膨胀式与后凸式椎体成形术治疗胸腰椎体压缩性骨折

【目的】探讨SKY膨胀式与KYPHON后凸式椎体成形术治疗胸腰椎椎体压缩性骨折的效果。【方法】21例共27个胸腰椎椎体压缩性骨折中,15例17个椎体行SKY膨胀式椎体成形术治疗,6例10个椎体行KYPHON后凸式椎体成形术治疗, 通过对病人临床疗效评定及X线复查的恢复情况,了解两种治疗方法的临床疗效,并与同期采用非手术治疗的胸腰椎压缩性骨折患者进行比较。【结果】经1-11个月的复查随访,所有经过椎体成形术治疗的胸腰椎压缩性骨折病人,腰背痛消除无复发,椎体高度恢复无丢失,未出现骨水泥泄漏等并发症,未出现对照组出现的长期卧床并发症。【结论】SKY膨胀式或 KYPHON球囊后凸式椎体成形术治疗胸腰椎椎体压缩性骨折疗效肯定、安全,能够早期解除病人腰背痛,重建椎体高度, 有利于病情康复及减少并发症的发生,比采用非手术治疗效果更好。相比较而言,SKY膨胀式椎体成形术较为经济,适用于单个椎体骨折或陈旧性骨折,KYPHON球囊成形术更适用于压缩程度重、终板破裂或两个以上椎体骨折者。     

Early Emotional Development and Primitive Mental States: A Brief Perspective

This paper focuses on early emotional development, both during pregnancy and in early infancy, as relevant to understanding primitive mental states encountered in clinical work. The first prism chosen in this search to understand the origins of our mind is based on clinical experience and its psychoanalytic theorization. Two main psychoanalytic theoretical approaches are relevant to understanding the psyche of the infant: the first emphasizes primary narcissism and conceptualizes the baby as immersed in a mental state of merger with the primal object; the second approach relates to the baby's psyche as a separate entity that is able to experience a raw sense of separateness from the object, right from the beginning of life. Clinical implications that stem from each theoretical approach are discussed. The second prism chosen is based on psychoanalytic interpretation of fetus and infant observations and on developmental studies. These observations and studies deepen our understanding of the coming into being of thinking processes, emotions and relational patterns during the whole lifespan, in general, and in the therapeutic situation, in particular. The author also discusses the limitations inherent in building retroactive conclusions, about the origins of emotional development that are drawn from within the clinical situation.     

Osteoporosis in COPD outpatients based on bone mineral density and vertebral fractures

One of the extrapulmonary effects of chronic obstructive pulmonary disease (COPD) is osteoporosis. Osteoporosis is characterized by a low bone mineral density (BMD) and microarchitectural deterioration. Most studies in COPD patients use dual‐energy X‐ray absorptiometry (DXA) only to determine osteoporosis; therefore, microarchitectural changes without a low BMD are missed. The aim of this study was to determine the prevalence and correlates of osteoporosis in COPD patients based on DXA, spinal X‐rays, and combinations thereof. DXA and spinal X‐rays were obtained and pulmonary function tests, body composition, 6‐minute walking distance, medical history, and medication use were assessed in 255 clinically stable COPD outpatients of a large teaching hospital in the Netherlands. Half of all patients had radiologic evidence of osteoporosis. Combining the results of DXA with spinal X‐rays augmented the proportion of COPD patients with osteoporosis compared with both methods separately. The prevalence of osteoporosis was not significantly different after stratification for Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) stage. Most patients with osteoporosis did not receive pharmacologic treatment. Age, body mass index (BMI), and parathyroid hormone (PTH) level were significant independent correlates for osteoporosis. Chest physicians should be aware of the high prevalence of osteoporosis in patients with COPD, even in the presence of a low GOLD score, as well as especially in elder COPD patients with a low BMI and/or an increased PTH level. © 2011 American Society for Bone and Mineral Research.     

Body weight change during use of a monophasic oral contraceptive containing 20 μg ethinylestradiol and 75 μg gestodene with a comparison of the women who completed versus those who prematurely discontinued intake

Objectives: Evaluation of the impact of an oral contraceptive on body weight with a comparison of women who completed versus women who prematurely discontinued intake. Methods: Data on body weight were retrospectively analyzed from four large prospective clinical trials with an oral contraceptive containing 20 μg ethinylestradiol and 75 μg gestodene (EE/GSD). A total of 1971 young fertile women were included in the evaluation, and 1467 completed 12 cycles. Results: We found no clinically relevant change of body weight during treatment with an oral contraceptive containing 20 μg ethinylestradiol and 75 μg gestodene in the vast majority of users after 12 treatment cycles. The mean change of body weight was less than 0.3 kg in this time period for all users. Nearly 70% of women experienced a minor change in their body weight of ± 2 kg. An additional 13% lost more than 2 kg body weight in the course of 12 treatment cycles. A total of 11% increased their weight by 2-4 kg. A total of 1255 (85.5%) of women had a body mass index (BMI) of ≤ 25 at baseline compared to 1253 (85.4%) after 12 cycles of treatment. There was no significant difference in the change of body weight between the women completing 12 cycles of treatment and those who prematurely discontinued EE/GSD. Conclusions: This retrospective analysis confirms that there was only a negligible change of body weight during intake of an oral contraceptive containing 20 μg ethinylestradiol and 75 μg gestodene. There was no difference in weight change between the women completing the study or discontinuing intake.     

Prior loss of body mass index,low body mass index,and central obesity independently contribute to higher rates of fractures in elderly women and men

We aimed to comprehensively evaluate the association of body composition with fracture risk using longitudinal data from a Swedish cohort of 44,366 women and men (mean age of 70 years) and a subcohort of 5022 women. We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18 years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7 years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05–1.19). In the subcohort (median follow-up 10 years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05–1.28) for any fracture and 1.48 (95% CI, 1.16–1.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Impact of Lactation on Maternal Body Weight and Body Composition

Women worldwide generally lose weight and bodyfat during lactation. This loss, although increased bylonger, more intensive breastfeeding, is modest and maybe reduced by increased food intake and decreased activity. Higher parity and older age areassociated with greater weight loss postpartum amongpoorly nourished women. Well-nourished women or thosewho breastfeed only for a limited time may not return to their prepregnant weight or body compositionby the end of the lactation period. Those who areoverweight or obese may have difficulty initiating ormaintaining lactation. For the majority of women in the world, lactation is unlikely to representa threat to their health. To advise women on how tooptimize their health and lactational performance, onemust consider all of the changes in maternal nutritional status that occur during a reproductive cycle,which may or may not compensate for the modest decreasesin body weight associated with lactation.     

Clinical trial of a monophasic estroprogestin oral formulation containing 20 μg ethinyl estradiol and 75 μg gestodene

The attempt to decrease the hormonal components of combined estrogen/progestin-containing oral formulations has led to use of low-dose formulations. The monophasic formulation containing ethinyl estradiol 20 μg (EE20) plus gestodene 75 μg (GSD75) was studied in an open ,non-comparative ,multicenter ,clinical trial investigating its efficacy ,safety ,effects on body weight ,blood pressure and sexual function. To evaluate the impact on sexual function ,the Golombok Rust Questionnaire on Sexual Satisfaction (GRISS) was used. The study population comprised 216 women treated for 1 year. The EE20/GSD75 formulation did not show any significant effect on blood pressure ,hematological parameters ,body weight or sexual function. The treatment was well tolerated with a high compliance rate by the patients, with a low rate of estrogen-dependent symptoms. Moreover ,there was no overall effect on sexual function ,with no disturbance of sexual behavior or activity. In conclusion ,our data show that the EE20/GSD75 has a very good tolerability profile ,without any significant side-effects.     

肾病综合征蛋白尿的中医辨证施治

本文从《内经》及后世先贤之有关论述,揭示“肾综”蛋白尿与中医之脾肾精微下漏相类的观点。并对蛋白尿产生之病理机转、标本辨证、治法用药等方面,进行较详尽而有力之论述。同时,从多年之临床实践,提出了功善消除蛋白尿之中药,为中医辨治“肾综”蛋白尿,提供一定的理论依据及实践经验。