阿仑膦酸钠治疗骨质疏松症研究进展

阿仑膦酸钠是氨基二膦酸盐类骨吸收抑制剂,其可抑制破骨细胞活性,降低骨转换,增加骨密度(BMD),提高骨强度,有效预防骨折.目前,该药已广泛用于治疗和预防绝经后妇女骨质疏松症(PMO)、男性骨质疏松症(0P)、糖皮质激素(GC)引起的OP、高钙血症和变形性骨炎等.     

乳铁蛋白对糖皮质激素性骨质疏松大鼠骨密度及骨形态学的影响

目的探讨乳铁蛋白对糖皮质激素性骨质疏松(GIOP)大鼠骨密度及骨组织形态学的影响。方法 60只雌性4月龄Wistar大鼠,随机分为对照组、模型组、乳铁蛋白治疗组和阿仑膦酸钠治疗组。除对照组外,各组均予地塞米松2.0mg/kg肌肉注射(2次/周)诱导糖皮质激素性骨质疏松模型。造模同时分别给予乳铁蛋白3g/kg·d~(-1)、阿仑膦酸钠160mg/kg·d~(-1)预防性治疗,对照组、模型组予0.9%氯化钠注射液灌胃。3个月后行骨密度及骨形态学检测。结果 (1)与对照组相比,模型组左侧股骨及椎骨骨密度、骨小梁厚度及面积、成骨细胞计数明显降低,破骨细胞计数明显升高(P0.01)。(2)乳铁蛋白治疗组大鼠骨密度较模型组明显升高(P0.01),与阿仑膦酸钠治疗组、对照组比较差异无统计学意义;(3)乳铁蛋白治疗组大鼠成骨细胞计数较模型组显著增多(P0.01),与阿仑膦酸钠治疗组差异无统计学意义;(4)乳铁蛋白治疗组大鼠破骨细胞计数较模型组显著降低(P0.01),较阿仑膦酸钠治疗组显著增多(P0.01);(5)乳铁蛋白治疗组大鼠左侧股骨及椎骨骨小梁厚度与面积较模型组厚度显著增厚、面积显著变大(P0.01),较阿仑膦酸钠治疗组厚度显著变薄、面积显著减少(P0.01)。结论 (1)乳铁蛋白可改善GIOP大鼠骨微结构,增加成骨细胞数目,降低破骨细胞数目。(2)乳铁蛋白与阿仑膦酸钠在增加骨密度、阻止成骨细胞数目降低方面疗效相似,但在降低破骨细胞数目、增加骨小梁厚度、骨小梁面积方面乳铁蛋白疗效不如阿仑膦酸钠。     

阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响

目的探讨阿仑膦酸钠对全髋关节置换术后髋臼周围骨密度的影响。方法将符合全髋置换纳入标准的患者随机分成阿仑膦酸钠组与对照组,阿仑膦酸钠组术后除常规治疗外尚服用阿仑膦酸钠,对照组仅常规治疗。2组患者均应用骨密度测量仪（DEXA）分别于术后第6天、3、6个月测定髋臼各个分区的骨密度。结果获得完整随访病例共58例,术后3、6个月各区骨密度均呈持续下降趋势,和对照组相比,术后3个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区骨密度2组相比差异无统计学意义（P〉0．05）。与对照组相比,术后6个月阿仑膦酸钠组髋臼假体周围骨量（Ⅲ区）的差异有统计学意义（P〈0．01）,其余各测量区2组相比差异无统计学意义（P〉0．05）。结论阿仑膦酸钠能有效防止髋臼假体周围骨量减少。     

伊班膦酸钠治疗骨质疏松症的临床研究

伊班膦酸钠系含氮的第三代双膦酸盐药物,能强效抑制破骨细胞活性,甚至诱导破骨细胞凋亡,有效增加骨密度,降低骨折的发生率.本文就伊班膦酸钠治疗骨质疏松症相关的临床研究进行了综述.结果 表明,伊班膦酸钠能有效地治疗骨质疏松症,其依从性和安全性良好.     

口服双膦酸盐对预防老年人非骨水泥型全髋关节置换术后骨溶解的临床研究

目的探讨口服双膦酸盐对老年患者非骨水泥全髋关节置换术后股骨柄周围骨密度的影响。方法将52例符合纳入标准的患者随机分成阿仑膦酸钠组与对照组,阿仑膦酸钠组术后1周服用阿仑膦酸钠,对照组仅口服钙尔奇D。2组患者均应用骨密度测量仪(DEXA)分别于术后3周及6月测定股骨近端各个分区的骨密度。结果获得完整随访病例共46例,术后6月各区骨密度均呈持续下降趋势,和对照组相比,术后6月阿仑膦酸钠组假体柄周围骨量(3、6、7区)的差异有统计学意义(P<0.05),其余1、2、4、5测量区骨密度2组相比差异无统计学意义(P>0.05)。结论口服双膦酸盐能有效防止老年患者非骨水泥型髋关节假体周围骨量减少。     

双膦酸盐相关性非典型骨折:病例报告及文献复习

双膦酸盐是治疗骨质疏松的重要药物,属骨吸收抑制剂类。其通过抑制破骨细胞介导的骨吸收,减缓骨骼重建,增加骨密度,降低骨折的发生率。国外文献报道双膦酸盐有致非典型骨折的风险,并且骨折不愈合或延迟愈合的风险增高[1]。迄今为止,中国大陆境内尚未有该类药物致非典型骨折的报道。现报道1例口服阿仑膦酸钠(商品名:福善美)致右股骨中段非典型骨折病例,并结合文     

狄诺塞麦:治疗绝经期女性骨质疏松的新希望

狄诺塞麦是目前用于治疗绝经期骨质疏松的第一种单克隆抗体药物.它能与细胞核因子-κB受体活化因子配体(RANKL)结合,通过抑制破骨细胞的产生、功能和存活,减少骨吸收达到治疗作用.临床试验显示,在绝经后骨质疏松妇女中,狄诺塞麦增加骨密度(BMD)和降低骨折风险的作用优于安慰剂和阿仑膦酸,不良反应与安慰剂和阿仑膦酸相当.药...     

含服阿仑膦酸钠致创伤性溃疡三例并文献复习

骨质疏松(osteoporosis)是一种以骨量降低和骨组织微结构破坏为特征,导致骨脆性增加和易于骨折的代谢性骨病;临床表现以弥漫性骨痛、骨折为主[1,2].阿仑膦酸钠能明显缓解骨质疏松性骨痛,显著提高骨密度,增加骨强度,有效降低骨折风险,已成为临床抗骨质疏松治疗的一线用药.然而,不正确的含服方法使其不良反应增加.本研究组先后接诊3例因骨质疏松含服阿仑膦酸钠片后,发生口腔黏膜病变,且均符合创伤性溃疡诊断标准[3].为了引起临床足够重视,现报告如下.     

阿仑膦酸钠治疗绝经后骨质疏松或骨量减少妇女1年间的β-CTX和骨密度的相关性研究

目的 通过观察阿仑膦酸钠治疗绝经后骨质疏松或骨量减少1年后骨密度和骨吸收指标(β-CTX)的变化,了解骨密度变化与骨吸收指标变化的关系.方法 入选了35例绝经后骨质疏松或骨量减少患者,给予阿仑膦酸钠70mg/w,碳酸钙600 mg/d和维生素D125 IU/d,治疗12m.在基线和治疗12m后进行DXA骨密度测定,在基线、治疗3 m和12 m后测定骨吸收指标β-CTX.结果 治疗1年后腰椎2～4、股骨颈和全髋骨密度均有上升,而所有受试者治疗3m后β-CTX均较基线下降(74.21±43.66)％.治疗3m后β-CTX的变化率和治疗12m后腰椎2～4和股骨颈骨密度绝对值呈相关(Betastd=-0.418,P=0.017; Betastd =-0.321,P=0.032).结论 治疗3m骨吸收指标β-CTX的变化率有望成为预示患者对阿仑膦酸钠反应的早期指标.     

阿仑膦酸钠联合骨化三醇治疗女性绝经后骨质疏松性髋部骨折的疗效及对骨代谢的影响

目的 探讨阿仑膦酸钠联合骨化三醇治疗绝经后老年女性骨质疏松性髋部骨折的临床效果及其对骨代谢的影响.方法 70例绝经后老年女性骨质疏松性髋部骨折患者随机分为治疗组和对照组,均行外固定手术治疗,术后第3周开始服药治疗,对照组给予阿仑膦酸钠治疗,治疗组给予阿仑膦酸钠联合骨化三醇治疗,疗程均为6个月,评价临床疗效,检测两组治疗前后的骨代谢指标[骨碱性磷酸酶(BALP)、空腹血骨钙素(BGP)、抗酒石酸盐酸性磷酸酶异构体5b(TRACP-5b)、胶原羟基末端肽(CTX)].结果 治疗组临床疗效优良率(91.4％)显著高于对照组(54.3％)(x2=12.208,P＜0.05).治疗后,治疗组BALP和BGP水平显著上升,TRACP-5b和CTX水平显著下降,与治疗前和对照组比较均有显著性差异(t=5.463、6.018,3.791、3.240,8.857、8.452,8.779、9.180,P＜0.05).而对照组治疗前后BALP、BGP、TRACP-5b、CTX水平差异无统计学意义(P＞0.05).结论 阿仑瞵酸钠联合骨化三醇能有效改善绝经后老年女性骨质疏松性髋部骨折患者的骨代谢,促进骨折愈合.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.