Effects of Denosumab and Teriparatide Transitions on Bone Microarchitecture and Estimated Strength: the DATA‐Switch HR‐pQCT study

In postmenopausal osteoporosis, switching from teriparatide to denosumab results in continued bone mineral density (BMD) gains whereas switching from denosumab to teriparatide results in BMD loss. To assess the effects of these transitions on bone microarchitecture and strength, we performed high‐resolution peripheral QCT (HR‐pQCT) at the distal tibia and radius in postmenopausal osteoporotic women who received 24 months of teriparatide 20 μg daily followed by 24 months of denosumab 60 mg every 6 months, 24 months of denosumab followed by 24 months of teriparatide, or 24 months of both medications followed by 24 months of denosumab. The 77 women who completed at least one post‐switch visit are included in this analysis. Tibial cortical volumetric BMD (vBMD) increased between months 24 and 48 in the teriparatide‐to‐denosumab (net 48‐month change –0.8% ± 2.4%) and combination‐to‐denosumab groups (net 48‐month changes +2.4% ± 4.1%) but decreased in the denosumab‐to‐teriparatide group (net 48‐month change –3.4% ± 3.2%, p < 0.001 for all between‐group comparisons). Changes in total vBMD, cortical thickness, and estimated stiffness (by micro–finite element analysis [µFEA]) followed a similar pattern, as did changes at the radius. Conversely, tibial cortical porosity remained stable between months 24 and 48 in the teriparatide‐to‐denosumab and combination‐to‐denosumab groups (net 48‐month changes +7.2% ± 14.8% and –3.4% ± 12.1%, respectively) but increased in the denosumab‐to‐teriparatide group (net 48‐month change +16.2% ± 11.5%, p < 0.05 versus other groups). Trabecular vBMD changes did not differ among groups. Together, these findings demonstrate that in women treated with denosumab, switching to teriparatide is associated with a reduction in total and cortical vBMD, cortical thickness, and estimated strength, whereas switching to denosumab from teriparatide or combination therapy results in improvements in these parameters with the greatest improvements observed in women treated with combined therapy followed by denosumab. These findings strongly suggest that the use of teriparatide after denosumab should be avoided and that the use of combined teriparatide/denosumab followed by denosumab alone may be a useful treatment strategy in those with severe osteoporosis. © 2017 American Society for Bone and Mineral Research.     

Degree of Trauma Differs for Major Osteoporotic Fracture Events in Older Men Versus Older Women

To examine the degree of trauma in major osteoporotic fractures (MOF) in men versus women, we used data from 15,698 adults aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) study (5994 men) and the Study of Osteoporotic Fractures (SOF) (9704 women). Participants were contacted tri‐annually to ascertain incident fractures, which were confirmed by radiographic reports and coded according to degree of self‐reported trauma. Trauma was classified as low (fall from ≤ standing height; fall on stairs, steps, or curb; minimal trauma other than fall [coughing, turning over]); moderate (collisions with objects during normal activity without associated fall); or high (fall from > standing height; severe trauma [motor vehicle accident, assault]). MOF included hip, clinical vertebral, wrist, and humerus fractures. Mean fracture follow‐up was 9.1 years in SOF and 8.7 years in MrOS. A total of 14.6% of the MOF in men versus 6.3% of the MOF in women were classified as high trauma (p < 0.001); men versus women more often experienced fractures resulting from severe trauma as well as from fall > standing height. High‐trauma fractures were more significantly common in men versus women at the hip (p = 0.002) and wrist (p < 0.001) but not at the spine or humerus. Among participants with MOF, the odds ratio of a fracture related to high‐trauma fracture among men versus women was 3.12 (95% confidence interval [CI] 1.70–5.71) after adjustment for traditional risk factors. Findings were similar in analyses limited to participants with hip fractures (odds ratio [OR] = 3.34, 95% CI 1.04–10.67) and those with wrist fracture (OR = 5.68, 95% CI 2.03–15.85). Among community‐dwelling older adults, MOF are more likely to be related to high trauma in men than in women. These findings are not explained by sex differences in conventional risk factors and may reflect a greater propensity among men to engage in risky behavior. © 2015 American Society for Bone and Mineral Research.     

Psychosocial Predictors of Success following Bariatric Surgery

Background: Bariatric surgery is the treatment of choice for morbid obesity, but it does not lead to equal results in every patient. In addition to surgery, a number of non-surgical and psychological factors may influence patients' ability to adjust to the postoperative condition. Understanding the relationship between potential predictive variables and success after bariatric surgery will enable better patient selection, and the development of interventions to improve outcome. Methods: A systematic literature search identified relevant variables, such as demography, preoperative weight, motivation, expectations, eating behavior, psychological functioning, personality, and psychiatric disorders, which may have predictive value for success after bariatric surgery. Results: Greater success following bariatric surgery appears to occur in patients who are young and female, and have a high self-esteem, good mental health, a satisfactory marriage, and high socio-economic status, who are self-critical and cope in a direct and active way, are not too obese, were obese before the age of 18, suffer from and are concerned about their obesity, have realistic expectations and undisturbed eating behaviors. Occasionally, these variables may have poor or no predictive value. Although reliable predictors are lacking, most treatment teams propose their own exclusion criteria. Conclusion: The existing literature about potential predictors of success after bariatric surgery is far from conclusive; it is still uncertain which factors can predict success. Even where psychosocial functioning does not predict outcome, it is important to identify patients' characteristics which may be linked to their prognosis and to provide necessary pre- and postoperative psychosocial interventions.     

三桠苦叶的化学成分研究

[目的]研究三桠苦叶丙酮部位的化学成分.[方法]应用多种色谱方法进行分离和纯化,并利用核磁共振等方法解析化合物结构.[结果]从三桠苦叶丙酮部位中分离得到10个化合物,鉴定了7个化合物,它们的结构分别被鉴定为山奈酚(Ⅰ),槲皮素(Ⅱ),胡萝卜苷(Ⅲ),异鼠李素(Ⅳ),山奈酚-3-O-β-D-葡萄吡喃糖苷(V),山奈酚-3-O-β-D-葡萄吡喃糖醛酸苷(Ⅵ),3,5,4’-三羟基-8,3’-二甲氧基-7-异戊烯氧基黄酮(Ⅶ).[结论]化合物Ⅰ、Ⅱ、Ⅳ、Ⅵ为首次从该属植物中分离得到.     

气温与节气对上消化道出血影响的临床再分析

[目的]深入调查、分析、总结上消化道出血(UGB)发病与节气和气温的相关性,为上消化道出血未病先防提供依据.[方法]回顾性调查分析近10年来闽西地区2 166例UGB患者的发病节气,作圆形统计分析,计算此期间各节气UGB的发病例数,观察其发病的节气规律;应用双变量相关的统计方法分析UGB发病数与不同节气中的气象因子,包括最高气温、最低气温、平均气温、气温较差、雨日、降水量之间的相关性.[结果]2 166例UGB患者的发病在节气上存在集中性,发病高峰日处于大雪节气,高峰期为上年的处署至当年的春分.UGB与气温较差呈正相关(相关系数r为0.799,P＜0.01);与最低气温、平均气温、最高气温、降水量呈负相关(相关系数r分别为-0.832、-0.823、-0.758、-0.600,均P＜0.01);与雨日呈负相关(相关系数r为-0.503,P＜0.05).[结论]UGB在平均气温较低、气温较差大时段,尤其是大雪节气较容易发病,预防重点应放在此期间.     

益气除痰方对A549细胞凋亡及凋亡相关基因表达的影响

[目的]研究益气除痰方对肺癌A549细胞凋亡的影响及其分子作用机制.[方法]应用四甲基偶氮唑盐(MTT)比色法检测益气除痰方对A549细胞的生长抑制作用,流式细胞术碘化丙啶(PI)单染法测定细胞凋亡率,逆转录—聚合酶链反应(RT-PCR)法测定用药前后调亡相关基因p53、bcl-2、baxmRNA表达的变化.[结果]益气除痰方含药血清对A549细胞具有生长抑制作用,且具有一定的时间—浓度依赖性;流式细胞术结果显示:益气除痰方含药血清对A549细胞具有显著诱导凋亡的作用,其低、中、高剂量组凋亡率分别为(8.40±1.67)％、(15.80±2.95)％、(27.4±0.96)％(P＜0.05);RT-PCR结果显示:益气除痰方可显著上调p53 mRNA、bax mRNA表达,下调bcl-2 mRNA表达(P＜0.05或P＜0.01).[结论]益气除痰方可促使A549细胞凋亡,其机制可能与提高p53表达,下调bcl-2/bax比例有关.     

中药脑栓康治疗急性缺血性中风气虚血瘀证的临床试验

为客观评价益气活血化瘀复方脑栓康（ 由黄芪、水蛭、葛根等中药组成） 治疗急性缺血性中风（ 脑血栓形成） 气虚血瘀证的临床疗效, 采用随机双盲对照临床试验, 将１１１ 例急性缺血性中风（ 脑血栓形成）气虚血瘀证患者随机分为两组。试验组５６ 例接受脑栓康和基础治疗, 安慰剂组５５ 例接受安慰剂和基础治疗。基础治疗包括西药脱水药（ 甘露醇和／ 或速尿） 、支持疗法, 不用抗凝及扩血管药。疗程为４ 周。结果：①试验组和安慰剂组显著进步分别为２４ ．０８％ 、５．７７ ％ , 进步分别为７２ ．２２ ％ 、８８ ．４６％ , 无效分别为３ ．７０ ％ 、５ ．７７％ , 总有效率分别为９６ ．３０ ％ 、９４．２３ ％ 。两组总疗效差异有显著性（ Ｐ＜ ０ ．０５） ; 两组预期治疗（ｉｎｔｅｎｔｉｏｎ－ｔｏ－ｔｒｅａｔ） 的组间比较, 总疗效差异也有显著性（ Ｐ＜ ０ ．０５） , 提示试验组疗效优于安慰剂组。②试验组对急性缺血性中风气虚血瘀证症状的改善比安慰剂组好（ Ｐ＜ ０ ．０１） 。③未发现脑栓康的不良反应。结果表明： 脑栓康是一种治疗急性缺血性中风（ 脑血栓形成） 气虚血瘀证的安全、有效的药物, 值得进一步研究和开发     

股方肌骨瓣移植加内固定治疗青壮年股骨颈头下型骨折

股骨颈骨折较常见于老年人。近年来,随着交通意外及工伤事故的增多,青壮年股骨颈骨折有上升的趋势。股骨颈头下型骨折因部位特殊,影响股骨头的血液供应,骨折后股骨头血供不足,易发生股骨头缺血坏死,其发生率一般为20％－40％「‘」,是骨科治疗的难点。青壮年股骨颈...     

Conflict: Internal and External

In his focus on the concept of conflict from a psychoanalytic perspective, the author distinguishes internal from external conflicts, providing several examples from both, and suggests that external conflicts can be internalized and internal ones externalized. Conflicts are described as the consequence of the coexistence of elements perceived, experienced or believed to be mutually incompatible. The author reminds readers of the classical Freudian view of these concepts within the Structural Model, where the Ego is described as the servant of three masters: External world, Id and Super-ego. The author refers to the role of therapists in dealing with their analysands’ conflicts and provides a vignette as illustration. He also makes references to the narratives of novels, films, plays and operas which often concern situations of external and/or internal conflict. Finally, the author provides instances of how conflicts, both intrapsychic and external, can find a resolution, including through negotiated compromises.