骨钙素（NTOC）、总I型胶原氨基端延长肽（P1NP）及血清碱性磷酸酶（ALP）相比较,吸烟组数值最大,β-CTx与吸烟状况呈正相关（P＜0.05）;戒烟时间最长组的β-CTx、NTOC、P1NP及ALP数值最小,且戒烟时间与β-CTx、NTOC、P1NP及ALP呈负相关（均P＜0.05）;年龄＜60岁患者中,戒烟组与吸烟组相比,β-CTx、NTOC、P1NP及ALP明显降低,差异均有统计学意义（均P＜0.05）。结论吸烟可导致T2DM男性的骨吸收指标β-CTx和骨形成指标NTOC、P1NP及ALP增高,β-CTx增高更为明显,在非老年的男性T2DM患者中,戒烟后这种影响是可逆的,随着戒烟时间的延长骨代谢指标改善更为明显。     

老年女性喝牛奶与骨密度和骨转换标志物的关系

目的 调查老年女性喝牛奶与骨密度、骨转换标志物的关系。方法 对261例65～94(81±5)岁的老年女性喝牛奶的情况进行调查,并进行骨密度和骨转换标志物的检测,然后分析喝牛奶与骨密度、骨转换标志物的关系。 结果 坚持喝牛奶的老年女性骨质疏松率为46.96%,明显低于未坚持喝牛奶的63.75%(P＜0.05);与不喝牛奶的相比,喝牛奶老年女性的骨转换标志物(包括I型胶原羧基端肽β特殊序列、总I型胶原氨基端前肽和N端骨钙素)水平较低(均P＜0.05)。 结论 老年女性坚持喝牛奶有助于降低其骨转换水平,进而提高其骨量正常率。     

老年性骨质疏松现状及骨质疏松性骨折的危险因素分析

目的 探究老年性骨质疏松（osteoporosis,OP）发病现状及老年性骨质疏松性骨折（osteoporosis fracture,OF发生的相关影响因素。方法 选取2019年1月至2022年1月于台州市中心医院老年科及骨科就诊的1000例老年患者临床资料进行回顾性分析,共检出OP患者310例,依据骨折与否分为OF组（n=100）和非OF组（n=210）,比较两组性别、年龄、既往有无骨折史、不同部位骨密度（bone mineral density,BMD）,以及Ⅰ型胶原羧基端肽β特殊序列（β C-terminal cross-linked telopeptides of typeⅠcollagen,β-CTX）、25羟维生素D3[25 hydroxyvitamin D3,25-(OH)D3]、Ⅰ型前胶原氨基端延长肽（propeptide of typeⅠprocollagen,PINP）等骨代谢指标,采用多因素Logistic回归分析老年OF发生的危险因素;采用受试者操作特征（receiver operator characteristics,ROC）曲线分析血清骨代谢指标对OF的预...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.