A model for estimating the potential costs and savings of osteoporosis prevention strategies

A model was developed which estimates the costs of osteoporosis risk evaluation and treatment, and the resulting savings in terms of reduced fracture frequency, for the adult female population of the United States. In the absence of treatment, the model predicts 1.44 million fractures will occur annually from non-violent causes. Treatment of all women beginning at age 50 with an agent that slows bone loss by 50% would reduce the number of these fractures by 0.59 million. Selective treatment of the 47% of women at the greatest fracture risk would reduce the number of fractures by 0.45 million, but would only cost 47% as much as treating all women. Additional data are required before the model can be used to evaluate specific treatment regimens. However, it appears that selective treatment of those at highest risk would yield the greatest benefit to cost ratio, if only benefits related to reduced fracture frequency are considered.     

丹参及血管内皮生长因子对动物肢体缺血模型侧支循环建立的作用

目的 :建立兔左后肢无主干及分支动脉供血的缺血模型 ,并观察丹参及血管内皮生长因子 ( VEGF)对兔后肢缺血模型侧支循环建立的作用。方法 :通过手术方法在兔后肢大腿段建立一个无主干及分支动脉供血的严重缺血模型。动物随机分为 5组 :未治疗组、丹参组、VEGF组、丹参加VEGF组及生理盐水对照治疗组。在解剖及生理水平上观察各组动物缺血肢体缺血及侧支循环建立情况。结果 :术后第 1天未治疗组动物左 /右小腿血压比为 0 ;动脉造影显示左侧只有髂外动脉中段以上显影、以下主干及分支均未显影。对侧后肢主干及分支动脉显影良好 ,即左侧毛细血管密度( 4 9.8± 1 7.6)个 /mm2 ,右侧为 ( 385 .7± 36.7)个 /mm2 ,P<0 .0 0 1 ;毛细血管数 /肌束数比值 :左侧( 0 .2 1± 0 .0 7) ,右侧 ( 0 .98± 0 .0 5 ) ,P<0 .0 0 1。治疗结束时 ,丹参加 VEGF组动物小腿血压比最高( 0 .74± 0 .1 7) ,它显著高于对照组、丹参组和 VEGF组 ;毛细血管密度与毛细血管数 /肌束数比值亦以丹参加 VEGF组为最高 ;动脉造影显示 ,丹参加 VEGF组中缺血组织处具有治疗意义的粗大的侧支循环形成。结论 :丹参与 VEGF联合应用具有强大的促进缺血模型侧支循环建立的作用     

反应停抗Lewis肺癌小鼠肿瘤血管生成的作用

目的 :研究具有抗血管生成作用的药物反应停对 Lewis肺癌小鼠皮下移植瘤和肺转移瘤的作用 ,并探讨其与肿瘤细胞凋亡的关系。方法 :2 4只皮下接种 Lewis肺癌肿瘤细胞 ( 1×1 0 6cell/mouse)的 C57BL/6小鼠随机分为两组 ,治疗组每日反应停 77.5 mg· kg-1灌胃 ,对照组每日生理盐水灌胃。第 2 1天处死动物 ,秤取瘤重、肺重 ,计数肺转移结节数 ,免疫组化染色后计数肿瘤组织微血管密度 ,流氏细胞仪测定分析肿瘤细胞凋亡率及细胞周期。结果 :反应停治疗组皮下移植瘤重量与对照组间差异无显著性 ( P>0 .0 5 ) ,但是肿瘤平均体积有下降趋势 ;反应停治疗组肺重、肺转移结节数目、肿瘤微血管密度低于对照组 ( P<0 .0 5 )。反应停治疗组肿瘤细胞凋亡率及 G1、S、G2 期肿瘤细胞百分数与对照组比较差异无显著性 ( P>0 .0 5 )。结论 :反应停有明显地抑制肿瘤细胞转移的作用 ,移植瘤体积有缩小的趋势 ,但不影响细胞的增殖周期     

龈沟液隐血试验与牙龈出血指数、龈下菌群的关系

目的 探索一种无创性的牙龈出血检测方法－－龈沟液隐血试验（GCFobt），并分析牙龈出血与微生物之间的内在联系。方法 用隐血试纸进行102例唾液标本的唾液隐血（Sobt）检查，1600个位点的GCFobt、牙龈出血指数（SBI）、探诊深度（PD）检测，分别对79、32个龈下细菌标本作涂片检查和厌氧培养，分析临床指数与龈下细菌的关系。结果 GCFobt具较高灵敏度（68.05）和特异度（80.5%），较Sobt更能说明局部牙周炎症状况，与SBI有非常显著相关关系（P＜0.001）；GCFobt阳性与阴性部位螺旋体、杆菌、球菌百分含量有非常显著差异（P＜0.001）；在0与3之间黑色菌检出率有非常显著差异（P＜0.01），在0与2、3之间梭杆菌检出率有显著差异（P＜0.05）。结论 GCFobt是一种快速、简便、无创伤的检测牙龈出血新方法，可以作为牙周病临床检查的一项客观指标。     

慢性非特异性溃疡性结肠炎中医研究述评

本文通过对古典医籍及近１０年文献有关慢性非特异性溃疡性结肠炎的资料分析，认为本病的证候特点与中医病名“休息痢”相符，病机归纳为脾虚为发病之本，湿热为致病之标，血瘀为局部病理变化，治疗方面得出了健脾益气化湿、活血化瘀解毒、托疮祛腐生肌等方法是治疗本病之关键的结论，提出分期治疗本病的思想，认为提高近期治愈率、降低复发率及做好癌前监测是今后研究的努力方向。     

部分性脾栓塞术的临床应用：——附37例报告

应用部分脾栓塞术(PSE)治疗难治性原发性血小板减少性紫癜27例,血栓性血小板减少性紫癜1例;难治性再生障碍性贫血2例;Evan's 综合症2例;系统性红斑狼疮合并血小板减少性紫癜2例;继发性脾亢3例.获完全缓解者24例(64.9%);部分缓解者8例(21.6%),总有效率为86.S%.24例获完全缓解者18例追踪1年,6例复发,复发率为33.3%.与25例切脾对照组及文献报道比较,差异无显著性(P>0.05).本文对 PSE 术后外周血小板的变化进行讨论,并与脾切除作了对比。本文还对血小板破坏场、栓塞范围和方法等影响疗效的因素进行了探讨.作者认为 PSE 术可作为脾切除的替代术.     

沈阳市961名老年干部牙健康状况调查

目的了解并分析沈阳市老年干部牙健康状况。方法按第二次全国口腔健康流行病学抽样调查标准,对沈阳市961名60岁以上的老年干部进行口腔健康调查,结果用SPSS软件处理。结果患龋率为67.12%,患龋者的龋均随着年龄的增长而逐渐增高(P<0.05),龋齿全部充填率为33.18%。缺牙率为80.65%,人均失牙7.38颗,人均保留牙的数目与年龄呈负相关(P<0.01)。无牙牙合率为10.20%,无牙牙合与牙列缺损的修复率分别为98.98%和36.04%。牙周健康状况与年龄呈负相关(P<0.01)。结论牙列缺失及缺损是老年人常见的口腔疾患,龋病和牙周病是其主要原因。加强老年人的口腔保健意识,是提高口腔疾病治疗成功率的重要环节,进而增进老年人的全身健康。     

Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan.

This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Case report: Concordant traumatic brainstem contusion delayed diagnosis in a young man with Wilson's disease

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism. The corresponding gene locus has been localized on the long arm of chromosome 13. Three different clinical variants of the disease can be distinguished: hepato-cerebral, abdominal/hepatic, and central nervous type. The heterogeneity of symptoms can cause problems in differential diagnosis, especially when another concordant disorder can also explain the pathogenesis of symptoms. The case report of a young man who suffered from brainstem contusion demonstrates the possibilities of misinterpretation because presenting symptoms could be attributed either to traumatic brain injury followed by adjustment disorder or Wilson's disease. Clinical signs included leftsided hemiparesis, bilateral gaze direction nystagmus, marked dysarthria with consecutive pervasive mutism, choreo-athetoid movements, spasmodic torticollis and diplopia dependent on gaze direction. Slit lamp examination showed Kayser-Fleischer's corneal ring. EEG- and computer assisted tomography investigations revealed non-specific findings. The patient was treated with D-Penicillamine. Alternative treatment with oral zinc preparations is discussed.

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Zusammenfassung Beim Morbus Wilson handelt es sich um eine autosomal rezessiv vererbte Störung des Kupferstoffwechsels. Der Genort konnte auf dem langen Arm des Chromosoms 13 lokalisiert werden. Klinisch können aufgrund ihrer Symptomatik drei Verlaufsformen (hepato-zerebraler, abdominalhepatischer und zerebraler Typ) unterschieden werden. Die Vielfalt der Symptome kann differentialdiagnostische Schwierigkeiten bereiten. Das Beispiel eines jungen Mannes mit einer traumatischen Hirnstammkontusion zeigt, wie die Diagnose der hepato-lentikulären Erkrankung dadurch erschwert wurde, daß die Pathogenese der Symptome durch die Hirnstammkontusion und darauf folgende Anpassungsstörungen erklärt worden war. Die Symptomatik bestand aus linksseitiger Hemiparese, lateralem Blickrichtungsnystagmus, Dysarthrie mit nachfolgendem universalem Mutismus, choreo-athetodischen Bewegungsstörungen, Torticollis spasmoidicus und blickrichtungsabhängigem Auftreten von Doppelbildern. Bei der Spaltlampenuntersuchung stellte sich der Kayser-Fleischer Ring dar. EEG- und computertomographische Untersuchungen erbrachten nur unspezifische Befunde. Die Behandlung erfolgte mit D-Penicillamin. Die alternative Behandlung mit oraler Gabe von Zinksalzen wird diskutiert.

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Résumé La maladie de Wilson est une affection héréditaire autosomale recessive concernant le métabolisme cuivré. Le locus du gène a été situé sur le bras long du chromosome 13. Du point de vue clinique on distingue trois formes symptomatologiques: le type hepato-cérébral, hepato-abdominal et cérébral. La diversité des signes cliniques peut poser des problèmes de diagnostic différentiel, car d'autres affections peuvent se présenter avec cette même Symptomatologie. Nous rapportons ici l'exemple d'un homme jeune, porteur d'une maladie de Wilson et victime d'une contusion traumatique du tronc cérébral, dont les signes cliniques ainsi que les troubles du comportement pouvaient été autant rapportés à la contusion du tronc cérébral qu'à l'affection métabolique.La Symptomatologie comprenait une hemiparesie gauche, un nystagmus lateralisé, une dysarthrie avec mutisme secondaire universel, des mouvements choréo-athétosiques, un torticolis spasmodique et une diplopie dépendante de la direction du regard. L'examen à la lampe à fente permettait à mettre en evidence un anneau de Kayser Fleischer. L'EEG et le scanner cérébral ne montraient pas d'anomalies specifique.Le traitement a consisté en l'administration de D-Penicillamine. Traitment alternative avec les sels de zinc est discuté.