Prediction of bone mass changes after successful parathyroidectomy using biochemical markers of bone metabolism in primary hyperparathyroidism: is it clinically useful?

ABSTRACT Objective To measure type 1 serum amino-terminal propeptide procollagen (P1NP) and type 1 cross-linked C-terminal telopeptide collagen (CTX) before parathyroidectomy (PTX) in PHPT patients, correlating these measurements with bone mineral density (BMD) changes. Subjects and methods 31 primary hyperparathyroidism (HPTP) were followed from diagnosis up to 12-18 months after surgery. Serum levels of calcium, parathyroid hormone (PTH) vitamin D, CTX, P1NP, and BMD were measured before and 1 year after surgery. Results One year after PTX, the mean BMD increased by 8.6%, 5.5%, 5.5%, and 2.2% in the lumbar spine, femoral neck (FN), total hip (TH), and distal third of the nondominant radius (R33%), respectively. There was a significant correlation between BMD change 1 year after the PTX and CTX (L1-L4: r = 0.614, p < 0.0003; FN: r = 0.497, p < 0.0051; TH: r = 0.595, p < 0.0005; R33%: r = 0.364, p < 0.043) and P1NP (L1-L4: r = 0,687, p < 0,0001; FN: r = 0,533, p < 0,0024; TH: r = 0,642, p < 0,0001; R33%: r = 0,467, p < 0,0079) preoperative levels. The increase in 25(OH)D levels has no correlation with BMD increase (r = -0.135; p = 0.4816). On linear regression, a minimum preoperative CTX value of 0.331 ng/mL or P1NP of 37.9 ng/mL was associated with a minimum 4% increase in L1-L4 BMD. In TH, minimum preoperative values of 0.684 ng/mL for CTX and 76.0 ng/mL for P1NP were associated with a ≥ 4% increase in BMD. Conclusion PHPT patients presented a significant correlation between preoperative levels of turnover markers and BMD improvement 1 year after PTX.

Biomarcadores de fibrosis y función ventricular derecha en maratonistas con distinto grado de entrenamiento: estudio en la maratón de Santiago / Fibrosis and right ventricular function biomarkers in marathon runners: a study at the Santiago, Chile marathon

Resumen: Introducción: Atletas altamente entrenados muestran cambios cardíacos estructurales como adaptación a la sobrecarga, producto del ejercicio repetitivo y extenuante. Se han evidenciado elevación de biomarcadores de remodelado y fibrosis miocárdica posterior al ejercicio intenso en atletas. Sin embargo, el comportamiento de estos biomarcadores según el nivel de entrenamiento previo no se ha evaluado. Objetivo: Investigar biomarcadores de fibrosis y función ventricular derecha en maratonistas con distinto nivel de entrenamiento previo. Métodos: Se incluyeron 36 maratonistas hombres, sanos, que completaron 42 km en la maratón de Santiago. Se dividieron según entrenamiento previo en dos grupos, Grupo 1 (G1): ≥100 km/semana y Grupo 2 (G2): <100 km/semana. Se realizó ecocardiografía transtorácica y se evaluaron niveles plasmáticos de galectina-3 y del propéptido amino terminal del procolágeno tipo III (PIIINP) en la semana previa a la carrera e inmediatamente posterior a ésta. Resultados: Posterior a la maratón, la función sistólica del ventrículo derecho disminuyó en el grupo G2 junto con un aumento significativo de los niveles plasmáticos de PIIIPNP (61±16 a 94±24 ng/mL, p=0,01). Estos cambios no se observaron en el grupo G1 (65 ± 11 a 90±29 ng/mL, p=0,10). Los niveles plasmáticos de galectina-3 aumentaron significativamente en ambos grupos posterior al ejercicio (6,8±2,2 a 19,7±4,9 ng/mL, p 0,012 y 6,0±1,1 a 19,4 ± 5,9 ng/mL, p 0,01) en los grupos G1 y G2, respectivamente). Conclusiones: Atletas con menor grado de entrenamiento, presentan posterior a una maratón un significativo aumento de productos de degradación del colágeno (PIIIPNP) asociado a disminución de la función del ventrículo derecho. Los niveles de galectina-3 plasmática aumentan significativamente en ambos grupos post-esfuerzo independiente del entrenamiento previo.

Abstracts: Introduction: Highly trained athletes show structural cardiac changes as adaptation to overload. Rise in remodeling biomarkers and myocardial fibrosis after intense exercise in athletes has been evidenced; however, the behavior of these biomarkers according to pre-competition training level has not been evaluated. Objective: To evaluate fibrosis biomarkers levels and right ventricle function in marathon runners according to their previous training level, in the period prior to a marathon race and immediately after it. Methods: Thirty-six healthy male marathon runners were included. Subjects were grouped according to their previous training level: Group 1 (G1): ≥100 km/week and Group 2 (G2): <100 km/week. Transthoracic echocardiography along with plasmatic levels of galectin-3 and amino terminal propeptide of type III procollagen (PIIINP) were measured one week previous and immediately after the marathon. Results: Post-effort right ventricle systolic function decreased in G2, together with a significant elevation of PIIIPNP (61±16 to 94±24 ng/mL, p=0.01). These changes were not observed in G1 (from 65±11 to 90±29 ng/mL, p=0.10). Plasma galectin-3 increased significantly in both groups immediately post-exercise (6.8±2.2 to 19.7±4.9 ng/mL, p=0.012, and 6.0±1.1 to 19.4±5.9 ng/mL, p=0.01, in G1 and G2. respectively). Conclusion: Less trained athletes evidenced higher post marathon levels of PIIIPNP which is associated with a decreased global right ventricle function. Plasma galectin-3 levels increased significantly after intense exertion regardless of the intensity of previous training.

Correlation Between Radiographic Area and Immunolocation of MMP-2 and MMP-9 in Unilocular Radiographic Lesions

Unilocular bone cysts are the most common entities affecting the maxillofacial region. The mechanism of proliferation and expansion remains unclear. Metalloproteinases (MMPs) are associated to diverse pathological conditions. The aim of the present study was to correlate the radiographic aspect (area) and the presence of MMP-2 and MMP-9 in dentigerous cysts, radicular cysts and keratocystic odontogenic tumors. The radiographic area of each lesion was calculated using the mathematical formula of the ellipse area. All specimens were subjected to immunohistochemical analysis for these enzymes. The average radiographic area was 284.17 mm2, 235.81 mm2 and 381.81 mm2, respectively. Statistical analyses revealed no association between the immunoreactivity of MMPs and radiographic area of the lesions in all pathologies studied, except for MMP-2 and radicular cysts, for which smaller lesions had increased immunostaining for this enzyme. The results demonstrate that quantities of MMP-2 and MMP-9 are especially involved with dentigerous and radicular cysts in expansion, whereas these enzymes seem to be related to the biological behavior of keratocystic odontogenic tumors, indicating invasion and cell proliferation. Moreover, there is an inverse association between MMP-2 and MMP-9 in keratocystic odontogenic tumors (p=0.03; rs=-0.660), indicating activity in different regions.

Cistos ósseos uniloculares são as entidades mais comuns que afetam a região maxilofacial. O mecanismo de proliferação e expansão permanece obscuro. As metaloproteinases (MMPs) estão associadas a diversas condições patológicas. O objetivo do presente estudo foi correlacionar o aspecto radiográfico (área) e a presença de MMP-2 e MMP-9 em cistos dentígeros, cistos radiculares e tumores odontogênicos queratocísticos. A área radiográfica de cada lesão foi calculada usando a fórmula matemática da área de elipse. Todas as amostras foram submetidas à análise imunoistoquímica para estas enzimas. A área radiográfica média foi de 284,17 mm2, 235,81 mm2 e 381,81 mm2, respectivamente. As análises estatísticas não mostraram associação entre a imunorreatividade de MMPs e área radiográfica das lesões em todas as patologias estudadas, exceto para MMP-2 e cistos radiculares, nas quais as lesões menores tinham maior imunomarcação para esta enzima. Os resultados demonstraram que a quantidade de imunomarcação da MMP-2 e MMP-9 estão envolvidos com cistos dentígeros e radiculares na expansão óssea, ao passo que estas enzimas parecem estar relacionados com o comportamento biológico dos tumores odontogénicos queratocísticos, indicando invasão e proliferação celular. Além disso, há uma relação inversa entre a MMP-2 e MMP-9 em tumores odontogénicos queratocísticos (p=0,03; rs= -0,660), indicando atividade em diferentes regiões.

Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV) paediatric patients (8-14 years) were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-β1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), hyaluronic acid (HA), procollagen type III amino-terminal peptide (PIIINP) and osteopontin (OPN), were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05). The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.

Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.

The effects of discontinuing long term alendronate therapy in a clinical practice setting / Efeitos da retirada do uso prolongado de alendronato na prática clínica

OBJECTIVE: To assess bone turnover markers (BTM) and bone mineral density (BMD) after discontinuation of alendronate treatment used for five or more years. SUBJECTS AND METHODS: 40 patients (pt) with post-menopausal osteoporosis treated with alendronate (10 mg/d) for at least five years (Group 1, G1) had their medication discontinued. Group 2 (G2): 25 pt treated with alendronate for at least one year. Group 3 (G3): 23 treatment-naïve osteoporotic pt. BMD was evaluated in G1 and G2 at baseline and after 12 months. Collagen type I cross-linked C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) levels were measured in all pt at baseline, and in G1 and G2 every three months for 12 months. Data were analyzed using ANOVA on ranks and Mann-Whitney tests. RESULTS: Mean BMD values in G1 and G2 did not differ during follow-up. However, 16 pt (45.7 percent) in G1 and one (5.2 percent) in G2 lost BMD (P < 0.001). BTM at baseline was not different between G1 and G2, and both were lower than G3. A significant increase in BTM levels was detected in G1 pt after three months, but not in G2. CONCLUSION: Observed BMD loss and BTM rise after alendronate withdrawal imply that bone turnover was not over suppressed, and alendronate discontinuation may not be safe.

OBJETIVO: Avaliar a evolução dos marcadores de metabolismo ósseo (MMO) e da densidade mineral óssea (DMO) após cinco anos de uso de alendronato em mulheres osteoporóticas na pós-menopausa. SUJEITOS E MÉTODOS: 40 pacientes (pct) osteoporóticas, na pós-menopausa, em uso de alendronato (10 mg/dia) por pelo menos 5 anos (Grupo 1 − G1) tiveram o uso do bisfosfonato suspenso. O grupo 2 (G2): 25 mulheres na pós-menopausa, em uso de alendronato (10 mg/dia) há pelo menos 1 ano. Grupo 3 (G3): 23 pct osteoporóticas, controles ainda sem tratamento. G1 e G2 submeteram-se à avaliação da DMO por DXA (basal e após 12 meses de seguimento). Todas as pct colheram amostras basais de CTX e P1NP, e G1 e G2 submeteram-se a coletas trimestrais de CTX e P1NP durante 1 ano. Resultados foram analisados por ANOVA on ranks e Mann-Whitney. RESULTADOS: Níveis médios de DMO não variaram em G1 ou G2 durante o estudo; no entanto, 16 pct (45,7 por cento) no G1 e 1 pct (5,2 por cento) no G2 apresentaram redução clinicamente significativa de DMO (P < 0,001). Níveis basais de CTX e P1NP não diferiram entre G1 e G2, com ambos inferiores aos níveis de G3. Em G1, observou-se elevação significativa de CTX e P1NP após 3 meses. Os níveis de CTX e P1NP em G2 permaneceram estáveis durante todo o seguimento. CONCLUSÃO: Não parece haver supressão excessiva do metabolismo ósseo na prática clínica. A suspensão temporária do alendronato após seu uso prolongado pode não ser segura.

Use of the plasma CTX for assessing the bone activity of the mandible among osteopenic and osteoporotic patients

The aim of this study was to determine whether the plasma CTX bone remodeling marker is useful for indicating the bone metabolic activity level of the mandible. Thirty-six patients were selected; all were postmenopausal and aged 50 years or over. In accordance with the WHO criteria for osteoporosis, a control group was set up (n = 10) in which the T-score was greater than -1 and a diseased group with T-score less than -1. Using MDP-99mTc samples, the radioisotope uptake in the femoral neck (R2) and mandibular body (R1) was analyzed. A third examination was performed using the plasma CTX biochemical bone-modeling marker. The inferential results for the diseased group showed that Ln(R1) presented a statistically significant linear relationship with Ln(CTx) (p = 0.067) and with the T-score (p = 0.018). The plasma CTX bone remodeling marker is useful for monitoring the bone metabolic activity of the mandible.

Noninvasive serum markers: liver fibrosis staging among hepatitis C virus infected patients

Accurate monitoring of changes in fibrosis would be helpful in defining the need for intervention, and the response to treatment. In this case control study we aimed to evaluate the diagnostic utility of different serum markers and indices in detecting the stage of fibrosis in order to recommend the most accurate and efficient serum marker to be used in routine clinical practice to replace or minimize the use of liver biopsy. A written informed consent was collected from all patients and the study was approved by the ethical committee; thirty FICV infected patients admitted to Alexandria University hospital were enrolled together with fifteen healthy adults as controls. Initial liver biopsy was done to assess the degree of liver fibrosis. Laboratory work up included all routine liver tests, estimation of Hyaluronic acid level, Matrix metalloproteinase[MMP-1], Aminoterminal propeptide type III procollagen [PIIINP]. Marker Algorithms based on common laboratory tests included AST-to-platelet ratio [APRI score], AST-to-ALT ratio, Fibro test, Actitest. Forn's index, Shasta index and hepascore were calculated together with PIIINP/MMP-iscore. A statistically significant increase in ALT, AST, Hyaluronic acid and PIIINP, as well as APRI score, Hepascore and Shasta score was found among HCV patients compared to controls p<0.05; while MMP-1, Forn's score, fibrotest were not significantly different between both groups. Comparing serum markers with METAVIR fibrosis stage we found that PIIINP, APRI score, Forn's score and ALT/AST ratio were significantly correlated to Metavair fibrosis stage in groups with no or early fibrosis while MMP-l, Shasta score, 1-lepascore and Fibrotest were significantly correlated to late stages of fibrosis P<0.05. When using a calculated stepwise logistic regression analysis; a manual score equation for fibrosis has emerged; where F0F1 vs F2F3F4 score=-0.60 log MMP-l+ 0.936 log PIIINP and F0F1F2 vs. F3F4 score=-0.421 log MMP-l-0.272 log PHINP. These equations yielded different cut off scores which were applied in order to estimate two clinically relevant fibrosis stages in patients, FOFI versus F2F3F4 termed "significant fibrosis" and FOFIF2 versus F3F4 or "extensive fibrosis". A score below 0.2 observed in 23 patients [76.7%] excluded the presence of extensive fibrosis [F3F4] with negative predictive values of 99% and 86% respectively. A combination of markers as well as indices is an emerging tool for differentiating early from advanced fibrosis. PIIINP, APRI, Forn's score and ALT/AST ratio were significantly correlated to Metavair fibrosis stage in no or early fibrosis group. While Shasta score, HA, Hepascore, Fibrotest and MMP were significantly correlated to late stages. Fibrotest was of significant value for detecting early as well as significant fibrosis, but poor at predicting intermediate levels of fibrosis. Shasta score, APRI score and Forn's score showed AUC 1.0 with a sensitivity of 100% and specificity of 100% to exclude the presence of significant fibrosis. Liver biopsy may still be needed for chronic HCV cases to correctly stage liver fibrosis

Serum leptin and biochemical markers of bone remodeling in osteoporotic postmenopausal women before and after antiresorptive treatment

To assess changes in the leptin and biochemical markers of bone remodeling in osteoporotic postmenopausal before and after antiresorptive treatment. Gynecology and Obstetrics Departments, Faculty of Medicine, Mansoura University. This study included sixty three postmenopausal women. They had hone mineral density and T-score more than 2 SD below normal healthy premenopausal women. In addition twenty normal premenopausal women 'were included as a reference group. The postmenopausal osteoporotic women were subdivided into three groups according to treatment modalities: group I: hormone replacement therapy [HRT]. Group II: alendronate therapy, and group III: combined HRT and alendronate. Blood and urine samples were collected from all groups before and 12 months alter treatment. Serum osteocalcin and leptin were measured by enzyme immunoassay while urinary deoxpyridinoline [Dpyr] was measured by chemiluminescence method. Bone alkaline phosphatase was determined by using agarose gel ectrophoretic method. Serum N-terminal propeptide of type procollagen [PINP] and serum C-terminal telopeptide of type I collagen [ICTP] were measured by radioimmunoassay. Total and bone alkaline phosphatase, usteocalcmn, serum ICTP, deoxypyridinoline and leptin were significantly increased while hone mineral density, T-score, calcium, inorganic phosphorus and serum PINP were significantly decreased in postmenopausal women in comparison to premenopausal healthy women. Serum leptin, osteocalcin, serum ICTP and urinary deoxypyridinoline were significantly decreased while serum PINP and bone mineral density significantly increased after treatment with HRT. aicadronate or combined HRT and alendronate for 12 months. Urinary deoxypyridinoline [marker or of bone resorption] showed most significant change [-60%] followed by serum PINP [marker of bone formation] [53.5%] during antiresorptive treatment. Serum leptin showed significant positive correlation with body mass index. osteocalcin. ICTP and deoxypyridinoline and significant negative correlation with serum PINP. body mineral density and T-score while hone alkaline phosphatase showed no significant correlation with leptin-Leptin has a regulatory role for hone formation in postmenoPausal wonton and those with high bone turnover could profit more from antiresorptive treatment than women with low or normal bone turnover

Serum levels of bone-specific alkaline phosphatase and procollagen type I carboxyterminal peptide in vitamin D deficiency.

Vitamin D deficiency in adults causes osteomalacia where there is a defect in bone mineralization resulting in an excess of unmineralised osteoid in the bone matrix. The aim of this study was to evaluate the markers of bone formation: total (TALP), bone-specific alkaline phosphatase (BSALP) and procollagen type I carboxyterminal peptide (PICP) in vitamin D deficiency. We studied 100 vitamin D deficient subjects and 82 gender-matched controls. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D level of less than 7 ng/ml, and greater than 10 ng/ml for normal controls. Serum TALP assay was performed by a standard automated method, BSALP and PICP were measured by enzyme immunoassays (Metra Biosystems) and vitamin D by radioimmunoassay. There was significant difference in the TALP between female vitamin D deficient and control subjects (mean +/- sem = 99.8 +/- 8.2 vs 70.5 +/- 2.8 iu/l, p<0.001). Elevated serum TALP (>130 iu/l) was found in 20% (20/100) of the vitamin D deficient patients. There were no significant differences in BSALP or PICP between vitamin D deficient patients and gender-matched control subjects. There was no correlation between vitamin D and PICP in patients but in control subjects, a significant negative correlation (r= -0.431, p<0.0001) was found. In conclusion, although elevated TALP was observed in a minority of vitamin D deficient patients, it is a better marker than PICP. The lack of PICP response in vitamin D deficient subjects suggests the possibility of vitamin D deficiency leading to a block in osteoblast differentiation.

Correlation between serum procollagen-IC end terminal peptide [PCICP] levels and bone mineral density measurements in hormone treated and untreated postmenopausal women

This study aimed to compare bone mineral density measurements [BMD] and serum procollagen-1C end terminal peptide [PC1CP] level in untreated and hormone treated postmenopausal women. A cross-sectional study compared the biophysical BMD and biochemical PC1CP parameters in a group of untreated postmenopausal women [n = 50] with a group of postmenopausal women on hormone replacement therapy [HRT] [n = 35]. The results showed that the untreated postmenopausal women had higher osteoblastic and osteoclastic activity than postmenopausal women on HRT. PC1CP was 11.3% lower in the women on HRT compared with controls. The difference in bone density of L2-L4 between the two groups was 16.1%. So, it was concluded that postmenopausal women receiving HRT readjusted their bone remodeling so that although osteoblastic function was reduced, there was much greater deduction in osteoclastic function which resulted in an overall higher bone mass observed in the BMD of women on HRT

Serum laminin, hyaluronan, and procollagen Ill: diagnostic and prognostic markers in liver cirrhosis

This work was carried out on 30 patients with liver cirrhosis and ten normal subjects, age and sex matched, served as controls. The patients were classified according the Child and Turcotte [Child A: n=16 Child B: n=6. Child C: n=8]. Serum laminin, hyaluronan, and type III procollagen were determined to evaluate their role as diagnostic and prognostic markers in inducing major severe complications in liver cirrhosis. The serum laminin, hyaluronan, and type III procollagen were significantly elevated in liver cirrhosis patients compared to controls and this elevation increased with more advanced Child stage. Also there was a positive correlation, between these parameters and esophageal varices and the occurrence of major complications in liver cirrhosis. We can concluded that serum laminin, hyaluronan and procollagen III are useful, and noninvasive parameters in patients with liver cirrhosis and as clinically important markers in addition to Child classification for deterioration of liver cirrhosis

Sensibilidad de los marcadores del remodelamiento óseo: su modificación en la menopausia, ante la terapia estrogénica de reemplazo y ante una enfermedad metabólica generalizada / Markers of bone turnover, their sensibility to bone remodeling: changes in menopause, in hormone replacement therapy and in a metabolic bone disease

Evalua una batería de marcadores bioquímicos específicos y sensibles para predecir cambios en la velocidad del remodelamiento óseo. Se estudió a mujeres sanas pre y postmenospáusicas y en estas últimas a su vez se evaluó los cambios producidos después de 90 días de una terapia hormonal de reemplazo. Respecto de los marcadores bioquímicos de formación, la FA total aumentó en las postmenospáusicas respecto del grupo premenospáusico (P < 0,0001), al igual que la BGP (1 < 0,01); en cambio, la FA ósea no registró cambios significativos. Luego de la terapia hormonal de reemplazo ninguno de estos marcadores registraron cambios significativos. Todos los marcadores de resorción aumentaron en als mujeres postmenospáusicas. Los convencionales tales como el calcio urinario/creatinina y la hidroxiprolina con un p < 0,01 y p < 0,006 respectivamente. Los nuevos marcadores de resorción presentaron los siguientes cambios: Pyr p < 0,001; 72 por ciento; D-Pyr p < 0,003, 27 por ciento y Crosslaps p < 0,003, 70 por ciento de aumento respectivamente. Ante la terapia estrogénica, si bien los marcadores convencionales no mostraron diferencias significativas respecto del nivel basal, la Pyr disminuyó significativamente en un 15 por ciento (p < 0,03), la D-Pyr en un 15 por ciento (p < 0,04) y los Crosslaps en un 39 por ciento (p < 0,001). También se investigó la precisión diagnóstica de los marcadores bioquímicos en pacientes con un remodelamiento óseo aumentado, como es el caso de enfermedades celíacas. Estas se compararon con los normales que presentaban igual estado estrogénico observándose distintos comportamientos entre pre y postmenospáusicas. La BGP aumentó sólo en las celíacas premenospáusicas (p < 0,003). La FA total en los dos grupos estrogénicos (p < 0,0001 y p < 0,005 respectivamente), al igual que la FA ósea (p < 0,0003 y p< 0,0004, respectivamente). El marcador de resorción D-Pyr no presentó diferencias significativas en ninguno de los dos grupos, la Pyr sílo en las premenopáusicas (p < 0,01). La hidroxiprolina aumentó en ambos (p < 0,04 y p < 0,004, respectivamente), al igual que los Crosslaps (p < 0,001 para los dos grupos estrogénicos)

Serum procollagen peptide III in diabetes mellitus

Serum levels of procollagen peptide type III [P-Ill-P] were estimated in 65 diabetics of both types [I and II] with and without complicating macro - and / or microangiopathy. There was a significant increase in the mean serum level of P-Ill-P in patients with diabetic macroangiopathy compared to those without macroangiopathy denoting increased collagen deposition in the large arteries by the time of development of macroangiopathy. Mean serum level of P-Ill-P was significantly higher in patients with type II diabetes who had macroangiography and were under insulin than in patients who were under oral hypolycaemics. As insulin stimulates glycogen synthetase activity, which enhances collagen synthesis by fibroblasts, the insulin dependent fibroblast sensitization may play a role in the progression of macroangiopathy. A correlation was found between mean serum P-Ill-P and the duration of type I diabetes suggesting that serum P-Ill-P may represent a marker for the presence of long term complications in diabetics, particularly macroangiopathy

Serum iron and type III procollagen peptide [PIIINP] in patients with chronic viral hepatitis and their relation to the disease activity

We studied thirty patients with chronic viral hepatitis [15 had hepatitis B virus and 15 had hepatitis C virus infection] and 10 normal healthy volunteers as a control group. They were investigated by procto-sigmoidoscopy, abdominal ultrasonography, liver biopsy and fasting blood samples were taken to assess, serum iron, total iron binding capacity [TIBC], serum type III procollagen [PIIINP], Alanine aminotrransferase [ALT], Asparate aminotransferase [AST], alkaline phosphatase and serum bilirubin. The results did show a high level of both serum iron and PIIINP in patients with chronic as compared to the control group. No correlation was found between serum iron and either PIIINP or aminotransferases, but significant correlations were found to both alk. phos. and bilirubin. A positive correlation was found between PIIINP and ALT indicating that PIIINP a know marker for liver fibrogenesis might be a maraker for disease activity. inspite on the finding of absent relation between serum iron and disease activity in patients with chronic viral hepatitis, the high serum levels of iron in these patients needs further studied to evaluate its clinical significance

Procollagen III peptide and laminin as serum markers of diabetic retinopathy

Sixty two diabetic patients [44 NIDDM and 18 IDDM patients] and twenty control subjects were subjected to estimation of serum fructosamine, serum procollagen III peptide [PIIlP] and serum laminin. Patients were classified according to fundus examination into either those without retinopathy or with background [BGR] or with proliferative [PR] retinopathy. Serum fructosamine was elevated in all diabetics. PIIlP was significantly higher in patients with PR than controls or patients with BGR. Elevation of serum laminin was noticed in all diabetics than controls except in IDDM patients without retinopathy but the difference between patients with and without retinopathy was not significant. Both serum level of laminin and PIIlP were found significantly elevated in NIDDM who received insulin. There was significant correlation between serum PIIlP and laminin with the duration of diabetes and with each other. There was no correlation between either PIIlP and laminin and fructosamine. As a conclusion, estimation of serum PIIP may be of value as a marker of diabetic retinopathy. Serum laminin level does not help to differentiate between diabetic patients with and without retinopathy. Insulin treatment increases the levels of both serum laminin and PIIIP

Serum procollagen III and serum laminin P1 in childhood acute rheumatic fever

The study included 35 cases of acute rheumatic fever [21 cases with carditis, 6 cases with arthritis and 8 cases with carditis and arthritis], aged 5-15 years and 15 healthy age matchable children as controls. Both cases and controls were subjected to thorough history, complete clinical examination, complete blood count, E.S.R. determination, estimation of antistreptolysin 0 titre, plain X-ray chest and heart, and determination of serum procollagen III and serum laminin P1. All the cases as well as the different subgroups studied of rheumatic fever had significantly lower serum procollagen III and significantly higher serum laminin P1 than controls. Serum laminin P1 was significantly higher in cases with cardiomegally than cases without cardiomegally. Cases with double mitral lesions showed significantly higher serum laminin P1 than cases with isolated mitral regurge. Serum laminin P1 was a sensitive indicator in carditis [95.2%], in carditis with arthritis [62.5%], and in arthritis [50%]

Serum procollagen type III-peptide in healthy normal subjects and its importance in hepatic patients

Blood samples were collected from healthy normal and hepatic subjects in order to estimate the level of serum procollagen type III- peptide [by RIA technique] as well as liver function tests. Hepatic patient samples were classified into two groups according to the stage of liver injury i.e. early and late phase. Our data revealed that there is a close relationship between the level of serum procollagen and the stage of liver disease. It could be used as a good marker for the differentiation between the two phases of hepatic injury which should helps the treatment of these patients