A Comparison of Bone Mineral Density and Its Predictors in HIV-Infected and HIV-Uninfected Older Men

ObjectiveBone health in older individuals with HIV infection has not been well studied. This study aimed to compare bone mineral density (BMD), trabecular bone score (TBS), and bone markers between HIV-infected men and age- and body mass index (BMI)-matched HIV-uninfected men aged ≥60 years. We investigated the associations of risk factors related to fracture with BMD, TBS, and bone markers in HIV-infected men.MethodsThis cross-sectional study included 45 HIV-infected men receiving antiretroviral therapy and 42 HIV-uninfected men. Medical history, BMD and TBS measurements, and laboratory tests related to bone health were assessed in all the participants. HIV-related factors known to be associated with bone loss were assessed in the HIV-infected men.ResultsThe mean BMD, TBS, and osteopenia or osteoporosis prevalence were similar among the cases and controls. The HIV-infected men had significantly higher mean N-terminal propeptide of type 1 procollagen and C-terminal cross-linking telopeptide of type I collagen levels. Stepwise multiple linear regression analysis demonstrated that low BMI (lumbar spine, P = .015; femoral neck, P = .018; and total hip, P = .005), high C-terminal cross-linking telopeptide of type I collagen concentration (total hip, P = .042; and TBS, P = .010), and low vitamin D supplementation (TBS, P = .035) were independently associated with low BMD and TBS.ConclusionIn older HIV-infected men with a low fracture risk, the mean BMD and TBS were similar to those of the age- and BMI-matched controls. The mean bone marker levels were higher in the HIV group. Traditional risk factors for fracture, including low BMI, high C-terminal cross-linking telopeptide of type I collagen level, and low vitamin D supplementation, were significant predictors of low BMD and TBS.     

超声引导下神经阻滞麻醉联合全身麻醉对股骨头置换老年患者麻醉效果及术后认知功能的影响

摘要 目的：研究超声引导神经阻滞麻醉联合全身麻醉对股骨头置换老年患者的麻醉效果及对术后认知功能的影响。方法：选取2019年1月至2021年12月期间我院收治的150例拟行股骨头置换术的老年患者,随机分为对照组和观察组,各75例。对照组患者行常规全身麻醉,观察组在对照组的基础上行超声引导下神经阻滞麻醉,比较两组患者的血流动力学指标,拔管时间、苏醒时间和复苏室停留时间,苏醒后疼痛,术后认知功能及不良反应的发生率。结果：观察组患者各时间点的心率（HR）和平均动脉压（MAP）均较对照组低（P＜0.05）。观察组拔管时间、苏醒时间和复苏室停留时间均较对照组短（P＜0.05）。观察组患者术后视觉模拟评分（VAS）均低于同一时间点的对照组（P＜0.05）。与对照组相比,观察组患者术后1 h、12 h和24 h的简易智力状态检查（MMSE）评分均较高（P＜0.05）,观察组术后1 h、12 h和24 h术后认知功能障碍（POCD）发生率较对照组低（P＜0.05）。两组患者不良反应发生率无差异（P＞0.05）。结论：超声引导神经阻滞麻醉可稳定血流动力学,缩短拔管、苏醒及复苏室停留时间,减轻术后疼痛,改善术后认知功能,减少POCD的发生,值得临床推广。     

Influence of muscle activity on the forces in the femur: An in vivo study

Experiments were performed on two patients with custom-made instrumented massive proximal femoral prostheses implanted after tumour resection. In vivo axial forces transmitted along the prostheses were telemetered during level walking, single- and double-leg stance, and isometric exercises of the hip muscles. These activities varied the lever arms available to the external loads: minimum for double-leg stance and maximum for hip isometric exercises. Kinematic, force plate, EMG and telemetered force data were recorded simultaneously. The force magnification ration (FMR; the ratio of the telemetered axial force to the external force) was calculated. The FMRs ranged from 1.3 (during double-leg stance) to 29.8 (during abductors test), indicating that a major part of the axial force in the long bones is a response to muscle activity, the strength of which depends on the lever arms available to the external loads. From these results, it was shown that the bulk of the bending moment along limbs is transmitted by a combination of tensile forces in muscles and compressive forces in bones, so moments transmitted by the bones are smaller than the limb moments. It was concluded that appropriate simulation of muscle forces is important in experimental or theoretical studies of load transmission along bones.     

Protective effect of Agrimonia pilosa polysaccharides on dexamethasone‐treated MC3T3‐E1 cells via Wnt/β‐Catenin pathway

A water‐soluble polysaccharide (APP‐AW) was isolated from Agrimonia pilosa and prepared to three sulphated derivatives (S1, S2 and S3). The results showed that pre‐treatment with APP‐AW, S1, S2 and S3 each at the concentration of 50 μg/mL for 48 hours was able to prevent cytotoxicity induced by 1 μmol/L dexamethasone (Dex) in MC3T3‐E1 cells via inhibition of apoptosis, which is in line with the findings in flow cytometry analysis. Meanwhile, the decreased ALP activity, collagen content, mineralization, BMP2, Runx2, OSX and OCN protein expression in DEX‐treated MC3T3‐E1 cells were reversed by the addition of APP‐AW, S1, S2 and S3. Moreover, APP‐AW, S1, S2 and S3 rescued DEX‐induced increase of Bax, cytochrome c and caspase‐3 and decrease of Bcl‐2, Wnt3, β‐catenin and c‐Myc protein expression in MC3T3‐E1 cells. Our findings suggest that pre‐treatment with APP‐AW, S1, S2 and S3 could significantly protect MC3T3‐E1 cells against Dex‐induced cell injury via inhibiting apoptosis and activating Wnt/β‐Catenin signalling pathway, thus application of these polysaccharides may be a promising alternative strategy for steroid‐induced avascular necrosis of the femoral head (SANFH) therapy.     

Osthole stimulates bone formation,drives vascularization and retards adipogenesis to alleviate alcohol‐induced osteonecrosis of the femoral head

Characteristic pathological changes in osteonecrosis of the femoral head (ONFH) include reduced osteogenic differentiation of bone mesenchymal stem cells (BMSCs), impaired osseous circulation and increased intramedullary adipocytes deposition. Osthole is a bioactive derivative from coumarin with a wide range of pharmacotherapeutic effects. The aim of this study was to unveil the potential protective role of osthole in alcohol‐induced ONFH. In vitro, ethanol (50 mmol/L) remarkably decreased the proliferation and osteogenic differentiation of BMSCs and impaired the proliferation and tube formation capacity of human umbilical vein endothelial cell (HUVECs), whereas it substantially promoted the adipogenic differentiation of BMSCs. However, osthole could reverse the effects of ethanol on osteogenesis via modulating Wnt/β‐catenin pathway, stimulate vasculogenesis and counteract adipogenesis. In vivo, the protective role of osthole was confirmed in the well‐constructed rat model of ethanol‐induced ONFH, demonstrated by a cascade of radiographical and pathological investigations including micro‐CT scanning, haematoxylin‐eosin staining, TdT‐mediated dUTP nick end labelling, immunohistochemical staining and fluorochrome labelling. Taken together, for the first time, osthole was demonstrated to rescue the ethanol‐induced ONFH via promoting bone formation, driving vascularization and retarding adipogenesis.     

加味八珍汤联合PFNA术治疗老年股骨转子间骨折患者的临床效果及对血液流变学指标的影响

目的:研究加味八珍汤联合股骨近端防旋髓内钉(Proximal Femoral Nail Antirotation,PFNA)对老年股骨转子间骨折患者的临床效果及对术后隐性失血和血液流变学的影响。方法:选择2014年3月至2017年3月我院收治的68例接受PFNA治疗的转子间骨折者,将其随机平均分为观察组(34例,术后口服加味八珍汤颗粒7天)、对照组(34例)。对比两组总失血量、隐性失血量、隐性失血比例、血液流变学指标(血浆粘度及全血黏度低、中、高切)、不良反应等。结果:⑴两组各剔除2例,94.12%(64/68)的受试者完成研究。⑵两组总失血量相当,差异无统计学意义(P0.05);与对照组相比,观察组隐性失血量及隐性失血发生率均显著降低(P0.05)。⑶治疗前,两组血浆粘度及低、中、高切全血黏度比较差异无统计学意义(P0.05);治疗后,两组血浆粘度及低、中、高切全血黏度均显著低于本组治疗前(P0.05),且观察组以上指标均明显低于对照组(P0.05)。⑷观察组发生肌间静脉血栓1例,无药物过敏及毒副反应;对照组发生1例深静脉血栓、4例肌间静脉血栓。观察组不良反应率为3.125%,显著低于对照组(15.625%,P0.05)。结论:加味八珍汤既可显著减少老年股骨转子间骨折患者PFNA术后隐性失血,又能改善血流动力学、减少并发症。     

髓内固定对老年股骨转子间骨折患者关节功能的影响

摘要 目的：研究髓内固定对老年股骨转子间骨折患者关节功能的影响。方法：选取2016年9月~2019年9月我院收治的股骨转子间骨折的老年患者80例为研究对象,采用随机数字表法将其分为两组,每组各40例。对照组患者采用Gamma钉进行治疗,观察组患者采用股骨近端防旋髓内钉固定治疗。比较两组患者的围术期相关指标、骨折愈合时间、Harris评分、临床治疗效果及并发症的发生情况。结果：观察组患者的手术时间、切口长度、术中出血量、术后引流量、住院时间及骨折愈合时间均显著少于或短于对照组(P＜0.05)。术前,两组患者的Harris评分比较无统计学差异(P＞0.05);术后6个月及术后12个月,两组患者的Harris评分均较术前显著升高,且观察组显著高于对照组(P＜0.05)。观察组患者的治疗优良率为92.50 %,显著高于对照组(75.00 %,P＜0.05)。两组患者深静脉血栓、感染、褥疮、固定松动、股骨头坏死及严重疼痛的发生率比较无统计学差异(P＞0.05)。结论：股骨近端防旋髓内钉固定治疗老年股骨转子间骨折效果明显优于Gamma钉治疗,可有效缩短骨折愈合时间,提高髋关节功能。     

切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响

摘要 目的：探讨切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响。方法：本研究为回顾性研究,选取98例移位股骨颈骨折患者的临床资料,根据手术方式的不同将患者分为A组（n=50,切开复位）和B组（n=48,闭合复位）,比较两组患者优良率、骨折复位质量、髋关节功能、围术期指标、术后并发症发生率和二次手术发生率。结果：A组患者术后6个月的优良率为78.00%（39/50）,高于B组的58.33%（28/48）（P<0.05）。两组术后负重下地时间、术中透视时间比较无差异（P>0.05）;B组手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。两组患者术后1个月、术后3个月、术后6个月髋关节功能Harris评分均较术前升高,且A组高于B组（P<0.05）。两组二次手术及并发症发生率比较无差异（P>0.05）。A组Ⅰ型、Ⅱ型的例数均多于B组,Ⅲ型例数少于B组（P<0.05）。结论：与闭合复位空心钉内固定相比,切开复位空心钉内固定虽损伤较大,但其术后骨折复位质量和髋关节功能改善效果更佳,且不增加并发症发生率和二次手术发生率。     

6MWT在评价老年肺结核应用及与血气分析相关性

摘要 目的：探究6分钟步行试验（6-minute walk test,6MWT）在评价老年肺结核患者病情中的应用,并分析6MWT同肺结核患者血气指标的相关性。方法：选择2019年1月至2019年12月于我院接受治疗的200例高龄肺结核患者为实验组,另选取同期于我院接受体格检查的50例健康个体为对照组,分别对两组患者实施6MWT实验,测量两组个体的步行距离、实验前后血氧饱和度（SpO₂）,计算SpO₂下降率,并对所有实验组患者实施肺功能实验,评估肺功能相关指标同6MWT相关性。结果：（1）对比显示实验组患者的6MWT、SpO₂、PaO₂明显低于对照组,PaCO₂高于对照组（P<0.05）;（2）实验前后比较显示实验组患者试验后的SpO₂、PaO₂低于实验前,PaCO₂高于实验前（P<0.05）;（3）相关性分析显示,实验组患者的6MWT同FEV1、FEV1/FVC呈正相关（P<0.05）;（4）相关性分析显示实验组患者的6MWT同SpO₂、PaO₂呈正相关,同PaCO₂呈负相关（P<0.05）。结论：6MWT同高龄肺结核患者肺功能及血气相关指标存在明显的相关性,可将6MWT作为老年肺结核患者病情评估指标之一。