74例老年重型颅脑损伤的临床分析

报道74例老年重型颅脑伤,占同期重型颅脑伤总数的11.9％。死亡28例,病死率37.8％。颅内血肿病死率为51.4％。70岁以上的5例无一例存活。老年人反应力低下,颅脑伤时,早期临床表现难以反映实际伤情,密切观察、早期确诊十分重要。枕部着力对冲伤并发血肿者较多。有无多发伤、严重内科情况也不可忽视。早期清除颅内血肿,术中防止低血压,预防并发症等可降低病死率。原发伤的轻重、合并伤、并发症和年龄是影响预后的因素。颅脑伤后并有脑供血不足常导致预后不佳,应予重视。     

肾气虚、肾气阴两虚、脾气虚证微量元素谱的判别分析

本文通过对107例肾气虚、肾气阴两虚、脾气虚证患者头发中八种微量(和宏量)元素含量的观察,发现中医不同证候与微量元素有一定的关系。其中肾气虚组、肾气阴两虚组的铷含量均低于脾气虚组,肾气虚组与脾气虚组比较,其差异有显著性意义(P<0.05),提示铷含量降低,可能是肾虚证的特异性变化之一。应用计算机马氏距离多因素分类判别法对上述三组微量元素含量进行判别,准确判别率分别为87％、75％、83％,并建立了这三个证候分类判别的微量元素谱.进一步证实了中医不同证候与多种微量元素有重要的联系。     

导数光谱法在益智仁挥发油定性鉴别中的应用

紫外、可见光导数光谱法能提供较多的定性特征,因此大大地增加了紫外、可见指印光谱图在定性鉴别上的应用。特别是当吸收带发生重叠或共存物相互干扰时,导数光谱法就更显示出其优越性。导数光谱法的显著特点是谱带较窄,分辨力较高。本文以一阶、二阶紫外导数光谱对益智仁挥发油作了定性研究,并比较了海南、广州两地产的益智仁挥发油的异同。     

多元分析在冠心病脉图计量诊断中的应用

多元分析方法是现代医学计量诊断的主要方法。本文运用多元分析方法结合电子计算机技术,对冠心病脉图计量诊断问题进行了探讨,结果:用逐步判别分析法判别冠心病及阳气虚与气阴虚不同证型,回代符合率分别为94.25%和82%.用主成分分析法的结果表明,只取三个主成分便可反映原指标中75%以上的主要信息,三个主成分基本上综合了冠心病血流动力流变学方面的病理性改变。并依据主成分值的大小对冠心病患者进行了病理分型,为临床进一步诊断与治疗提供了综合性的客观依据。     

计算机模式识别法在类风湿性关节炎中医证型微量元素谱上的应用

计算机多因素分类法能解决单因素或双因素无法全面解决的问题。应用计算机模式识别法(多因素分类判别)对中医证候分类是个新课题。本文介绍利用此法对类风湿性关节炎的寒热错杂型、寒湿阻络型及肝肾两虚型患者分别和健康人发样微量元素含量进行t检验,变量经过处理,选取各中医证型的特征参量并进行判别,其结果为类风湿性关节炎的寒热错杂型、寒湿阻络型及肝肾两虚型和健康人的准确判别率分别为95.6％、100％和90.2％。提示可能不同中医证候的类风湿性关节炎具有不同的微量元素谱.     

心气虚证的计量诊断初探

本文利用无创性心功能检测的有关参数,结合多元分析方法与电子计算机技术,对心气虚证的计量诊断进行了初步探索,用Fisher判别分析法建立了心气虚证诊断的判别函数。所选判别指标为:X_1:射血前期与左室射血时间比值(PEP/LVET),X_2:心脏收缩力指数(HI),X_3:每分心输出量(CO)。得出判别心气虚证与正常人的判别[1]式为:Z=11.16X_1-0.29X_2-0.0019X_3,判别心气虚证与非心虚证的判别[2]式为:Z=13.3X_1-0.15X_2-0.0011X_3。其中判别[1]式的判别符合率、敏感度、特异度分别是90％、86.16％、93％,判别[2]式的判别符合率、敏感度、特异度分别是85％、86.6％、83％。具有较为满意的判别效果。     

Examining the Relationships Between Bone Tissue Composition,Compositional Heterogeneity,and Fragility Fracture: A Matched Case‐Controlled FTIRI Study

Fourier transform infrared imaging (FTIRI) provides information on spatial distribution of the chemical composition of thin tissue specimens at ～7 µm spatial resolution. This study of 120 age‐ and bone mineral density (BMD)‐matched patients was designed to investigate the association of FTIRI variables, measured in iliac crest biopsies, with fragility fractures at any site. An earlier study of 54 women found hip BMD to be a significant explanatory variable of fracture risk for cortical bone but not for cancellous bone. In the current study, where age and BMD were controlled through matching, no such association was observed, validating the pairing scheme. Our first study of unmatched iliac crest biopsies found increases in collagen maturity (cancellous and cortical bone) and mineral crystal size (cortical bone only) to be a significant explanatory variable of fracture when combined with other covariates. The ratio for collagen maturity has been correlated to the amount of enzymatic collagen cross‐links. To assess the impact of other FTIRI variables (acid phosphate substitution, carbonate‐to‐phosphate ratio, and the pixel distribution [heterogeneity] of all relevant FTIRI variables), we examined biopsies from a matched case‐controlled study, in which 60 women with fractures were each paired with an age‐ and BMD‐matched female control. With the matched data set of 120 women, conditional logistic regression analyses revealed that significant explanatory variables of fracture were decreased carbonate‐to‐phosphate ratio in both cancellous (odds ratio [OR] = 0.580, 95% confidence interval [CI] 0.37–0.909, p = 0.0176) and cortical bone (OR = 0.519, 95% CI 0.325–0.829, p = 0.0061), and increased heterogeneity (broadened pixel distribution) of collagen maturity for cancellous bone (OR = 1.549, 95% CI 1.002–2.396, p = 0.0491). The observation that collagen maturity was no longer linked to fracture in age‐ and BMD‐matched samples suggests that age‐dependent variation in collagen maturity may be a more important contributory factor to fragility fractures than previously thought. © 2015 American Society for Bone and Mineral Research.     

Association of 3D Geometric Measures Derived From Quantitative Computed Tomography With Hip Fracture Risk in Older Men

We investigated the associations of 3D geometric measures and volumetric bone mineral density (vBMD) of the proximal femur assessed by quantitative computed tomography (QCT) with hip fracture risk among elderly men. This study was a prospective case‐cohort design nested within the Osteoporotic Fractures in Men Study (MrOS) cohort. QCT scans of 230 men (65 with confirmed hip fractures) were evaluated with Mindways' QCTPRO‐BIT software. Measures that are indicative of bone strength for the femoral neck (FN) and for the trochanteric region (TR) were defined. Bending strength measures were estimated by minimum section modulus, buckling strength by buckling ratio, and a local thinning index (LTI). Integral and trabecular vBMD measures were also derived. Areal BMD (aBMD) of the total proximal femur from dual‐energy X‐ray absorptiometry (DXA) is presented for comparison. Associations of skeletal measures with incident hip fracture were estimated with hazard ratios (HR) per standard deviation and their 95% confidence intervals (CI) from Cox proportional hazard regression models with adjustment for age, body mass index (BMI), site, and aBMD. Men with hip fractures were older than men without fracture (77.1 ± 6.0 years versus 73.3 ± 5.7 years, p < 0.01). Age, BMI, and site‐adjusted HRs were significant for all measures except TR_LTI. Total femural BMD by DXA (HR = 4.9, 95% CI 2.5–9.9) and QCT (HR = 5.5, 95% CI 2.5–11.7) showed the strongest association followed by QCT FN integral vBMD (HR = 3.6, 95% CI 1.8–6.9). In models that additionally included aBMD, FN buckling ratio (HR = 1.9, 95% CI 1.1–3.2) and trabecular vBMD of the TR (HR = 2.0, 95% CI 1.2–3.4) remained associated with hip fracture risk, independent of aBMD. QCT‐derived 3D geometric indices of instability of the proximal femur were significantly associated with incident hip fractures, independent of DXA aBMD. Buckling of the FN is a relevant failure mode not entirely captured by DXA. Further research to study these relationships in women is warranted. © 2016 American Society for Bone and Mineral Research.     

Bone Health in Patients With Hematopoietic Disorders of Bone Marrow Origin: Systematic Review and Meta‐ Analysis

Blood cell production and bone homeostasis are physically interlinked systems that exhibit active cross‐talk. We examined how bone health is affected in patients with hematopoietic disorders due to abnormal proliferation of bone marrow cells. The electronic databases Medline, Embase, PubMed, BIOSIS Previews, Web of Science, and Cochrane were searched for studies presenting numerical values for trabecular bone volume or bone mineral density in control and patients with hematopoietic disorders. We identified 5 studies for beta‐thalassemia, 6 for sickle cell anemia, 2 for polycythemia vera and essential thrombocythemia, 3 for chronic myelogenous leukemia, 6 for myelofibrosis, 5 for multiple myeloma, and 4 studies each for systemic mastocytosis, lymphocytic leukemia, and hemochromatosis. The effect of the disease state on bone density was significant and negative for beta‐thalassemia (r = –2.00; 95% confidence interval [CI] –3.41, –0.58; p < 0.005), sickle cell anemia (–0.91; –1.36, –0.47; p < 0.00005), chronic myelogenous leukemia (–0.55; –0.88, –0.22; p < 0005), mastocytosis (–0.99; –1.16, –0.82; p < 0.00001), lymphoblastic leukemia (–0.69; –0.98, –0.40; p < 0.00001), multiple myeloma (–0.67; –0.99, –0.35; p < 0.00005), and hemochromatosis (–1.15; –1.64, –0.66; p < 0.00001). The changes were negative but not significant for polycythemia vera (–0.16; –0.38, 0.05; p = 0.069) and essential thrombocythemia (–0.33; –0.92, 0.26; p = 0.14). In myelofibrosis, disease state was associated with increased bone density (0.74; 0.12, 1.36; p < 0.05). Bone density change significantly and negatively correlated with the level of ferritin and bone marrow cellularity but not with hemoglobin or erythropoietin. Thus, independent of hematopoietic lineage, abnormal proliferation of bone marrow cells appears to be associated with bone loss. Iron metabolism may independently contribute to bone homeostasis. © 2016 American Society for Bone and Mineral Research.