绝经后骨质疏松症皮质骨孔率、矿化及形态的MRI定量研究

目的探讨绝经后骨质疏松症(osteoporosis,OP)患者皮质骨孔率、形态结构、矿化和类骨质密度MRI指标是否受到影响,并探讨MRI指标与绝经后妇女骨密度(BMD)的关系。方法回顾性分析本院于2021年6月到2023年6月期间收治的30名OP患者和38名非OP患者的临床资料。在1.5T时,对皮质骨孔率(孔隙水和总水)、类骨质密度(结合水[BW])、形态结构(皮质骨厚度)和矿化(磷[P]密度[31P]和31P/BW浓度比)进行量化,比较OP组和非OP组之间的MRI测量结果,并评估其与BMD的相关性。结果OP组的骨质疏松症患者骨密度明显高于非OP组(11.6mol/L vs 9.5mol/L;P=0.007;P=0.007),总水密度(21.2mol/L vs 19.7mol/L;P=0.03),骨皮质厚度(4.8mm vs 5.6 mm;P<0.001)和31P密度(6.4mol/L vs 7.5mol/L;P=0.01)明显低于非OP组。孔隙密度和总水密度与DXA和外周定量CT骨密度呈负相关(P<0.001),而皮质骨厚度和31P密度与DXA和外周定量CT BMD呈正相关(P=0.01)。BW、31P密度、31P/BW浓度比与DXA呈正相关(P<0.05),与外周定量CT无关。结论:皮质骨的固态MRI能够帮助检测绝经后骨质疏松症中反映孔洞、形态结构和矿化的参数的潜在损害。

胆总管结扎术诱导大鼠肝纤维化相关骨质疏松模型的建立

目的:构建并评估肝纤维化骨质疏松大鼠模型。方法:2016年9月至2018年9月,将40只雄性SD大鼠(南京医科大学实验动物中心提供),采用随机数字表法分为假手术4周(4W)、假手术6W、胆总管结扎(BDL)4W、BDL6W组。实验动物分别行假手术及胆总管结扎术后4周及6周后检测血清肝纤维化指标,获取肝脏及股骨标本并行肝脏组织马松(Masson)染色分析肝纤维化、股骨微计算机断层扫描技术(Micro CT)分析骨质疏松。组间比较采用单因素方差分析结合Bonferroni’s多重比较检验。结果:血清肝纤维化指标检测结果显示除血清透明质酸酶外[(1368.48±1093.82)U/L比(108.785±17.69)U/L,t=3.277,P<0.05],谷丙转氨酶(AST)、谷草转氨酶(ALT)、血清Ⅳ型胶原蛋白在BDL4W和假手术4W之间差异均无统计学意义[(317.73±98.69)U/L比(212.13±58.51)U/L,(81.03±21.82)U/L比(41.1±21.19)U/L,(19.81±0.42)μg/L比(19.35±0.34)μg/L,t=1.586、1.007、0.938,P值均>0.05);而BDL6W组各血清学指标均显著高于假手术6W组(t=5.845、3.442、4.928、3.754,P值均<0.05)。肝脏Masson染色结果显示BDL4W大鼠出现肝纤维化改变,BDL6W大鼠更为明显。与假手术组大鼠比较,BDL6W大鼠Micro CT结果显示具有明显骨质疏松改变。结论:大鼠胆总管结扎术可构建肝脏纤维化及相应骨质疏松动物模型。

负压条件下滑动水口滑板工作面的损伤情况

对钢包用后滑动水口滑板表面进行分析,研究其工作面结构疏松化的原因。滑板为高温烧成的Al_2O_3-ZrO_2-C质材料,在负压状态下加热,可形成明显的疏松化层,这与热力学计算结果一致;在Ar气氛或N2气氛下加热,可观察到轻微的疏松化现象,与负压条件下加热相比疏松化程度较轻;在埋碳气氛下加热,几乎没有疏松化现象。通过负压条件下的加热试验,可再现滑板工作面组织的疏松化反应,这也是评价滑板表面损伤的有效方法。

Is osteoporosis a peculiar association with primary biliary cirrhosis?

AIM： （1） To compare the prevalence of osteoporosis （t-score ≤-2.5 SD） between stage IV PBC patients, and two groups of age- and sex-matched controls： one with hepatitis C virus （HCV）-related cirrhosis, and the other one consisting of a group of healthy subjects from the general population, （2） to identify the main risk factors for the development of bone loss. METHODS： Thirty-five stage IV PBC patients （mean age 52.5±10 years）, 49 females with HCV-related cirrhosis （mean age 52.9±5.8 years） and 33 healthy females （mean age 51.8±2.22 years） were enrolled in the study. Bone metabolism was evaluated by measuring serum calcium corrected for serum albumin （Ca corr.）, 25-hydroxy vitamin D （25-OH vit D）, parathyroid hormone, osteocaldn. Bone mineral density （BMD） was assessed at the lumbar spine by dual-photon X-ray absorptiometry. RESULTS： Osteoporosis was present in 5/35 PBC patients （14.2%） and in 7/49 HCV-related drrhotic patients （14.3%）, without any statistical difference between the two groups. Among healthy control subjects, none had osteoporosis. No difference was found between the three groups in serum parameters of bone metabolism. Univariate analysis showed that menopausal state and low BMI were significantly correlated with osteoporosis. Multivariate regression analysis showed that menopausal status, BMI〈23, and old age were independent variables significantly correlated with osteoporosis. CONCLUSION： PBC in itself has no negative influence on BMD. End-stage liver disease patients carry a disease-specific risk for osteoporosis, but have an effective risk of bone loss in relation to individual potential risk for each patient. A practical message should be taken into account, that is, every effort should be made to prevent osteoporosis when a patient has simple osteopenia, or if it is a woman in or near menopausal age.

Osteoporosis as A Source of Tissue Mineralization Research on Osteoporosis Therapy and Dissolution of Arterial Mineralization

Based on research conducted by the author in the last thirty-five years, this article presents the physicochemical mechanisms of the osteoporosis process, transport of substances created as its result, and the phenomena of tissue mineralization resulting from osteoporosis. Examination of bones, joint cartilage, arteries, veins, parts of heart, thyroid, salivary glands, various tumors and others was conducted with the use of biological and polarizing microscopy, SEM, EDS, ASA, IR, Raman spectroscopy, and X-ray diffraction. Several devices of the same kind, e.g. different types of SEM, were used. Specimens used for examination were obtained from post-surgery and post rnortem materials. Examination of human bones focused on their mineralization and demineralization （osteoporosis）. Examination of the mineralization of other tissues was conducted in terms of the ageing of human body. Obtained results show that the process of osteoporosis leads not just to mechanical degradation of bones, but through the transport of ions （mainly Ca and P）, it also causes mineralization of soft tissue. Such mineralization occurs in mineralization centers that have been classified in regard to genetics. Tissue mineralization in its first stage is latent and consists of including atoms, mainly Ca and P, into the biological structures of compounds that build the tissues. Latent mineralization may evolve into the next stage--apparent mineralization. Both types of mineralization cause many health issues and may lead to death. This article also presents initial results of research on dissolution of aortic mineralization.

Percutaneous estrogen in prevention of early postmenopausal bone loss in Chinese women

OBJECTIVE: To identify the optimal dosage of 17beta-estradiol gel + oral progestin for preventing bone loss in postmenopausal Chinese women. METHODS: A 3-year open label, randomized, prospective clinical trial was conducted. Sixty healthy women who had been postmenopausal for 1 to 5 years were recruited and divided into following 4 groups: group 1, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus micronized progesterone (MP) 100 mg/d; group 2, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d; group 3, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus micronized progesterone (MP) 100 mg/d; and group 4, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d. Estrogen and progestin were given continuously for 25 days per month. Bone mineral density (BMD) was measured using quantitative computed tomography (QCT) for trabecular bone of L2-5 and dual energy X-ray absorptiometry (DEXA) for L2-4 and hip 5 times during the trial at baseline and at the 6-, 12-, 18-, 24- and 36-month visits. RESULTS: Fifty-nine patients (98.3%, 59/60) stayed in the study for 1 year, 56 patients (93.3%, 56/60) for 2 years, and 51 (85%, 51/50) for 3 years. On average, menopausal symptoms were relieved by 80% after 6 months of treatment. By the 24th month, the mean increase in BMD ranged from 4.3% to 7.5% in trabecular bone; and by the 36th month, it ranged from 4.2% to 6.2% in L2-4 and 1.61% to 3.77% in the neck. There were significant difference after treatment (P 0.05) was found in improvement of symptoms, levels of bone markers or BMD. CONCLUSION: A daily dose of estradiol gel, either 0.75 mg or 1.5 mg, is effective in preventing early postmenopausal bone loss and relieving menopausal symptoms. After 3-year treatment, spinal BMD could increase steadily, so does hip BMD, especially in the first 2 years.

Relationships between endothelial nitric oxide synthase gene polymorphisms and osteoporosis in postmenopausal women

Objective： To investigate the relationships between endothelial nitric oxide synthases （eNOS） G894T and 27 bpvariable number tandem repeat （VNTR） gene polymorphisms and osteoporosis in the postmenopausal women of Chinese Han nationality. Methods： In the present study, 281 postmenopausal women from Xi＇an urban area in West China were recruited, and divided into osteoporosis, osteopenia, and normal groups according to the diagnostic criteria of osteoporosis proposed by World Health Organization （WHO）. The bone mineral density （BMD） values of lumbar vertebrae and left hips were determined by QDR-2000 dual energy X-ray absorptiometry. Blood samples were tested for plasma biochemical indicators including testosterone, estradiol, calcitonin, osteocalcin, and procollagen type I amino-terminal propeptide by enzyme-linked immunosorbent assay （ELISA）, tartrate-resistant acid phosphatase by spectrophotometric method, and the content of nitric oxide by Griess method. Genome DNA was extracted from whole blood, and G894T polymorphism of eNOS gene was analyzed by using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） method and 27 bp-VNTR polymorphism of eNOS gene was genotyped by PCR method. Then the relationships between genotypes and biochemical indicators, genotypes and osteoporosis, and haplotypes and osteoporosis were analyzed. Results： The average BMD values of the femoral neck, ward＇s triangle and lumbar vertebrae 1-4 （LI-L4） in the subjects with T/T genotype in eNOS G894T locus were significantly higher than those in the subjects with G/T and G/G genotypes （P〈0.05）. The average BMD of the femoral neck in the subjects with a/a genotype of eNOS 27 bp-VNTR locus was evidently higher than that in the subjects with b/b genotype （P〈0.05）. The plasma testosterone and osteocalcin concentrations in the subjects of eNOS G894T G/T genotype were evidently higher than those in the subjects of other genotypes （P〈0.05）; the plasma estradiol concentration in the subjects of eNOS 27 bp-VNTR a/a genotype was obviously higher than that in the subjects of b/b genotype （P〈0.01）. eNOS G/G homozygous frequencies in osteoporosis women, osteopenia women, and normal women were 85.37%, 76.38%, and 83.87%, respectively （P〉0.05）. 0% osteoporosis woman, 0.79% osteopenia women, and 3.23% normal women were eNOS a/a homozygous （P〈0.05）. The frequencies of eNOS 27 bp-VNTR a allele were 5.33% in the osteoporosis group, 10.24% in the osteopenia group, and 16.13% in the normal group （P〈0.05, odds ratio （OR）=0.29, 95% confidence interval （CI）=0.11-0.77）, suggesting that a/a genotype and a allele might have protective effects on osteoporosis. The haplotype analysis showed that G-b was 87.7% （214/244） in the osteoporosis group （P〈0.05, OR=2.48, 95% CI=1. 18-5.18）. G-a was 5.3% （13/244） in the osteoporosis group （P〈0.05, OR=0.29, 95% CI=0. 11-0.77）. G-b was a risk factor for osteoporosis, and G-a a protective factor. Conclusion： eNOS G894T G/T genotype influenced the plasma testosterone and osteocalcin concentrations, and T/T genotype influenced BMD. eNOS 27 bp-VNTR a/a genotype increased plasma estradiol concentration to have a protective effect on osteoporosis.

Effect of Zuogui pill and Yougui pill on osteoporosis： a randomized controlled trial

OBJECTIVE： To evaluate the effect and safety of Zuogui pill and Yougui pill, classic Y/n and Yang tonic formula （CYYTF）, in the treatment of osteoporosis and the underlying mechanism. METHODS： Participants aged 55 to 75 with osteoporosis and Kidney deficiency in Traditional Chi-nese Medicine （TCM） will be included and randomly allocated into two groups： treatment group and control group. Participants in the treatment group were treated with Zuogui pill or Yougui pill TCM formula granule, while the control group received pla- cebo. Primary outcomes are the lumbar spine on bone mineral density （BMD） （L1-4） and femoral BMD. Secondary outcomes include pain intensity, health-related quality of life （HRQoL）, bone turn- over markers and safety. RESULTS： Totally 200 patients were enrolled from December 2014 to April 2016 from four hospitals. There were no statistically significant differences between the two groups at baseline （P 〉 0.05） and it was good to comparability. Statistically signifi- cant differences between the two groups were ob- served for the lumbar BMD （L1-4）, pain VAS scores and HRQoL at six months and twelve months and femoral BMD at twelve months （P 〈 0.05）, but no significant differences for femoral BMD and bone turnover markers at six months （P 〉 0.05）. More- over, significant difference was observed at differ- ent time before and after treatment in terms of lum- bar spine （L1-4） BMD, femoral BMD, pain VAS scores and health-related quality of life, and there was an crossover effect between the time and groups be- fore and after treatment. In additional, in the treat- ment group, 8 patients lost to follow-up and 3 patients had adverse events （AEs） and in the control group, 10 patients lost to follow-up and 2 patients had AEs. No remarkable differences were observed between the two groups with regard to AEs, lost rate and safety （P 〉 0.05）. CONCLUSION： Zuogui pill or Yougui pill could improve BMD, ease pain, relieve Kidney deficiencysyndrome, improve the quality of life osteoporosis patients, inhibit bone conversion and regulate the coupling balance of bone formation and bone resorption, but long-term efficacy should be confirmed by a longer term follow-up and larger of samples clinical randomized controlled trials.

A new method to optimize the fracture geometry of a frac-packed well in unconsolidated sandstone heavy oil reservoirs

The worldwide proven recoverable reserves of conventional oil are less than the amount of the heavy oil.Owing to weakly consolidated formation,sand production is an important problem encountered during oil production in heavy oil reservoirs,for which frac-pack technique is one of the most common treatments.Hence,how to obtain the optimal fracture geometry is the key to increasing well production and preventing sand.Due to the faultiness that current optimization of the fracture geometry only depends on well productivity,fracture-flow fraction was used to describe the contribution of the fracture collecting and conducting fluids from the reservoir.The higher the fracture-flow fraction,the more likely bilinear flow pattern occurs,thus leading to smaller flow resistance and better results in oil productivity and sand prevention.A reservoir numerical simulation model was established to simulate the long-term production dynamic of a fractured well in rectangular drainage areas.In order to reach the aim of increasing productivity meanwhile preventing sand,a new method based on Unified Fracture Design was developed to optimize the fracture geometry.For a specific reservoir and a certain amount of proppant injected to the target layer,there exits an optimal dimensionless fracture conductivity which corresponds to the maximum fracture-flow fraction,accordingly we can get the optimal fracture geometry.The formulas of the optimal fracture geometry were presented on square drainage area conditions,which are very convenient to apply.Equivalent Proppant Number was used to eliminate the impact of aspect ratios of rectangular drainage area,then,the same method to optimize the fracture geometry as mentioned for square drainage areas could be adopted too.