Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: The Oslo‐Truro‐Amsterdam (OSTRA) collaborative study

Objective

To examine variables associated with bone mineral density (BMD) and vertebral deformities in women with rheumatoid arthritis (RA) from 3 northwest European countries.

Methods

Female patients were recruited from rheumatology clinics in Oslo, Norway; Truro, UK; and Amsterdam, The Netherlands (150 total, 50 per center, age 50–70 years, disease duration ≥5 years). Demographic and clinical data were collected and BMD was measured by means of dual energy x‐ray absorptiometry. Associations between demographic and clinical measures on the one hand and BMD and vertebral deformities on the other were investigated by single and multiple regression analyses.

Results

Body mass index (BMI), medication use, RA damage measures, and BMD differed significantly between the 3 centers. Overall, Norwegian patients had the lowest BMI, used more corticosteroids and antiosteoporotic drugs, had lower joint damage measured by Larsen score, and lower BMD at both spine and hip. High age, low BMI, and high cumulative dose of corticosteroids (last 2 years) are related to low BMD. A high Larsen score was associated with low BMD at the hip. Larsen score was the independent determinant of vertebral deformities after correction for center, age, BMI, and BMD.

Conclusion

Data from 3 countries on BMD and vertebral deformities in female patients aged 50–70 years with longstanding RA are presented, demonstrating an association between radiographic RA damage and low BMD and between radiographic RA damage and vertebral deformities.

     

葛根黄酮对D-半乳糖致衰老大鼠骨质的影响

目的研究葛根黄酮对D半-乳糖致衰老大鼠骨质的影响。方法用D-半乳糖注射Wistar雄性大鼠5个月,建立衰老模型,对青年对照组、致衰老模型组、葛根黄酮组和正常老龄对照组进行骨常规参数测定及比较。结果致衰老模型组骨密度、骨结构力学参数、生物力学参数、骨钙、镁、锰及羟脯氨酸含量均比青年对照组有所降低(P<0.01),而骨磷含量、骨和血清碱性磷酸转移酶活性均比青年组有所升高(P<0.01),这些变化与正常老龄对照组的变化趋势一致,并比后者变化得更显著。相比之下,葛根黄酮组在骨密度、骨结构力学参数、生物力学参数、骨钙、镁、锰及羟脯氨酸含量参数指标均比致衰老模型组增高(P<0.05)。结论长期摄入D半-乳糖导致大鼠衰老的同时,可诱发致衰老性骨质疏松,而葛根黄酮可以改善D-半乳糖致衰老性骨质的变化。     

Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease

BACKGROUND: The main process involved in hepatic osteodystrophy seems to be osteoporosis, but decreased 25-hydroxylation of vitamin D might lead to osteomalacia and secondary hyperparathyroidism. METHODS AND RESULTS: We studied bone mineral density (BMD) by using DEXA-Expert Lunar, biochemical markers of bone turnover and calcium-parathyroid hormone (PTH)-vitamin D axis in 100 patients with chronic viral hepatitis secondary to hepatitis C virus: 49 non-cirrhotic (NCir) and 51 with cirrhosis (Cir) confirmed by liver biopsy and/or clinical and biochemical features. When compared to the age-matched population, 25% of the patients had low BMD at the lumbar spine (LS), 26.2% at Ward's triangle, 15.5% at the femoral neck (FN), and 20.2% at the trochanter. No difference was found either between Cir and NCir groups or between sexes. Urinary N-telopeptide was increased in 31.86% of the patients, and negatively correlated with BMD at the LS and trochanter (P < 0.02). Serum bone-specific alkaline phosphatase was elevated in 21% of the patients and negatively correlated with BMD at the trochanter and Ward's triangle (P < 0.02). Fasting 25-hydroxyvitamin D was low in only three Cir patients, with no difference between the Cir and NCir groups, but it was higher in men (51.8 +/- 16.0 ng/mL) compared to women (40.4 +/- 14.4 ng/mL; P = 0.001). Fasting serum calcium was lower in Cir than NCir patients, P = 0.019. Fasting intact PTH was elevated in 42% of the patients, but the mean serum levels were similar in Cir and NCir groups. CONCLUSION: We found no evidence of vitamin D deficiency, but cannot exclude the participation of PTH in the high bone turnover and bone loss in the population with chronic viral hepatitis.     

骨瓜提取物注射液对骨质疏松性椎体压缩骨折患者疼痛缓解及骨密度的影响

目的探析骨质疏松性椎体压缩骨折患者应用骨瓜提取物注射液对疼痛及骨密度的影响。方法对2017年1月~2018年12月在某院进行治疗的84例骨质疏松性椎体压缩骨折患者进行分组研究,采用抽签法分为对照组(n=42)与研究组(n=42)。对照组应用锝[99Tc]亚甲基二膦酸盐注射液治疗,在此基础上,研究组联合应用骨瓜提取物注射液治疗,对比两组临床疗效及疼痛程度、骨密度、骨钙素水平变化。结果研究组临床总有效率为95.24%,对照组为78.57%,差异有统计学意义(P<0.05)。研究组治疗2个月、6个月后疼痛评分均低于对照组,差异有统计学意义(P<0.05)。研究组治疗6个月后骨密度大于对照组,差异有统计学意义(P<0.05)。研究组治疗6个月后骨钙素水平低于对照组,差异有统计学意义(P<0.05)。结论骨质疏松性椎体压缩骨折患者应用骨瓜提取物注射液治疗,可进一步提高临床效果,缓解疼痛,增加骨密度。     

雷奈酸锶治疗骨质疏松症的疗效及安全性的Meta分析

目的系统评价雷奈酸锶治疗骨质疏松症的疗效及安全性。方法检索Cochrane的RCT中心数据库、Embase、PubMed、CNKI数据库和维普数据库中雷奈酸锶治疗骨质疏松症的临床研究,按照纳入及排除标准筛选出随机对照试验,使用"Cochrane协作网的偏倚评论指标"评估搜集的文献质量。提取有效数据,采用RevMan 5.3软件进行Meta分析。结果共纳入双盲、随机对照试验6项,结果表明,雷奈酸锶治疗12个月后,腰椎、髋部及股骨颈骨密度提升度比安慰剂对照组分别高6.72%(95%CI:6.17%~7.27%,P<0.01)、3.97%(95%CI:3.53%~4.40%,P<0.01)及3.51%(95%CI:3.21%~3.81%,P<0.01)。雷奈酸锶组的不良反应发生率、因不良反应导致的患者退出率和安慰剂组相似,差异无统计学意义(P>0.05);雷奈酸锶组的皮肤和胃肠道不良反应事件发生率高于安慰剂组,差异有统计学意义(P<0.05)。结论相对于安慰剂对照,雷奈酸锶可显著提高腰椎、髋部及股骨颈骨密度,两者的安全性近似。     

Serum IL‐36 cytokines levels in type 2 diabetes mellitus patients and their association with obesity,insulin resistance,and inflammation

BackgroundThe interleukin (IL)‐36 cytokines include IL‐36α, IL‐36β, IL‐36γ, and IL‐36Ra. Little was known about their roles in type 2 diabetes mellitus (T2DM).MethodsThe study included 40 T2DM patients and 42 healthy control subjects. The anthropometric and biochemical measurements were performed using automatic biochemical analyzer, high‐performance liquid chromatography, and electrochemiluminescence immunoassay. Circulating IL‐36α, IL‐36γ, IL‐36Ra, and IL‐17 levels were determined by enzyme‐linked immunosorbent assay.ResultsSerum IL‐36α, IL‐36γ, and IL‐17 levels in T2DM patients were significantly higher than those in controls, whereas serum IL‐36Ra levels in T2DM patients were lower. Correlation analysis showed that serum IL‐36α was positively correlated with high sensitivity C‐reactive protein. Serum IL‐36α was negatively correlated with IL‐36Ra. Serum IL‐17 was negatively correlated with low‐density lipoprotein cholesterol.ConclusionsThis study demonstrated that T2DM patients displayed increased IL‐36α and IL‐36γ expression and decreased IL‐36Ra expression. Moreover, the inflammatory cytokine levels were directly proportional to the inflammation and blood lipid levels. Our results suggest that IL‐36 cytokines may be a new target for the diagnosis or treatment of T2DM.     

Comparison of seven different reagents of peroxidase method for small and dense low density lipoprotein cholesterol (sdLDL‐C) measurement

BackgroundWe validated the performance of seven different reagents of peroxidase method for sdLDL‐C in two automatic analyzers that are common in Chinese laboratories.MethodsSeven commercially available sdLDL‐C assays were analyzed with the Beckman AU5400 and Mindray BS2000 automatic analyzers. A total of 336 blood samples were collected and the reference interval was also validated in 298 apparently healthy individuals. Serum samples were used for method comparison of precision, recovery, lower limit of detection, comparison and concurrence analysis, as well as reference interval for the Mindray reagent.ResultsThe repeatability CV% of the seven sdLDL‐C assays were 0.81%~3.66% for Mindray BS2000 and 0.76%~3.91% for Beckman AU5400, while Total CVs for Mindray BS2000 sdLDL‐C assay were 1.34%~4.81%, and that of Beckman AU5400 were 2.25%~10.33%. The measured recovery rates of sdLDL‐C assays were within the allowable ±10% deviation range. There was no obvious difference between the reagents in the lower limit detection. There was a difference between the validation results of the reference range and the manufacturer''s.BSBE, Mindray, and Dongou had a high degree of association with DENKA SEIKEN on Mindray BS2000, while BSBE, Mindray, Dongou and Merit Choice had a high degree of association with DENKA SEIKEN on Beckman AU5400. Passing–Bablok regression showed excellent linear correlation between BSBE and Mindray and DENKA SEIKEN and on Beckman AU5400.ConclusionsOur results indicate that the basic performance can meet the testing requirements, but the comparability between them is still insufficient.     

Hepatocellular Carcinoma: An Update

Hepatocellular carcinoma (HCC) is the most common malignant tumor of males in the world, with an incidence of 1,000,000 new cases a year. It is endemic in Southeast Asia and Sub-Saharan Africa. Risk factors include chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), Aflatoxin B1 uptake, hemochromatosis, and &#102 1-antitripsin deficiency. Epidemiological studies provide evidence for the association of HCC with HBV infection. The incidence of HCC is high in regions hyperendemic for HBV. Chronic carrier state and maternal-infant transmission are important factors in the development of HCC. Evidence of direct oncogenic effect of HBV is well established, HCCs contain viral DNA sequences integrated into hepatocyte DNA that act as random insertional mutagens, and these sites are near genes involved in the control of proliferation and differentiation. The mechanism of hepatitis C virus in hepatocarcinogenesis is still imprecise but a high percentage of cases are related to this virus. Chronic alcohol consumption and cirrhosis are cofactors that increase the development of HCC in patients with chronic viral infection. In experimental carcinogenesis a multipotential element called oval cell proliferates in the early stages. The cellular events are accompanied by increased expression of several growth factors that enhance the survival of carcinogen-activated cells by suppressing apoptosis and increasing elements entering the cell cycle. Hepatic carcinogenesis is a complex process associated with accumulation of genetic and epigenetic changes that run through steps of initiation, promotion and progression. Activation of oncogenes of the "ras" family and others has been detected during chemically-induced HCC in rodents, but there is little evidence of such activation in human tumors. The role of tumor supressor genes such as retinoblastoma (RB) and P53 genes has been documented. Aflatoxin B1 that contaminates foods in endemic areas has a clear role in hepatocarcinogenesis. Metabolites of this toxin promote apurinic sites and G to T mutations in chromosomal DNA, the third base of codon 249 of the P53 gene is preferentially targeted to form aducts with aflatoxin B1, and this mutation has been specifically identified in HBV infection. Histological and cytological criteria for the diagnosis of HCC are well established and are based in architectural and cytological changes. An important issue is the diagnosis of liver "nodules" detected by image, from which small biopsies or aspiration material is obtained. Special studies such as reticulin, CD34, cytokeratin profile, and MOC-31 can be very useful for the differential diagnosis of primary and metastatic tumors. Telomerase activity has been found in HCC and negative in pericancerous tissue. It is more pronounced in poorly differentiated tumors and correlates with factors of clinical importance, such as prognosis and recurrences. Cells of well-differentiated HCC have an ultrastructural appearance similar to normal hepatocytes. During the process of dedifferentiation, there is progressive loss of organization of intracellular organelles. The cell cohesion is lost, intercellular gaps with microvilli appear, the sinusoids become capillarized, and reparative changes are seen in the spaces of Disse. A variety of inclusions, such as Mallory bodies, granular material, secondary lysosomes, and Dubin-Johnson pigment, have been described. Fibrolamellar carcinoma has a characteristic histological picture and ultrastructurally oncocytic features. Neuroendocrine granules and combination of HCC with bile duct carcinoma are seen by electron microscopy.     

Overview Article: Ultrastructural Features of the Common Epithelial Tumors of the Ovary: Part II

The ultrastructural features of benign and malignant serous, mucinous, and endometrial variants of ovarian carcinoma are presented. Clear cell tumors and Brenner tumors are also discussed.

Where possible, specific electron microscopic features are stressed.