营养和生活习惯对骨密度和骨强度的影响

目的：调查分析营养和生活习惯对跟骨骨密度的影响。 方法：在对苏州市20~65岁成年人进行了骨密度现状调查的基础上，随机选取了158人作为观察对象，男104人，女54人。随后对受试者进行营养(喝牛奶)和生活习惯(抽烟、饮酒和日照时间)的调查。 结果： ①喝牛奶人群的超声波衰减系数和骨质量指数明显高于不喝牛奶的人群(P < 0.01)。②饮酒或吸烟超声波衰减系数和骨质量指数均低于不饮酒或不吸烟组(P < 0.01)。③每天日照的时间对跟骨超声参数均数大小排列顺序为：30 min以上>15~ 30 min >15 min以下，组间差异有显著性意义。 结论：①钙是骨合成代谢的原料，是骨骼正常生长及形成峰值骨量的物质基础，充足的钙摄入可以防止骨质疏松的发生。②饮酒和吸烟是导致骨质疏松的危险因素。饮酒过量可导致骨质疏松症，使骨折危险性增加；香烟中的烟碱可直接或间接刺激破骨细胞活性，使血钙、尿钙的浓度增加，使骨密度下降。③日照时间的长短，可以促进活性维生素D的形成，从而可以提高钙的吸收，达到提高骨量的目的。     

不同负荷跑台运动对雌性大鼠骨骼的作用及其位点效应*☆

背景：活体骨骼在力学环境发生变化时，骨的建造和重建发生力学适应性变化。而不同强度运动对骨骼的作用以及对不同部位骨骼的适应性变化尚不明确。 目的：探讨不同负荷跑台运动对雌性大鼠不同部位骨骼骨密度的影响及其位点效应。 方法：雌性SD大鼠随机分为运动组和对照组，运动组进行为期17周的跑台训练，测量运动第4，7，9，11，13，15，17周时两组大鼠全身、颅骨、前肢、肋骨、脊椎骨、盆骨、后肢的骨密度。 结果与结论：运动对于大鼠全身、颅骨、前肢骨、脊椎和盆骨的骨密度具有较大影响，而对于肋骨的骨密度的影响没有显著性意义，说明跑台运动对大鼠不同部位骨骼的作用不同。     

舞蹈学员超声骨强度特点

背景：超声检测骨强度是骨骼状态的一项重要指标。 目的：探讨舞蹈学员骨强度特点及其影响因素。 方法：纳入专业舞蹈学习8年以上受试者60人,采用超声骨密度仪对其进行身体成分和左脚脚踝骨强度测试。 结果与结论：舞蹈专业受试者骨强度值显著高于同龄人平均水平。无论男、女受试者骨强度值均具有随着体质量指数增长而增长的趋势,女受试者骨强度具有与脂肪量成正比,与左腿推定肌肉量成反比的趋势。提示体质量指数可能是决定骨强度的重要因素,运动影响骨强度可能存在阈值,阈值下运动能提高骨强度,超过阈值则无益。     

不同人群负重和非负重运动对骨密度的影响

背景：人体骨密度受多种因素的影响,其中运动是一个重要的物理因素。 目的：归纳总结运动对不同人群骨密度影响研究现状,为运动健身提供理论指导。 方法：用计算机检索中国期刊全文数据库(CNKI：1985/2009)和Medline database(1985/2009),按纳入和排除标准,对文献进行筛选,资料收集和质量评价,共纳入45篇文章。从运动对青少年儿童、中年、老年不同人群的骨密度进行总结。 结果与结论：儿童青少年正处在生长发育期,其骨密度的质量对骨密度的峰值及成年之后骨质疏松的情况都会产生重要的影响。中年雌激素水平降低可能会影响运动对骨量变化的作用。有氧运动对维持骨矿含量和延缓老年性骨质疏松症的出现有良好的影响。运动对各人群的骨骼骨密度都有一定的影响,不同类型运动对骨密度影响不同,负重运动明显较非负重运动有益于骨密度增长;长期运动对骨密度的影响应受重视。     

上海市高知女性跟骨骨密度测定：197个结果分析*

背景：研究表明,女性骨峰值低于男性,而不同地区人群骨矿含量存在差异,因此有必要建立各地区不同人群的峰值骨密度。 目的：调查上海市高知女性骨密度随年龄、体质量指数等变化规律。 方法：纳入27~62岁高知女性受试者共197例,5岁为一个年龄段,共分为7组。准确记录各组受试者年龄,身高及体质量,并采用超声波骨密度仪测定各组受试者跟骨骨密度。用逐步回归分析各组骨峰值与年龄、体质量和握力的相关性。 结果与结论：研究结果显示上海市女性骨量峰值出现在38~39岁年龄段。骨密度值的下降率在31~35岁和41~45岁下降幅度最大。逐步回归分析结果显示,上海高知女性骨峰值与年龄、体质量、握力成正相关,年龄对骨峰值的影响最为明显,峰值骨量越低或出现越早,发生骨质疏松的危险越大。结果表明上海市高知女性群体发生骨质疏松的危险性较大。     

神经支配与种植体骨结合和骨感知的相关性

背景：完善的神经支配在骨形成过程中起决定性的作用。神经损伤后可能影响正常的骨代谢,而骨的再生在一定程度上依赖其支配区域神经的再生。通过改良种植体表面结构或局部使用生长因子等可促进骨结合。 目的：对神经系统支配骨代谢、失神经支配对骨骼重建的影响以及种植体植入后骨结合过程中神经支配的建立、骨感知等方面的研究进行回顾分析。 方法：由第一作者检索1990/2008 PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www. wanfangdata.com.cn)有关神经系统支配骨代谢、失神经支配对骨骼重建的影响以及种植体植入后骨结合过程中神经支配的建立、骨感知等方面的文献,英文检索词为“bone metabolism,innervation,osseointegration osseoperception”,中文检索词为“骨代谢,神经支配,骨结合,骨感知”。排除重复性研究。计算机初检得到54篇文献,根据纳入标准保留28篇进一步归纳总结。 结果与结论：神经系统发出的信号对破骨细胞和成骨细胞功能施加强有力的作用。骨膜表面普遍存在神经支配,其功能紊乱将影响骨骼的重建。骨骼中可检测出多种神经肽、神经激素、神经递质及其相关受体,揭示神经系统参与了骨的代谢和再生。种植体周围软硬组织神经支配的建立可能与骨结合、骨感知的形成密切相关。未来的研究需要进一步探索骨感知形成的解剖和神经生理病理学基础。     

雌激素对5-羟色胺能神经元的作用机制及其临床应用

抑郁症是常见的发病率较高的精神疾病。研究表明,女性抑郁症终身患病率是男性的1．7倍,男女抑郁症患病率在青春期前无差异,但在女性月经初潮后开始出现差异直至55岁后男女患病率差异消失,说明雌激素变化可能与抑郁症患病相关。在女性一生中的多个特殊生理时期,如青春期、围产期、围绝经期等,存在雌激素水平的显著变化,同时雌激素为主的激素替代治疗对发生在女性特殊时期抑郁症有治疗作用。而5-羟色胺（5-HT）作为脑内重要的神经递质之一,对人的认知、情绪等方面都产生重要的影响。     

兰州地区错牙合畸形的Bolton指数分析

背景：对跟骨骨密度和骨强度进行全面评价，为骨质疏松症的预防和治疗提供新的思路。 目的：了解苏州市20~65岁人群跟骨骨密度及骨强度与纵跳高度、闭目单足站立时间的相关性。 设计、时间及地点：随机整群分层抽样调查，于2007年在苏州市体育科学研究所完成。 对象：每5岁为一个年龄段，随机抽取20~65岁成年人，男性104人，年龄(34.1±9.7)岁，身高(172.54±4.94) cm，体质量(69.50±8.82) kg；女性54人，年龄(39.5±13.6)岁，身高(160.14±10.61) cm，体质量(53.70±8.15) kg。 方法：按照国家体育总局群体司颁发的《国民体质测定标准手册》的要求测试闭目单足站立时间和纵跳高度。采用超声骨密度仪测试跟骨超声参数，即反映骨密度的超声波衰减系数和反映骨强度的跟骨骨质量指数。在跟骨超声参数测试之前，对受试者进行运动方式和运动年限的调查。 主要观察指标：①单足闭目平衡站立时间和纵跳高度对跟骨超声参数的影响。②不同的运动方式和运动年限对跟骨超声参数的影响。 结果：①纵跳高度与超声波衰减系数和跟骨骨质量指数之间有显著相关性(P < 0.01)。即纵跳高度越高，骨密度和骨强度越大，骨折危险性降低。②单足闭目平衡站立时间与超声波衰减系数不存在相关性；而与跟骨骨质量指数存在显著相关性(P < 0.05)。③力量和跳跃等运动项目的超声波衰减系数和跟骨骨质量指数要高于游泳和散步等有氧运动项目，差异存在显著性(P < 0.05)。④运动年限在3年以上成年人的超声波衰减系数和跟骨骨质量指数高于运动年限在1年以下的成年人，差异存在显著性(P < 0.05)。 结论：苏州市20~65岁人群纵跳高度与跟骨的骨密度和骨强度存在线性关系，单足闭目平衡站立时间仅与骨强度存在相关性。经常进行力量和跳跃项目锻炼且锻炼年限越长，骨密度和骨强度越高。     

骨量及骨代谢中胰岛素生长因子1、转化生长因子β和白细胞介素6在长期递增负荷运动状态下的变化*☆

背景：研究表明,合理的适量运动能够促进骨量,相反过量运动会影响骨量的蓄积,但负荷过量的运动对骨代谢的影响作用机制目前仍不清楚。 目的：探讨长期递增负荷运动对骨量的影响效应,以及对骨代谢的影响作用机制。 方法：将SD大鼠分别进行4,9,11,13,15,17周的递增负荷运动,并设置对照组,以放射免疫分析法测定各组大鼠雌二醇水平,以酶联免疫法测定各组血清胰岛素生长因子1,转化生长因子β及白细胞介素6的浓度,以双能X射线骨密度仪测定各组骨密度水平。 结果与结论：和同期对照组相比,胰岛素生长因子1和转化生长因子β在运动后9和17周显著降低(P < 0.05),转化生长因子β在运动第4周显著升高(P < 0.05),白细胞介素6在运动第9,15,17周均显著升高(P < 0.05)。雌二醇水平在运动第13,15和17周降低(P < 0.05或P < 0.01),全身骨密度值在运动第15,17周显著降低(P < 0.01)。结果证实,长期递增负荷运动导致大鼠机体骨代谢发生改变,由骨形成占优势过渡为骨吸收占优势,最终出现骨密度值降低,骨代谢平衡向破骨方向倾斜的重要致因与过量运动所造成的性腺轴功能受抑,雌二醇水平降低有关。     

骨祖细胞的特征及其相关影响因素***★

学术背景：寻找能重建再造骨缺损的种子细胞，获得稳定可靠的细胞来源是组织工程化骨构建的重要先决条件。组织工程化骨已成为最有希望进入临床应用的组织工程成果之一。目前骨组织工程的研究集中于成骨细胞范畴，而对可以增殖、分化为成骨细胞并最终成骨的骨祖细胞的研究相对较少。 目的：本文就骨祖细胞的特征及其相关影响因素进行综述，以便了解骨祖细胞在骨组织工程学领域的应用前景和研究价值。 检索策略：由本文作者应用计算机检索PubMed1996-01/2007-06期间的相关文章，检索词为“osteoprogenitor cells，bone tissue engineering，bone formation”，同时检索维普数据库2000-01/2007-06期间的相关文章，检索词为“骨祖细胞，骨组织工程，骨形成”。对资料进行初审，并查看每篇文献后的引文。纳入标准：文章所述内容与骨祖细胞特性及其相关影响因素有关。排除标准：内容陈旧或重复文献。 文献评价：共收集到66篇关于骨祖细胞特征及其相关影响因素的文献， 纳入30篇。1 篇为综述，其余29篇为临床或基础研究。 资料综合：①骨祖细胞的特征：骨祖细胞具有阶段性的分化特征，第一代是增殖能力最强的骨祖细胞；随着年龄的增长，骨祖细胞的增殖能力逐渐减弱，但数目无明显减少。②传统观念认为骨形成过程主要是由内分泌系统及局部因子等调控。然而，越来越多的证据表明，骨组织内的一些神经细胞因子、富含脯氨酸的酪氨酸激酶2、骨形态发生蛋白2、内皮细胞等均可加强骨祖细胞的成骨能力。 结论：骨祖细胞具有阶段性分化和增龄性变化的生物学特性，其增殖分化受多种因素影响，但具体机制尚不明确。     

骨质疏松女性1 455名运动行为分析

背景：早在1989年,世界卫生组织就提出预防骨质疏松的3大原则：补钙、运动疗法和饮食。然而,更多的人却把眼光放在补钙和饮食上,忽略了运动疗法在预防骨质疏松上的重要作用。 目的：分析女性骨质疏松患者运动与腰椎骨密度相关性,进一步明确运动对人体腰椎骨密度的影响。 方法：对2003-08/2005-12在四川大学华西医院康复科门诊及住院女性患者4 383人,用双能X光机测定腰椎骨密度,根据骨密度T值评分,其中1 455例为骨质疏松患者;并对运动时间进行问卷分级,分为经常运动385例、偶尔运动115例、不运动955例,用SPSS12.0统计软件比较不同运动时间与腰椎骨密度关系。 结果与结论：3组骨质疏松患者L2、L3、L4骨密度、平均骨密度及T值均为经常运动组>不运动组>偶尔运动组,T值、平均骨密度组间比较差异有显著性意义(P < 0.05),但骨密度组间比较差异无显著性意义(P > 0.05),L2、L3、L4骨容量及骨总容量均为经常运动组>偶尔运动组>不运动组,但组间比较差异无显著性意义(P > 0.05)。结果提示,女性骨质疏松患者其运动量增加可提高腰椎骨密度,但要明显提高腰椎骨密度需达到一定运动量。     

运动与运动方式对骨密度的影响

不同的运动形式对骨密度的影响各异，高冲击性的训练优于低强度的耐力训练。振动训练作为新兴的运动形式，备受科学界的关注，而且对其与骨密度的研究也日益深入。但是由于运动强度、时间、频率等因素的不同研究结果存在一定的差异，尤其是对老年人的抗阻训练研究国内鲜有报道，急需在这方面多做研究。振动训练可以提高肌肉的力量从而对骨骼产生积极的影响，因此振动训练在预防骨质疏松方面可能会发挥重要作用。随着分子生物学技术的进步，有关骨代谢调控基因的研究日益增多，但是与运动结合进行研究的较少，有待深入探索。     

Psychosocial aspects in osteoporosis

Osteoporosis is a disease characterized by a decrease in bone mineral density which results in an increase in bone fracture. Its etiology is still unknown. Several risks factors have been described: increase in coffee intake, decrease in calcium intake, a sedentary lifestyle, a decrease in estrogen secretion and genetic factors. It has been recently shown that mood disorders, such as Major Depression associated with high levels of cortisone, constitute a risk factor for the development of osteoporosis. Psychoneuroimmunoendocrinology considers an integrated human being, a biopsychosocial unit permanently related to his environment, overcoming the cause - effect relationship. Taking into account this point of view we studied the psychoaffective and psychodynamic aspects in patients with osteoporosis. Several disorders have been found, an increase in anxiety indexes, depression, alexithymia, a larger number of early traumatic life events, a decrease in the support network and lower quality of life. Consequently, this pathology should be dealt with within an interdisciplinary framework. It is equally important to detect osteoporosis at an early stage in patients showing mood disorders.     

Use of the Precaution Adoption Process Model to examine predictors of osteoprotective behavior in epilepsy.

In the neurology literature it is well established that anti-epileptic drugs (AEDs) lead to bone loss (osteopenia and osteoporosis). Several large epidemiologic studies have found twice the fracture rate in persons with epilepsy compared to the non-epilepsy population. While an increasing level of awareness for preventative measures and screening by neurologists and primary care physicians are recommended, so far no one has attempted to address how knowledge related to calcium and exercise, health beliefs (based on the Health Belief Model) and self-efficacy (confidence in abilities) impact osteoprotective behaviors in epilepsy, based on the Precaution Adoption Process Model (PAPM). The seven-stage PAPM, unlike other health behavior theories where a person is either practicing or not practicing the behavior, conceptualizes behavior change as dynamic and occurring over time. Validated instruments were used to assess knowledge, health beliefs, self-efficacy and stages of the precaution adoption process for four osteoprotective behaviors. For dietary calcium; exercise knowledge and calcium self-efficacy predicted higher stages of precaution adoption. For calcium supplements; age perceived susceptibility for osteoporosis and perceived benefits of calcium predicted higher stages. Exercise adoption stage was most predicted by exercise knowledge and health motivation. For DEXA screening adoption; age and perceived susceptibility predicted higher stages. This study provides hints how persons with epilepsy could be influenced to move from the unaware/unengaged positions into to the stages of adoption and maintenance for osteoprotective behaviors.     

Modeling bone mineral metabolism, with special reference to calcium and lead.

Realistic modeling of lead kinetics requires both qualitative and quantitative understanding of bone metabolism. In this paper, bone metabolism is discussed based on the behavior of Ca, Sr, and Ra tracers. Apposition, the increase of mineral volume, is the chief feature of bone metabolism in the neonatal and young animal. Resorption, which together with apposition functions to model the growing skeleton, is also important during growth. In adulthood, with stabilization of the total bone mass, resorption balances apposition at a relatively low level. This continuing low-level resorption/apposition remodeling process maintains healthy bone and restructures the bone in response to changing functional demands. In addition to these processes, surface exchange and diffuse exchange occur in bone. Rapid exchange between blood and bone calcium (or tracer) takes place at all bone surfaces in intimate contact with blood. Diffuse exchange is a slow process by which bone-seeking elements can penetrate the entire bone volume. Particularly in longer-lived animals like humans, slow exchange of tracer with bone Ca is the dominant mechanism of tracer uptake during adulthood. These three mechanisms of uptake and loss (apposition/resorption, rapid exchange, and diffuse exchange) appear to be the essential mechanisms determining metabolism of bone-seeking elements. The magnitudes of accretion plus rapid exchange, of resorption, and of diffuse exchange have been estimated with the aid of radiotracers and fluorescent markers.     

The transition from pediatric to adult care for youth with epilepsy: Basic biological,sociological, and psychological issues

Transition from pediatric to adult health care for adolescents with epilepsy is challenging for the patient, family, and health care workers. This paper is the first of three that summarize the main findings from the 2nd Symposium on Transition in Epilepsies, held in Paris from June 14–25, 2016. In this paper we describe five basic themes that have an important effect on transition. First, there are important brain changes in adolescence that leave an imbalance between risk taking and pleasure seeking behaviors and frontal executive function compared with adults. Second, puberty is a major change during the transition age. The three most important but separate neuroendocrine axes involved in puberty are gonadarche (activation of the gonads), adrenarche (activation of adrenal androgen production), and activation of the growth hormone-insulin like growth factor. Third, sexual debut occurs during the transition years, and at an earlier age in adolescents with epilepsy than controls. Adult sexual performance is often unsatisfactory. Although AED-induced alterations in sexual hormones and temporal lobe epilepsy may play a role in hyposexuality, depression, anxiety, and other social factors appear most important. Fourth, psychological development is very important with an evolution from an early stage (ages 10–13 years) with concrete thinking, to a middle stage (ages 14–17) with analytic and more abstract introspective thinking, and then to a late stage (ages 18–21) with at least the beginnings of adult reasoning. Epilepsy may derail this relatively orderly progression. Adolescents with autistic spectrum disorder may present with severe behavior problems that are sometimes related to undiagnosed epilepsy. Fifth, bone health in adolescence is critical to establish adequate mineralization for all of adult life. While AED interference with Vitamin D metabolism is important, there is evidence that the effects of AEDs on bone are more complex and involve changes in remodeling. Hence, some non-inducing AEDs may have a significant effect on bone health. All five of these themes lead to recommendations for how to approach adolescents and young adults during transition and some specific interventions to achieve maximum long-term adult independence and quality of life.     

A 21-week bone deposition promoting exercise programme increases bone mass in young people with Down syndrome

Aim To determine whether the bone mass of young people with Down syndrome may increase, following a 21‐week conditioning training programme including plyometric jumps. Method Twenty‐eight participants with Down syndrome (13 females, 15 males) aged 10 to 19 years were divided into exercise (DS‐E; n=14; eight females, six males mean age 13y 8mo, SD 2y 6mo) and non‐exercise (DS‐NE; n=14; five females, nine males mean age 15y 5mo, SD 2y 6mo) groups. Total and regional (hip and lumbar spine [L1–L4]) bone mineral content (BMC) and total lean mass were assessed by dual energy X‐ray absorptiometry at baseline and after a 25‐minute training session performed twice a week. Repeated‐measures analyses of variation were applied to test differences between pre‐ and posttraining values for BMC and total lean mass. Differences between increments were studied with the Student’s t‐test. Linear regression models were fitted to test independent relationships. Results After the intervention, higher increments in total and hip BMC, and total lean mass, were observed in the DS‐E group (all p<0.05). A time×exercise interaction was found for total lean mass (p<0.05). The increment in total lean mass, height, and Tanner stage accounted for almost for 60% in the increment in total BMC in the DS‐NE group (p<0.05). Interpretation Twenty‐one weeks of training have a positive effect on the acquisition of bone mass in young people with Down syndrome.     

ECT generalized seizure drives heart rate above treadmill stress test maximum

OBJECTIVES: Heart rate (HR) accelerates with the electroconvulsive therapy (ECT) seizure and decelerates when it ends. The peak HR during ECT seizure has been reported to reflect clinical impact. We aimed to identify the expected range for ECT peak HR and how it varies with age and sex, as a reference in clinical use. METHODS: We examined medical records for the maximum peak seizure HR over the ECT course for all ECT patients over defined periods at 2 clinical sites. Methohexital-succinylcholine anesthesia was usually used. Subject totals were 87 men and 90 women. RESULTS: Electroconvulsive therapy peak HR was 140 to 180 bpm and did not fall with age through 80 years, separately for men and women. A few patients lay outside this cluster and showed age-related decrease. Overall and including the extreme elderly, peak HR fell by 0.29 bpm/yr. CONCLUSIONS: Electroconvulsive therapy seizure peak HR less than 140 bpm points to weakness of the ECT seizure (and need to increase stimulus dose), cardiac disease, or medication effect limiting HR. Electroconvulsive therapy peak HR exceeds treadmill exercise maximum HR after 60 years and falls significantly less with age than the 0.7 to 1 bpm/yr reported for maximum HR with treadmill exercise stress. These comparisons suggest that ECT peak HR and treadmill maximum HR are limited by different aspects of physiology, and that exercise HR is limited by metabolic demand and humoral activity rather than the heart itself.