破骨细胞相关因子在骨再建过程中表达的定量分析

目的 研究肿瘤坏死因子-α（TNF-α）、核因子-?资B受体激动剂（RANKL）、抗酒石酸酸性磷酸酶（TRAP）在骨再建过程中的表达。方法 用8周龄雄性C57BL/6J小鼠建立骨折模型,用RT-PCR法对骨形成过程中TNF-α、RANKL和TRAP的表达进行时程分析。结果 骨折后TNF-α、RANKL、TRAP的表达均上调, 但峰值在不同的时间点出现。TNF-α在骨折后2 d达峰值, RANKL的峰值出现在骨折5 d后, 而TRAP的表达在骨折后10 d达到峰值。结论 骨的再建也有破骨细胞相关因子的参与, 它有赖于成骨和破骨的精确平衡。     

Effect of activity reminiscence therapy as brain-activating rehabilitation for elderly people with and without dementia

Background: Preventing the progression of dementia is a widespread challenge. However, currently there is limited evidence supporting the effectiveness of dementia rehabilitation. Methods: We practiced activity reminiscence therapy (ART) as brain‐activating rehabilitation for both lucid and demented persons (n = 18) in a day‐service setting as well as in a group home. The ART sessions were conducted 1 hour every week for 12 weeks (intervention period). We compared the results of three cognitive tests (the Mini‐Mental State Examination, the Kana Pick‐out test and the ‘logical memory’ component of the Wechsler Memory Scale‐Revised) and four behavior and caregiver's burden scales (the Clinical Dementia Rating, the Multidimensional Observation Scale for Elderly Subjects, the Dementia Behavior Disturbance scale and the Zarit Caregiver Burden Interview) conducted during the control period with those taken during the intervention period. At the end of the intervention period, we interviewed the staff and families individually to assess whether the participants seemed to have changed after intervention and, if so, how. Results: In cognitive tests, only immediate and delayed recall of the Wechsler Memory Scale‐Revised showed significant improvement. None of the four behavior and caregiver's burden scales showed any significant changes after intervention. However, the interviews showed improvements in subjective aspects of communication, interaction and behavior. Conclusion: ART uses old‐style tools. The nostalgia brought about by using these familiar tools led to effective recall of experiences, in which the participants taught the staff how to use the tools, which were unfamiliar to the staff. Through this role‐reversal, they gained a sense of self‐worth and a desire to live. Due to the reconstructed relationship between participants and caregivers, we consider ART to be effective in maintaining and improving emotional functions, activities of daily living and memory. ART should be useful for both lucid and mildly demented persons as brain‐activating rehabilitation therapy.     

Effective treatment of the anaemia associated with multiple myeloma by recombinant human erythropoietin

We administered recombinant human erythropoietin to an anaemic patient with multiple myeloma (IgD, λ type) who had been dependent on blood transfusions. The recombinant human erythropoietin (60 units/kg) was given intravenously three times weekly and transfusion requirements, haemoglobin level, and reticulocyte responses were monitored. The patient had an increase in haemoglobin level and reticulocyte counts within 14 days, and no longer needed transfusions. No organ dysfunction or other toxic effects were observed. We consider that recombinant human erythropoietin may be a new method to treat anaemia associated with multiple myeloma.     

Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis

We studied potential indicators of severe acute pancreatitis by measuring the blood concentrations of various cytokines, polymorphonuclear leucocyte elastase (PMN-E), acute phase reactants, pancreatic amylase (P-AMY), pancreatic elastase-1 (E-1) and white blood cell (WBC) counts in patients with acute pancreatitis. In addition, the presence of multiple organ damage was assessed. Subjects consisted of 22 patients with acute pancreatitis including severe (n= 11), moderate (n= 4) and mild (n= 7) cases. A significant positive correlation was observed between the number of organs damaged and the peak concentrations of interleukin (IL)-6, PMN-E, C-reactive protein (CRP) and pancreatic secretory trypsin inhibitor (PSTI). Among these markers, blood concentrations of PMN-E and IL-6 rapidly increased and peaked at the early phase of acute pancreatitis whereas CRP and PSTI did not. The elevation of PMN-E and IL-6 was greater the more severe the symptoms. However, no significant correlation was observed between the number of organs damaged and the maximum serum concentrations of P-AMY and E-1, or the WBC count, which have been considered to be markers of pancreatitis. These results suggest that PMN-E and IL-6 concentrations are useful indicators of severity and prognosis and their determination facilitates the selection of appropriate treatment in the early stages of disease to prevent the aggressive progression of acute pancreatitis.     

Two Cases of Malignancy-Associated Hypercalcemia Treated with Mithramycin

The hypocalcemic effect of mithramycin, an antitumor antibiotic,was studied in two consecutive hypercalcemic patients with malignancy.Case 1 was a 60-year-old woman with advanced breast cancer.Severe, generalized bone metastasis seemed to be the cause ofthe hypercalcemia. Serum calcium levels reached 14.6mg/dl (ionizedcalcium 3.84 mEq/I) despite continued therapy with saline (5liters/day) with frosemide (60mg/day, intravenously), high dosesof elcatonin (up to 440 MRC units/day) and prednisolone (30mg/day). Case 2 was a 49-year-old woman with recurrence of ovariancancer. Bone metastasis was not found on X-ray films. Hypercalcemiawas progressive in spite of extensive treatments with saline(2 liters/day) with frosemide (40 mg/day), indomethacin (150mg/day), elcatonin (160 MRC units/day) and prednisolone (30mg/day). Meantime, serum calcium rose to 14.6mg/dl (ionizedcalcium 3.57 mEq/I). In both cases, mithramycin (1.25 mg) wasthen administered intravenously. Serum calcium levels droppedto 9.6 and 9.4 mg/dl two days after the administration of mithramycinin case 1 and case 2, respectively. These observations indicate that mithramycin is more effectivethan any other drug tested for the treatment of hypercalcemiacaused by malignancy irrespective of the presence or absenceof bone metastasis. Therefore, it should be widely used forhypercalcemic emergency.     

Morphological Features and Physical Analysis of Causative Factors

Materials from 213 autopsy cases collected by the Pathology Team of the Special Committee for Investigation of Effects of Atomic Bombs, the National Science Council of Japan, were reviewed and sequence of the events, especially in the bone marrow from cases dead between a few days and 120 days after the exposures, was discussed in the light of newer knowledges in radiation pathology. The regeneration of the hematopoiesis in the irradiated bone marrows appeared to initiate from some surviving differentiated marrow cells and not from the so-called stem cells. Distorsion of the bone-marrow structures may have some bearing to abnormal regeneration, hyperplasia and neoplasia of the marrow elements.