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The purpose of the present study was to investigate the relationships among physical activity, metacarpal bone mineral density (BMD), and bone resorption marker in healthy active adult men. Seventy healthy men (mean age, 68.4 years, range, 48-85 years) were recruited. The metacarpal BMD of the nondominant hand was measured by computed X-ray densitometry, and the levels of urinary cross-linked N-telopeptides of type I collagen (NTx), as a marker of bone resorption, were measured with an enzyme-linked immunosorbent assay. The relationships among BMD, urinary NTx levels, and activities in leisure time and at work were examined. BMD was 2.77 +/-0.48 (mean+/- SD; range, 1.54-3.60) mmAl, and NTx levels were 44.9 +/-21.0 (range, 11.7 - 91.0) nmol BCE/mmol creatinine. Single regression analysis showed that BMD was significantly correlated with NTx levels and activity at work (r = - 0.331 and P < 0.01; r = 0.468 and P < 0.05, respectively), while NTx levels were significantly correlated with activities in leisure time and at work (r = -0.250 and P < 0.01; r = -0.325 and P < 0.01, respectively). NTx levels were decreased and BMD were increased with higher activity at work. The present study shows that increased physical activity as a result of hard work may have the potential to decrease bone resorption and increase BMD in healthy adult men.

We examined the effect of exercise training and detraining on bone mineral density (BMD) in postmenopausal women with osteoporosis. Thirty-five postmenopausal women with osteoporosis, aged 53-77 years, were randomly assigned to three groups: a control group (n = 20), a 2-year exercise training group (n = 8), and an 1-year exercise training plus 1-year detraining group (n = 7). Exercise training consisted of daily brisk walking and gymnastic training. Calcium lactate, 2.0 g, and 1alpha-hydroxyvitamin D3, 1 microg were supplied daily to all subjects. No significant differences in initial lumbar BMD, measured by dual-energy X-ray absorptiometry (DXA) were found among the three groups. The mean percent change in BMD compared with the baseline was significantly higher at 1 and 2 years in the exercise training group and at 1 year in the detraining group than in the control group, and did not differ significantly at 2 years between the detraining and control groups. These findings indicate that our exercise training program led to a significant increase in lumbar BMD in postmenopausal women with osteoporosis compared with the control, but that the BMD reverted toward a level that was not significantly different from the control with detraining. Continued exercise training is needed to maintain the bone mass gained through exercise training.

Metacarpal cortical bone mass was measured in 507 healthy Japanese men aged 40–95 years, using a microdensitometer to determine age-related changes in cortical bone in these middle-aged and elderly men. Total bone mass showed a significant negative correlation with age (r = −0.281; P < 0.0001). While bone width showed no significant correlation with age, bone marrow width showed a significant positive correlation (r = 0.210; P < 0.0001), and cortical bone width and cortical bone density showed a significant negative correlation with age (r = −0.265; P < 0.0001; r = −0.268; P < 0.0001, respectively). On the other hand, cortical bone width and cortical bone density showed a significant positive correlation with total bone mass (r = 0.814; P < 0.0001; r = 0.474, P < 0.0001, respectively). These findings suggest that cortical bone mass decreases significantly with aging in middle-aged and elderly men, perhaps as a result of two factors — decreased cortical bone width, ie, cortical bone thinning due to bone loss at the endosteal side of the cortex, and decreased cortical bone density due to progression of intracortical porosity. Cortical bone thinning may influence age-related cortical bone loss more than decreasing cortical bone density.

The effect of the combined administration of vitamin D3 and vitamin K2 on bone mineral density (BMD) of the lumbar spine was examined in postmenopausal women with osteoporosis. Ninety-two osteoporotic women who were more than 5 years after menopause, aged 55–81 years, were randomly divided into four administration groups: vitamin D3 (1α hydroxyvitamin D3, 0.75 μg/day) (D group; n = 29), vitamin K2 (menatetrenone, 45 mg/day) (K group; n = 22), vitamin D3 plus vitamin K2 (DK group, n = 21), and calcium (calcium lactate, 2 g/day) (C group; n = 20). BMD of the lumbar spine (L2–L4) was measured by dual energy X-ray absorptiometry at 0, 1, and 2 years after the treatment started. There were no significant differences in age, body mass index, years since menopause, and initial BMD among the four groups. One-way analysis of variance (ANOVA) with repeated measurements showed a significant decrease in BMD in the C group (P < 0.001). Two-way ANOVA with repeated measurements showed a significant increase in BMD in the D and K groups compared with that in the C group (P < 0.05 and P < 0.001, respectively), and a significant increase in BMD in the DK group compared with that in the C, D, and K groups (P < 0.0001, P < 0.05 and P < 0.01, respectively). These findings indicate that combined administration of vitamin D3 and vitamin K2, compared with calcium administration, appears to be useful in increasing the BMD of the lumbar spine in postmenopausal women with osteoporosis.

The effect of increased physical activity on bone mineral density (BMD) of the lumbar vertebrae was examined in postmenopausal osteoporotic women. Thirty-five postmenopausal women, aged 53-77 years, whose BMD in the lumbar vertebrae (L2-L4) measured by dual energy x-ray absorptiometry (Norland XR-26) was below (> 30%) the young adult mean, were divided into two groups: a control group of 20 women and an exercise group of 15 women. The physical exercise consisted of daily outdoor walking and gymnastic training performed for 12 months. During the study period, all subjects were treated with calcium lactate, 2.0 g, and 1 alpha-hydroxyvitamin D3, 1 microgram, daily. Initial L2-L4 BMD was 0.611 +/- 0.045 (mean +/- SEM) g/cm2 in the control group and 0.606 +/- 0.066 g/cm2 in the exercise group (NS). In the control group, the BMD changes were -0.54 +/- 0.58% (mean +/- SEM) at 6 months and +1.00 +/- 1.29% at 12 months, compared to the baseline (P = 0.3424, by oneway ANOVA). In the exercise group, however, the changes were +1.78 +/- 0.90% and +4.48 +/- 0.93%, respectively (P = 0.0305, by two-way ANOVA). These data suggest that increased physical activity consisting of daily outdoor walking and gymnastic training can be useful in increasing lumbar BMD in postmenopausal osteoporotic women on calcium and vitamin D3 supplementation.

The effect of moderate running exercise on tibial and lumbar vertebral bone mass was examined in mature osteopenic rats by bone histomorphometry. Ten 37-week-old female Wistar rats, with bone loss resulting from being fed a relatively low-calcium diet for 14 weeks after ovariectomy at the age of 23 weeks, were randomly divided into two groups of five animals each; control and exercise groups. The exercise consisted of treadmill running at 12 m/min for 1 h per day on 5 days per week for 12 weeks. During the exercise period, all animals were fed a standard calcium diet. After 12 weeks of exercise, bone histomorphometry was evaluated for cancellous bone (secondary spongiosa) of the proximal tibia and the fourth lumbar vertebra and for cortical bone of the tibial shaft. The findings suggested that in the mature osteopenic rat, there was a beneficial effect of moderate running exercise with adequate calcium intake on bone mass only in a weight-bearing long bone, the tibia. The mechanism for increased bone mass appeared to be both decreased bone resorption and increased bone formation in cancellous bone and increased bone formation in cortical bone.

Dual-energy X-ray absorptiometry (DXA) was used to examine the effects of quantitative application of treadmill running exercise on bone mineral density (BMD) of the tibia and the fourth and fifth lumbar (L4 + L5) vertebrae in mature osteopenic rats. Twenty 37-week-old rats with bone loss, resulting from feeding a relatively low calcium diet for 14 weeks after ovariectomy at the age of 23 weeks, were divided into four groups of five rats each according to the intensity and duration of the exercise: 12 m/minute, 1 h/day in group EX1; 18 m/minute, 1 h/day in group EX2; 12 m/minute, 2 h/day in group EX3; and sedentary control in group CON. With a standard calcium diet, the exercise was performed 5 days a week for 12 weeks, and the BMD of both the right tibia and the L4 + L5 vertebrae was measured using DXA at weeks 0, 4, 8, and 12. At the end of 12 weeks of exercise, the right femur and the L5 vertebra were dissected and the mechanical strength was measured using a three-point bending test and a compression test, respectively. After 12 weeks of exercise, a significant increase in the tibial BMD was observed in only group EX1 compared with that in group CON (p = 0.0039, by two-way analysis of variance). However, any significant increase in the L4 + L5 vertebral BMD was not observed in any exercise groups compared with that in the control group. While a maximum breaking force of the femoral shaft in group EX1 was significantly greater than that in group CON (p < 0.05, by Mann-Whitney's U-test), that in groups EX2 and EX3 did not significantly differ from that in group CON. However, there was no significant difference in a maximum breaking force of the L5 vertebral body among all the exercise and control groups. These results indicated that the beneficial effects of treadmill running exercise under a standard calcium diet were recognized only in the weight-bearing bones of the mature osteopenic rats resulting from estrogen deficiency and inadequate calcium intake only when an optimal level of exercise was applied.

The mechanism of age-related cortical bone loss was investigated in 229 Japanese women, 41-94 years of age, by metacarpal bone mass measurement. While no significant correlation was found between bone width and age, a significant increase in bone marrow width, and significant decreases in cortical bone density and total bone mass were observed in association with aging (P0.0001). There was a significant negative correlation between total bone mass and bone marrow width (r = -0.239; P0.0005), and significant positive correlations between both total bone mass and cortical bone density (r = 0.539; P0.0001) and cortical bone width (r = 0.839; P0.0001). The findings suggested that age-related cortical bone loss in middle-aged and elderly women resulted from two different factors; a decrease in cortical bone density caused by progression of intracortical porosity, and a decrease in cortical bone width as a result of bone loss on the endosteal surface. The latter had a greater influence on an age-related cortical bone loss than the former.

Abstract This paper presents fluid condensation behaviors around a well in a gas-condensate reservoir which are computed using a 2-Dimensional, 2-Phase compositional simulator of radial geometry. We discuss retrograde condensation behavior focusing on near a producing well. Effects of interfacial tension to relative permeabilities and effects of the gravity forces are taken account for in this study. The calculation program of phase behavior based on Soave Redlich-Kwong (SRK-EOS) was composed and was tested to match published laboratory data. Using real reservoir rock and fluid properties obtained from a reservoir offshore Sarawak in Malaysia, we demonstrates some predicted results of presumable retrograde condensation behaviors around a well. Introduction When we develop gas condensate reservoir it is important to predict condensate dropout around a wellbore because productivity of well stream gas is highly dependent upon the liquid saturation changes. It is more exaggerated especially for a rich gas reservoir which contains heavier components such as propane, butane, etc. Particularly in gas condensate reservoirs, the condensated liquid starts to accumulate around a production well when the flowing bottom hole pressure falls below the dew point of the fluid. The mobility of the fluid which consists of two phases as gas and condensated liquid is seriously decreased, and most of condensated liquid is left inpore space of the reservoir. This is the reason that the productivity is severely reduced. In this study we use SRK EOS which is one of the equations of state in the type of van der Waals to analyze p-v-T relationship. In this equation we use the method written by J. Richard Elliott et al. to obtain binary interaction coefficient. This parameter is used for mixing rule of SRK EOS parameter a, b. And to compute relative permeabilities, we use the method proposed by K.H. Coats. In this method we obtain relative permeability as a function of interfacial tension and saturation. The next chapter describes formulation for multicomponents, numerical simulator. The simulator is two-phase, two-dimensional radial model which represents vertical profiles around a wellbore including the effects of gravitational forces. The purpose of this study is to simulate the fluid behaviors around a production well for a condensate reservoir. Description of this model Kazemi et al. give detailed descriptions of compositional models for three phase, three dimensional flow in porous media. The method described by Kazemi is modified to the 2-D radial compositional model used in this study. The calculation of this model is carried out as following three steps. Step 1. At first properties of the reservoir (pressure, temperature, porosity, permeability, thickness, well radius, and effective radius, etc.), of the fluid (compositions, critical pressure, critical temperature, molecular weight and specific gravity, etc.) are given. The reservoir is supposed to be radial geometry with a well being at the center of it. The reservoir fluid flow in this model occur in the radial and vertical directions (Fig. 1). The compositions of the fluid are assumed to contain 11 components which are 9 hydrocarbons, C1, C2, C3, i-C4,.. C7+ and CO2, N2. Properties of the critical point for C7+ is given by Standing's Method. Step 2. In next step we solve phase behavior from input data. In this calculation SRK-EOS is used to compute vapor/liquid equilibrium and volumetric behavior of fluid. (1) Here is correction factor which is a function of accentric factor and a, b are parameter in SRK-EOS. Applying this equation for the mixture fluid, parameters a, b need to be corrected by binary interaction coefficients determined by J. Richard Elliott et al. Density and fugacity are given with compressibility factor which is calculated by SRK-EOS. Because the density is the weak point for this type of cubic equations, Peneloux et al. introduced a volume correction parameter for improving the volumetric prediction. We use the following method to improve density prediction. (2) where (3) P. 385^

Interest in cardiovascular protection by calcium channel antagonists has grown over the past decade. We investigated the prevention of cardiac remodeling and renal injury by the long-acting calcium channel antagonist benidipine using 12 week-old Dahl salt-sensitive (Dahl S) rats fed a high-salt (4% NaCl) diet. Six-week benidipine treatment (10mg/kg chow) decreased systolic blood pressure by 22% in Dahl S rats. This blood pressure reduction was associated with decreases in cardiac mass and weight of the aortic wall. Collagen content in the left ventricle tended to decline with benidipine treatment. In addition, glomerular filtration rate increased by 33% and arterial and glomerular lesions improved morphologically with this treatment. Regression of cardiac mass and collagen content in the left ventricle was due mainly to blood pressure reduction; however, collagen content in the low-pressure right ventricle was not only related to systemic blood pressure but to the severity of renal lesions. These data suggest that the calcium channel antagonist benidipine attenuates cardiac and renal injury in hypertensive Dahl S rats, and that part of the cardiac hypertrophy is due to a non-hemodynamic mechanism that might be responsible for, or be a consequence of, the lesions in the kidney. (Hypertens Res 1995; 18: 245-253)

Rheumatoid factor (RF), an autoantibody against the Fc portion of denatured IgG, has long been recognized as an important biologic marker not only for rheumatoid arthritis but also for other auto-immune diseases. In this study, we measured the level of serum RF in four patients with RF positive systemic vasculitis using laser nephelometry. Three patients were diagnosed as polyarteritis nodosa and the other patient was diagnosed as systemic vasculitis without the finding of typical necrotizing vasculitis from biopsies. In the result, we found that the level of RF paralleled the disease activity in these cases. When active phase of the disease, the level of RF showed very high, and after the treatment combined with plasmapheresis, corticosteroid and immunosuppressive agent, the level of RF decreased in accordance with CRP, ESR and clinical features. These suggested that RF was the disease specific marker for RF positive vasculitis and beneficial informations for proper diagnosis and better treatment could be provided by measurement of the level of RF in patients with RF positive systemic vasculitis.

A 43-years-old woman was admitted to the Hokkaido University Hospital because of high fever, muscle weakness and dyspnea in May 1993. She had has muscle weakness of upper extremities since December 1992. She had developed swollen hand, polyarthralgia and Raynaud's phenomenon. High fever and severe dyspnea developed in May 1993. Chest roentogenogram was normal in April 1993. Physical examination showed Velcro rales in both lower lung fields. Her laboratory data showed increased muscle enzymes, high titers of anti-nuclear-antibody (1: 1280) and anti-RNP-antibody (index 199.4 (normal7)). Anti-DNA, anti-Sm and anti-Jo-1-antibodies were all negative. Blood gas analysis showed severe hypoxemia. Chest roentogenogram revealed diffuse bilateral interstitial infiltrates prominent in the bases. Diagnosis of mixed connective tissue disease with acute interstitial pneumonitis was made. She was treated with steroid pulse therapy (methylprednisolone 1 g x 3 days) followed by high dose oral prednisolone (60 mg/day), and diffuse interstitial infiltrates disappeared within one week. Prednisolone could be tapered to 17.5 mg/day without relapse. Acute interstitial pneumonitis is a rare complication of mixed connective tissue disease, but may be life threatening. In such cases, high dose steroid therapy should be started without delay.

Hypovitaminosis D and K due to malnutrition or sunlight deprivation, increased bone resorption due to immobilization, low bone mineral density (BMD) and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease. The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease. PubMed was used to search the literature for randomized controlled trials (RCTs) regarding Parkinson’s disease and hip fractures. The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer. Five RCTs were identified and the relative risk and 95% confidence interval were calculated for individual RCTs. Sunlight exposure increased serum hydroxyvitamin D [25(OH)D] concentration, improved motor function, decreased bone resorption and increased BMD. Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration, strongly decreased bone resorption and increased BMD. Menatetrenone (vitamin K2) decreased serum undercarboxylated osteocalcin concentration, decreased bone resorption and increased BMD. Sunlight exposure (men and women), menatetrenone (women), alendronate and risedronate with vitamin D supplementation (women) significantly reduced the incidence of hip fractures. The respective RRs (95% confidence intervals) according to the intention-to-treat analysis were 0.27 (0.08, 0.96), 0.13 (0.02, 0.97), 0.29 (0.10, 0.85) and 0.20 (0.06, 0.68). Interventions, including sunlight exposure, menatetrenone and oral bisphosphonates with vitamin D supplementation, have a protective effect against hip fractures elderly patients with Parkinson’s disease.

We report the case of a 30-year-old Japanese woman with anorexia nervosa and vertebral fractures who was treated with etidronate. She had a history of anorexia nervosa, chronic back pain, osteoporosis, and multiple vertebral fractures (morphometric fractures) that responded poorly to treatment with alfacalcidol (1 μg daily) for 1 year and was treated with cyclical etidronate (200 mg for 2 weeks every 3 months) for 7 years. The lumbar spine bone mineral density (BMD) increased, and the serum alkaline phosphatase and urinary cross-linked N-terminal telopeptides of type I collagen levels and back pain decreased. During the 7-year period of treatment with etidronate, no osteoporotic fractures occurred. The patient experienced neither renal dysfunction nor hyperparathyroidism caused by osteomalacia. No gastrointestinal tract symptoms were observed. Thus, etidronate was effective for increasing the lumbar spine BMD and reducing back pain over a 7-year period without causing either osteoporotic fractures or adverse events.

Jun Iwamoto1, Yoshihiro Sato2, Tsuyoshi Takeda1, Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Neurology, Mitate Hospital, Fukuoka, JapanAbstract: The purpose of the study was to confirm the short-term outcome of conservative treatment in terms of the ability to return to play and factors influencing return to play in athletes with symptomatic lumbar disc herniation. A total of 100 consecutive athletes (72 male and 28 female) who consulted our sports medicine clinic during the 16-year period between September 1993 and October 2009 because of severe low back pain and/or leg pain/numbness due to lumbar disc herniation were studied. The mean age of the subjects was 23 years. All of them were conservatively treated by being advised to discontinue their sporting activities with/without short-term medication. After the subjective symptoms had reduced by more than 80%, individual training was started in order to allow the athletes to return to play. Seventy-nine athletes (79.0%) returned to play at an average of 4.8 months (range 1–12 months) after the start of treatment and were able to sustain the activities for at least 6 months, the minimum duration of follow-up in the study. The outcome of the conservative treatment was not influenced by the intensity of the sporting activity. Multiple logistic regression analyses showed that the severity of the symptoms prior to the start of treatment was the factor influencing the ability of the athletes to return to play. The present study confirmed the satisfactory short-term outcome of conservative treatment in athletes with symptomatic lumbar disc herniation regarding return to play and revealed that subjective symptoms prior to the start of treatment appeared to be a key factor in return to play after conservative treatment.Keywords: lumbar disc herniation, athletes, return to play, conservative treatment, sciatica, low back pain

AIM: To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS: We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS: During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION: The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

Recently, analytical formulas (1,2) of integration for the boundary element method (BEM) have been shown to be effective for the analysis of electric fields. However, these formulas can be applied only to isotoropic materials, not to anisotoropic materials. In practice, as with a liquid crystal, it is necessary to analyze anisotropic materials. But until now, to analyze anisotropic materials, we have had to use a numerical integration.

In this paper, an automatic mesh generator is proposed for the Boundary Element Method (BEM). The mesh generator can make a complicated shape from a few data on a personal computer by adopting the Constructive Solid Geometry(CSG) method [1]. Four primitives (a rectangular parallelepiped, an ellipsoid, a circular cone and a cylinder) have already been defined [2]. The objective shape can be constructed by logical operations (UNION, JOIN AND SUBTRACTION) among primitives having a simple mesh on it. Every primitive has an in-out function which judges whether some point is inside the primitive or not, because this is required to perform logical operations. However, figures such as spiral springs could not be produced from the previous primitives. A new added “Sweeping Primitive” is made by sweeping a two-dimensional (2D) figure and it enables us to make a great variety of figures.

Electronic devices such as capacitors, quartz oscillators and sensors are becoming smaller in recent electronic apparatuses. Controlling the electric characteristics of a device by its geometry is based on an accurate calculation of the electric-field where the device has many edges and materials of different natures in the body. This paper presents an example calculation of the electric field near the edges of dielectric materials. The field has singularity on the edge. In order to reduce the error of the analysis as much as possible, numerical techniques such as the multiplicity of flux variable[1], higher order elements and a performance index of potential error[2] are applied to this boundary element calculation.

Jun Iwamoto1, Atsushi Miyata2, Yoshihiro Sato3, Tsuyoshi Takeda1, Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Internal Medicine, Yahata Clinic, Tokyo, Japan; 3Department of Neurology, Mitate Hospital, Fukuoka, JapanAbstract: A retrospective study was conducted to evaluate the outcome of treatment with alendronate (ALN) for 5 years in postmenopausal Japanese women with an increased risk of fractures. Forty postmenopausal Japanese women with osteoporosis or osteopenia and clinical risk factors for fractures (mean age: 75.4 years) were analyzed; 33 patients were treated with alendronate and 7 were treated with alfacalcidol (ALF, controls) in an outpatient clinic run by general practitioners. The metacarpal bone mineral density (BMD) measured using a computed X-ray densitometer, urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of alkaline phosphatase (ALP) were monitored during the 5-year treatment period. The urinary NTX and serum ALP levels decreased significantly in the ALN group, compared with the ALF group. The metacarpal BMD was sustained in the ALN group but decreased significantly in the ALF group; the difference between these two groups was also significant. The present study evaluated the outcome of treatment with ALN for 5 years in postmenopausal Japanese women with osteoporosis or osteopenia and clinical risk factors for fractures. ALN successfully suppressed bone turnover and sustained the metacarpal BMD over the 5-year period of treatment in postmenopausal Japanese women with an increased risk of fractures.Keywords: alendronate, osteoporosis, osteopenia, risk factors for fractures, postmenopausal women

Purpose: The comparative effects of alendronate and alfacalcidol on bone mineral density (BMD) and bone turnover have already been established in postmenopausal women with osteoporosis. An open-labeled prospective study was conducted to compare the treatment effects of alendronate and alfacalcidol on hip BMD and bone turnover in Japanese men with osteoporosis or osteopenia with clinical risk factors for fractures. Materials and Methods: One hundred twelve men with osteoporosis or osteopenia with clinical risk factors for fractures (mean age: 71.4 years) were randomly divided into two groups of 56 patients each: the alendronate (5 mg daily) and alfacalcidol (1 µg daily) groups. The BMD of the total hip, urinary level of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of bone-specific alkaline phosphatase (BSAP) were measured during the 12-month-treatment period. Results: Forty-five patients in the alendronate group and 42 patients in the alfacalcidol group completed the trial. Alendronate increased BMD (+2.3% at 12 months) following reductions in the urinary level of NTX (-46.4% at 3 months) and serum level of BSAP (-34.1% at 12 months), while alfacalcidol sustained BMD (-1.9% at 12 months) as well as the urinary level of NTX (+13.2% at 3 months) and serum level of BSAP (+1.8% at 12 months). Conclusion: The present study confirmed that alendronate has better efficacy than alfacalcidol (active control) in increasing hip BMD and reducing bone turnover in Japanese men with osteoporosis or osteopenia with clinical risk factors for fractures.

Purpose: To compare the effects of alendronate and raloxifene on lumbar bone mineral density (BMD), bone turnover, and lipid metabolism in elderly women with osteoporosis. Subjects and Methods: One hundred twentytwo postmenopausal women with osteoporosis (mean age: 69.4 years) were randomly divided into 2 groups of 61 patients: the alendronate group and the raloxifene group. BMD of the lumbar spine, urinary level of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of alkaline phosphatase (ALP), total cholesterol (TC), high and low density lipoprotein cholesterols (LDL-C and HDL-C, respectively), and triglycerides (TG) were measured during the 12-month-treatment period. Results: The trial in 50 patients in the alendronate group and 52 patients in the raloxifene group could be completed. Both alendronate and raloxifene increased lumbar BMD (+8.0% and +2.4% at 12 months, respectively), followed by reductions of urinary NTX level and serum ALP level; however, the effects of alendronate were more pronounced than those of raloxifene. Only raloxifene reduced the serum levels of TC and LDL-C (-3.9% and -7.7% at 12 months, respectively), without any significant effect on the serum HDL-C and TG levels. Conclusion: The present study confirmed the efficacy of alendronate greater than raloxifene in increasing lumbar BMD through its effect on marked reduction of the bone turnover more than by raloxifene, and some beneficial effects of raloxifene on lipid metabolism in elderly women with osteoporosis.

Juvenile dermatomyositis (JDMS) is a relatively rare disease characterised by vasculopathy.1-4 Involvement of the gastrointestinal tract may occur in some subjects and is often life threatening. We describe here a case of fatal JDMS with gastrointestinal perforation. Immunohistochemical examination by antibody against factor VIII seems to be useful for evaluating the pathological basis of vasculopathy in JDMS. A 13 year old Japanese girl was admitted in April 1994 with high fever, muscle pain, and muscle weakness. She noticed a facial rash for two months before admission. Physical examinations were; blood pressure 135/90 mm Hg, temperature 38°C, and weight 50 kg. She presented with an erythematous rash on her face, neck and arms, heliotropic eruption, Gottron’s sign, and nail fold telangiectasia. Proximal muscular weakness and pain were prominent. Laboratory findings were as follows; stool occult blood negative, leucocyte count 5800/mm3, erythrocyte count 4800 × 103/mm3, thrombocyte count …

Vitamin K2 is widely used for the treatment of osteoporosis in Japan. To understand the effects of vitamin K2 on bone mass and bone metabolism, we reviewed its effects on the development of osteopenia in rats, which characterizes models of osteoporosis. Vitamin K2 was found to attenuate the increase in bone resorption and/or maintain bone formation, reduce bone loss, protect against the loss of trabecular bone mass and its connectivity, and prevent the decrease in strength of the long bone in ovariectomized rats. However, combined treatment of bisphosphonates and vitamin K2 had an additive effect in preventing the deterioration of the trabecular bone architecture in ovariectomized rats, while the combined treatment of raloxifene and vitamin K2 improved the bone strength of the femoral neck. The use of vitamin K2 alone suppressed the increase in trabecular bone turnover and endocortical bone resorption, which attenuated the development of cancellous and cortical osteopenia in orchidectomized rats. In addition, vitamin K2 inhibited the decrease in bone formation in prednisolone-treated rats, thereby preventing cancellous and cortical osteopenia. In sciatic neurectomized rats, vitamin K2 suppressed endocortical bone resorption and stimulated bone formation, delaying the reduction of the trabecular thickness and retarding the development of cortical osteopenia. Vitamin K2 also prevented the acceleration of bone resorption and the reduction in bone formation in tail-suspended rats, which counteracted cancellous bone loss. Concomitant use of vitamin K2 with a bisphosphonate ameliorated the suppression of bone formation and more effectively prevented cancellous bone loss in tail-suspended rats. Vitamin K2 stimulated renal calcium reabsorption, retarded the increase in serum parathyroid hormone levels, and attenuated cortical bone loss primarily by suppressing bone resorption in calcium-deficient rats while maintaining the strength of the long bone in rats with magnesium deficiency. These findings suggest that vitamin K2 may not only stimulate bone formation, but may also suppress bone resorption. Thus, vitamin K2 could regulate bone metabolism in rats, which represented the various models of osteoporosis. However, the effects of vitamin K2 on bone mass and bone metabolism seem to be modest.

Etidronate is an oral bisphosphonate compound that is known to reduce bone resorption through the inhibition of osteoclastic activity. The efficacy of etidronate for involutional (postmenopausal and senile) and glucocorticoid-induced osteoporosis, as well as that for other skeletal diseases, was reviewed in Japanese patients. Cyclical etidronate treatment (200 mg or 400 mg/day for 2 weeks about every 3 months) increases the lumbar bone mineral density (BMD) in patients with involutional osteoporosis and prevents incident vertebral fractures in patients with glucocorticoid-induced osteoporosis. The losses of the lumbar BMD in patients with liver cirrhosis and the metacarpal BMD in hemiplegic patients after stroke are prevented, and the lumbar BMD is possibly increased, preventing fragile fractures in adult patients with osteogenesis imperfecta type I. Furthermore, proximal bone resorption around the femoral stem is reduced and some complications may be prevented in patients who undergo cementless total hip arthroplasty. Oral etidronate treatment may also help to transiently relieve metastatic cancer bone pain followed by a decrease in abnormally raised bone resorption in patients with painful bone metastases from primary cancer sites, such as the lung, breast and prostate. Thus, oral etidronate treatment is suggested to be efficacious for osteoporosis, as well as other skeletal diseases associated with increased bone resorption, in Japanese patients. Randomized controlled trials needed to be conducted on a large number of patients to confirm these effects.

The purpose of this study was to determine factors that could predict the one-year response of the lumbar bone mineral density (BMD) to alendronate treatment in elderly Japanese women with osteoporosis. Eighty-five postmenopausal women with osteoporosis, all of whom were between 55-88 years of age, were treated with alendronate (5 mg daily) for 12 months. Serum calcium, phosphorus, and alkaline phosphatase (ALP) and urinary NTX levels were measured at the baseline and 6 months, and lumbar (L1-L4) BMD was measured by dual energy X-ray absorptiometry at the baseline and 12 months. Multiple regression analysis was used to determine factors that were correlated with the percent change in lumbar BMD at 12 months. Lumbar BMD increased by 8.1 % at 12 months with a reduction in the urinary NTX level by 51.0 % at 6 months. Baseline lumbar BMD (R2=0.226, p < 0.0001) and percent changes in serum ALP and urinary NTX levels (R2=0.044, p < 0.05 and R2=0.103, p < 0.001, respectively) had a negative correlation with the percent change in lumbar BMD at month 12, while the baseline number of prevalent vertebral fractures (R2=0.163, p < 0.001), serum ALP level, and urinary NTX level (R2=0.074, p < 0.05 and R2=0.160, p < 0.001, respectively) had a positive correlation with it. However, baseline age, height, body weight, body mass index, years since menopause, serum calcium and phosphorus levels, and percent changes in serum calcium and phosphorus levels at 6 months did not have any significant correlation with the percent change in lumbar BMD at 12 months. These results suggest that lumbar BMD was more responsive to one-year of alendronate treatment in elderly osteoporotic Japanese women with lower lumbar BMD, more prevalent vertebral fractures, and higher bone turnover, who showed a greater decrease in bone turnover at 6 months, regardless of age, years since menopause, and physique. Alendronate may be efficacious in elderly Japanese women with evident osteoporosis that is associated with high bone turnover, and the percent changes in serum ALP and urinary NTX levels at 6 months could predict the one-year response of lumbar BMD to alendronate treatment.

Vitamin K2, as well as bisphosphonates, such as etidronate, alendronate, and risedronate, is widely used in the treatment with osteoporosis in Japan. Etidronate increases the lumbar bone mineral density (BMD), and prevents new vertebral fractures, in patients with osteoporosis, while alendronate and risedronate increase the lumbar and femoral neck BMDs, and prevent new vertebral and femoral neck fractures. Vitamin K2 enhances gamma-carboxylation of bone glutamic acid residues and the secretion of osteocalcin, sustains the lumbar BMD, and prevents osteoporotic fractures in patients with osteoporosis. Bisphosphonates, such as alendronate and risedronate, rather than vitamin K2, should be initially chosen for the treatment of osteoporosis, because they are more efficacious than vitamin K2. Available evidence suggest that risedronate prevents deterioration of the connectivity of the trabeculae in ovariectomized rats, whereas vitamin K2 increase the trabecular thickness, and that a combination of risedronate and vitamin K2 has a synergistic effect on preventing the deterioration of trabecular bone architecture induced by estrogen deficiency. Some studies have shown that combined treatment with etidronate and vitamin K2 appears to be more effective than etidronate alone in the prevention of new osteoporotic vertebral fractures. Based on these findings, combined treatment with vitamin K2 and bisphosphonates may be more efficacious in the prevention new vertebral fractures than a single treatment with bisphosphonate in postmenopausal women with osteoporosis. Thus, this combined treatment should be recommended for the treatment of postmenopausal osteoporosis. It is proposed that the role of vitamin K2 should be emphasized, when used in combination with bisphosphonates, especially in patients with vitamin K deficiency.

The transmission characteristics of a 70 GHz transversely magnetized partially filled solid-plasma waveguide can be varied by irradiating the plasma material with a semiconductor laser. The experimental results are explained by the increase in the slow surface wave resonant magnetic field in the waveguide. These findings indicate the possibility of controlling the propagation characteristics of the slow surface wave in the solid-plasma waveguide by means of optical injection.

Since 1972, many prosthesis for the knee joint have been reported. They are, however, designed only for hinge and rolling functions neglecting the screw-home function. Surgical damage by massive bone resection would not permit secondary operation even if it is required and only osteosynthesis or hinge prosthesis are indicated thereafter. Musculo-tendinous stability being absolutely required on surgery, ligamentous transfer is often accompanyed in those prosthesis.In view of the above, we deviced a new functional endoprosthesis for the knee joint which satisfies all three functional phases of knee motion and maintains sufficient stability.The functional endoprosthesis (Keio type) is indicated for osteoarthritis, rheumatoid arthritis and some type of condylar fracture. Operative damage by this endoprosthesis is fairly less and secondly reconstruction using any type of similar prosthesis may still remain the treatment of second choice.

Three cases of circulatory disturbance with ulcer for mation in the pitching hand of baseball pitchers are reported. The pathophysiology was of an entirely new entity. In one case, the neurovascular bundles of the middle finger were entrapped by the proximal edges of Cleland's ligaments. In the other two cases, the blood vessels to the index and middle fingers were com pressed within the lumbrical canal. Hypertrophy of the lumbrical muscles and/or thickening of the palmar apo neurosis were responsible for the compression of the vessels. Surgical release of Cleland's ligaments or pal mar aponeurosis, including superficial transverse fiber and vertical septa, resulted in good recovery of the circulation of the involved fingers. All of the pitchers returned to professional or college league baseball with out recurrence of the ulcer.

Nylon membrane having hydrophilic poly(oxyethylene) side chains and cationic N+ sites was synthesized by allowing hydrophilic epoxy compounds containing ethylene glycol moieties to react with dimethylaminated Nylon 6 membrane. Amounts of cations and water content were varied by changing reaction time or kind of epoxy compounds. The membrane was further heparinized to obtain antithrombogenic membrane. The amount of heparin released from the membrane increased with increase in the water content of the membrane. The amount of heparin released from the membrane prepared by using bifunctional epoxy compounds was much smaller than that by monofunctional compounds.

In order to learn how pathological changes and symptoms of gonarthritis progress over a long period of time, we selected those cases having a history for over 10 years, in which the patient had not received surgical operation, as the subjects of our investigation.The subject cases including 96 joints were investigated to find out the correlations between the progress of pathological change and such factors as sex, age, obesity, occupation, way of living, type of toilet, hospital visit, or FTA (femoro-tibial angle) etc. The results were as follows:(1) Changes at the medial condyle get most easily aggravated, which are followed by those occurred at the patellofemoral joint and the aggravation is the least in changes at the lateral condyle.(2) Obesity as opposed to normal makes the grade of gonarthritis worse.(3) There are no correlations between aggravation of gonarthritis and age, sex, way of living or occupation.(4) In advanced cases, patients use western style toilets.(5) In advanced cases, patients visit hospital more frequently.