Bone growth patterns in Chinese children and adolescents: a 6-year follow-up study provides evidence for sexual dimorphism and tracking

Summary We prospectively examined bone growth patterns in 894 children aged 6–17 years at the baseline visit, with a 6-year follow-up. Results show bone “tracking” over a six-year interval and sexual dimorphism of bone attained levels and timing of peak bone growth. Our findings underscore childhood and adolescence as critical periods for building bone and developing gender differences. Introduction Bone growth patterns were prospectively examined in 894 Chinese children (496 males), aged 6–17 yrs, from a population-based twin cohort. Whole-body bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were measured by DEXA at baseline and a 6-yr follow-up. Methods Graphic smoothing plots and generalized estimating equations were used to model bone attained levels, growth, and “tracking”. Results Attained levels of BMC and BA increased curvilinearly with age. Male attained levels were higher than females after age ∼15 yr, but BMD was lower between 13–17 yrs (Tanner stage I to IV). In both genders, peak BMC and BMD growth lagged ∼2 yrs behind peak BA growth, which lagged 2 yrs behind peak height growth. Peak bone growth occurred 1–3 yrs later in males. Over the 6-yr follow-up, all bone measurements “tracked”, but “shifting” across ranks also occurred, and baseline tertile ranking influenced bone growth. Females with early menarche had higher attained levels than females with late menarche at age 12–13 yrs. Conclusion Our findings confirm and expand previous studies on peak bone growth conducted in Caucasian cohorts, particularly sexually dimorphic and maturational effects. The significant “tracking” of bone measurements in this 6-yr follow-up study underscores the importance that osteoporosis prevention should begin in childhood and adolescence. Fengxiu Ouyang and Binyan Wang contributed equally to this article. Source(s) of support: This study is supported in part by grant R01 HD049059, R01 HL0864619 and R01 AR045651 from the National Institute of Health and by the Food Allergy Project.     

Hepatitis B immunity in adolescents and necessity for boost vaccination: 23 years after nationwide hepatitis B virus vaccination program in Taiwan

The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15–18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984–1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.     

李莹教授治疗肾病的经验

李莹教授毕业于长春中医学院，从事中医内科临床、科研、教学工作50余年，是吉林省首批名中医。她笔耕不辍，讲学传道，精通典籍，厚德载物，度人济世，尤其擅长治疗肾病，是吉林省中医药科学院肾病内科的创始人，并于1998年开始被国家中医药管理局指定为全国名老中医药专家学术经验继承工作指导老师。笔者有幸跟随李老师学习，成为第四批学术经验继承人之一。     

对诊断PADAM的游离睾酮指数的评估

目的 评价诊断中老年男子部分雄激素缺乏综合征（PADAM）的游离睾酮指数（FTI）.方法 对129例45岁以上健康男性的FTI进行年龄相关分析.以推算的游离睾酮（CFT）值为依据,对FTI进行有效性检验.结果 男子在中老年期FTI与增龄呈明显的负相关.FTI敏感性97.78%,特异性58.33%.结论 计算简单的FTI可用于PADAM病人的筛选和随访,尤其对70岁以上男子是血清FT较为有效的参数.     

A dermal equivalent developed from fibroblast culture alone: Effect of EGF and insulin

We have recently developed a new dermal equivalent without exogenous materials by culturing dermal fibroblasts alone in serum-containing medium treated with several supplements. In this study, we investigated the effects of epidermal growth factor (EGF) and insulin on the formation of a dermal equivalent. After cultured dermal fibroblasts reached a confluence in serum-containing medium, they were treated with EGF or insulin. The combined effects of EGF and insulin were also studied. Macroscopically, in contrast to the culture without supplement, the addition of EGF or insulin produced a fibrous sheet. The combination of EGF and insulin showed a more marked effect than a single factor. Histologically, EGF or insulin alone induced a three-dimensional tissue containing several layers of fibroblasts. The combination of EGF and insulin produced a thicker tissue. It was composed of abundant extracellular matrix containing fibroblasts, suggesting a dermis-like tissue. It revealed collagen fibers by Masson-trichrome staining. Immunohistochemically, the components of dermal extracellular matrix such as type 1 collagen, elastin, and fibrillin-1 were diffusely expressed. Ultrastructurally, a large number of collagen fibrils with cross-striated patterns were found around the fibroblasts. These results showed that a dermal equivalent could be formed by culturing dermal fibroblasts alone postconfluently in serum-containing medium with EGF and insulin. They suggest that the two factors play an important role in the formation of a dermal equivalent.     

慢性鼻窦炎鼻息肉合并支气管哮喘患者鼻窦内镜术后对支气管哮喘疗效的影响

目的观察鼻窦内镜术(endoscopic sinu ssurgery，ESS)对慢性鼻窦炎伴支气管哮喘患者哮喘发作的影响。方法对210例慢性鼻窦炎患者施行ESS术，其中伴有支气管哮喘病史者42例(20．0％)。210例患者均于术前、术后采用酶联免疫吸附测定法(ELISA)检测外周血单个核细胞(PBMC)培养上清液中的白细胞介素4(IL-4)，干扰素γ(IFN-γ)，可溶性白细胞介素2受体(sIL-2R)和可溶性IgE低亲和力受体(solube CD23，sCD23)的含量，并与20例正常对照组进行比较。通过主观和客观标准评定42例患者哮喘发作及对皮质类固醇的耐受状况，并对术后患者进行为期1年(10例)和3年(32例)的随访。结果鼻窦炎合并支气管哮喘患者术前PBMC培养上清液中IL-4，sIL-2R、sCD23含量较对照组显著升高，而IFN-γ含量较对照组显著减少。术后IL-4、sIL-2R、sCD23含量较对照组显著降低，而IFN-γ含量显著增高。术后哮喘改善水平由随访术后1年的45％提高到术后3年的70％。42例中32例(76％)哮喘发作次数明显减少，术前长期服用类固醇的2l例中，14例(67％)减少了对口服类固醇的使用。结论ESS对慢性鼻窦炎伴支气管哮喘患者的治疗有较满意的远期疗效。ESS能调节IL-4、IFN-γ sIL-2R、sCD23水平，降低哮喘的发作频率和对类固醇的依赖。     

Genetic association studies of interleukin-13 receptor alpha1 subunit gene polymorphisms in asthma and atopy.

Interleukin (IL)-13 plays a central role in asthma pathogenesis by binding to the IL-13 receptor, which is a heterodimer composed of the IL-13 receptor alpha1 subunit (IL-13Ralpha1) and IL-4Ralpha. The genetic diversity at the IL-13Ralpha1 gene (IL13RA1) locus on chromosome Xq24 was characterised and the association of identified polymorphisms with asthma and atopy phenotypes examined. The promoter and coding region of IL13RA1 were screened for common genetic variants, and polymorphisms found were genotyped in a large cohort of 341 asthmatic Caucasian families (each containing at least two asthmatic siblings) and 182 nonasthmatic control subjects. Genetic association was determined using case-control and transmission disequilibrium test analyses. Two common polymorphisms were identified, a newly found thymidine (T) to guanine (G) transition of nucleotide -281 (-281T>G) single nucleotide polymorphism in the IL13RA1 promoter and the previously described 1365A>G variant in the IL13RA1 proximal 3' untranslated region. No significant association of either -281T>G or 1365A>G with risk of asthma or atopy phenotypes was found, apart from a suggestive association between the IL13RA1 -281T/1365A haplotype and raised total serum immunoglobulin E levels in adult female asthmatics. These findings indicate that the interleukin-13 receptor alpha1 subunit gene -281T>G and 1365A>G polymorphisms do not contribute to asthma susceptibility or severity, although the interleukin-13 receptor alpha1 subunit gene locus might be involved in the control of immunoglobulin E production.     

同种异体骨支撑架微创治疗股骨头坏死的临床研究

目的应用改良髓芯减压术结合同种异体骨支撑架加自体骨和脱钙骨基质（decalcified bone matrix，DBM）治疗早期股骨头坏死，探索早期股骨头坏死的微创治疗方法。方法2004年1月～2005年4月，23例24个髋关节采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的同种异体骨支撑架经隧道拧入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。观察手术前后Harris评分变化、x线影像学表现及是否需进一步治疗。结果本组所有患者均获得随访，平均随访19（12—27）个月，以最后一次随访资料作为最终评价依据。Harris评分，术前优良率为43．5％（10／23）。术后优良率为91．3％（21／23）。22侧髋关节影像学表现保持稳定，无明显并发症发生。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死，增加了股骨头负重区软骨下骨的机械支撑，成骨作用强，有利于股骨头坏死的修复与重建，同时，不破坏患者股骨头本身的血液供应，创伤小，操作简单，值得临床推广使用。     

有限内固定结合外固定支架治疗胫骨远端骨折

目的探讨有限内固定结合Hybrid外固定支架治疗胫骨远端骨折的疗效。方法从2003年1月～2005年7月,使用Hybird外固定支架治疗胫骨远端骨折21例,按AO分类:A1型4例;A2型5例;A3型4例;C1型2例;C2型3例;C3型3例,其中开放性骨折8例,手术采用有限切开,骨片钉固定,Hybrid外固定支架不跨踝关节固定。结果术后21例均获随访,平均随访时间12.3个月,骨折平均愈合时间7.6个月。功能评定采用Bone的踝关节活动度进行评价,优良率达76%。结论Hybrid外固定支架设计合理并能维持骨干的轴线,骨片钉能很好的固定骨折块,同时避免了软组织的并发症,可使踝关节早期活动,防止踝关节僵硬,因而是治疗胫骨远端骨折有效的方法之一。