Bone lesions in multiple myeloma: variation and value of radiologic classification in prognosis

In this report, we studied the frequency, the types and the prognosis value of the Durie and Salmon's classification of radiological bone lesions in multiple mycloma. Our study concerned 52 patients presenting multiple myeloma, defined according to South West Oncology Group criteria, collected during nine years (1988-1996). Radiological anomalies were noted in 89% of the cases. When we compared the medial survival and the 5 years survival rate in the different groups, we found a statistically significant difference with a better survival for groups 0,1,2 considered all together as compared to group 3 patients (p = 0.0155), (71% versus 37%). According to our series, prognostic value is obviously significant when comparing groups 0, 1, and 2 to group 3.     

Bone lesions in malignant diseases--II. Therapeutic management

A pathogenetically based therapeutic strategy and modality for malignant bone diseases has been created only in the last two decades. The most frequent pathogenetic defect, osteoblast/osteoclast uncoupling in the osteolytic foci and the diffuse humoral osteoporosis afford little in terms of choice of treatment which makes the inhibitors of osteoclastic activity the major medicamentous agents for their management. We discuss the mechanisms of action, pharmacokinetics, preparations and regimens of administration of biphosphonates, calcitonine and galium nitrate. Results of large double blind, placebo-controlled studies of clondronate and pamidronate in oncohematologic diseases are summarised: statistically significantly lower frequency of the osteolytic foci, pathological fractures, hypercalcemic episodes, low levels of C-L bonds, increase of bone mineral density, management of pain, and better quality of life.     

Bone and kidney lesions in experimental cadmium intoxication.

Young male rats were fed a diet containing cadmium (0, 10, 30, 100, and 300 ppm) so as to morphologically investigate the relationship between bone and kidney lesions caused by experimental cadmium intoxication. In the early stage of the experiment, before the occurrence of kidney lesions, ingeted cadmium caused osteoporotic changes in bone. In later stages, slight pathologic changes in the kdidney occurred in association with urinary excretion of cadmium. However, there was no evidence of osteomalacic change in bone during the 12-week experimental period. These findings suggest that cadmium may act primarily on bone, rather than secondarily through disturbances of the kidneys, which have some protective ability against cadmium intoxication in the early stage of ingestion of the metal.     

IL-6与OPG/RANKL/RANK信号通路在风湿性关节炎发病机制中的作用

风湿性关节炎是一种常见的慢性全身性炎性疾病,属于自身免疫性疾病.研究表明IL-6结合IL-6受体发挥生物学效应和风湿性关节炎密切相关.IL-6对风湿性关节炎中软骨退化和降解的影响,可能是通过调节OPG/RANKL/RANK信号通路实现的.IL-6可以直接刺激破骨细胞,也可以通过促进RANKL的表达而间接增强破骨细胞活性,继而对风湿性关节炎的发生发展产生重要影响.     

小儿过敏性紫癜多器官损害的临床分析

目的 :探讨过敏性紫癜患儿多器官损害的临床情况。方法 :对 13 8例过敏性紫癜患儿进行回顾性分析 ,了解其脏器损害情况及临床表现。结果 :13 8例患儿中有 12 5例 (90 6% )出现多器官损害 ,其中 2个器官损害 43例 (3 1 2 % ) ,3个以上器官损害 82例 (5 9 4% )。结论 :过敏性紫癜可存在多器官损害 ,包括皮肤、关节、消化系统、泌尿系统、神经系统、循环系统等 ,在临床诊治中应充分认识 ,做到尽早发现病情 ,尽早诊治 ,避免误诊 ,减少并发症。     

人乳头状瘤病毒多重感染不同类型与宫颈病变程度的关系

目的 探讨人乳头状瘤病毒(HPV)多重感染不同类型与宫颈病变的关系,为临床HPV多重感染率与宫颈病变的发生提供依据.方法 采用HPV基因分型(PCR-反向点杂交)检测技术,分析192例HPV多重感染者的HPV型别,同时检测其宫颈病变程度;192例HPV多重感染者分为3组,其中高危型HPV多重感染组54例,高危型与低危型HPV的混合感染组108例,低危型HPV多重感染组30例.结果 高危型HPV多重感染组中,16、58、52型HPV最常检出,检出率分别为51.85％、48.15％、24.07％,低危型HPV多重感染组中,11、53、6型HPV最常检出,检出率分别为60.00％、46.67％、40.00％;高危型HPV多重感染组与混合感染组相比,宫颈不同程度病变的构成比差异无统计学意义,以上两种感染类型与低危型HPV多重感染组相比,宫颈病变程度的差异均有统计学意义(P＜0.01);多元logitic回归分析显示,感染16型HPV(OR值2.94、95％CI:1.47～5.89,P＜0.01)使宫颈癌患病风险增加.结论 高危型HPV的多重感染是加重宫颈病变的重要因素,高危的16型HPV感染不但多见,而且使宫颈癌的患病风险增加.     

Bone lesions in malignant diseases--I. Current concepts of major pathogenetic mechanisms and forms

Bones are among the major parts of the body that are targeted in neoplastic diseases. Bone lesions increasing in number and size and diffuse osteoporosis are found in 30-80% of cancer patients. All literature data about the pathogenetic factors of osteolytic and osteosclerotic bone lesions are classified into four groups: 1. Directly connected with the neoplastic tumour mass. 2. Humoral interaction between the tumour cells and bone cells. 3. Systemic effects and complications of the neoplastic process. 4. Extracancerous factors. We discuss here the basic pathogenetic forms of bone lesions in neoplasias: 1. Local osteolysis in the area of neoplastic infiltration. 2. Humorally activated demineralisation with hypercalcemia. 3. Light chain osteomalacia. 4. Hypophosphatemic osteomalacia. We consider the major current biochemical markers of bone remodelling and their use in diagnosing and monitoring bone disease in neoplastic conditions.     

HPV单一与多重型别感染子宫颈病变风险比较

目的 对比HPV单一与多重型别感染者子宫颈病变风险,探索相应的管理模式.方法 回顾性总结2010年至2012年在北京大学第一医院妇产科同时行子宫颈细胞学与HPV检测且高危型HPV阳性妇女7 192例的临床资料,分析HPV高危型单一与多重型别感染者子宫颈癌前病变及浸润癌的相关性.结果 7 192例HPV高危型感染者中单一及多重型别感染率分别占75.88%及24.12%.在单一及多重型别感染者中,最常检出的型别均为16型,其次为58型、52型、53型.单一与多重型别感染者中细胞学高级别异常及以上占比分别7.81%及8.24%,两者无统计学差异(χ2=0.343,P=0.574),Logistic回归分析发现HPV16、31、33型别感染与细胞学高级别及以上异常具有相关性[OR分别为3.700(95%CI:3.048~4.492)、2.038(95%CI:1.568~2.647)、1.563(95%CI:1.110~2.201)].单一与多重型别感染者中CIN2+检出率分别为22.29%及23.04%,CIN3+检出率分别为11.72%及8.73%,两组感染者CIN2+检出无统计学差异(χ2=0.226,P=0.653),CIN3+检出有统计学差异(χ2=0.622,P=0.011),在HPV16、HPV16/18单一与多重型别感染者CIN2+检出均无统计学差异(χ2值分别为2.215、2.680,均P>0.05),CIN3+检出均有统计学差异(χ2值分别为0.622、11.112,均P<0.05),在非HPV16/18型单一及多重型别感染者CIN2+、CIN3+检出均无统计学差异(χ2值分别为2.747、0.199,均P>0.05).Logistic回归分析发现HPV 16型、单一型感染、细胞学异常及高级别异常与子宫颈病变CIN2+具有相关性[OR值分别为2.358(95%CI:1.934~2.874)、1.264(95%CI:1.020~1.566)、2.216(95%CI:1.779~2.761)、9.599(95%CI:7.728~112.575);HPV16、33型别感染、细胞学异常及高级别异常与CIN3+具有相关性[OR值分别为4.192(95%CI:3.102~5.665)、1.806(95%CI:1.183~2.757)、2.919(95%CI:1.360~2.708)、10.357(95%CI:7.545~14.215).结论 HPV多重型感染虽可导致更多的细胞学异常,但尚未导致更多的高级别细胞学异常;HPV单一型别、HPV16型别、16/18型别感染者的CIN3+风险增高,临床上应重视对这一人群的管理.     

The relationship between bone-loss of steroid-induced osteonecrosis and local expression of OPG/OCIF

OBJECTIVE: To probe the relationship between the osteoprotegerin/osteoclastogenesis inhibitory factor (OPG/OCIF) expression of bone and the relative bone-loss. METHODS: Steroid-induced osteonecrosis-model was reproduced in thirty-one new Zealand hares, and 24 ones were alive 3 days after administration of endotoxin and methylprednisolone. The alive creatures were divided into control group and trial groups randomly. After the creatures being executed, bone-density measurement of the femurs, HE staining, Ca(+ +) staining and OPG/OCIF immunohistochemistry staining were performed, followed by image processing and statistical analysis. RESULTS: In the early period of steroid-induced osteonecrosis, the local OPG/OCIF expression significantly decreased, with a large number of osteoclasts in the local medulla, followed by a progressively bone-loss. CONCLUSION: Corticosteroid could inhibit OPG/OCIF expression in the bone, increase the activity and differentiation of osteoclast relatively, and worsen bone-loss in steroid-induced osteonecrosis.     

A case of multiple intrahepatic portosystemic venous shunts associated with multiple hemangioma-like lesions of the liver

Intrahepatic portosystemic venous shunts (IPVS) are rare, except for the minute ones observed in cirrhotic liver. This report concerns a case with frequent episodes of consciousness loss, diagnosed as IPVS and multiple hemangioma-like lesions of the liver by US, CT and angiography. To our knowledge, this is the first report of association of IPVS and such angiographically evident hemangioma-like lesions of the liver. The etiology of IPVS is mostly considered to be congenital though, there are still many arguments about it. The relation between IPVS and the hemangioma-like lesions of the liver is discussed.     

Receptor activator of NF(Kappa)B ligand/osteoprotegerin (RANKL/OPG) system and osteopontin (OPN) serum levels in a population of apulian postmenopausal women

AIM: Osteoporosis is a bone disease, characterized by a reduction of bone resistance; in postmenopausal period bone metabolism is imbalanced. Several parameters have been proposed as markers of bone metabolism; the attention have been recently placed on the receptor of activator of NF(Kappa)B ligand receptor (RANKL) and osteoprotegerin (OPG), namely RANKL/OPG system. The aim of this paper is to evaluate changes in postmenopausal women in serum concentration of OPG, RANKL, and their ratio (i.e. RANKL/OPG ratio), osteopontin (OPN), bone-type alcaline phosphatase (BAP), serum-N-Telopeptide of type I collagen (serum-NTX); and their correlations with bone mineral density (BMD). METHODS: An Apulian population group of 163 native postmenopausal women were followed at the Osteoporosis Centre of Policlinico of Bari (Southenrn Italy). Patients were classified into 3 separate groups, according to T-score: osteoporotic, osteopenic and control group. Serum concentrations of OPG, RANKL, RANKL/OPG ratio, BAP and NTX have been calculated. RESULTS: No differences were found in OPG and BAP values. Significant correlations were found in the osteopenic group between OPG and RANKL (negative), and between RANKL and OPN or serum-NTX, OPN and serum-NTX or RANKL/OPG ratio, BAP and serum-NTX, serum-NTX and RANKL/OPG ratio (positive). In the other groups a significant correlation was observed between BAP and NTX. CONCLUSIONS: In postmenopausal women, important modifications of bone metabolism markers (i.e. RANKL, OPG and OPN) could be due to serious engagement of bone turnover, especially in the pre-osteoporotic phase. Low bone density in postmenopausal women should be identified as soon as possible, and urgent measures are needed to reverse the process. Parameters namely RANKL e OPG may become an important index for the evaluation of the activity of drugs against osteoporosis, old and new like AMG 162 (anti-RANKL action).     

Identification and assessment of work-related nervous system lesions

Short historical data on occupational neurotoxicology, as well as on the pathogenic mechanisms of the nervous system impairments due to occupational factors are described. The main difficulties in the assessment of peripheral and central nervous system lesions are stressed.     

HPV感染型别及多重感染对宫颈病变的影响

目的探讨人乳头瘤病毒(HPV)感染型别及多重感染对宫颈病变的影响。方法选取2016年2月-2018年2月于河南省人民医院行液基薄层细胞学检查-联合HPV-DNA检查的患者2 126例为研究对象。结果2 126例受检者中,HPV阳性者362例,阳性率17.03%,共检出17个亚型。HPV感染率最高的3种高危型分别为HPV16(2.92%)、HPV52(1.93%)和HPV56(1.88%),HPV感染率最高的低危型为HPV6(0.75%)。362例HPV阳性者中单一HPV感染322例,占15.15%,多重感染40例,占1.88%。未见上皮内病变或恶性细胞(NILM)、无明确诊断意义的不典型鳞状细胞(ASCUS)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)和反应性细胞改变伴随炎症分别占67.13%、12.15%、8.84%、2.76%和9.12%。慢性宫颈炎、低级别上皮病变、高级别上皮病变和浸润癌分别占65.19%、18.23%、10.50%和6.08%。不同宫颈病理分级患者HPV感染率不同。校准年龄因素后,HPV型别Logistic回归分析显示HPVl6和HPV18感染与浸润癌的关系较大(P<0.05)。结论 HPV16和HPV18能使宫颈病变的发展更快,HPV病毒感染的多寡与宫颈病变存在显著关系,宫颈癌HPV感染倾向于单一HPV感染。