双膦酸盐治疗骨质疏松症时每日补充维生素D 800~1200 IU是否足够？

目的观察双膦酸盐治疗时每日补充800~1200 IU维生素D是否可以获得理想的25羟维生素D(25OHD)水平。方法将112例骨质疏松症女性患者根据补充维生素D的剂量分为800 IU组和1200 IU组,在双膦酸盐治疗前和16周时检测血清25OHD,比较治疗前后25OHD的变化和获得理想25OHD水平的患者例数。结果 112例患者治疗前25OHD 24.26±7.98 ng/ml,治疗16周时25OHD 32.04±8.12 ng/ml。补充维生素D 800 IU组治疗后25OHD提高5.08±8.35 ng/ml,25OHD≥30 ng/ml患者为55.56%,25OHD≥33 ng/ml为38.89%;补充维生素D 1200 IU组治疗后25OHD提高10.29±8.20 ng/ml,25OHD≥30 ng/ml患者为60.34%,25OHD≥33 ng/ml为46.55%。结论双膦酸盐治疗时每日补充维生素D800~1200 IU可以显著提高25OHD水平,但仍然约有50%的患者不能达到理想的血清25OHD水平。     

地塞米松对护骨素基因敲除小鼠骨微结构的影响

目的探讨小剂量地塞米松对生长期小鼠骨密度及骨微结构的影响及其与OPG途径的关系。方法 20只4周龄OPG~(-/-)雌性小鼠及20只野生型小鼠随机分四组(n=10):野生型安慰剂组(WT+saline),野生型地塞米松干预组(WT+DEX,地塞米松1mg/kg体重,肌肉注射,每周3次),OPG~(-/-)敲除小鼠安慰剂组(OPG~(-/-)+saline),OPG~(-/-)敲除小鼠DEX干预组(OPG~(-/-)+DEX,地塞米松1 mg/kg体重,肌肉注射,每周3次)。6周后处死小鼠,一侧胫骨行显微CT扫描分析。结果OPG~(-/-)组的组织骨密度、骨小梁体积分数、骨小梁数量、骨小梁厚度均较其他三组降低(P0.05)。OPG~(-/-)+DEX组的组织骨密度、骨小梁体积分数、骨小梁数量、骨小梁厚度均较WT及WT+DEX组降低(P0.05)。OPG~(-/-)组的骨小梁模型因子及骨小梁分离度均较其他三组增加(P0.05);OPG~(-/-)+DEX组的骨小梁模型因子及骨小梁分离度均较WT及WT+DEX组增加(P0.05)。WT及WT+DEX组之间骨小梁微结构参数均无统计学差异。结论在生长期小鼠OPG基因功能缺失时,地塞米松有部分拮抗骨量丢失的作用,表明除了OPG/RANKL途径,地塞米松对骨代谢的影响是多途径的。     

妊娠期糖尿病的医学营养治疗疗效评价

目的:探讨医学营养治疗对妊娠期糖尿病(GDM)孕妇妊娠结局的影响.方法:将我院门诊产前检查确诊为GDM,并完成随访的孕妇分为医学营养治疗(MNT)组61例与非干预组60例.同时选择同期在我院分娩的正常孕妇作为正常对照组60例.比较3组的母儿并发症的发生率.结果:MNT组巨大儿、新生儿低血糖、新生儿住院、羊水过多发生率均低于非干预组,差异有统计学意义(P＜0.05);两组妊娠期高血压疾病、胎膜早破、早产、胎儿窘迫、剖宫产、足月低体重儿(小于胎龄儿)、新生儿呼吸窘迫综合征(NRDS)发生率比较,差异无统计学意义(P＞0.05).非干预组巨大儿、新生儿低血糖、新生儿住院发生率均明显高于正常对照组(P＜0.05),两组羊水过多、妊娠期高血压疾病、胎膜早破、早产、胎儿窘迫、剖宫产、足月低体重儿(小于胎龄儿)、NRDS发生率比较,差异无统计学意义(P＞0.05).MNT组与正常对照组比较,羊水过多、妊娠期高血压疾病、胎膜早破、早产、胎儿窘迫、剖宫产、巨大儿、足月低体重儿(小于胎龄儿)、新生儿低血糖、新生儿住院、NRDS发生率差异均无统计学意义(P＞0.05).结论:医学营养治疗可有效减少GDM围生期母儿并发症,有利于获得良好的母儿结局.     

Bone mesenchymal stem cell-conditioned medium decreases the generation of astrocytes during the process of neural stem cells differentiation

Objectives: The aim of this study was to investigate the effect of bone mesenchymal stem cell (BMSC) conditioned medium (CM) and Bone morphogenetic protein-4 (BMP-4) on the generation of astrocytes during the process of NSCs differentiation.

Design: Neural stem cells (NSCs) were grown under different culture conditions.

Setting: The First Affiliated Hospital of Anhui Medical University, Hefei, China.

Outcome Measures: The study consisted of four groups: NSCs cultured under control conditions (group 1) or with the addition of BMSC-CM (group 2);(BMP-4) (group 3) or both (group 4).The expression of glial fibrillary acidic protein (GFAP) was detected by immunocytochemical staining and Western blotting.

Results: The expression of GFAP was higher in Group3 and lower in Group 2 compared to that in Group 1. The expression of GFAP in Group 4 was intermediate between that of Group 2 and Group 3.

Conclusions: These results suggest that BMSC-CM can decrease the generation of astrocytes and that the inhibition of the (BMP-4) /Smad1/5/8 signaling pathway may be the underlying mechanism. This phenomenon may be mediated by increasing the expression of Smad6.     

Store–Operated Ca2+ Channels in Mesangial Cells Inhibit Matrix Protein Expression

Accumulation of extracellular matrix derived from glomerular mesangial cells is an early feature of diabetic nephropathy. Ca²⁺ signals mediated by store–operated Ca²⁺ channels regulate protein production in a variety of cell types. The aim of this study was to determine the effect of store–operated Ca²⁺ channels in mesangial cells on extracellular matrix protein expression. In cultured human mesangial cells, activation of store–operated Ca²⁺ channels by thapsigargin significantly decreased fibronectin protein expression and collagen IV mRNA expression in a dose-dependent manner. Conversely, inhibition of the channels by 2-aminoethyl diphenylborinate significantly increased the expression of fibronectin and collagen IV. Similarly, overexpression of stromal interacting molecule 1 reduced, but knockdown of calcium release–activated calcium channel protein 1 (Orai1) increased fibronectin protein expression. Furthermore, 2-aminoethyl diphenylborinate significantly augmented angiotensin II–induced fibronectin protein expression, whereas thapsigargin abrogated high glucose– and TGF-β1–stimulated matrix protein expression. In vivo knockdown of Orai1 in mesangial cells of mice using a targeted nanoparticle siRNA delivery system resulted in increased expression of glomerular fibronectin and collagen IV, and mice showed significant mesangial expansion compared with controls. Similarly, in vivo knockdown of stromal interacting molecule 1 in mesangial cells by recombinant adeno–associated virus–encoded shRNA markedly increased collagen IV protein expression in renal cortex and caused mesangial expansion in rats. These results suggest that store–operated Ca²⁺ channels in mesangial cells negatively regulate extracellular matrix protein expression in the kidney, which may serve as an endogenous renoprotective mechanism in diabetes.     

闽南地区部分脆性髋部骨折的发病特点及治疗现状

目的通过回顾分析闽南地区到我院骨科住院治疗的脆性髋部骨折患者的发病特点以及治疗的现状,为本地区老年人脆性髋部骨折的预防和治疗提供依据。方法采用回顾性研究方法,收集我院2010~2012年骨科收治的年龄大于50岁的脆性髋部骨折患者的病历资料及部分获得随访的患者的随访资料,采集患者个人特征(性别与年龄)、受伤的年份与季节、骨折类型、治疗方式、抗骨质疏松方案、随访1年的死亡率,并进行统计分析整理。结果 3年间我院收治年龄大于50岁的脆性髋部骨折患者560例,发病有地区性特点,各年份病例数基本持平(2010年190例,2011年184例,2012年186例),各年份构成比差异无统计学意义(P0.05);女性患者(373例)明显多于男性(187例),男女比例为1∶2,男女构成比差异有显著的统计学意义(P0.05);股骨颈骨折(316例)多于股骨转子间骨折(244例);平均年龄高达77.19±10.38岁,各年龄段构成比差异有显著的统计学意义(P0.05);发病例数以春季(149例)、冬季(145例)为多,冬春季与夏秋季间的构成比差异有统计学意义(P0.05);采用手术治疗比例89.11%(499/560);住院期间有进行骨密度检查的患者80例,住院期间有抗骨质疏松治疗的患者比例63.93%(358/560),获得随访的患者出院后继续抗骨质疏松治疗的比例仅20.63%(59/286);随访超过1年的231例患者中,手术组1年死亡率(6.57%)明显低于非手术组(72.73%),差异有显著性统计学意义(P0.05)。结论闽南地区脆性髋部骨折发病有其地区特点,尤其在年龄、性别、发病部位、发病季节、治疗方法有一定分布规律,目前抗骨质疏松治疗重视程度仍然不够,应加强宣传,深入开展防治策略研究来预防骨折的发生。     

抗癌消水膏治疗恶性胸腔积液的疗效与胸水中Th1/Th2细胞因子的相关性

目的：探讨抗癌消水膏治疗恶性胸水的疗效与胸水中Th1/Th2型细胞因子的关系。方法：在临床以上干扰素腔内注射法为对照组，评价抗癌消水膏的疗效。采用ELISA法检测恶性胸水中IL－2，IL－8，IL－10，IFN－γ水平，比较抗癌消水膏有效组与无效组治疗前后各细胞因子的变化，结果：抗癌消水膏有效组IL－2、IL－8、IFN－γ均有上升，IL－10下降（P＜0．05）；无效组各细胞因子变化无差异（P＞0．05）。结论：恶性胸水中Th1细胞因子优势是抗癌消水膏治疗恶性胸水的主要机理之一。     

哮喘患儿特应性形成的研究

目的探讨个体特应性的发生、发展过程及对哮喘发病的影响。方法调查４１０例哮喘儿童的螨皮试情况,并对三个哮喘家系进行常见过敏原皮试和总ＩｇＥ（ＴＩｇＥ）测定,并对该性状与Ｄ１１Ｓ５３３作遗传连锁分析。结果哮喘儿童的螨皮试阳性率及阳性反应程度随年龄增长而增强,至学龄前期渐趋稳定。三个家系３９人中１７例过敏原皮试阳性,１５名哮喘者中１１例阳性（７３３％）,过敏原种类上下各代不同,过敏原皮试与Ｄ１１Ｓ５３３之间无连锁。结论人类存在有控制特异性ＩｇＥ基因,呈常染色体显性遗传,其遗传位点与ＴＩｇＥ不同。个体特应性受遗传影响,其对外界抗原起反应的能力随个体发育不断成熟,至学龄前期渐趋稳定。早期反复的呼吸道感染,犹如佐剂促进了特应性发展。对有特应性家族史的个体,在早期应避免接触过敏原,尽可能减少呼吸道感染,以减少哮喘发病。     

41例糖尿病足截肢患者截肢原因与中医辨证分析

目的分析和总结41例糖尿病足截肢患者的截肢原因与中医辨证的关系。方法将患者截肢前的相关化验指标、检查结果以及证候特点进行归纳总结,寻找其共同特点并进行分析。结果急诊截肢的糖尿病足患者主要截肢原因为严重感染而并非严重缺血,其辨证特点为邪盛正虚而以邪盛为主。择期截肢患者主要截肢原因为患足反复感染与慢性缺血引起的肢体废用,其辨证仍以正虚与邪实并重。结论糖尿病足截肢原因与中医辨证的自身的特点,可为今后重症糖尿病足患者的肢体预后判断与治疗提供一定的参考。     

高效液相色谱法测定哈布达日-16味丸中盐酸小檗碱的含量

目的：测定哈布达日-16味丸中盐酸小檗碱的含量.方法：采用HPLC法以Agilet TC-C18柱（250minx4.6 mm,5u）,流动相为乙腈-0.05%磷酸二氢钠溶液（用磷酸调节PH值至3）（28：72）,检测波长350nm.结果：盐酸小檗碱的浓度在19.5～390mg·L-1范围内线性关系良好（r=0.9998）,平均回收率为97.3%,方法精密度RSD=1.44%（n=6）.结论：该法简便、快速、准确,可作为哈布达日16味丸中盐酸小檗碱的含量测定方法.