中国大陆地区妇女骨质疏松筛选工具探讨

目的建立适用于中国大陆地区40岁及以上妇女的骨质疏松（osteoporosis，OP）筛选工具。方法以20～39岁妇女腰椎骨密度的均数和标准差作为参考值计算T—score。以双能X线骨密度仪（dual—energy X—ray absorptiometry，DxA）的测量结果作为金标准，采用二分类的Bayes判别分析，建立判别函数。结果我国大陆地区40岁及以上妇女OP筛选工具（osteoporosis screening tool for Chinese，OSTC）为：体重-2×年龄＋50。判别准则为OSTC〉0为无OP危险性，OSTC≤0为有OP危险性。OSTC的正判率为75．78％，灵敏度为76．8％，特异度为75．1％，Kappa值为0．51（P=0．000），说明OSTC与DXA的判定结果一致性尚可。结论OSTC是一个简便的OP筛选工具。根据年龄、体重两个变量的简单计算，即可对我国大陆地区40岁及以上的妇女进行OP危险性的筛选。但OSTC没有得到外部数据的验证，其优劣还有待进一步评价。     

Enhanced transcription factor DNA binding and gene expression induced by arsenite or arsenate in renal slices

Although the kidney represents a target for the accumulation and toxicity of arsenic, little is known about the molecular targets of arsenic in this organ. Therefore, these studies were designed to examine the molecular impact of arsenite [As(III)] and arsenate [As(V)] at low (nanomolar) concentrations. Precision-cut rabbit renal cortical slices were challenged with As(III) or As(V) for up to 8 h. Neither form of the metal induced overt cytotoxicity as assessed by intracellular K+ levels over this time period at concentrations from 0.01-10 microM. In addition, no alterations in the expression of Hsp 60, 70, or 90 were observed. However, induction of heme oxygenase-1 (Hsp 32) was seen following a 4-h challenge with As(III), but not with As(V). As(III) and As(V) induced DNA binding of AP-1 at 2- and 4-h exposure; following a 6-h exposure there was no difference. Although no alteration in the DNA binding activity of ATF-2 was induced by As(III) or As(V), both forms enhanced the DNA binding activity of Elk-1. Enhanced DNA binding activity of AP-1 and Elk-1 correlated with increased gene expression of c-fos, but not c-jun, at 2 h. c-myc gene expression was also induced by As(III) and As(V), albeit at a later time point (6 h). These results suggest that acute arsenic challenge, by either As(III) or As(V), is associated with discrete alterations in the activity of signaling pathways and gene expression in renal tissue.      

Timing of renal replacement therapy initiation by AKIN classification system

Introduction

Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits.

Methods

We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables.

Results

A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay.

Conclusions

For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time-based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI.     

电针对实验性糖尿病周围神经病变大鼠坐骨神经传导速度和超微结构的影响

目的:观察电针对实验性糖尿病周围神经病变大鼠坐骨神经传导速度及神经纤维超微结构的影响。方法:实验于2005-01/12在上海中医药大学附属岳阳中西医结合医院中心实验室完成。选用清洁级雄性Wistar大鼠100只,按随机数字表法选取15只作为正常对照组。在链脲佐菌素制备实验性糖尿病大鼠(n=85)基础上制备实验性糖尿病周围神经病变大鼠模型,以空腹血糖≥15mmol/L,坐骨神经感觉神经传导速度,运动神经传导速度明显减慢、摆尾温度阈值升高及坐骨神经有髓纤维形态学改变为造模成功的标准。在确认实验性糖尿病周围神经病变大鼠模型成功的基础上,采用随机数字表法抽取60只大鼠,分为3组,即电针经(组、电针非经(组、模型对照组,每组20只。①电针经(组:取肾俞(双)、足三里(双)(,将大鼠固定,针刺0.5cm,并接电针治疗仪,连续波,频率2Hz,20min/次,隔日1次,共治疗12次。②电针非经(组:将大鼠尾尖作为刺激点,具体方法和治疗次数同上。③模型对照组:不作任何治疗,只作与电针经(组相同的固定。④正常对照组:作与电针经(组相同的固定。造模后4周,以神经电生理法测试各组大鼠的运动神经、感觉神经传导速度;造模后8周,应用透射电镜观察各组大鼠的坐骨神经组织超微结构。结果:实验过程中模型对照组、电针非经(组及电针经(组大鼠分别死亡5,4,1只,因此进入结果分析每组分别抽取15只进行指标检测。①各组大鼠造模4周时的坐骨神经传导速度比较:模型对照组的运动神经传导速度、感觉神经传导速度显著低于正常对照组(31.37±3.70,18.17±9.54;41.30±1.15,44.22±8.80)m/s(P<0.01)。电针经(组经治疗后运动神经传导速度、感觉神经传导速度显著高于模型对照组(38.04±2.01,37.98±5.10)m/s(P<0.01),但未达到正常对照组水平(P<0.05);电针非经(组大鼠的运动神经传导速度、感觉神经传导速度与模型对照组差异无显著性意义(32.74±5.42,21.39±5.61)m/s(P>0.05)。②各组大鼠造模8周时的坐骨神经超微结构比较:模型对照组大鼠坐骨神经有髓神经纤维髓鞘结构模糊、松散、排列紊乱,出现空泡状缺损。电针非经(组大鼠坐骨神经有髓神经纤维髓鞘结构松散、排列紊乱,出现断裂或空泡状缺损。电针经(组大鼠坐骨神经髓纤维髓鞘结构损伤脱失的程度较模型对照组有所减轻,但未达到正常对照组水平。结论:电针对糖尿病周围神经病变具有一定的防治作用,其作用可能是通过改善糖尿病周围神经病变大鼠周围神经有髓纤维的形态及功能而实现的。     

基于象素形态测量法分析精神分裂症患者脑白质结构

目的:应用基于象素的形态测量学方法,分析精神分裂症大脑白质结构与健康人的差异。方法:①分组:精神分裂症组为10名北京大学精神卫生研究所和北京回龙观医院2005-04/2006-03收治,符合ICD-10、DSM-Ⅳ精神分裂症偏执型诊断标准的患者;健康对照组是年龄、性别和受教育程度与精神分裂症组相匹配的健康志愿者10名。所有受试者均签署知情同意书。②检测方法和参数:采用西门子1.5TSonataMRI成像系统,对所有受试者行全脑扫描,解剖图像采用T1加权序列矢状成像(MPRAGE),共采集96层。TR=1900ms,TE=3.93ms,flip15°,FOV=220mm×220mm,图像分辨率0.43mm×0.43mm×1.70mm。③数据处理:在SPM5平台上,使用VBM5工具箱进行技术进行处理。采用MNI的标准脑图谱配准,配准后图像分辨率2mm×2mm×2mm;采用HMRF算法进行组织分割,目标是测量白质密度,故未经体积调制;用12mm半高全宽高斯核对脑白质密度图进行平滑;然后采用SPM的组分析方法,对两组进行成组t检验,t>3.61,P<0.001(未校正)、相连象素大于20个的信号变化脑区视为有差异脑区。结果:20名受试者均完成测试进入结果分析。精神分裂症组密度低于对照组的区域有双侧颞下回、双侧额下回、双侧梭状回、左侧海马旁回、左侧胼胝体、左侧丘脑、左侧顶下叶、左侧楔前叶、右侧额中回、右侧颞中回,没有发现精神分裂症组白质密度高于对照组的区域。结论:①精神分裂症患者白质缺陷部位广泛。结合同一研究对象的功能磁共振成像研究结果提示左侧丘脑和双侧梭状回与精神分裂症有密切关系。②基于象素的形态测量学的方法有快速和全自动的特点,具有不受分析人员主观影响等优点。     

人工肩关节置换翻修术3例报告

①探讨人工肩关节置换术后翻修术中的指证和方法。②选择2001-09/2002-04上海长征医院收治的肩关节置换术后患者3例,例1(男,36岁),例3(男,75岁)为急性肱骨近端4部分粉碎性骨折,分别行单极人工肩关节置换术、全肩关节置换术各1例;例2(女,63岁)为肱骨近端骨巨细胞瘤,行双极人工肩关节置换术。3例术后均表现肩关节活动受限,例2,例3三角肌萎缩,肩关节脱位(人工肱骨头置位不当)或半脱位。例1,例2均行人工肩关节置换翻修术;例3行肩关节镜检查,发现肩关节假体置位理想,但所用关节盂过厚,与肱骨头假体关节面不够匹配,关节囊修复理想。未予再次置换假体。3例患者术后分别随访36,40和9个月。③结果:例1人工肩关节置换术后翻修患者术后完全不疼。例2由于人工肱骨头置位不当、脱位,肩关节假体突至皮下,显著疼痛,翻修术后疼痛缓解。例3全肩关节置换术翻修术后患者所用关节盂过厚,致关节活动受限,而腋神经损伤致三角肌瘫痪,肩关节不稳,易脱位、被动运动痛。例1肱骨近端骨折单极人工肩关节置换术翻修术后患者上举120°,外旋60°,内旋80°。例2,例3患者由于三角肌萎缩,术后肩关节半脱位,肩关节活动受限。3例患者假体X射线表现置位较好,假体周围无透亮区、无松动;肿瘤术后患者未见肿瘤复发迹象;患者均较满意。④人工肩关节置换翻修术的基本指证为假体周围骨折;假体松动;假体置位不当、关节脱位或半脱位、活动受限。行人工肩关节置换术,对于神经肌肉功能应特别注意,并加以必要的保护;肱骨头的上下位置对于植入物的功能极为重要。     

Current experiences with robotic surgery at Severance Hospital,Yonsei University in Korea

We started performing laparoscopic cholecystectomies in 1991. Since that time, many surgeons have been trained in laparoscopic and minimally invasive surgery, and laparoscopic surgery has been used in numerous procedures, with patients benefitting as a result. We performed the first automated surgery in Korea using Automated Endoscopic System for Optimal Positioning in June 1996. Inspired by Inbae Yoon and assisted by his generous donation, our hospital started the IB Yoon Multi‐Specialty Endoscopic Research & Training Center in 1998. Subsequently in March 2005, we started the Severance Robotic and Minimally Invasive Surgery Center. The establishment of these centers has enabled us to widen the use of laparoscopic surgery and to teach many surgeons the principles of and the techniques involved in laparoscopic and robotic surgery. We performed our first robotic surgery using the da Vinci Surgical System in July 2005. In the 4 years since introducing the da Vinci Surgical System, we have successfully performed more than 2600 robotic surgical procedures. As the collaboration between medicine and robotic engineering produces more technically advanced results, we hopefully can develop our own version of the robotic system in the near future.     

去除神经支配大鼠骨骼肌中钠钾三磷酸腺苷酶表达的变化

背景胰岛素诱导的离子运输改变可影响代谢调节,并且胰岛素抵抗条件下钠钾三磷酸腺苷酶活性的降低导致高血压以及糖原合成、葡萄糖氧化和ATP产生的减少.目的观察钠钾三磷酸腺苷酶在胰岛素抵抗模型中的表达调控.设计对照实验.单位英国邓迪大学生命科学学院分子生理学系.材料实验于1999-10/2000-02完成.使用15只体质量200～250 g的清洁级成年雄性Sprague Dawley大鼠.每次实验使用5只,相同实验重复3次.方法去除大鼠一侧后肢神经支配,4 d后将骨骼肌从去除神经支配的后肢和对侧对照后肢中解剖并分离,从红色肌肉(比目鱼与红色腓肠肌)和白色腓肠肌中分离粗制细胞膜.应用免疫印迹法和Northern杂交分析法分别检测蛋白质和mRNA的表达.使用Bio-Rad GS-670图像密度仪对蛋白质和mRNA的信号强度进行定量.主要观察指标对照侧和去除神经支配后肢骨骼肌中钠钾三磷酸腺苷各亚基蛋白质和mRNA表达水平的比较.结果15只大鼠全部进入结果分析.与对照侧相比,去除神经支配的后肢中①红色骨骼肌中α2和β1亚基的蛋白质表达分别下降46%和77%.在红色和白色骨骼肌中,α1亚基的蛋白质表达分别增加了20%和15%.β2亚基的蛋白质表达在红色和白色骨骼肌中均未发生显著变化.②在红色腓肠肌和比目鱼肌中,α2亚基的mRNA水平分别下降了29%和39%,β1亚基的mRNA水平分别下降了80%和52%.在红色和白色腓肠肌中,α1亚基的mRNA水平分别增加了9倍和1.3倍.β2亚基的mRNA水平在红色腓肠肌中无显著变化,但在白色腓肠肌中减少了59%.结论①在去除神经支配的大鼠骨骼肌中,钠钾三磷酸腺苷酶各亚基的表达受转录和转录后双重调控.②α2和β1亚基的蛋白质表达显著下降的结果提示,在大鼠骨骼肌中,去除神经支配造成的胰岛素抵抗使原本受胰岛素调节的钠钾三磷酸腺苷酶亚基的表达机制被破坏.