骨质疏松性胸腰椎骨折的若干问题讨论

骨质疏松症是一种以骨组织微结构退化和骨量减少为特怔的代谢性骨病,可致骨骼脆性增加和骨折发生率升高m。流行病学研究显示,美国骨质疏松症的发病率为18.6%121,而我国为15.7%[3],50岁以上人群骨质疏松症发病率女性为20.7%,男性为14.4%|31。到2050年我国为此每年花费约I 745亿元141。随着人口老龄化进展,骨质疏松症及其相关的骨折已成为一个世界性的严重问题。     

鼠胚神经干细胞体外培养方法的优化

目的:神经干细胞能够分化为神经元和神经胶质细胞,但其纯化、培养技术尚不完善通过不同接种密度和传代方法,筛选优化神经干细胞的体外培养技术。方法:实验于2006-05/12在四川大学移植免疫实验室完成。①动物:选取清洁级孕12～16 d雌鼠,实验过程中对动物的处置符合动物伦理学标准。②实验方法:取孕鼠胚胎脑皮质,胰蛋白酶 乙二胺四乙酸消化组织,分离神经干细胞,加入含B27、碱性成纤维细胞生长因子、表皮生长因子的DMEM/F12培养基.传至第3代时.调整细胞密度至1×10~7L~(-1),1×10~8L~(-1),1×10~9L~(-1),1×10~(10)L~(-1)进行培养。另取原代培养7～10 d后的神经干细胞,收集形成的细胞球,机械吹打法传代是离心后用由粗到细的吸管轻柔吹打.或用带5号针头的无菌注射器吹打分离细胞.操作中避免产生气泡.使用注射器时吹打的次数保持5次。胰酶消化联合机械吹打法传代是离心后加入胰蛋白酶,37℃水浴10min,用由粗到细且经火焰抛光的吸管轻柔吹打.或用带5号针头的无菌注射器吹打.以胎牛血清终止消化。③实验评估:观察第3代神经干细胞生长状态.MTT法检测各密度下培养1,3,5,7 d时的增殖情况。计数两种传代方法亚代神经干细胞形成的克隆球数目,比较增殖效果。免疫荧光染包检测神经球巢蛋白、BrdU标记、神经元特异性烯醇化酶、胶质细胞原纤维酸性蛋白的表达。结果:①神经干细胞的培养和鉴定:从胚胎大鼠脑皮质分离培养出的细胞可聚集成球状.并在体外大量扩增和长期存活,巢蛋白、神经元特异性烯醇化酶、胶质细胞原纤维酸性蛋白均呈阳性表达,免疫荧光染色可见大量BrdU标记的阳性细胞。②不同接种密度对神经干细胞增殖的影响:按1×10~9L~(-1)密度培养的细胞分裂增殖最为迅速.于第7天达高峰,且克隆球生成数量明显多于1×10~7L~(-1),1×10~8 L~(-1),1×10~(10)L~(-1)密度(P均<0.05)。③不同传代方法对亚代神经干细胞克隆增殖效果的影响:采用机械吹打法传代的神经干细胞所增殖形成的细胞球结合紧密,抛光玻璃管 注射器吹打后细胞球能较好地分开.但不能完全分散成单细胞.传代后细胞能够继续生长,并形成亚代神经干细胞球。经胰酶消化的神经球在机械吹打后也不能完全形成单细胞,且其亚代克隆的形成能力明显低于机械吹打法(P<0.05)。结论:①从胚胎大鼠脑皮质分离培养出的细胞具有神经干细胞特性,可诱导分化为神经元和星形胶质细胞②1×10~9L~(-1)为最佳细胞接种密度,机械吹打法亚代克隆的活性和增殖能力明显优于胰酶消化联合机械吹打法。     

On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure

Background

Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM) patients. Treatment effects with improved left ventricular (LV) ejection fraction (EF) have been observed in patients without overt heart failure, but it is unclear whether these changes are clinically meaningful.

Methods

This retrospective study of a UK database of TM patients modelled the change in EF between serial scans measured by cardiovascular magnetic resonance (CMR) to the relative risk (RR) of future development of heart failure over 1 year. Patients were divided into 2 strata by baseline LVEF of 56-62% (below normal for TM) and 63-70% (lower half of the normal range for TM).

Results

A total of 315 patients with 754 CMR scans were analyzed. A 1% absolute increase in EF from baseline was associated with a statistically significant reduction in the risk of future development of heart failure for both the lower EF stratum (EF 56-62%, RR 0.818, p < 0.001) and the higher EF stratum (EF 63-70%, RR 0.893 p = 0.001).

Conclusion

These data show that during treatment with iron chelators for cardiac siderosis, small increases in LVEF in TM patients are associated with a significantly reduced risk of the development of heart failure. Thus the iron chelator induced improvements in LVEF of 2.6% to 3.1% that have been observed in randomized controlled trials, are associated with risk reductions of 25.5% to 46.4% for the development of heart failure over 12 months, which is clinically meaningful. In cardiac iron overload, heart mitochondrial dysfunction and its relief by iron chelation may underlie the changes in LV function.     

18F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis.

PURPOSE: 18F-deoxyglucose positron emission tomography (FDG-PET) is increasingly applied in the staging of lung cancer (LC). This study analyzes the potential contribution of PET in radiotherapy planning for LC with special respect to tumor-associated atelectasis. METHODS AND MATERIALS: Thirty-four patients with histologically confirmed LC, who had been examined by PET during pretreatment staging, were included. All were irradiated after CT-based therapy planning with anterior/posterior (AP) portals encompassing the primary tumor and the mediastinum (CT portals, CP). The result of the PET examination was unknown in treatment planning. In retrospect, a PET portal (PP) was delineated and compared with the CP. RESULTS: In 12/34 cases, the shape and/or size of the portals were changed, primarily (n = 10) the size of the fields was reduced. The median area of CP was 182 cm2 versus 167 cm2 of PP. Seventeen of 34 patients had dys- or atelectasis caused by a central primary tumor. In these cases, differences between CP and PP were significantly more frequent than in the other patients (8/17 vs. 3/17, p = 0.03). CONCLUSION: In this retrospective analysis, the information provided by FDG-PET would have contributed to a substantial reduction of the size of radiotherapy portals. This applies particularly for patients with tumor-associated dys- or atelectasis.     

Untersuchungen zum stoffwechsel von Hähnchenlinsen während des ersten Lebensjahres

Zusammenfassung In Linsen von Hähnchen wurden während des ersten Lebensjahres verschiedene Stoffwechselgrössen bestimmt. Dabei zeigte sich, daß das Linsengewicht im Gegensatz zu den Linsen anderer Tierarten in einer komplizierten Funktion (Gleichung 4. Grades) zum Lebensalter steht. Möglicherweise kommt es nach etwa 11 Monaten zu einem Stillstand der Gewichtszunahme. Der prozentuale Anteil des Trockengewichtes am Linsenfrischgewicht bleibt in dem von uns kontrollierten Zeitraum konstant.Im Mineralhaushalt der Linsen fällt in den ersten 4 Wochen vor allem eine starke Änderung des K⁺/Na⁺-Quotienten infolge Zunahme des K⁺ auf.Die untersuchten Fermentaktivitäten verhalten sich nicht gleichartig. Die Aktivitäten von G-6-PDH, MDH, SDH, GOT und GPT lassen mit zunehmendem Lebensalter keine wesentliche Änderung erkennen, da ihre Aktivitätserhöhung beim Älterwerden durch eine Verminderung mit zunehmendem Linsengewicht weitgehend ausgeglichen wird. Die Aldolase zeigt dagegen eine ständige Aktivitätsabnahme, die LDH bemerkenswerterweise eine ständige Zunahme der Aktivität. Diese steht im Gegensatz zu den Ergebnissen bei Linsen anderer Tierarten.

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Summary Several metabolic data of chicken lenses during the 1st year of life were studied. The ratio of lens-weight to age differs from that of other animal species, as it is a complicate function (equation of 4th degree). The weight increase probably stops after the age of 11 months. The percentage of dry-weight remained constant during the investigated period.During the first 4 weeks there is a remarkable increase of the K⁺/Na⁺-quotient due to gain of K⁺.The enzyme activities which were studied, demonstrate different age-related patterns. The G-6-PDH, MDH, SDH, GOT and GPT do not show any considerable change of activity (calculated per g lens fresh-weight) with increasing age. The activity of aldolase decreased continuously with advancing age. LDH increases progressively. These results are in contrast to those obtained with other species.

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Résumé Différentes métabolites du cristallin de jeunes coques ont été déterminées pendant la première année de leur vie. La relation entre le poids et l'age du cristallin constitue une fonction compliquée (équation de 4-me degré) contrairement aux résultats obtenus chez d'autres animaux. Probablement l'augmentation du poids s'arrête après le 11ième mois. La relation entre le poids sec et le poids frais du cristallin reste constant pendant la période de vie examinée par nous.Pendant les premières 4 semaines un changement du quotient K⁺/Na⁺ est observé qui est causé par une augmentation frappante du K⁺.Les activités des enzymes examinés ne sont pas égales. Les activités de G-6-PDH, MDH, SDH, GOT et GPT ne changent pas essentiellement avec l'âge (calculées per g cristallin de poids mouillé). L'activité de l'aldolase montre une diminution permanente tandis que la LDH augmente progressivement. Ces résultats sont différents des résultats obtenus avec les cristallins d'autres animaux.

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Der deutschen Forschungsgemeinschaft danken wir für die Unterstützung der vorliegenden Untersuchung. (Ho 249/1 und Ho 249/3).

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Aus dem klinischen Institut für experimentelle Ophthalmologie der Universität Bonn, Direktor: Professor Dr. E. Weigelin.     

Insulin und Wärmeregulation

Ohne ZusammenfassungMit 3 Kurven.