Clinical correlations between chronic hepatitis C infection and decreasing bone mass density after treatment with interferon-alpha

Objective: To compare the bone mass density in chronic hepatitis patients before and after interferon-a treatment.Methods: A total of 70 patients with chronic hepatitis C were treated with interferon-a and were evaluated. The treatment dosage was three million IU three times a week for one year. All the patients underwent bone mass density detection at lumbar spine and femoral neck before and after the interferon-a treatment. All the necessary information such as age,sex, and laboratory test, history of occurrence of fractures, lifestyle, and menopause status was collected by interviewers face-to-face from participants at the research visit. Smoking was categorized by whether participants were nonsmokers or smokers. Menopause was designated if there had been complete cessation of menses for more than 12 months. All statistical analyses were performed by SPSS version 14(SPSS, Inc., Chicago, IL, USA).Results: Among 70 patients, 52% were male, 48% were female and the mean age was(57.0 ± 9.6) years(range: 24–79). Twenty-nine percent of the patients had a history of smoking. The mean body mass index was(24.4 ± 3.6) kg/m^2(range: 18.4–35.3). Of the70 cases, 21 had high fibrosis-4. The prevalence of overall fracture history was 2.9%(two patients).Conclusions: Chronic hepatitis C virus infection did increase the risk of development of metabolic bone disease in this cohort. Indeed, greater reduction of bone mass density occurs in advanced liver fibrosis. The bone loss in earlier stages of chronic hepatitis C infection is likely to result from increased bone reduction rather than decreased bone formation. Overall, these observations suggest an important role for chronic hepatitis C virus infection in increased bone turnover in osteodystrophy pathogenesis.

Androgen and bone mass in men

<abstract>Androgens have multiple actions on the skeleton throughout life. Androgens promote skeletal growth and accumulation of minerals during puberty and adolescence and stimulate osteoblast but suppress osteoclast function, activity and lifespan through complex mechanisms. Also androgens increase periosteal bone apposition, resulting in larger bone size and thicker cortical bone in men. There is convincing evidence to show that aromatization to estrogens was an important pathway for mediating the action of testosterone on bone physiology. Estrogen is probably the dominant sex steroid regulating bone resorption in men, but both testosterone and estrogen are important in maintaining bone formation.

CHIP regulates bone mass by targeting multiple TRAF family members in bone marrow stromal cells

Carboxyl terminus of Hsp70-interacting protein（CHIP or STUB1） is an E3 ligase and regulates the stability of several proteins which are involved in different cellular functions. Our previous studies demonstrated that Chip deficient mice display bone loss phenotype due to increased osteoclast formation through enhancing TRAF6 activity in osteoclasts. In this study we provide novel evidence about the function of CHIP. We found that osteoblast differentiation and bone formation were also decreased in Chip KO mice. In bone marrow stromal（BMS） cells derived from Chip^-/- mice, expression of a panel of osteoblast marker genes was significantly decreased. ALP activity and mineralized bone matrix formation were also reduced in Chip-deficient BMS cells. We also found that in addition to the regulation of TRAF6, CHIP also inhibits TNFα-induced NF-κB signaling through promoting TRAF2 and TRAF5 degradation. Specific deletion of Chip in BMS cells downregulated expression of osteoblast marker genes which could be reversed by the addition of NF-κB inhibitor. These results demonstrate that the osteopenic phenotype observed in Chip^-/- mice was due to the combination of increased osteoclast formation and decreased osteoblast differentiation. Taken together, our findings indicate a significant role of CHIP in bone remodeling.

NUMB maintains bone mass by promoting degradation of PTEN and GLI1 via ubiquitination in osteoblasts

The adaptor protein NUMB is involved in asymmetric division and cell fate determination and recognized as an antagonist of Notch.Previous studies have proved that Notch activation in osteoblasts contributes to a high bone mass. In this study, however, an osteopenic phenotype was found in 9-week-old mice using osteoblastic specific Col1a1–2.3-Cre to ablate both Numb and its homologue Numbl. The trabecular bone mass decreased dramatically while the cortical bone mass was unaffected. Here, the Notch signal was not activated,while the tensin homologue deleted on human chromosome 10(PTEN), which dephosphorylates phosphatidylinositide 3-kinases, was elevated, attenuating protein kinase B(Akt). The ubiquitination assay revealed that NUMB may physiologically promote PTEN ubiquitination in the presence of neural precursor cell-expressed developmentally downregulated protein 4–1. In addition, the deficiency of Numb/Numbl also activated the Hedgehog pathway through GLI1. This process was found to improve the ratio of the receptor activator of nuclear factor-k B ligand to osteoprotegerin, which enhanced the differentiation of osteoclasts and bone resorption. In conclusion, this study provides an insight into new functons of NUMB and NUMBL on bone homeostasis.

Effect of chronic sleep deprivation on peak bone mass in rats: An experimental study

Objective:To investigate the effects of chronic sleep deprivation(CSD)on bone microstructure and peak bone mass(PBM)in SD rats.Methods:Twenty-four SD rats were randomly divided into CSD group and control group.In the CSD group,a CSD model was established using a new sleep deprivation instrument for rats and mice,and intervened for 5 weeks.Bone turnover markers including P1NP and CTX-1 before and after the experiment were observed.After the experiment,the left femur were scanned by Micro-CT,and the cortical bone and bone trabecula were three-dimensionally reconstructed,respectively.The bone mineral density(BMD)and relevant parameters were detected.Results:CT images of the femur(proximal ends)showed significant trabecular loss in CSD rats.Trabecular parameters including bone volume fraction(BV/TV),trabecular number(Tb.N)and trabecular separation(Tb.Sp)in the CSD group were all lower than those in the control group.The bone cortex of the middle segment of the femur and tibia in CSD rats was also lower than that in the control group.The parameters of bone cortex including total tissue area(Tt.Ar),cortical bone area(Ct.Ar)and cortical bone thickness(Ct.Th)in the CSD group were significantly lower than those in the control group(P<0.01).After chronic CSD,BMD of both bone trabecula and bone cortex of the femur was lower,while the corresponding P1NP and CTX-1 were significantly higher than those in the control group.Conclusion:Sleep plays an important role in PBM formation.CSD accelerates bone turnover and thus significantly reducing PBM in SD rats.

Profile of Bone Mass and Its Determining Factors in Type 2 Diabetes: Case-Control Study

Background: Type 2 diabetes mellitus, beyond its well-known cardiovascular and neurological complications, is now increasingly recognized as having deleterious effects on bone tissue. It’s thus presented as an independent risk factor for bone fragility with a considerable fracture risk relating to many more or less intricate parameters. The general objective of our study is to assess bone mass during type 2 diabetes in Senegalese women. Methodology: We had carried out a cross-sectional and descriptive study. Socio-demographic characteristics were collected on the basis of a questionnaire. Then each of the subjects had undergone a complete clinical examination followed by a blood sample for a biological assessment of certain cardiovascular risk factors. Bone mass was measured using a bio-impedancemeter. Results: We recruited 88 women with type 2 diabetes and 83 healthy control women. The mean age of diabetic subjects was 52.7 years ± 6.8 (with extremes of 39 and 74 years). In control, the mean age was 51.0 ± 8.5 years (with extremes of 35 and 72 years). Among the diabetic subjects, 22 subjects or 25% practiced a regular walk against 27 (32.5%) in the control. Forty-three among the diabetic subjects (48.8%) were known hypertensive and followed. According to the body mass index, 71 patients (80.7%) were overweight compared to 59 (71.1%) controls. According to the waist size, 80 (90.9%) diabetic subjects had an elevated waist size compared to 69 control women (83.1%). Among diabetic subjects, 41 patients (46.5%) were hyperglycemic imbalance according to fasting blood glucose and 59 patients (67%) according to glycated hemoglobin level. Thirty-seven diabetics (42%), had both high fasting blood glucose and elevated glycated hemoglobin. The mean duration of diabetes was 8.68 ± 7.18 years. We found significantly higher bone mass in type 2 diabetic subjects (p = 0.03). Among diabetics, 27.3% had low bone mass compared to 36.1% of control. It’s noted that the subjects of the “low bone mass” group among the control subjects also have a significant drop in other anthropometric parameters (weight, body mass index, waist size, muscle mass). It should also be noted that the fat mass is significantly higher in diabetic subjects with normal or even high bone mass. In control subjects, bone mass was positively correlated with weight (r = 0.36;p = 0.001), muscle mass (r = 0.93;p < 0.0001) and fasting blood glucose (r = 0.26;p = 0.02);and negatively correlate with age (r = 0.22;p = 0.04). On the other hand, in type 2 diabetic subjects, bone mass is positively correlated with age (r = 0.22;p = 0.04), muscle mass (r = 0.89;p < 0.0001) and the diabetes duration (r = 0.44;p = 0.001). Conclusion: Bone mass is higher in type 2 diabetics compared to healthy controls. Chronic hyperglycemia and the diabetes duration are believed to be responsible for the increase in bone mass. In addition, an increase in muscle mass would lead to an increase in bone mass.

Spectrum-effect relationship between HPLC fingerprints and bioactive components of Radix Hedysari on increasing the peak bone mass of rat

The traditional Chinese medicine of Radix Hedysari plays an important role in invigorating gas for ascending, benefiting blood for promoting production of fluid, and promoting circulation for removing obstruction in collaterals, which is consistent with the principle of treatment for osteoporosis. This study is designed to investigate the bioactive components on increasing peak bone mass (PBM) by exploring the spectrum-effect relationship between chromatography fingerprints and effect. Multiple indicators are selected to evaluate the pharmacological activity. In fingerprints, 21 common peaks are obtained, five of which are identified. Furthermore, gray relational analysis (GRA) is a quantitative method of gray system theory and is used to describe the correlation degree of common peaks and pharmacological activities with relational value. 21 components are then divided into three different regions, of which ononin and calycosin play an extremely significant role in increasing PBM. In addition, factor analysis and hierarchical cluster analysis (HCA) are used to screen the optimal producing area for Radix Hedysari. This provides a comprehensive and efficient method to improve the quality evaluation of Radix Hedysari, confirming the bioactive components for PBM-enhancement and further develop its medicinal value.

Factors influencing peak bone mass gain

Bone mass is a key determinant of osteoporosis and fragility fractures.Epidemiologic studies have shown that a 10%increase in peak bone mass(PBM)at the population level reduces the risk of fracture later in life by 50%.Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood.Race,gender,and family history(genetics)are responsible for the majority of PBM,but other factors,such as physical activity,calcium and vitamin D intake,weight,smoking and alcohol consumption,socioeconomic status,age at menarche,and other secondary causes(diseases and medications),play important roles in PBM gain during childhood and adolescence.Hence,the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people,and thus to reduce the low bone mass or osteoporosis risk in later life.This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.

Administration of soluble activin receptor 2B increases bone and muscle mass in a mouse model of osteogenesis imperfecta

Osteogenesis imperfecta（OI） comprises a group of heritable connective tissue disorders generally defined by recurrent fractures, low bone mass, short stature and skeletal fragility. Beyond the skeletal complications of OI,many patients also report intolerance to physical activity, fatigue and muscle weakness. Indeed, recent studies have demonstrated that skeletal muscle is also negatively affected by OI, both directly and indirectly. Given the well-established interdependence of bone and skeletal muscle in both physiology and pathophysiology and the observations of skeletal muscle pathology in patients with OI, we investigated the therapeutic potential of simultaneous anabolic targeting of both bone and skeletal muscle using a soluble activin receptor 2B（ACVR2B） in a mouse model of type Ⅲ OI（oim）. Treatment of 12-week-old oim mice with ACVR2 B for 4 weeks resulted in significant increases in both bone and muscle that were similar to those observed in healthy,wild-type littermates. This proof of concept study provides encouraging evidence for a holistic approach to treating the deleterious consequences of OI in the musculoskeletal system.

Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica

AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors(SNDTs).METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs(n = 8). RESULTS Buttock masses occurred in three patients with SNDT(37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs(87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm(range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging(MRI).CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.

Bone mineral density in Iranian patients: Effects of age, sex, and body mass index

Introduction: Osteoporosis is a multifactorial skeletal disease that is characterized by reduced bone mineral density (BMD). BMD values depend on several factors such as age, sex and age at menopause. The purpose of this study was to determine the prevalence and changes in bone mineral density in Iranian patients. Methods: Three hundred patients were selected through random sampling technique in 2009. BMD was assessed by Norland (Excell) technique at the lumbar and femoral neck. Weight and height were measured through standard methods. A thorough history was taken from each patient. The data was analyzed using SPSS software version 13.0. P-values less than 0.05 were considered statistically significant. Results: From among the 300 studied patients, 86.6% were female. their mean age was 52.7 years. Their average body mass index (BMI) was 28.14 kg/m2. Mean T-Score at lumbar spine and femoral neck was -1.07 ±1.19 and -1.75 ± 1.33 respectively. Mean BMD value at lumbar spine and femoral neck was 0.92 ± 0.19 and 0.77 ± 0.16 respectively. The prevalence of osteoporosis at lumbar spine and femoral neck was 33.7% and 16.7, respectively. There was a significant correlation between age, BMI and BMD values (P-Value Conclusion: This study shows that ageing and low BMI are risk factors associated with bone loss. it is recommended to measure BMD and implement prevention programs for high-risk people.

Bone mineral density in lifelong trained male football players compared with young and elderly untrained men

Purpose: The purpose of the present controlled cross-sectional study was to investigate proximal femur and whole-body bone mineral density(BMD), as well as bone turnover profile, in lifelong trained elderly male football players and young elite football players compared with untrained age-matched men.Methods: One hundred and forty healthy, non-smoking men participated in the study, including lifelong trained football players(FTE, n = 35)aged 65—80 years, elite football players(FTY, n = 35) aged 18—30 years, as well as untrained age-matched elderly(UE, n = 35) and young(UY,n = 35) men. All participants underwent a regional dual-energy X-ray Absorptiometry(DXA) scan of the proximal femur and a whole-body DXA scan to determine BMD. From a resting blood sample, the bone turnover markers(BTMs) osteocalcin, carboxy-terminal type-1 collagen crosslinks(CTX-1), procollagen type-1 amino-terminal propeptide(P1NP), and sclerostin were measured.Results: FTE had 7.3%—12.9% higher(p < 0.05) BMD of the femoral neck, wards, shaft, and total proximal femur in both legs compared to UE,and 9.3%—9.7% higher(p < 0.05) BMD in femoral trochanter in both legs compared to UY. FTY had 24.3%—37.4% higher(p < 0.001) BMD in all femoral regions and total proximal femur in both legs compared to UY. The whole-body DXA scan confirmed these results, with FTE showing similar whole-body BMD and 7.9% higher(p < 0.05) leg BMD compared to UY, and with FTY having 9.6% higher(p < 0.001) wholebody BMD and 18.2% higher(p < 0.001) leg BMD compared to UY. The plasma concentration of osteocalcin, CTX-1, and P1NP were 29%,53%, and 52% higher(p < 0.01), respectively, in FTY compared to UY.Conclusion: BMD of the proximal femur and whole-body BMD are markedly higher in lifelong trained male football players aged 65—80 years and young elite football players aged 18—30 years compared to age-matched untrained men. Elderly football players even show higher BMD in femoral trochanter and leg BMD than untrained young despite an age difference of 47 years.

Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity:A systematic review and meta-analysis

Background:Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity;however,weight loss can also result in bone loss and increased fracture risk.Weight-loss-induced bone loss may be attenuated with exercise.Our aim was to compare changes in bone mineral density(BMD)in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise.Methods:We included randomized controlled trials(RCTs)in adults with overweight or obesity(aged-18 years;body mass index-25 kg/m^(2))that prescribed diet-induced weight loss alone or in combination with supervised exercise,and measured any bone structural parameters.Risk of bias was assessed using the Cochrane Risk of Bias tool.Random-effects meta-analyses determined mean changes and net mean differences(95%confidence intervals(95%CIs))in the percentage of areal BMD(aBMD)change between groups.Results:We included 9 RCTs.Diet-induced weight loss led to significant losses in femoral neck aBMD(mean change:-1.73%(95%CI:-2.39%to-1.07%),p<0.001)and total hip aBMD(-2.19%(95%CI:-3.84%to-0.54%),p=0.009).Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group(net difference:-0.88%(95%CI:-1.73%to-0.03%));however,there were no differences in aBMD changes at any other skeletal site:total hip(-1.96%(95%CI:-4.59%to 0.68%))and lumbar spine(-0.48%(95%CI:-1.81%to 0.86%)).aBMD changes did not differ significantly according to exercise modality(resistance exercise,aerobic exercise,or a combination of the two)during diet-induced weight loss.Conclusion:Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise.Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss.The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions.Additional RCTs with appropriate,targeted exercise interventions should be conducted.

累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位

背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙状切迹背侧骨块螺钉固定的数量比较差异有显著性意义(P<0.05)。③Logistic多因素回归分析显示,乙状切迹骨块螺钉固定的数量是影响尺背侧乙状切迹骨块移位唯一的危险因素(P<0.05)。④提示在累及桡骨背侧的桡骨远端关节内骨折中,Ⅱ型最常见,Ⅲ型和Ⅰ型次之,大部分患者均存在乙状切迹背侧骨块。而乙状切迹背侧骨块其受下尺桡关节韧带影响易发生术后移位,术中至少1枚有效螺钉固定能降低其移位风险并有助于提高治疗效果。

Research progress on the role of cold-sensitive channel TRPM8 in controlling low temperature-induced bone metabolic imbalance

With increasing aging population,osteoporosis has emerged as a public health problem worldwide.Epidemiological data reveal that the prevalence of osteoporosis in cold regions is high,and low temperatures may crucially affect bone mass.Recent studies have found that the transient receptor potential melastatin-8(TRPM8)channel,a cold-sensitive ion channel,can sense cold environment,and can be activated in cold environment.It may play an antagonistic role in low temperature-induced bone mass reduction.Mechanistically,this function may be ascribed to the activation of TRPM8 channel proteins in human bone marrow mesenchymal stem cells(hBM-MSCs),which causes osteoblast differentiation and mineralization in the bone.TRPM8 channel on the surface of brown adipocytes participates in the thermogenesis in brown adipose tissue(BAT)and the regulation of whole-body energy balance to maintain bone homeostasis.TRPM8 may be involved in bone remodeling throughout life.This paper reviews recent research on the possible antagonistic mechanism of TRPM8 in signaling pathways related to low temperature-induced bone mass loss and assesses the possibility of TRPM8 as a molecular target for the prevention and treatment of low temperature-induced osteoporosis in cold regions.

Bone anabolics in osteoporosis: Actuality and perspectives

Vertebral and nonvertebral fractures prevention is the main goal for osteoporosis therapy by inhibiting bone resorption and/or stimulating bone formation.Antiresorptive drugs decrease the activation frequency,thereby determining a secondary decrease in bone formation rate and a low bone turnover.Bisphosphonates are today’s mainstay among antiresorptive treatment of osteoporosis.Also,oral selective estrogen receptor modulators and recently denosumab have a negative effect on bone turnover.Agents active on bone formation are considered a better perspective in the treatment of severe osteoporosis.Recombinant-human parathyroid hormone(PTH)has showed to increase bone formation and significantly decrease vertebral fractures in severe patients,but with a modest effect on nonvertebral fractures.The study of Wnt signaling pathway,that induces prevalently an osteoblastic activity,opens large possibilities to antagonists of Wnt-inhibitors,such as sclerostin antibodies and dickkopf-1 antagonists,with potential effects not only on trabecular bone but also on cortical bone.

The Relationship between Bone Mineral Density and Obesity in Women

The aim of this study was to determine the relationship between obesity and osteoporosis. A total of 30 Saudi women, aged between 20 and 50 years, were selected randomly. We calculated each subject’s body mass index (BMI) and determined their lumbar and femur bone mineral densities using dual-energy X-ray absorptiometry (DXA). We examined the interaction between obesity and bone mineral density (BMD) using logistic regression, after adjusting for age, family history of osteoporosis, maternal fractures, smoking, and any sedentary lifestyles. BMI was shown to be the most effective independent variable with respect to bone density. We evaluated the Pearson correlation coefficients of BMI, BMD of the lumbar spine, and BMD of the femoral neck with reference to the variables of the study, and found a significant correlation (P 30 kg/m2) were at increased risk of osteoporosis at the femoral neck and severe osteopenia in the lumbar spine.

Sonographic Diagnosis of Bone Tumors

This paper presents the results of sonographic and radiographic exami nations in 48 patients clinically diagnosed as having bone tumors. Sonography revealed bone destruction in all 48 cases, elevated periosteum in 26 cases and soft tissue mass in 34 cases. The results obtained in this series demonstrate that mostbone tumors have their characteristic sonographic features such as giant cell tu-mors, malignant bone tumors, bone cysts, as well as metastatic lesions. Studyshowed that sonography has equally high accuracy in the diagnosis of these tumorscompared with radiography.

不同慢性病中老年女性骨折风险及低骨量切点预测分析

背景:中老年女性是骨质疏松的高发人群,慢性病增加骨质疏松罹患风险。低骨量是骨质疏松发病前的危险阶段,目前缺少常见慢性病人群的骨折风险差异及诊断指标切点值的相关报道。目的:通过对不同慢性病中老年女性骨折风险的分析,探讨肥胖、高血压、高血脂、糖尿病、动脉硬化与骨密度的相关性,找到可预测低骨量指标的切点值,为防治骨质疏松提供参考。方法:将45-70岁203名女性受试者分为正常组和慢性病组,采用超声骨密度测量仪进行跟骨骨密度测试,采用动脉硬化仪测试肱-踝脉搏波传导速度,采用全自动生化分析仪测试血糖、血脂,采用身体成分分析仪测试体质量指数、脂肪质量及肌肉质量。结果与结论:①61-70岁女性骨密度和骨折风险系数及51-60岁、61-70岁骨强度与<50岁比较,差异有显著性意义(P<0.05);②糖尿病组骨折风险明显高于其余各组,动脉硬化组则高于正常组和肥胖组(P<0.05);③骨密度与年龄、左侧血管弹性程度、右侧血管弹性程度、三酰甘油呈负相关,与体质量指数呈正相关(P<0.05);上述指标与骨密度受试者工作特征(ROC)曲线下面积介于0.5-0.7之间,低骨量对应切点分别为55.5岁(年龄)、756.0 cm/s(左侧血管弹性)、789.0 cm/s(右侧血管弹性)、1.115 mmol/L(三酰甘油)、22.35 kg/m^(2)(体质量指数);④结论:糖尿病和动脉硬化增加中老年女性骨折风险,测定体质量指数、血管弹性和三酰甘油对女性低骨量预测具有一定早期诊断价值。

Mediastinal small cell carcinoma with liver and bone marrow metastasis, mimicking lymphoma

Primary mediastinal neuroendocrine tumors are a rare malignancy that accounts for < 10% of all mediastinal tumors. The case presented here involves a 52-yearold man who had been suffering for 3 mo from chronic cough, anorexia and substantial weight loss, as well as 2 wk of jaundice prior to his admission. A computed tomography scan showed a 4.3 cm × 6.6 cm mediastinal mass with multiple liver nodules scattered along both hepatic lobes. Endoscopic ultrasound showed a large heterogeneous hypoechoic mass at the mediastinum with multiple target-like nodules in the liver. Fine-needle aspiration specimens revealed numerous, small, round cells with hyperchromatic nuclei, scarce cytoplasm, and frequent mitotic features. Immunohistochemical study revealed positive results for AE1/AE3, CD56 and chromogranin A, with negative findings for synaptophysin, CK20, vimentin, CK8/18 and CD45. The patient was subsequently diagnosed with a poorly differentiated neuroendocrine carcinoma, small cell type. A bone marrow biopsy also revealed extensive involvement by the carcinoma.