肱骨近端、髋部骨折老年女性骨密度和骨代谢指标对比研究

目的对髋部、肱骨近端骨折老年女性的骨密度和骨代谢指标进行对比分析,进一步揭示上述骨折部位女性患者骨密度和骨代谢指标特征性变化情况。方法经患者及家属同意,共纳入62例老年髋部骨折女性患者(其中股骨颈骨折39例,股骨粗隆间骨折23例)、肱骨近端骨折21例,收集患者年龄、检测患者骨密度、血清骨转换指标(Ⅰ型胶原氨基端延长肽,P1NP;Ⅰ型胶原C端肽β降解产物,β-CTX)。结果肱骨近端骨折女性患者平均年龄为(66.1±8.0)岁,明显小于股骨颈骨折、粗隆间骨折女性患者(P<0.05);肱骨近端骨折女性髋部(T=-1.19±0.66)、腰椎骨密度(T=-1.67±1.00)明显高于粗隆间骨折女性髋部(T=-2.36±1.17)、腰椎骨密度(T=-2.61±1.42)(P<0.05),同时显著高于股骨颈骨折患者髋部骨密度(T=-2.33±0.99)。股骨颈骨折、股骨粗隆间骨折患者髋部、腰椎骨密度相比差异无统计学意义;三组间血清P1NP比较差异没有统计学意义,粗隆间骨折女性血清β-CTX(732.18±334.37μg/L)要明显高于肱骨近端骨折患者(529.66±292.34μg/L)(P<0.05)。结论相对于髋部骨折患者,肱骨近端骨折老年女性患者年龄较低,骨密度相对较高;骨吸收活跃可能是导致粗隆间骨折女性骨密度下降的原因。     

中医“肾髓系统”刍议

肾藏精,精生髓,髓充脑、养骨、生血,"肾、精、髓"物质与功能共同构成了中医"肾髓系统",其中"肾为本,精为要,髓为枢",肾中精气盛衰决定髓的盈亏,是脑为髓海、肾主骨、精化血的生理和病理基础;同时,中医现代研究发现干细胞与肾精关系密切,体现了"肾髓系统"的物质和功能特点。     

CD3单抗和淋巴细胞功能相关抗原-1对狼疮肾炎外周血单个核细胞的共刺激作用

目的：探讨CD3单抗（mAb)和淋巴细胞功能相关抗原－1单抗（LFA－1mAb)对狼疮肾炎（LN）患者外周血单个核细胞（PBMC）的共刺激作用。方法：2例LN患者被分为活动期（n=14)和非活动期（n=15)，以12例健康献血员为对照，观察CD3mAb或（和）LFA－1mAb共刺激及阻断1－磷酯酰肌醇3－激酶（PI3－K）对体外培养96h后PBMC增生和IL－2产生的影响。PBMC提取采用Ficoll密度梯度离心法，细胞增生实验采用^3H-TdR掺入法，IL－2测定采用ELISA法。结果：PBMC培养96h后，自然生长的LN非活动期和活动期PBMC ^3H-TdR掺入量和IL－2合成与正常对照无明显差异（P值均＞0或0．05）；与自然生长的PBMC相比，CD3mAb单独处理增加了LN非活动期（P值均＜0．05）和活动期（P值均＜0．05）PBMC^3H-TdR掺入量和IL－2合成。而单独CD3mAb对正常对照PBMC^3H-TdR掺入量和IL－2合成没有影响（P值均＞0．05）。与CD3mAb单独处理组相比，CD3mAb和LFA－1mAb共刺激均增加了LN活动期（P值均＜0．05）和非活动期（P值均＜0．05）及正常对照（P值均＜0．05）PBMC ^3H-TdR掺入量和IL－2合成；与对照组相比，CD3mAb和LFA－1mAb共刺激后活动期（P值均＜0．01）和非活动期（P值均＜0．01）PBMC^3H-TdR掺入量和IL－2合成均增加，但活动期效应明显强于非活动期（P＜0．01）。PI3－K特异抑制剂Wortmannin(WT)的加入明显抑制了CD3mAb和LFA－1mAb共刺激诱导的PBMC增生和IL－2的分泌效应（P＜0．01，P＜0．01）。结论：CD3和FLA－1对狼疮肾炎PBMC具有共刺激作用，这种共刺激作用可能参与了狼疮肾炎T、B细胞的异常活化，阻断共刺激传递信号分子PI3－K则能抑制CD3和LFA－1介导的共刺激作用。     

饮食抗原对IgA肾病产生的影响

本研究探讨抗原刺激粘膜免疫及封闭网状内皮系统与ＩｇＡ于肾小球系膜沉积的关系实验用８－１０周ＢＡＬＢ／ｃ雌性小鼠６０只，分别口服饮食抗原（麦胶蛋白和牛－γ球蛋白），并于实验开始后前３周用或不用印度墨水尾静脉注射。实验第１４周后杀检，作肾组织病理检查。结果表明：单纯口服饮食抗原组，免疫荧光显示，肾小球系膜ＩｇＡ阳性率为（５８％～６７％）；口服抗原加网状内皮系统封闭组，则为（７３％～８３％），ＩｇＡ荧光稍强于ＩｇＧ。光镜和电镜结果均提示肾小球系膜区增生；网状内皮系统功能在１４周明显减弱。２４ｈ尿蛋白无异常。第１４周静注同类抗原后部分有一过性血尿。结果提示：口服饮食抗原，可导致ＩｇＡ在肾小球系膜区沉积；如封闭网状内皮系统，则可减慢ＩｇＡ的排泄速度，进一步促进ＩｇＡ在肾小球系膜区沉积。     

Simple technique to visualize random set-up displacements using a commercially available radiotherapy planning system

PURPOSE: To visualize random set-up displacements in isodose distribution images, we introduce a simple technique using a commercially available radiotherapy planning system (RTP). MATERIALS AND METHODS: A distribution of set-up displacement is known to be compatible with that of a Gaussian distribution. Based on that assumption, 41 intentionally misaligned beams with 1-mm intervals were planned in the respective weights according to Gaussian distribution. "Modified" isodose distributions were then visualized using a commercially available RTP. In the next step, only two beams misaligned with one standard deviation (SD) of the Gaussian distribution were used in place of 41 beams, as a large number of beams increases the workload and is unsuitable for clinical use. Differences between the two versions of isodose distribution images were assessed visually. RESULTS: In modified dose distribution images, the edge of distribution was dull compared to normal images. These images show that the larger SD of set-up displacement dulls the edge of dose distribution. Images from two beams were not significantly different to those from 41 beams. CONCLUSION: Using this technique, the impact of random set-up displacements was effectively reflected in isodose distribution images.     

Strengthening of calcium phosphate cement by compounding calcium carbonate whiskers

The purpose of this study was to investigate how aragonite (calcium carbonate) whiskers influenced the strengthening and carbonating of alpha-tricalcium phosphate (alpha-TCP) based calcium phosphate cement. Aragonite whiskers of 0.95 microm width with an aspect ratio of 6.6 were prepared. The cement powder, alpha-TCP containing 0-50 mass% aragonite whisker, was mixed with 0.6 mol/L NaH2PO4 solution and incubated at 37 degrees C and 100% relative humidity. Diametral tensile strength (DTS) value increased significantly when appropriate amount of aragonaite whiskers was added. For example, DTS value of set cement containing 20 mass% aragonite whisker was 5.8 +/- 0.5 MPa, whereas DTS value of set cement containing no whiskers was 1.3 +/- 0.2 MPa after 1-week incubation. SEM observation revealed that the shape of the whiskers and the densification of the structure could have contributed to the strengthening of the set cement. Moreover, FTIR spectra implied that a bone-like carbonated apatite was precipitated in the cement. The results obtained in the present study revealed that the shape as well as any slight dissolution of aragonite whiskers could contribute to improving the properties of a-TCP based calcium phosphate cement.     

Microvasculature change and placenta growth factor expression in the early stage of a rat remnant kidney model

BACKGROUND/AIM: There is significant loss of microvasculature and impaired angiogenesis in rat remnant kidney (RK). Placenta growth factor (PlGF) is a potential angiogenic growth factor. In this study, we investigate the changes of microvasculature and expression of PlGF in the first 4 weeks of the early stage of a rat RK model. METHOD: RK was induced by right nephrectomy and ligation of two of the three branches of the left renal arteries (equivalent to 5/6 subtotal nephrectomy). Blood urea nitrogen (BUN), serum creatinine (Scr), and blood pressure (BP) were measured. Proliferation of endothelial cells was identified by double staining of two antibodies, anti-rat endothelial cell (RECA-1) and antiproliferating cell nuclear antigen (PCNA). RT-PCR and Western blot were used for PlGF analysis. RESULTS: BUN, Scr and BP remained stable after rising within the first week. An angiogenic response occurred in RKs, with an increase in the proliferation of peritubular and glomerular endothelial cells. Both PlGF protein and mRNA expression were significantly upregulated 2- to 3-fold in RK at week 1 and week 2, compared to the sham-operated group (p < 0.05). CONCLUSION: The expression of PlGF is upregulated and coincident with an early angiogenic response in rat RK, suggesting that PlGF may be involved in angiogenesis in progressive renal injury.     

A clinical study of endoscopic local coagulation therapy for hepatocellular carcinoma (HCC)

Eighteen subjects with cases of HCC who underwent endoscopic local coagulation therapy at Hiroshima City Hospital between 1998 and 2004 were studied and compared with 6 cases of HCC patients who underwent laparoscopic partial hepatectomy during the same period. The subjects composed of 10 cases of laparoscopic microwave coagulation therapy (L-MCT), 5 cases of laparoscopic radio frequency ablation therapy (L-RFA), and 3 cases of thoracoscopic microwave coagulation therapy (T-MCT). The operation time was 114 minutes for L-MCT and 92 minutes for L-RFA, both of which were significantly shorter than 208 minutes for resection cases. No complications were developed in any of the cases and the postoperative hospitalization period of the cases was 13.1 days, 8.2 days, and 13.0 days, respectively. Although each case of local recurrence was observed both in L-MCT and L-RFA groups, one case displayed observation difficulty from the liver surface and the other required a daughter nodule. The three-year survival rate was 71.4%, while the five-year survival rate was 53.6%. Endoscopic local coagulation therapy is not too invasive and useful for hepatocellular carcinoma in which percutaneous RFA is difficult. However, it is well indicated when the scope is evident with observation being feasible from the liver surface.     

p53基因突变与食管癌生物学行为的关系

目的为了探讨ｐ５３基因突变与食管癌生物学行为及预后的关系。方法应用ＰＣＲ－ＳＳＣＰ结合ＤＮＡ直接银染测序，对３０例散发性食管癌组织ｐ５３基因第５～８外显子进行检测。结果检出１１例阳性，突变检出率为３６．７％。９例为点突变，其中错义突变４例、无义突变２例、同义突变３例，其余２例为碱基插入和缺失导致的移码突变。统计学分析显示：中低分化食管癌的ｐ５３突变率为５６．３％，高分化组为１４．３％，两组相比有非常显著性差异（Ｐ＝０．０２５）；癌组织浸润累及食管壁全层的ｐ５３突变率５２．６％显著高于未累及全层组９．１％（Ｐ＝０．０２４）；有淋巴结转移组与无淋巴结转移组相比，ｐ５３突变率分别为６１．５％和１７．６％也具有非常显著性差异（Ｐ＝０．０２４）。结论ｐ５３基因突变与食管癌多种生物学行为如组织分化程度、肿瘤浸润程度及淋巴结转移有明显相关性。因此检测食管癌组织中是否存在ｐ５３基因突变有助于判断食管癌的恶性程度和患者的预后。还讨论了ｐ５３基因的“显性负效应”及同义突变的遗传学效应。