Phosphorus magnetic resonance spectroscopy in malformations of cortical development

Purpose: The aim of this study was to evaluate phospholipid metabolism in patients with malformations of cortical development (MCDs). Methods: Thirty‐seven patients with MCDs and 31 control subjects were studied using three‐dimensional phosphorus magnetic resonance spectroscopy (³¹P‐MRS) at 3.0 T. The voxels in the lesions and in the frontoparietal cortex of the control subjects were compared (the effective volumes were 12.5 cm³). Robust quantification methods were applied to fit the time‐domain data to the following resonances: phosphoethanolamine (PE); phosphocholine (PC); inorganic phosphate (Pi); glycerophosphoethanolamine (GPE); glycerophosphocholine (GPC); phosphocreatine (PCr); and α‐, β‐, and γ‐adenosine triphosphate (ATP). We also estimated the total ATP (ATP_t = α‐+β‐+γ‐ATP), phosphodiesters (PDE = GPC+GPE), phosphomonoesters (PME = PE+PC), and the PME/PDE, PCr/ATP_t and PCr/Pi ratios. The magnesium (Mg²⁺) levels and pH values were calculated based on PCr, Pi, and β‐ATP chemical shifts. Key Findings: Compared to controls and assuming that a p‐value < 0.05 indicates statistical significance, the patients with MCDs exhibited significantly lower pH values and higher Mg²⁺ levels. In addition, the patients with MCDs had lower GPC and PDE and an increased PME/PDE ratio. Significance: Mg²⁺ and pH are important in the regulation of bioenergetics and are involved in many electrical activity pathways in the brain. Our data support the idea that neurometabolic impairments occur during seizure onset and propagation. The GPC, PDE, and PME/PDE abnormalities also demonstrate that there are membrane turnover disturbances in patients with MCDs.     

个旧新诊断112例Graves'病患者骨代谢指标分析

目的探讨个旧地区弥漫性毒性甲状腺肿（GD）患者中骨代谢指标变化及其影响因素。 方法测定个旧地区112例初次诊断GD患者的血Ca、P、25(OH)D 、ALP、TRACP、PTH、Cr等指标,分别按照性别、年龄、25(OH)D缺乏程度分组比较,用多因素回归分析25(OH)D的相关影响因素。 结果个旧地区GD人群25(OH)D充足、不足、缺乏、严重缺乏的比例分别为17.86%、24.11%、48.21%及9.82%,随血清25(OH)D水平降低,PTH显著升高（P<0.05）;TRACP在维生素D不足组最高,在严重缺乏足最低（P<0.05）;女性血清25(OH)D及Cr水平低于男性（P<0.05）;40岁以下患者、40～60岁患者、60岁以上患者25(OH)D水平组间比较无统计学差异（P>0.05）;60岁以下人群血PTH及血Cr显著低于60岁以上人群（P<0.05）多因素线性回归分析提示PTH（B=-7.091,P<0.001）及女性（B=-4.999,P<0.001）与25(OH)D水平负相关。 结论个旧地区GD患者普遍存在25(OH)D不足甚至缺乏。女性25(OH)D水平较男性低;血PTH水平随着年龄的增长而增高,PTH水平及女性与25(OH)D水平负相关。加强对本地区GD患者骨代谢指标的早期检测及干预,可能有利于GD患者继发性骨质疏松的有效防治。     

Graves病患者血清磷水平与甲状腺功能的相关分析

目的 探讨Graves病患者血清磷水平与甲状腺功能的相关性。方法 纳入初次发病或复发但未使用药物治疗的Graves病患者348例,收集电解质、肝肾功能、甲状腺功能、促甲状腺素受体抗体（TRAb）、摄碘率等临床资料。以血清磷正常参考值范围上限1.45mmol/L为切点数值将其分为高磷组和正常磷组,采用非参数检验比较两组间各参数的差异,logistic回归分析评估可能影响血清磷水平的相关因素。结果 348例患者中,144例(41.38％)出现高磷血症。高磷组患者年龄和BMI均明显低于正常磷组（P<0.05）,而三碘甲状腺原氨酸（T₃）、游离三碘甲状腺原氨酸（FT₃）、TRAb、3小时摄碘率（3h RAIU）、24小时摄碘率（24h RAIU）和血清钙（Ca）均明显高于正常磷组（P<0.05）。Graves病患者的年龄（r=-0.158）和BMI（r=-0.146）与血清磷水平呈负相关,T₃（r=0.188）、FT₃（r=0.134）、3h RAIU（r=0.159）、24h RAIU（r=0.186）与血清磷水平呈正相关(P<0.05)。Logistic回归分析结果示,年龄（OR=0.982,95%CI 0.966～0.998,P=0.032）、性别（OR=0.555,95%CI 0.346～0.891,P=0.015）、FT₃（OR=1.030,95%CI1.007～1.053,P=0.011）是Graves病患者血清磷水平的影响因素。结论 Graves病患者存在磷代谢异常,年龄偏低、女性、FT₃水平升高患者更易出现高磷血症。     

血清iPTH、Ca、P和血液透析患者死亡率之间的关系

目的 探讨长沙市第一医院血透患者CKD-MBD标志物的达标率,以及它们和血液透析患者死亡率之间的关系.方法 对2014年1月至2016年12月期间,在本院进行血液透析的177例患者的病史、实验室检查结果进行了回顾性分析.以2009年KDIGO指南为标准,了解177例患者CKD-MBD标志物的达标率.根据临床结局将患者分为死亡组35例,存活组142例.使用广义估计方程比较死亡组和存活组患者的iPTH、钙、磷.再用Logistic回归模型评估血透患者血清磷、钙和甲状旁腺素与全因死亡率之间的关系.结果 本院177例血透患者中,有102例(57.6％)血清钙浓度、51例(28.8％)血清磷浓度、81例(45.8％) iPTH达到指南标准.死亡组和存活组患者的钙、iPTH有差异,而磷无差异.在本次研究中,钙和磷与血透患者的全因死亡率相关,而iPTH与全因死亡率无关.结论 本研究所显示的结果要不同于之前欧美国家观察性研究的结果,KDIGO指南的建议是否适合中国血透人群仍需要进一步的证明.     

La prise en charge des troubles du métabolisme minéral et osseux avant le stade de la dialyse reste encore perfectible. À partir des données de l’Observatoire national du métabolisme minéral et osseux Photo-Graphe

Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9 ± 14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved.     

32P 韧致辐射显像在甲状腺结节核素介入治疗中的应用

目的 探讨应用韧致辐射监测介入核素在人体甲状腺及其它部位的分布及其可行性。方法 ①以２个相同规格分别装有约１４．８ＭＢｑ的＾３２Ｐ胶体及＾９９ｍＴｃ的玻璃瓶为模型,进行＾３２Ｐ能谱、窗宽实验。②对介入治疗后甲状腺进行＾３２Ｐ显像,并与＾９９ｍＴｃ甲扫图比较。结果 ①＾３２Ｐ模型韧致辐射能谱为一连续曲线,其顶峰能量约为８３ｋｅＶ,最佳窗宽为６０％。②用实验的能量参数在人体可得到理想的３２Ｐ韧致辐射图     

腹膜透析和血液透析对尿毒症患者钙磷代谢影响的临床研究

目的探讨血液透析与腹膜透析对尿毒症患者在钙、磷代谢的影响。方法对97例血液透析及45例腹膜透析治疗均超过3个月以上的患者在0、3、6个月进行血钙、磷及全段甲状旁腺激素测定和比较,并记录患者的残余尿量。入选后2组高甲状旁腺激素患者使用骨化三醇治疗,血液透析高钙患者采用1.25mmol/L的钙浓度的透析液进行治疗。结果治疗初血液透析组的高血磷、高甲状旁腺激素和低甲状旁腺激素发生率分别为51.5%、37.1%、8.2%,而腹膜透析组分别为22.2%、17.8%、24.4%,经比较2组有统计学差异。两组患者尿量大于500ml的腹膜透析组占有55.6%、血液透析组6.2%,经比较2组有统计学意义。在使用低钙透析液及罗盖全治疗后3、6月,血液透析组和腹膜透析组患者的甲状旁腺激素均较治疗前明显减少,F值分别为23.803和4.9896,P<0.05,差异有统计学意义,血液透析组中的血钙较治疗前明显下降,F值为19.879,P<0.05,差异有统计学意义。结论相对于血液透析,尿毒症患者选择腹膜透析能更好地控制钙磷代谢,能更有效地保护残肾功能。关注透析患者的饮食,以及重视低钙透析液,骨化三醇在透析患者钙磷代谢中的治疗。     

不同血液净化方法对患者钙、磷、甲状旁腺激素、营养状态及生活质量的影响

目的 探究不同血液净化方法对血液透析患者钙、磷、甲状旁腺激素(iPTH)、营养状态及生活质量的影响.方法 前瞻性选取2019年6月至2021年1月汕头市中心医院血液净化中心收治的60例血液净化患者作为研究对象,按随机数表法将患者分为普通血液透析(HD)、透析+血液透析滤过(HD+HDF)、透析+血液灌流(HD+HP),...     

二维黑磷及其在口腔医学领域的研究应用进展

二维黑磷具备独特的层状结构和出色的光学性能、良好的生物相容性和高生物降解性。近年研究显示,二维黑磷在生物医学领域具有稳定的载药和光控调节缓释药物功能、优异的抗菌活性和促血管和神经再生能力,因此在口腔医学中具有广阔的应用前景。本文就二维黑磷的生物学特性及其在口腔医学领域的研究应用进展进行综述,以期为二维黑磷的进一步研究和...     

More than skin deep? Potential nicotinamide treatment applications in chronic kidney transplant recipients

Non-melanoma cutaneous carcinomas, or skin cancers, predominantly squamous cell carcinomas (SCCs), are the most common malignancies occurring in kidney transplant recipients (KTRs). Squamous cell carcinoma risk is dramatically elevated in KTRs, occurring at rates of up 45-250 times those reported in general populations. New non-melanoma skin cancers in KTRs with a prior non-melanoma skin cancer also develop at 3-times the rate reported in non-KTRs with the same clinical history. The unique aggressiveness of SCCs in KTRs increases patient morbidity, due to the high rate of new lesions requiring treatment, frequently surgical excision. Oral nicotinamide shows promise in the chemoprevention of the especially aggressive non-melanoma skin cancers which occur in KTRs. This benefit might be conferred via its inhibition of sirtuin enzymatic pathways. Nicotinamide’s concurrent hypophosphatemic effect may also partially ameliorate the disturbed calcium-phosphorus homeostasis in these patients-a putative risk factor for mortality, and graft failure. Conceivably, a phase 3 trial of nicotinamide for the prevention of non-melanoma skin cancers in KTRs, lasting at least 12-mo, could also incorporate imaging and laboratory measures which assess nicotinamide’s impact on subclinical cardiovascular and chronic kidney disease risk, and progression.