鲑鱼降钙素对老年患者人工肱骨头置换术后影响的疗效观察

目的:观察抗骨质疏松药物对老年肱骨近端骨折患者行人工股骨头置换后的疗效影响。方法 :2012年11月至2016年6月肱骨近端骨折行人工肱骨头置换术患者38例,依据术后是否应用抗骨质疏松药物分为治疗组和对照组,治疗组19例,其中3部分骨折11例、4部分骨折8例,骨密度(0.58±0.14) g/cm~2;对照组19例,其中3部分骨折10例、4部分骨折9例,骨密度(0.58±0.11) g/cm~2。检测两组术前、术后4、8、12、24、48周假体周围骨密度(BMD),并行VAS疼痛评分,采用Neer评分系统评价肩关节功能。结果:术后患者切口均为甲级愈合,无并发症发生。35例患者获得1年随访。治疗组假体周围骨密度高于对照组,差异有统计学意义(P0.05);两组患者术后2、8周VAS评分差异无统计学意义(P0.05);治疗组Neer评分总分及功能评分优于对照组,差异有统计学意义(P0.05),疼痛及活动度评分两组比较,差异无统计学意义(P0.05)。依据Neer评分系统,治疗组优10例,良5例,可3例;对照组优3例,良9例,可5例;两组比较差异有统计学意义(P0.05)。结论:人工肱骨头置换结合抗骨质疏松药物治疗老年肱骨近端骨折可有效提高假体周围骨密度,恢复肩关节功能,早期临床效果满意。     

A protocol for angiographic embolization in exsanguinating pelvic trauma: A report on 31 patients

Background?The indication for acquiring angiographic embolization in the initial treatment of severe pelvic fractures is controversial. We describe the characteristics and outcome of 31 patients with traumatic pelvic bleeding who underwent percutaneous angiography with embolization according to a standardized protocol.

Patients and methods?During an 8.5-year period, 1,260 patients were treated for pelvic trauma. We performed a prospective registration of the 46 patients who underwent angiography, and report the 31 patients who had signs of significant arterial injury on angiography, necessitating embolization.

Results?The rate of significant arterial injury after pelvic trauma was 2.5%. All patients had been subjected to high-energy injuries and all were severely injured as measured by the Injury Severity Score: 41 (17–66). Pelvic arterial injury was observed with all types of pelvic trauma, including isolated acetabular (4/31) and sacral fractures (3/31). The internal iliac artery or its branches was injured in 28 of 31 patients. Survival rate after embolization was 84%, and correlated inversely with increasing patient age. None of the patients died of bleeding.

Interpretation?Our findings show that significant pelvic arterial injuries occur in a minority of patients after pelvic trauma, and predominantly affect patients with multiple high-energy injuries regardless of fracture type. The effect of angiographic embolization was good.     

Moderate Ingestion of Alcohol Is Associated With Acute Ethanol‐Induced Suppression of Circulating CTX in a PTH‐Independent Fashion

The “J shape” curve linking the risk of poor bone health to alcohol intake is now well recognized from epidemiological studies. Ethanol and nonethanol components of alcoholic beverages could influence bone remodeling. However, in the absence of a solid underlying mechanism, the positive association between moderate alcoholic intake and BMD remains questionable because of confounding associated social factors. The objective of this work was to characterize the short‐term effects of moderate alcohol consumption on circulating bone markers, especially those involved in bone resorption. Two sequential blood‐sampling studies were undertaken in fasted healthy volunteers (age, 20–47 yr) over a 6‐h period using beer of different alcohol levels (<0.05–4.6%), solutions of ethanol or orthosilicic acid (two major components of beer), and water ± calcium chloride (positive and negative controls, respectively). Study 1 (24 subjects) assessed the effects of the different solutions, whereas study 2 (26 subjects) focused on ethanol/beer dose. Using all data in a “mixed effect model,” we identified the contributions of the individual components of beer, namely ethanol, energy, low‐dose calcium, and high‐dose orthosilicic acid, on acute bone resorption. Markers of bone formation were unchanged throughout the study for all solutions investigated. In contrast, the bone resorption marker, serum carboxy terminal telopeptide of type I collagen (CTX), was significantly reduced after ingestion of a 0.6 liters of ethanol solution (>2% ethanol; p ≤ 0.01, RM‐ANOVA), 0.6 liters of beer (<0.05–4.6% ethanol; p < 0.02), or a solution of calcium (180 mg calcium; p < 0.001), but only after calcium ingestion was the reduction in CTX preceded by a significant fall in serum PTH (p < 0.001). Orthosilicic acid had no acute effect. Similar reductions in CTX, from baseline, were measured in urine after ingestion of the test solutions; however, the biological variability in urine CTX was greater compared with serum CTX. Modeling indicated that the major, acute suppressive effects of moderate beer ingestion (0.6 liters) on CTX were caused by energy intake in the early phase (～0–3 h) and a “nonenergy” ethanol component in the later phase (～3 to >6 h). The early effect on bone resorption is well described after the intake of energy, mediated by glucagon‐like peptide‐2, but the late effect of moderate alcohol ingestion is novel, seems to be ethanol specific, and is mediated in a non–calcitonin‐ and a non–PTH‐dependent fashion, thus providing a mechanism for the positive association between moderate alcohol ingestion and BMD.     

Attenuation of cartilage degeneration by calcitonin gene‐related paptide receptor antagonist via inhibition of subchondral bone sclerosis in osteoarthritis mice

Osteoarthritis (OA) is a progressive joint disorder which affects cartilage and subchondral bone. Calcitonin gene‐related peptide (CGRP) plays a role in bone metabolism. The purpose of this study is to examine the therapeutic effect of the blocking CGRP on OA progression in mice by inhibition of subchondral bone sclerosis. OA was induced by the resection of the medial meniscotibial ligament of the knee in C57/BL6 mice. An intraperitoneal injection of the CGRP receptor antagonist (BIBN4096) was administered after OA surgery. At 1, 4, and 8 weeks after injection, histological analysis were performed. In vitro, the effect of CGRP and BIBN4096 on osteogenesis and osteoclastogenesis was analyzed. BIBN4096 could prevent cartilage degeneration and subchondral bone sclerosis. The OARSI score in the BIBN4096 group was significantly lower than that in the control. In vitro, CGRP up regulated osteocalcin expression, but its expression was down regulated by BIBN4096. CGRP inhibited osteoclastogenesis of raw 267.4 cells, but its effect was reduced by the addition of BIBN4096.The current study showed that subchondral bone sclerosis and increasing expression of CGRP occurs in the early phase of OA in relation to cartilage degeneration, and that BIBN4096 could effectively attenuate OA progression. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1177–1184, 2016.     

2型糖尿病中医辨证分型与血浆内皮素及降钙素基因相关肽研究

为探讨 2型糖尿病中医辨证分型与血浆内皮素及降钙素基因相关肽的关系 ,检测血浆内皮素 ( ET)及降钙素基因相关肽 ( CGRP)含量 ,分析其与中医各证型的关系。结果显示 :1糖尿病各型患者血浆 ET值均较正常对照组明显增高 ,其中血瘀气滞组 >阴阳两虚组 >气阴两虚组和阴虚热盛组 ,而气阴两虚组与阴虚热盛组之间无明显差异。2糖尿病各型患者血 CGRP值均较正常对照组明显下降 ,其中血瘀气滞组和阴阳两虚组 <气阴两虚组 <阴虚热盛组 ,而血瘀气滞组与阴阳两虚组之间无明显差异。说明糖尿病患者中医辨证各证型的微观机制及病程演变与血管内皮细胞功能、肽能神经功能的变化密切相关     

异丙酚对大鼠血流动力学和血浆及心肌内皮素、降钙素基因相关肽的影响

目的　探讨异丙酚对大鼠血流动力学和血浆及心肌内皮素 (ET)、降钙素基因相关肽 (CGRP)的影响。　方法　 12～ 14周 Wistar大鼠 2 4只 ,随机分为 3组 ,每组 8只 :A组 (对照组 ,注射 0 .9%生理盐水 ) ,B组 (低剂量异丙酚 )和 C组 (高剂量异丙酚 )静注异丙酚 5 m g/kg诱导麻醉后分别静脉持续 30 min注入异丙酚 30、6 0 m g·kg- 1 · h- 1 。总容量均相同 ,记录未注药时、注药后 2 ,10 ,2 0 ,30 m in的收缩压 (SBP)、平均动脉压 (MAP)、舒张压(DBP)、心率 (HR)及呼吸 ,测定血浆及心肌 ET、CGRP的含量。　结果　组内比较 :B组各时点血压、心率无差异(P<0 .0 5 ) ;C组随时间的延长 ,2 0 ,30 min的 SBP、MAP、DBP、HR均下降 (P<0 .0 5或 0 .0 1)。组间与 A组比较 :各组基础值无差异 ;B组仅在 2 ,10 m in时 HR下降 (P<0 .0 5 ) ;而 C组 SBP、MAP、DBP、HR均下降 (P<0 .0 5或0 .0 1) ,且 HR随时间的延长与 A组的差异明显增加 ,30 m in时 P<0 .0 0 1;B组和 C组血浆中 CGRP增高、ET下降 ,C组改变显著 ,心肌中 CGRP、ET无变化。　结论　异丙酚促进 CGRP释放 ,抑制 ET的释放 ,通过改变 CGRP/ET的平衡呈时间剂量依赖性降血压 ,减慢心率     

家族性甲状腺髓样癌诊断与治疗

家族性甲状腺髓样癌（FMTC）作为甲状腺髓样癌（MTC）的一个重要分型,恶性程度较高,具有早期侵犯区域淋巴结和远处转移的倾向,预后相对较差,且有发病率不断增高的趋势。近年来关于FMTC临床的诊断和治疗进展较多,血清降钙素水平检测、基因检测等诊断方法提供了更精准的术前评估与复发监测的手段;疾病早期,根治性手术治疗仍占FMTC治疗的主要地位。根据基因检测的结果,进行预防性甲状腺切除以及分子靶向治疗也得到了快速的发展和应用,使传统手术与新兴治疗方法相结合,进一步提高了FMTC的治疗效果。     

乙型脑炎患儿血浆和脑脊液中降钙素基因相关肽含量变化的研究

目的探讨降钙素基因相关肽(CGRP)与流行性乙型脑炎(乙脑)的关系。方法采用放射免疫分析(RIA)法检测52例乙型脑炎患儿血浆及脑脊液中降钙素基因相关肽(CGRP)含量。结果极期各型患儿血浆及脑脊液中CGRP即显著升高,其升高程度与病情严重程度密切相关;恢复期血浆中CGRP降至正常,而重型患儿脑脊液中的CGRP含量仍显著高于普通型和对照组。结论CGRP参与了乙脑病理生理过程,其含量的测定对病情严重程度的判断有重要参考价值。     

降钙素基因相关肽减轻局灶性脑缺血再灌注大鼠顶叶皮质tau磷酸化

目的:探讨外源性降钙素基因相关肽(Calcitonin gene related peptide,CGRP)对局灶性脑缺血再灌注大鼠顶叶皮质tau蛋白过度磷酸化的影响。方法:用线栓法制作局灶性脑缺血再灌注模型,应用免疫组织化学SABC法、Western Blotting和图像分析方法检测大鼠顶叶皮质tau蛋白在Ser199/202位点磷酸化程度和总tau蛋白表达、以及CGRP对缺血神经元tau蛋白过度磷酸化的影响。结果:缺血再灌注顶叶皮质tau蛋白在Ser199/202位点磷酸化水平和总tau蛋白显著升高(P<0.05);CGRP组大鼠顶叶皮质tau蛋白在Ser199/202位点磷酸化水平显著低于缺血再灌注组,总tau也降低(P<0.05)。结论:CGRP明显减轻局灶性脑缺血再灌注大鼠顶叶皮质tau蛋白磷酸化程度,降低tau蛋白磷酸化水平可能对缺血神经元起保护作用。     

雷尼替丁对颅脑手术患者胃酸、血浆ET和降钙素基因相关肽的影响

目的:观察雷尼替丁对颅脑手术患者胃酸、血浆ET及降钙素基因相关肽(CGRP)的变化规律,了解雷尼替丁对应激状态下胃酸、胃黏膜血液循环的影响.方法:将30例颅脑手术病人随机分为两组:对照组15例,术后不用雷尼替丁;治疗组15例,术后予以雷尼替丁150mg每日2次静脉滴注.2组病人术前4 h开始胃内pH监测,持续72h;并于手术前后应用放射免疫法分点测定ET与CGRP含量.结果:对照组患者手术后各时点胃内pH较手术前稍有下降(P＞0.05);治疗组患者手术后各时点胃内pH较手术前、对照组比较明显升高(P＜0.05).对照组患者手术后较手术前血浆ET升高、CGRP降低(P＜0.01);治疗组患者手术后较手术前血浆ET下降,CGRP升高(P＜0.01).结论:颅脑手术可导致少量胃酸分泌增加,血浆ET升高,CGRP降低,以及胃黏膜循环血量减少.雷尼替丁能显著减少其胃酸分泌,同时降低血浆ET浓度及增加血浆CGRP浓度,从而增加胃黏膜循环血量.