Value of CT Density Measurements in Distinguishing Parathyroid Adenoma,Thyroid,and Lymph Node.

Objective To explore the value of multi-phase contrast-enhanced computed tomography in the differential diagnosis of parathyroid adenoma,lymph node,and thyroid. Methods The enhanced multi-slice CT (MSCT) results of 21 parathyroid adenoma patients were analyzed,and their postoperative pathological specimens were examined. During the MSCT,the plain CT scan was recorded,along with the density of thyroid adenoma,lymph nodes,and thyroid at 35 s and 65 s (D0,D35,D65) following the injection of contrast medium. Results During the D0 phase,there was significant difference in CT values between the parathyroid adenoma and thyroid parenchyma[(45?12) HU vs.(90?15)HU,P=0.007]. According to ROC curve,75 HU,with 95.2% sensitivity and specificity,was the critical value for distinguishing the density of parathyroid adenoma and that of thyroid parenchyma. At 35 s following the injection of contrast medium,there was significant difference in the enhancement degree between parathyroid adenoma and lymph node[(182?39) HU vs.(80?20)HU,P=0.004]. According to ROC curve,111 HU,with 95.2 % sensitivity and specificity,was the critical value for distinguishing the density of parathyroid adenoma and that of lymph node 35 s following the injection of contrast medium. At 35 s to 65 s following the injection of contrast medium,the parathyroid adenoma experienced a decline in density,which was dramatically different from parathyroid adenoma,however,lymph node experienced a rise in density. Conclusion Enhanced CT measurements at different time points enable the differentiation among parathyroid adenomas,lymph nodes,and thyroid.

Effect of blood pressure variability on cardiovascular outcome in diabetic and nondiabetic patients with stroke.

BACKGROUND: The association between blood pressure (BP) variability and stroke outcome is controversial, and there are few studies that have focused on the impact of BP variability in diabetic patients with stroke. Therefore, we aimed to examine the impact of BP variability on cardiovascular outcome in diabetic and nondiabetic patients with stroke. METHODS: A total of 373 ischemic stroke patients with large artery atherosclerosis were recruited and followed up. Ambulatory BP monitoring was performed in all patients and divided according to the 25th and 75th percentiles interval of SD of daytime systolic BP (SBP). Kaplan-Meier analysis and Cox regression were used to assess the relationship between BP variability and cardiovascular outcomes including stroke recurrence, vascular events and cardiovascular death. RESULTS: The 339 patients were included in the final analysis. During an average follow-up of 19.0 ± 5.1 months (.6-26.8 months), 69 (20.4%) cardiovascular events occurred in all patients. Kaplan-Meier analysis found that there were no differences in cardiovascular events-free survival among the different BP variability groups in diabetic patients (P = .995); however, nondiabetic patients with greater BP variability showed a lesser cardiovascular events-free survival (P = .039). Through Cox regression we found the SD of daytime SBP (hazard ratio 1.103; 95% CI 1.011-1.203) was associated with cardiovascular outcomes in nondiabetic patients with stroke. CONCLUSIONS: We show that SBP variability is associated with cardiovascular outcomes in stroke patients without diabetes, but we didn't find a correlation between SBP variability and cardiovascular outcomes in stroke patients with diabetes.

Diagnostic value of combined parameters derived from ambulatory electrocardiography for detecting coronary artery disease in non-active chest pain patients.

BACKGROUND AND OBJECTIVE: The diagnostic value of ST-segment deviation detected by ambulatory electrocardiography (AECG) is controversial in identifying coronary artery disease (CAD) referred for coronary angiography (CAG). Recently, many parameters which evaluate CAD can be derived from AECG. Therefore, we aimed to investigate the diagnostic value of AECG in screening CAD referred for CAG when several parameters were combined. METHODS: We studied the 104 chest pain inpatients. All patients received the CAG and AECG. A lumen diameter reduction of ≥ 50% was considered CAD according to CAG. The parameters derived from AECG included ST-segment deviation, apnea hypopnea index (AHI), QT interval dispersion (QTd) and heart rate variability (HRV). The diagnostic value of AECG in screening CAD was evaluated. RESULTS: Of the 104 patients, 57 (54.8%) had CAD according to CAG. The sensitivity of ST-segment deviation in screening CAD was 64.9%; the specificity was 89.4%; and the Kappa value was 0.528. The sensitivity of at least three combined parameters including ST-segment deviation, AHI, QTd and HRV was 89.5%; the specificity was 87.2%; and the Kappa value was 0.767. CONCLUSION: AECG is very useful in screening CAD referred for CAG, especially while several parameters including ST-segment deviation, AHI, HRV and QTd are combined.

Forearm bone mineral density measurement with different scanning positions: a study in right-handed Chinese using dual-energy X-ray absorptiometry.

The purpose of our study was to determine whether different scanning positions influence forearm bone mineral density (BMD) measurements and to evaluate the association between forearm BMDs in different scanning positions and those of other skeleton sites. The study population consisted of 30 right-handed healthy Chinese volunteers. BMD was measured with GE Lunar Prodigy at the left forearm in both sitting and supine positions, and at lumbar spine and the right femur. All subjects received repeated measurements in the same day (repositioning), and the average of repeated BMD results was used for analysis. The BMD precision errors of the nondominant forearm in the sitting and supine positions varied from 1.13% to 2.46%. There were no statistically significant differences between BMD precision errors for each region of interest (ROI) between sitting and supine positions (all the p values were greater than 0.05). When comparing BMDs on the same side in the sitting position with those in the supine position, there were significant differences at both the 1/3 radius level and in the total radius (p<0.05). The BMD values at these ROIs obtained in the supine position were lower than those in the routine sitting position. The BMDs of the ultradistal radius in the both 2 different scanning positions were significantly associated with lumbar spine and femoral neck BMD, respectively. The total radius BMD in the different positions was associated with the BMD of the femoral neck. A change in body scanning position from sitting to supine will significantly influence forearm BMD results.

[Change in body compositions in female patients with human immunodeficiency virus related lipodystrophy syndrome].

OBJECTIVE: To study the changes of body composition in females patients with human immunodeficiency virus (HIV)-related lipodystrophy (LD) syndrome (HIV-LD). METHODS: Totally 25 female patients who were treated in our hospital from January 2002 to December 2009 were divided into LD group and non-LD group based on the existence of LD. All these patients were receiving highly active antiretroviral therapy (HAART). In addition, 12 healthy women were set as the controls. Total and regional body composition were measured by dual X-ray absorptiometry in all three groups. RESULTS: The fat mass (FM) was correlated negatively with the duration of HAART (r=-0.431, P=0.029). Multiple linear regression analysis showed that FM had positive correlation with weight and negative correlation with lean mass (LM) (r = - 0. 973, P =0. 000). Total, trunk and leg FM were significantly lower in LD patients than that in controls (P <0.05).Meanwhile, total, trunk and leg bone mineral contents were statistically lower in LD patients than that in controls (P <0. 05). Lumbar bone mineral density of LD patients was lower than that of non-LD patients and controls, and there was significant difference between LD patients and controls (P = 0. 001). LM of LD patients was higher than that of non-LD patients but without statistical difference (P > 0. 05). CONCLUSIONS: The peripheral and central FM and bone mineral contents remarkably decrease in female patients with HIV-LD. How-ever, HIV-LD patients tend to have higher LM than non-LD patients. .

Changes in trabecular bone score and bone mineral density in Chinese HIV-Infected individuals after one year of antiretroviral therapy.

OBJECTIVE: Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) have been associated with reduced bone mineral density (BMD) in persons with HIV (PWH). BMD provides information only about bone mineral quantity. Trabecular bone score (TBS) is a noninvasive tool that estimates bone microarchitecture. The aim of this study is to measure BMD and TBS of Chinese PWH after one-year ART. METHODS: We designed a retrospective study of adult Chinese PWH. Patients with a dual-energy X-ray absorptiometry (DXA) scan prior to ART initiation, and again 48 weeks later were included. Information regarding demographic and clinical history, HIV treatment history, BMD and TBS were collected. We analyzed differences in BMD and TBS over 48 weeks and associations between key risk factors and changes in BMD and TBS. RESULTS: Our study included 233 â€‹PWH (mean age â€‹= â€‹36.6 â€‹± â€‹11.1 years). Before ART initiation, 19.3% of PWH had normal BMD but abnormal TBS. Both BMD and TBS decreased after one-year ART. TDF and LPV/r-containing regimens were associated with greater declines in BMD at different site. Traditional risk factors such as old age, low BMI and female sex were associated with lower baseline TBS. Greater change in TBS over one year was associated with lower BMI and lower baseline CD4+ cell count, but unlike BMD measures, it was not correlated with treatment with TDF and LPV/r in our study population. CONCLUSIONS: We present the first longitudinal analysis of change in TBS over 48 weeks compared with BMD among Asian PWH receiving ART. Before ART initiation, approximately 20% of PWH with impaired bone microarchitecture would not have been identified if DXA were used alone to assess for bone damage. Both BMD and TBS decreased after one-year ART. Change in TBS was not associated with different antiretroviral agents. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The trabecular microarchitecture measured indirectly by TBS may provide clinicians additional information about bone damage in PWH.

Sex difference in the prevalence of left ventricular hypertrophy in dialysis patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is an important, independent negative predictor of cardiovascular morbidity and mortality in the general population and in dialysis patients. Previous studies suggest a sex dimorphism in the prevalence of LVH; however, this issue has never been approached in dialysis patients. METHODS: This study enrolled 237 prevalent dialysis patients: 49 on hemodialysis (HD) and 188 on peritoneal dialysis (PD) from a single center. LVH was defined by echocardiography measurements, which were normalized to body surface area (BSA) and height(2.7), respectively. RESULTS: The mean ages in HD and PD patients were 60 +/- 14 and 60 +/- 13 years, with a median dialysis vintage of 43 and 20 months, respectively. Although there was no significant difference in age, diabetes, proportion of uncontrolled hypertension, antihypertensive medication and blood pressure between male and female patients within each dialysis modality, the prevalence of LVH (whether indexed to BSA or height(2.7)) was consistently higher in females than in males. When these patients were divided into LVH or non-LVH groups, a significant difference in sex distribution was observed between the two groups (62.0% vs. 41.0% when the BSA-indexed standard was used, p < 0.01; 62.8% vs. 37.1% when the height(2.7)-indexed standard was used, p < 0.001). In logistic regression analysis, female sex was identified as a risk factor of LVH (odds ratio, OR = 2.48, 95% confidence interval, CI = 1.33-4.59; when BSA-indexed LVH was treated as dependent variable, and OR = 4.05, 95% CI = 1.96-8.38, when height(2.7)-indexed LVH was treated as dependent variable) even after adjustment for age, diabetes, blood pressure and antihypertensive medication. CONCLUSION: This study showed that the prevalence of LVH determined by echocardiography was significantly higher in female dialysis patients than in male dialysis patients. Compared with males, female patients had a 2.5- to 4-fold higher risk to develop LVH even after adjustment for other potential confounding factors, which may indicate that elderly females in the uremic scenario are more prone to develop LVH than elderly males.

The efficacy and safety of calcitriol and/or Caltrate D in elderly Chinese women with low bone mass.

AIM: To observe the efficacy and safety of Rocaltrol (calcitriol) and/or Caltrate D (calicum carbonate plus vitamin D) in elderly Chinese women with osteopenia or osteoporosis. METHODS: One hundred fifty Chinese women aged over 65 years with osteopenia or osteoporosis from three centers were randomly divided into two groups. Seventy-six participants received Caltrate D as one pill daily; the other 74 participants received 0.25 mug Caltrate D plus Rocaltrol daily. The changes in bone mineral density (BMD) served as primary end-points. Height changes, the presence of new vertebral fractures, muscle strength and balance were evaluated. RESULTS: The following are the mean percentage changes (and SD) in BMD over 12 months: at L2-L4, 0.83+/-3.88 in the Caltrate D group and 2.84+/-4.04 in the Rocaltrol+Caltrate D group (P=0.003, by ANCOVA); at the femoral neck, 0.04+/-3.94 in the Caltrate D group and 2.01+/-5.45 in the Rocaltrol+Caltrate D group (P=0.085, by ANCOVA); and in the trochanter, 1.59+/-4.57 in the Caltrate D group and 3.76+/-6.25 in the Rocaltrol+Caltrate D group (P=0.053, by ANCOVA). The stand and maximal forward reach test (SMFRT) was significantly enhanced in both groups during the 12 months of treatment, but no significant differences were found between these two groups. No severe adverse event related to these medications occurred throughout the study. CONCLUSION: Treatment with Rocaltrol plus Caltrate D or Caltrate D for 12 months in elderly Chinese postmenopausal women effectively increased BMD at the lumbar spine. Rocaltrol plus Caltrate D was more effective at the lumbar spine than Caltrate D alone.

Why is there significant overlap in volume status between hypertensive and normotensive patients on dialysis?

BACKGROUND/AIM: Volume overload is believed to play a pivotal role in the pathogenesis of hypertension in dialysis patients. Although the extracellular water (ECW) content in hypertensive dialysis patients was significantly higher than in normotensive dialysis patients on the whole, there was considerable overlap in ECW between the two groups. Little is known about the hemodynamic characteristics in subgroups of patients with normotension but a high volume (HV) status or with hypertension but a normal volume (NV) status. We investigate the overlap in ECW between controlled and uncontrolled hypertension in dialysis patients. METHODS: Fifty-two patients (mean age 62 years, 26 males and 26 females) on peritoneal dialysis were enrolled into this study. The ECW was assessed by bioimpedance analysis and normalized by individual height in meters (NECW). The mean value of NECW in both sexes was arbitrarily set to define NV status (lower than mean value) or HV status (higher than mean value). All patients were thus divided into four subgroups: controlled hypertension with NV (CHT-NV), controlled hypertension with HV (CHT-HV), uncontrolled hypertension with NV (UHT-NV) and uncontrolled hypertension with HV (UHT-HV). The stroke volume, cardiac output and total peripheral resistance were echocardiographically measured and their respective indices were calculated. RESULTS: There were 12 (23%), 8 (15%), 14 (27%) and 18 (35%) patients in the CHT-NV, CHT-HV, UHT-NV and UHT-HV subgroups, respectively. The four subgroups were matched for sex, diabetes and age. The NECW in the CHT-HV group was higher than that in CHT-NV and UHT-NV groups (p < 0.01), but was comparable with that in the UHT-HV group. The stroke volume and cardiac output indices in the CHT-HV group were not significantly different from those in the CHT-NV and UHT-NV groups. The total peripheral resistance index in the CHT-HV group was lower than that in UHT-NV and CHT-NV groups (p < 0.05), but was comparable to that in the UHT-HV group. There was no difference in heart rate among the four groups. CONCLUSIONS: The overlap in ECW between controlled hypertension and uncontrolled hypertension in dialysis patients was related to a significant difference in total peripheral resistance index, but not to significant differences in stroke volume and cardiac output indices. The CHT-HV patients were characterized by lower total peripheral resistance indices.

Peripheral resistance modulates the response to volume overload in peritoneal dialysis patients.

BACKGROUND: Volume overload is thought to be the most important cause of hypertension in peritoneal dialysis (PD) patients. However, there is also evidence that normalization of volume overload is not always accompanied by a drop in blood pressure (BP). In the present study, we hypothesized that dysregulation of peripheral resistance due to endothelial dysfunction would constitute an important determinant of BP response in overhydrated PD patients. METHODS: We performed an observational, prospective cohort study including all prevalent PD patients at the Peking University Third Hospital between 1 June 2006 and 30 November 2006. After baseline measurements, including echocardiography and bioelectrical impedance analysis, patients fulfilling inclusion criteria were reevaluated after 2 months of follow-up. All patients that exhibited significant changes in BP and extracellular water (ECW) between 2 visits were asked to undergo a second ultrasound. These patients were then divided into group A (parallel change between BP and ECW; n = 12) and group B (paradoxical change between BP and ECW; n = 10). RESULTS: The cohort included 22 patients (13 males) with a mean age of 59 +/- 13 years, on dialysis for 23.3 +/- 32.6 months. There were no baseline differences between groups A and B. However, while patients in group A significantly increased their cardiac output, total peripheral resistance remained stable. In group B, cardiac output did not change significantly but total peripheral resistance decreased significantly. CONCLUSION: In PD patients, a significant increase in fluid volume is not necessarily linked to a significant increase in BP. Rather, the change in total peripheral resistance was found to be the most important determinant of the extent to which increased fluid volume affected BP.

Volume overhydration is related to endothelial dysfunction in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: In dialysis patients, volume overhydration is common and is related to increased risk of cardiovascular morbidity and mortality. However, it remains unclear whether volume overload imposes those detrimental effects through endothelial dysfunction. METHODS: In this cross-sectional study, 81 stable patients on continuous ambulatory peritoneal dialysis in a single center were recruited. Volume status was evaluated by extracellular water, assessed by bioimpedance analysis, and normalized to individual height (nECW). Endothelial function was estimated by endothelial-dependent flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. RESULTS: There were 37 male and 44 female patients (mean age 61 +/- 12 years, dialysis vintage 20 +/- 23 months). FMD in female patients was significantly higher than that in male patients (9.17% +/- 6.23% vs 6.31% +/- 5.01%, p < 0.05). FMD was negatively correlated with weight (r = -0.308, p < 0.01), body mass index (r = -0.242, p < 0.05), systolic blood pressure (r = -0.228, p < 0.05), ECW (r = -0.404, p < 0.001), and nECW (r = -0.418, p < 0.001). No correlation was found between FMD and other variables. In multiple stepwise regression analysis, calcium x phosphate product (beta = 0.422, p < 0.001), nECW (beta = -0.343, p < 0.01), and dialysis vintage (beta = -0.237, p < 0.05) were independent determinants of FMD (adjusted R(2) = 0.327 for this model). CONCLUSION: There was independent correlation between index of volume status and FMD, and higher nECW was related to worse endothelial function. The results of this study may help us understand the underlying mechanism of volume overhydration leading to increased cardiovascular morbidity and mortality in dialysis patients.

The prevalence of left ventricular hypertrophy in Chinese hemodialysis patients is higher than that in peritoneal dialysis patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is common in dialysis patients, and an independent predictor of mortality. While recent studies have shown no differences in mortality between the two most common dialysis modalities, hemodialysis (HD) and peritoneal dialysis (PD), their impact on LVH is controversial. We thus performed cardiac ultrasound studies in prevalent dialysis patients receiving either HD or PD and compared LVH. METHODS: We included 48 HD and 62 PD patients receiving treatment for at least three months in our dialysis center. All patients underwent echocardiographic examination and blood pressure measurements immediately following therapy. Volume status was assessed by bioelectrical impedance analysis. RESULTS: There was no baseline difference in demographics or comorbidities between HD and PD patients. As expected, extracellular water (ECW) in post-HD patients was significantly lower than that in pre-HD and PD patients, while cardiac output (CO) and systolic blood pressure (SBP) were higher in pre-HD than that in post-HD or PD patients. There was no significant difference in CO or SBP between post-HD and PD patients. Left ventricular mass index (LVMI) was markedly higher in HD patients as compared to PD patients. Thus, the prevalence of LVH according to the Framingham criteria was 68.8% in HD patients and 45.2% in PD patients. Subgroup analysis showed similar results in the patients who had been on single-modality dialysis for at least two years and in the anuric patients. Finally, in a linear regression model (r(2) = 0.364, p < 0.001), SBP, treatment modality (to be in HD), and ECW were all independent predictors of LVMI. CONCLUSIONS: In a cross-sectional analysis of prevalent Chinese patients, we found a higher LVMI and a higher prevalence of LVH in HD than in PD patients. As LVMI was associated with high blood pressure and volume overload, we suggest that in these patients, PD may preserve more physiological hemodynamics even during long-term therapy.

The impact of visit-to-visit systolic blood pressure variability on residual renal function and left ventricular hypertrophy in peritoneal dialysis patients

Background/aim: Blood pressure (BP) variability is more closely associated with adverse outcomes than 'usual' BP in the general population. Residual renal function (RRF) and left ventricular hypertrophy (LVH) are thought to be predictors of poor outcome in dialysis patients. However, only a few studies have focused on BP variation and its link to RRF, LVH, and outcome in peritoneal dialysis (PD) patients. Therefore, we aimed to explore the effect of visit-to-visit BP variability on RRF and LVH in continuous ambulatory PD (CAPD) patients. Materials and methods: We performed an observational study that included all prevalent PD patients between 1 February 2006 and 31 January 2007. All patients underwent BP measurements, pulse wave velocity (PWV), cardiac ultrasound, and biochemical examination during the 1-year observation. Patients were divided into the HBPV group (higher BP variability) and LBPV group (lower BP variability) based on the standard deviation of systolic BP (SBP). Results: There were 70 patients recruited for the final analysis. Patients with HBPV had a higher SBP as compared to patients with LBPV at baseline. Renal Kt/V decreased significantly from 0.50 ± 0.49 to 0.32 ± 0.35 (P < 0.01) in HBPV group (but not in the LBPV group) during follow-up. Patients with HBPV also showed a higher left ventricular mass index (LVMI) and PWV than those with LBPV at the end of follow-up. Conclusion: Our study suggests that BP variability may affect RRF in PD patients. PD patients with HBPV had a faster decline in RRF and higher PWV and LVH.

[Bone loss is more severe in younger Cushing's syndrome women than in older ones: comparison of bone mineral density between Cushing's syndrome and healthy women].

OBJECTIVE: To investigate the influence of age on bone mass in Cushing's syndrome patients. METHODS: Measurement of bone mineral density (BMD) was conducted among 57 women with Cushing's syndrome (CS) and 49 healthy women. There were 14 CS women and 14 healthy women in the group aged 20 - 29; 27 CS women and 15 healthy women in the group aged 30 - 39; and 16 CS women and 20 healthy women in the group aged 40 - 49. RESULTS: Among the healthy women the peak bone mass of lumbar spine was in the group aged 30 - 39, while the peak bone mass of hip was in the group aged 20 - 29. The BMD values of the CS women were lower than those of the healthy women, especially those in lumbar spine and in Ward's triangle. The younger the CS women, the lower the BMD Z-score (for the BMD Z-score of lumbar spine P = 0.021, for the BMD Z-score of femoral neck P = 0.020, and for the BMD Z-score of Ward's triangle P = 0.026). Seventeen of the 57 (29.8%) CS women had osteoporosis, 29 (50.9%) of the 57 had osteopenia, and 15 (26.3%) had fractures. The CS women with bone fractures had lower BMD Z-score than those without fractures (for lumbar fracture P = 0.003). CONCLUSION: The BMD of CS women is lower than that of the healthy women. Bone loss is more severe in younger CS women than in older ones. CS women with low BMD are prone to have bone fracture.

The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients.

PURPOSE: The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. METHODS: All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. RESULTS: All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR  3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR  2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. CONCLUSION: The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.

[Correlation between prevalent and incident osteoporotic vertebral fractures in Beijing male elderly].

OBJECTIVE: To investigate the correlation between prevalent and incident osteoporotic vertebral fractures in Beijing male elderly. METHODS: Roentgenography of the thoracic and lumber vertebrae (T4-L4) and dual X-ray absorptiometry at the lumber spine (L2-4) and proximal femur (neck, greater trochanter, and Ward's triangle) were conducted so as to observe the vertebrae and measure the bone density upon 271 Beijing men, aged 72 +/- 6 (63.1 - 92.7). The subjects were followed up for 3.7 +/- 0.4 years. RESULTS: Prevalent fractures involving 98 vertebrae, mostly T12-L1 and mostly I degrees fracture, occurred in 71 men with an incidence rate of 28.3% (95% CI 22.8% - 34.3%). Incident fracture, mostly T12-L1 and mostly I degrees fracture too, occurred in 8 patients (95% CI 1.4% - 6.2%). The average baseline age of those with incident fracture was 77 +/- 8, significant higher than those of the subjects without fracture (71 +/- 6) and the subjects with only prevalent fractures (72 +/- 5) (both P < 0.05). The body height and weight of the subjects with only prevalent fractures were significantly lower than those of the other 2 groups (P = 0.025 and P = 0.05). However, the body mass index (BMI) was not significantly different among these 3 groups. The bone density values of femur neck and greater trochanter of the group with prevalent fracture but without incident fracture were 0.81 g/cm(2) +/- 0.11 and 0.4 g/cm(2) +/- 0.11 g/cm(2) respectively, both significantly lower than those of the group without fracture (0.85 g/cm(2) +/- 0.11 g/cm(2) and 0.78 g/cm(2) +/- 0.11 g/cm(2) respectively, both P < 0.05). The BMI value decreased in the order of the group without fracture, the group with only prevalent fracture, and the group with prevalent and incident fracture. The incidence rate of incident fracture was 7% in the group with prevalent fracture, significantly lower than that in the group without fracture (1.7%, P < 0.05). Among those with prevalent fracture the higher the degree of the prevalent fracture the more cases of incident fracture (P = 0.02). The incidence rate of incident fracture in those with prevalent fracture of 4 vertebrae was 33.3%, higher than those in other 2 groups. Logistic analysis showed that the baseline age and severity of vertebral fracture were closely correlated with incident fracture (OR = 1.229, 95% CI 1.037 - 1.407, and OR = 4.270, 95% CI 1.691 - 19.785). CONCLUSION: As independent of BMI, baseline age and severity of prevalent fracture are closely correlated with incident fracture in Beijing male elderly. Baseline BMI is a strong predictor of fracture risk.

[Study of bone mineral density in complete androgen insensitivity syndrome patients].

OBJECTIVE: To explore the characteristics and treatment of bone mineral density (BMD) change in complete androgen insensitivity syndrome (CAIS) of Chinese patients. METHODS: Fourteen cases of CAIS were studied retrospectively through analyzing and comparing BMD of pre- and post-orchidectomy with normal Chinese men and women. BMD at the lumbar spine and the femur were measured by dual energy X-ray absorptiometry (DXA). RESULTS: Ten cases of CAIS had pre-orchidectomy DXA, in which 6 cases had very significantly reduced L(2-4) BMD (0.92 +/- 0.08) g/cm(2) compared with normal men and women (P < 0.01). Five cases had significantly reduced femur neck BMD (0.89 +/- 0.12) g/cm(2) compared with normal male (P < 0.05). Seven cases had 12 post-orchidectomy DXA, in which all L(2-4) BMD (0.95 +/- 0.06) g/cm(2) were very significantly reduced compared with normal male and female (P < 0.01), femur neck BMD (0.91 +/- 0.08) g/cm(2) was also significantly reduced compared with normal male (P < 0.01) and normal female (P < 0.05). CONCLUSIONS: There are different degrees of osteopenia in patients of CAIS, especially in lumbar vertebra. This suggests that estrogen and androgen play important roles in the acquirement and maintenance of bone mass.

[Effect of age on the precision of dual X-ray absorptiometry measurement in middle-aged and elderly women].

OBJECTIVE: To investigate whether age influence the precision of dual X-ray absorptiometry (DXA) measurement at the hip in middle-aged and elderly women. METHODS: Totally 90 women were randomly selected and divided into three age groups: 45-55 years, 56-65 years, and 66-75 years. Each age group contained 30 women. Each woman was scanned twice at the same day. Bone mineral density (BMD) values of femoral neck, ward's triangle, and trochanter were collected and grouped by calculating the root mean square (RMS). Precision errors were expressed as RMS (standard deviation, SD). RESULTS: For the femoral neck and trochanter, significant differences of SD of BMD existed among all age groups. For the ward's triangle, significant difference of BMD existed among all age groups except between the 45-55 group and 56-65 age group. CONCLUSION: Age can influence the precision of DXA measurement at the hip in middle-aged and elderly women.

[Bone mineral density and leptin receptor polymorphism Gln223Arg in Han women in Beijing].

OBJECTIVE: To investigate the association between bone mineral density (BMD) and leptin receptor (LEPR) polymorphism (Gln223 Arg) in young women and postmenopausl osteoporotic women. METHODS: BMD values were determined by dual energy X-ray absorptiometry. The Gln223 Arg genotypes of LEPR were analyzed by using polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: Hardy-Weinberg equilibrium was evident for LEPR polymorphism. The subjects carrying the GG genotype of LEPR had significantly higher BMD at lumbar spine as compared with the subjects with GA and AA genotype in young women [(1.213 +/- 0.127) g/cm(2) vs (1.154 +/- 0.124) g/cm(2), P < 0.05]. There were no significant differences in BMD at the proximal femur among GG, GA and AA genotype in young women. No significant differences in BMD at all sites were observed among GG, GA and AA genotype in postmenopausl osteoporotic women. Correlation was found between BMD and leptin receptor polymorphism (Gln223 Arg) at lumbar spine (r = -0.151, P < 0.05). CONCLUSION: Leptin receptor polymorphism (Gln223 Arg) has association with peak bone mass in young women, which may be used as genetic marker in predicting the risk of developing osteoporosis in Chinese women of Han nationality.

[Bone mineral and body composition analysis of whole body in 292 normal subjects assessed by dual X-ray absorptiometry].

OBJECTIVE: To understand whole body bone mineral and body composition changes in normal subjects, and study the relationship between body composition and bone mineral. METHODS: 292 normal subjects aged 10-79 years old, including 140 males and 152 females, were selected to be measured bone mineral content (BMC), bone mineral density (BMD) lean and fat of whole body by dual X-ray absorptiometry (DXA). Individuals were divided into age-groups by every ten years and were analyzed by statistical methods. RESULTS: In males, peak values of BMC, BMD, lean and fat were in the 30-39, 20-39, 30-39, 70-79 age-groups. In females, they were in the 30-39, 30-39, 30-49, 50-69 age-groups respectively. Peak values of BMC, BMD and lean were higher in males than that in females, but peak value of BMD was not significantly higher in males than that in females. Peak value of fat was higher in females than that in males. Loss of BMC and BMD for females were more pronounced than that for males. Loss of lean for males was more pronounced than that for females. There are significant positive correlation between lean, weight and bone mineral in males and females. Fat has significant effect on BMC in females only. CONCLUSIONS: The normal bone mineral and body composition data of whole body for males and females, and the characteristic of changes with aging are provided for analyzing the relationship between bone mineral and body composition with ease.