BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in pati...BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in patients with ACS using a continuous glucose monitoring system(CGMS)and dual-energy X-ray absorptiometry(DXA).METHODS Patients diagnosed with ACS,including Cushing syndrome,mild ACS(MACS),and nonfunctional adrenal incidentaloma(NFAI),were recruited for this study.Glucose variability and glycemic status were assessed using CGMS.Regional bone mineral content(BMC),bone mineral density(BMD),and bone area(BA)were evaluated using DXA.CGMS-and DXA-derived parameters were compared across the subgroups of ACS.Correlation analysis was performed to examine relationships between varying degrees of cortisol secretion,measured by cortisol after 1 mg overnight dexamethasone suppression test(DST)or 24-hour urine free cortisol(24h UFC),and CGMS-or DXA-derived parameters.RESULTS A total of 64 patients with ACS were included in this study:19 with Cushing syndrome,11 with MACS,and 34 with NFAI.Glucose variability,time above range(TAR),and time in range(TIR)along with specific areal BMC,BMD,and BA,differed significantly between groups of Cushing syndrome and NFAI.A significant positive correlation was observed between glucose variability or TAR and cortisol after 1 mg overnight DST or 24h UFC.By contrast,TIR,along with regional BMC,BMD,and BA,were negatively correlated with varying degrees of cortisol secretion.CONCLUSION Glucose and bone metabolism impairments are on a continuum alteration from NFAI to MACS and Cushing syndrome.Prompt attention should be given to these patients with ACS,especially those with mild hormone secretion.Parameters of glucose variability and glycemic status along with bone condition in regions rich in cancellous bone will provide valuable information.展开更多
Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to...Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.展开更多
目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者...目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者,其中男性19例,女性43例,年龄51.1±23.5岁(29~72岁)。根据内固定系统枕骨端螺钉固定方式不同将患者分为两组:A组(38例)采用枕骨螺钉-棒-多轴螺钉内固定系统,男12例,女26例,年龄50.9±24.8岁(29~72岁),影像学表现脑干或颈髓受压30例、脊髓空洞6例、Chiari畸形2例;B组(24例)采用枕骨板-棒-多轴螺钉内固定系统,男7例,女17例,年龄51.4±22.4岁(32~69岁),影像学表现脑干或颈髓受压16例,脊髓空洞6例,Chiari畸形2例。A组随访时间36.5±11.8个月,B组随访时间36.1±9.8个月。两组患者年龄、性别、随访时间、影像表现无统计学差异(P>0.05)。收集并比较两组的术中出血量、手术时间、并发症发生率。术前及末次随访时进行颈部疼痛视觉模拟量表(visual analog scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分,术后1周及末次随访时测量两组患者CT植骨融合部横断面及矢状面骨性融合面积,术前、术后1周及末次随访时测量两组患者寰齿前间隙(atlantodental interval,ADI)、脊髓可用空间(space available for cord,SAC)、斜坡-椎管角(clivus canal angle,CCA)、延髓-脊髓角(cervico-medullary angle,CMA)。结果:A组术中出血量362.4±89.1mL、手术时间144.8±35.6min,B组术中出血量345.1±93.7mL、手术时间143.7±36.2min,两组间无统计学差异(P>0.05)。随访期间两组均无脊髓损伤、脑脊液漏等严重并发症发生,B组有2例患者出现连接棒断裂,3例患者出现复位丢失。两组术前NDI、VAS评分、JOA评分与末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。两组术前ADI、SAC、CCA、CMA与术后1周及末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。A组术后1周植骨融合部横断面面积、植骨融合部矢状面面积分别为385.44±84.51mm^(2)、290.28±110.41mm^(2),末次随访时分别为267.06±66.13mm^(2)、204.54±83.85mm^(2);B组术后1周分别为442.61±76.85mm^(2)、267.21±104.63mm^(2),末次随访时分别为172.43±37.37mm^(2)、124.87±48.10mm^(2),两组术后1周植骨融合部横断面面积和植骨融合部矢状面面积比较无统计学差异(P>0.05),末次随访时有显著性差异(P<0.05)。结论:应用枕骨螺钉-棒-多轴螺钉内固定系统枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位同枕骨板-多轴螺钉内固定系统相比疗效相当,但术后植骨融合效果更好,能达到可靠的枕颈固定。展开更多
目的:通过等时替代模型考查24 h活动行为与高海拔地区老年人骨密度(Bone Mineral Density,BMD)、肌质量之间的关系,探索活动行为时间再分配与BMD、肌质量之间的“剂量-反应”关系。方法:采用方便抽样法,招募428名世居高海拔地区60∼80...目的:通过等时替代模型考查24 h活动行为与高海拔地区老年人骨密度(Bone Mineral Density,BMD)、肌质量之间的关系,探索活动行为时间再分配与BMD、肌质量之间的“剂量-反应”关系。方法:采用方便抽样法,招募428名世居高海拔地区60∼80岁老年人。通过加速度计测量低强度体力活动(Light Physical Activity,LPA)、中高强度体力活动(Moderate-to-Vigorous Physical Activity,MVPA)、久坐行为(Sedentary Behavior,SB)时间,采用自我报告评价睡眠(Sleep,SLP)时间,使用等时替代模型评估LPA、MVPA、SB、SLP相互替代后与BMD、肌质量之间的关系。结果:(1)LPA与全身BMD(β=0.027)、下肢肌肉含量(Leg Muscle Mass,LMM)(β=0.728)和四肢骨骼肌质量指数(Appendicular Skeletal Muscle Index,ASMI)(β=1.036)呈正相关关系;MVPA与L1~L4椎骨BMD(β=0.059)、股骨颈BMD(β=0.081)、跟骨BMD(β=0.076)、全身BMD(β=0.078)、上肢肌肉含量(Arm Muscle Mass,AMM)(β=0.535)、LMM(β=0.897)和AMSI(β=2.121)呈正相关关系。(2)每天30 min LPA等时替代SB可显著提高老年人AMSI(β=1.061);每天30 min MVPA等时替代LPA可显著提高老年人股骨颈BMD(β=0.077);每天30 min MVPA等时替代SB可显著提高老年人L1~L4椎骨BMD(β=0.055)、跟骨BMD(β=0.044)、全身BMD(β=0.071)、AMM(β=0.378)、LMM(β=0.950)和AMSI(β=2.315);每天30 min MVPA等时替代SLP可显著提高老年人L1~L4椎骨BMD(β=0.024)、跟骨BMD(β=0.036)。(3)随着MVPA替代SB时间增加,全身BMD和AMSI迅速上升,反之缓慢下降;随着MVPA替代LPA、SLP时间增加,全身BMD和AMSI缓慢上升,反之迅速降低。(4)在所有替代形式中,30 min MVPA替代SB对改善BMD和肌质量的效应最佳;30 min MVPA替代LPA、SLP对肌、骨健康部分指标亦有正向影响。结论:提升MVPA时长有利于改善高海拔地区老年人肌、骨健康。按照等时替代思路,促进SB向MVPA转化,是防治高海拔地区老年人骨质疏松症、肌少症的有效策略。此外,LPA向MVPA、SLP向MVPA、SB向LPA转化可能对肌、骨健康存在限制性增益效应。展开更多
基金Supported by National Natural Science Foundation of China(General Program),No.82073909Four‘Batches’Innovation Project of Invigorating Medical through Science and Technology of Shanxi Province,No.2023XM022The Shanxi Provincial Central Leading Local Science and Technology Development Fund Project,No.YDZJSX2022A059 and No.YDZJSX20231A059。
文摘BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in patients with ACS using a continuous glucose monitoring system(CGMS)and dual-energy X-ray absorptiometry(DXA).METHODS Patients diagnosed with ACS,including Cushing syndrome,mild ACS(MACS),and nonfunctional adrenal incidentaloma(NFAI),were recruited for this study.Glucose variability and glycemic status were assessed using CGMS.Regional bone mineral content(BMC),bone mineral density(BMD),and bone area(BA)were evaluated using DXA.CGMS-and DXA-derived parameters were compared across the subgroups of ACS.Correlation analysis was performed to examine relationships between varying degrees of cortisol secretion,measured by cortisol after 1 mg overnight dexamethasone suppression test(DST)or 24-hour urine free cortisol(24h UFC),and CGMS-or DXA-derived parameters.RESULTS A total of 64 patients with ACS were included in this study:19 with Cushing syndrome,11 with MACS,and 34 with NFAI.Glucose variability,time above range(TAR),and time in range(TIR)along with specific areal BMC,BMD,and BA,differed significantly between groups of Cushing syndrome and NFAI.A significant positive correlation was observed between glucose variability or TAR and cortisol after 1 mg overnight DST or 24h UFC.By contrast,TIR,along with regional BMC,BMD,and BA,were negatively correlated with varying degrees of cortisol secretion.CONCLUSION Glucose and bone metabolism impairments are on a continuum alteration from NFAI to MACS and Cushing syndrome.Prompt attention should be given to these patients with ACS,especially those with mild hormone secretion.Parameters of glucose variability and glycemic status along with bone condition in regions rich in cancellous bone will provide valuable information.
基金Science and Technology Research Project in Kaifeng City,Henan Province Project approval:Science and Technology Research Project in Kaifeng City,Henan Province(1503005)。
文摘Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.
文摘目的:探讨应用枕骨螺钉-棒-多轴螺钉内固定系统行枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位的临床效果。方法:回顾性分析2017年1月~2023年1月于我院因“三明治”畸形伴寰枢关节脱位行后路复位、植骨融合、枕颈内固定术的62例患者,其中男性19例,女性43例,年龄51.1±23.5岁(29~72岁)。根据内固定系统枕骨端螺钉固定方式不同将患者分为两组:A组(38例)采用枕骨螺钉-棒-多轴螺钉内固定系统,男12例,女26例,年龄50.9±24.8岁(29~72岁),影像学表现脑干或颈髓受压30例、脊髓空洞6例、Chiari畸形2例;B组(24例)采用枕骨板-棒-多轴螺钉内固定系统,男7例,女17例,年龄51.4±22.4岁(32~69岁),影像学表现脑干或颈髓受压16例,脊髓空洞6例,Chiari畸形2例。A组随访时间36.5±11.8个月,B组随访时间36.1±9.8个月。两组患者年龄、性别、随访时间、影像表现无统计学差异(P>0.05)。收集并比较两组的术中出血量、手术时间、并发症发生率。术前及末次随访时进行颈部疼痛视觉模拟量表(visual analog scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分,术后1周及末次随访时测量两组患者CT植骨融合部横断面及矢状面骨性融合面积,术前、术后1周及末次随访时测量两组患者寰齿前间隙(atlantodental interval,ADI)、脊髓可用空间(space available for cord,SAC)、斜坡-椎管角(clivus canal angle,CCA)、延髓-脊髓角(cervico-medullary angle,CMA)。结果:A组术中出血量362.4±89.1mL、手术时间144.8±35.6min,B组术中出血量345.1±93.7mL、手术时间143.7±36.2min,两组间无统计学差异(P>0.05)。随访期间两组均无脊髓损伤、脑脊液漏等严重并发症发生,B组有2例患者出现连接棒断裂,3例患者出现复位丢失。两组术前NDI、VAS评分、JOA评分与末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。两组术前ADI、SAC、CCA、CMA与术后1周及末次随访比较有显著性差异(P<0.05),两组同时间点比较均无统计学差异(P>0.05)。A组术后1周植骨融合部横断面面积、植骨融合部矢状面面积分别为385.44±84.51mm^(2)、290.28±110.41mm^(2),末次随访时分别为267.06±66.13mm^(2)、204.54±83.85mm^(2);B组术后1周分别为442.61±76.85mm^(2)、267.21±104.63mm^(2),末次随访时分别为172.43±37.37mm^(2)、124.87±48.10mm^(2),两组术后1周植骨融合部横断面面积和植骨融合部矢状面面积比较无统计学差异(P>0.05),末次随访时有显著性差异(P<0.05)。结论:应用枕骨螺钉-棒-多轴螺钉内固定系统枕颈固定融合术治疗“三明治”畸形伴寰枢关节脱位同枕骨板-多轴螺钉内固定系统相比疗效相当,但术后植骨融合效果更好,能达到可靠的枕颈固定。
文摘目的:通过等时替代模型考查24 h活动行为与高海拔地区老年人骨密度(Bone Mineral Density,BMD)、肌质量之间的关系,探索活动行为时间再分配与BMD、肌质量之间的“剂量-反应”关系。方法:采用方便抽样法,招募428名世居高海拔地区60∼80岁老年人。通过加速度计测量低强度体力活动(Light Physical Activity,LPA)、中高强度体力活动(Moderate-to-Vigorous Physical Activity,MVPA)、久坐行为(Sedentary Behavior,SB)时间,采用自我报告评价睡眠(Sleep,SLP)时间,使用等时替代模型评估LPA、MVPA、SB、SLP相互替代后与BMD、肌质量之间的关系。结果:(1)LPA与全身BMD(β=0.027)、下肢肌肉含量(Leg Muscle Mass,LMM)(β=0.728)和四肢骨骼肌质量指数(Appendicular Skeletal Muscle Index,ASMI)(β=1.036)呈正相关关系;MVPA与L1~L4椎骨BMD(β=0.059)、股骨颈BMD(β=0.081)、跟骨BMD(β=0.076)、全身BMD(β=0.078)、上肢肌肉含量(Arm Muscle Mass,AMM)(β=0.535)、LMM(β=0.897)和AMSI(β=2.121)呈正相关关系。(2)每天30 min LPA等时替代SB可显著提高老年人AMSI(β=1.061);每天30 min MVPA等时替代LPA可显著提高老年人股骨颈BMD(β=0.077);每天30 min MVPA等时替代SB可显著提高老年人L1~L4椎骨BMD(β=0.055)、跟骨BMD(β=0.044)、全身BMD(β=0.071)、AMM(β=0.378)、LMM(β=0.950)和AMSI(β=2.315);每天30 min MVPA等时替代SLP可显著提高老年人L1~L4椎骨BMD(β=0.024)、跟骨BMD(β=0.036)。(3)随着MVPA替代SB时间增加,全身BMD和AMSI迅速上升,反之缓慢下降;随着MVPA替代LPA、SLP时间增加,全身BMD和AMSI缓慢上升,反之迅速降低。(4)在所有替代形式中,30 min MVPA替代SB对改善BMD和肌质量的效应最佳;30 min MVPA替代LPA、SLP对肌、骨健康部分指标亦有正向影响。结论:提升MVPA时长有利于改善高海拔地区老年人肌、骨健康。按照等时替代思路,促进SB向MVPA转化,是防治高海拔地区老年人骨质疏松症、肌少症的有效策略。此外,LPA向MVPA、SLP向MVPA、SB向LPA转化可能对肌、骨健康存在限制性增益效应。
