Suppression of NLRP3 inflammasome by ivermectin ameliorates bleomycin-induced pulmonary fibrosis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Ivermectin is a US Food and Drug Administration (FDA)-approved antiparasitic agent with antiviral and anti-inflammatory properties. Although recent studies reported the possible anti-inflammatory activity of ivermectin in respiratory injuries, its potential therapeutic effect on pulmonary fibrosis (PF) has not been investigated. This study aimed to explore the ability of ivermectin (0.6 mg/kg) to alleviate bleomycin-induced biochemical derangements and histological changes in an experimental PF rat model. This can provide the means to validate the clinical utility of ivermectin as a treatment option for idiopathic PF. The results showed that ivermectin mitigated the bleomycin-evoked pulmonary injury, as manifested by the reduced infiltration of inflammatory cells, as well as decreased the inflammation and fibrosis scores. Intriguingly, ivermectin decreased collagen fiber deposition and suppressed transforming growth factor-‍β1 (TGF-‍β1) and fibronectin protein expression, highlighting its anti-fibrotic activity. This study revealed for the first time that ivermectin can suppress the nucleotide-binding oligomerization domain (NOD)‍-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome, as manifested by the reduced gene expression of NLRP3 and the apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), with a subsequent decline in the interleukin‍-‍1β (IL‍-‍1β) level. In addition, ivermectin inhibited the expression of intracellular nuclear factor-‍κB (NF‍-‍κB) and hypoxia‑inducible factor‑1α (HIF‍-‍1α) proteins along with lowering the oxidative stress and apoptotic markers. Altogether, this study revealed that ivermectin could ameliorate pulmonary inflammation and fibrosis induced by bleomycin. These beneficial effects were mediated, at least partly, via the downregulation of TGF-‍β1 and fibronectin, as well as the suppression of NLRP3 inflammasome through modulating the expression of HIF‑1α and NF-‍κB.

Differences in perioperative outcomes after laparoscopic management of benign and malignant adnexal masses / 부인종양

OBJECTIVE: To compare the feasibility and safety of the laparoscopic management of adnexal masses appearing preoperatively benign with those suspicious for malignancy. METHODS: Retrospective study of 694 women that underwent laparoscopic management of an adnexal mass. RESULTS: Laparoscopic management of an adnexal mass was completed in 678 patients. Six hundred and thirty five patients had benign pathology (91.5%) and 53 (7.6%) had primary ovarian cancers. Sixteen patients (2.3%) were converted to laparotomy; there were 13 intraoperative (1.9%) and 16 postoperative complications (2.3%). Patients divided in 2 groups: benign and borderline/malignant tumors. Patients in the benign group had a higher incidence of ovarian cyst rupture (26% vs. 8.7%, p<0.05). Patients in the borderline/malignant group had a statistically significant higher conversion rate to laparotomy (0.9% vs. 16.9%, p<0.001), postoperative complications (1.9% vs. 12.2%, p<0.05), blood loss, operative time, and duration of hospital stay. The incidence of intraoperative complications was similar between the 2 groups. CONCLUSION: Laparoscopic management of masses that are suspicious for malignancy or borderline pathology is associated with an increased risk in specific intra-operative and post-operative morbidities in comparison to benign masses. Surgeons should tailor the operative risks with their patients according to the preoperative likelihood of the mass being carcinoma or borderline malignancy.

Experimental studies on cortical bone xenografts clinical and radiographical assessment

An autoclaved cortical bone xenografts of goat cadavers [ACXG] as well as fresh cortical autograft [control FCAG] were successfully used in reconstruction of an experimentally induced segmental femoral defect in canine model. Clinical and radiological assessments were carried out at different periods post-operatively. The obtained results were encouraging and very promising in terms of early return to full limb function at 4-6 weeks post-operatively, cortical union with remodeling were completed at 6 months post-operatively and complete acceptance and incorporation of the graft into the host bone was recorded at 12 months post-operatively. Hence the autoclaved cortical bone xenografts of goat cadavers can offer a worthwhile alternative fo fresh cortical autografts to veterinary orthopedists

CD95 and BCL-2 expression as apoptotic markers in rheumatoid arthritis patients

Dysregulation of apoptosis of the different immune cells including the peripheral blood mononuclea, cells [PBMNC], lymphocytes have been incriminated as a pathogenetic factor in rheumatoid arthrjts [RA]. CD95 [Fas] as a death receptor and Bcl-2 as an antiapoptotic protein are among the important factors responsible for controlling lymphocytes apoptosis. To assess the expression of CD95 and Bcl-2 as apoptotic markers in PBMNs in RA patients and correlate them with RA activity and functional capacity of RA patients. Twenty RA patients and 10 healthy controls were included in this study. All patients were maintained on 7.5 mg methotrexate /week and concomitant NSAIDs. All patients were examined clinically and disease activity measures including Ritchie articular index [RAI] and the number of swollen joints [SW44] were assessed and disease activity score [DAS] was calculated for each patient. Health assessment questionnaire [HAQ] was also determined. CD95 and Bcl-2 expression on the PBMNC were assessed in serum samples by flow cytometry in patients and controls, in addition to complete blood count, Rose Waaler test and ESR. Plain X-ray for both hands was also performed for all patients to detect joint erosions. The mean CD95 expression on PBMNC was significantly higher in RA patients compared to healthy controls [t=3.222, P= 0.004]. CD95 was also significantly and positively correlated with RAI, [DAS] and [ESR] [r=0.463, r=0.736, r=0.542 respectively and P<0.05 for all]. There was no statistically significant difference regarding the mean expression of Bcl-2 in RA patients and controls [t=0.122, P>0.05]. It did not also correlate with any of the studied variables. Increased CD95 expression on PBMNC in RA patients seems to be related to the inflammatory process [disease activity] in rheumatoid disease rather than to the apoptotic process as it is correlated with disease activity measures of the studied patients. Moreover, the normal expression of Bcl-2 in PBMNC indicated that the possibility of dysregulation of apoptosis in this study is unlikely

Evaluation of haemostatic mechanisms in the elderly

Aging is associated with changes in the haemostatic balance including coagulation, flbrinolytic and/or platelet activity. Adverse changes in coagulation and flbrinolytic factors are thought to contribute to the increased risk of cardio-vascular disease and atherothrombosis with age. In this study the aim was to determine how the biological factor of age affected coagulation, flbrinolytic factors and platelet glycoprotein receptors levels. In so doing the effect of age on the two important systems in the body involved in haemostasis namely, the coagulation and flbrinolytic systems was studied. The population studied consisted of ten young healthy controls aged 20 - 30 years representing [group I], twenty subjects aged 60 - 70 years [group II], twenty subjects aged 70 - 80 years [group III] and ten subjects above 80 years [group IV]. All groups were subjected to thorough history taking, complete clinical examination and routine investigations excluding obeses, hypertensives, diabetics, patients with chronic obstructive pulmonary disease [COPD] or ischemic heart disease and patients with peripheral vascular disease. Investigations of coagulation parameters [procoagulant markers] included prothrombin activity, estimation of flbrinogen level, Factor VII assay, Thrombin antithrombin [TAT] complex, Prothrombin fragment 1+2 [PF1+2]. Investigations of flbrinolytic system [flbrinolytic markers] included Tissue plasminogen activator [TPA] and tissue plasminogen activator- inhibitor [TPA-I], Flow cytometric investigation of platelet receptors, including platelet membrane glycoprotein GPIIb, Ilia, and GPIb. Prothrombin activity and TAT complex were found to increase with age but their differences between the aged groups and group I did not attain a statistical significance. Serum flbrinogen, factor VII and PF 1+2 were rising with the advancement of age and their means were significantly higher in all aged group in comparison with the young group.Serum TPA and TPA-I showed a progressive increase with age and their means were significantly higher in all aged group in comparison to the young group. Platelet glycoprotein receptors IIb, IIIa and Ib levels were found statistically significant higher in all aged groups in relation to group I. The maximum increase was found in group IV. The age-dependency of these markers has to be taken into account in respect to their clinical use in order to characterize patients with suspected risk of atherosclerotic events. In future, one should consider routinely screening for these markers in those above the age of 60 years and, if found to be high consider giving flbrinolytic and antithrombotic agents prophylactically

Common experience in the diagnosis of helicobacter pylori infection in children with abdominal symptoms in Egypt and in the United Kingdom

Are 1] to determine the role of Helicobacter pylori [Hp] infection in children with RAP, 2] to compare between two types of Hp stool antigen tests [Meridian and IDEIA Hp Star] in screening and follows up of the cases after treatment, and 3] to compare the results of the stool antigen by the results of the endoscopy in Egypt and UK. Over a 2 year period [2005 -2007], H Pylori positive children were selected. An age match, sex and social group of children were selected as controls from the GI clinic of Queen Mary's Hospital for Children and Suez Canal University Hospital- Ismailia, Egypt. Forty-eight Egyptian child with abdominal pain and/or vomiting and 40 children from United Kingdom were enrolled in the study. The age ranged from 5-16 years. The children had been screened for Hp by two different kits of stool antigen detection. Upper GI endoscopy [OGD] was performed in all the children, and biopsies for histological examination and rapid urease test [CLO test] were done. The prevalence of H. pylori in our sample was high in both Egypt [41.7%] and UK [37.5%]. In the Hp positive Egyptian cases, 90% of patients were males, while 66.6% of the patients in the UK were males. The main presenting symptoms were similar in both populations, which were mainly RAP, nausea, and vomiting. However haematemesis was observed only in the Egyptian children [10%]. In both groups, endoscopic data showed that the majority of Hp infection was associated with antral nodularity, erosive gastritis, and rarely with peptic ulcer. Hp assay results using the Meridian HpSA method in Egypt, showed comparable accuracy with those of the IDEIA Hpstar used in England. There is a close similarity in diagnostic approach and treatment of Hp infection in the UK and the Egyptian children. The stool antigen kits used in Egypt and those used in UK had high specificity and sensitivity when compared with the results of the endoscopy and histologic evaluation. The disappearance of symptoms after treatment suggests a possible relation between Hp and RAP. We recommend the use of Hp stool antigen as a rapid, simple, accurate, non- invasive method for Hp detection. Long term follow up studies after treatment with a larger study sample is required to clearly establish the role of Hp in RAP

Discoid medial meniscus [case report]

Discoid medial meniscus is extremely rare, 0.1 - 0.3%. There are no more than 24 cases of medial discoid meniscus reported in the literature. We present the first case report of discoid medial meniscus in the middle east. The patient was treated successfully arthroscopically by excision of central anomalous discoid portion of the meniscus

Tuberculous osteomyelitis of the calcaneous [case report]

We report a case of tuberculous osteomyelitis of the calcaneous in a tuberculin [Mantoux] negative patient. The lesion was very extensive involving most of the body of the calcaneous. Patient was cured after surgical excision and bone grafting with administration of antituberculous treatment for 9 months

Serum levels of soluble receptor activator of nuclear factors-KB ligand [sRANKL], osteoprotegerin [OPG] and bone mineral density in Egyptian osteoporotic elderly women

The aim of this study was to determnine the state of the OPG/RANKL system and its possible role in osteoporotic elderly women. The present study included 40 apparently healthy old osteoporotic women aged 64.5 +/- 4.5 years as group I,[GI] and 30 healthy women of matched age as group II [GII]. The two groups were subjected to complete history taking, thorough clinical examination, routine laboratory investigations, measurement of bone formation markers as serum alkaline phosphatase, serum calcium and serum osteocalcin and measurement of bone resorptiomz markers including: hydroxyproline in urine, serum OPG and serum RANKL CT Bone Density was done as well. In the current study, non significant differences were noted between the 2 studied groups as regard fasting blood glucose, renal amid hepatic function tests. A significant increase in serum alkaline phosphatase and urinary hydroxyproline and a significant decrease in serum calcium and serum osteocalcin was noted in group I compared to group Ii. Serum levels of RANKL were significantly elevated while serum OPG levels were significantly decreased in osteoporotic women compared to healthy controls. Changes in circulating OPG-RANKL correlates with serum osteocalcin and BMD changes. RANKL is an essential cytokine for the formation and activation of osteoclasts and promotes bone resorption, while OPG antagonizes these effects. Estrogen deficiency tilts the RANKL/OPG balance to favor osteoclastic activation and bone loss. RANKL blockade may emerge as a novel therapeutic option for human bone diseases. Further studies are necessary to elucidate the causes of osteoporosis and low bone mass in old women

Global right and left ventricular function and structure in children with acute poststreptococcal glomerulonephritis

Background and aim of work: Cardiac involvement is one of the features of acute poststreptococcal glomerulonephritis APGN. Echocardiography is recommended because there may be subtle changes indicating early cardiac involvement without frank signs of heart failure. The aim of the this study was to assess cardiac structural and functional changes [right and left] in children suffering from APGN during the acute phase of the disease

Study population: 25 cases of APGN patients compared with 25 controlled healthy children. Full investigation were done including M mode and 2D echocardiography for all cases. Isovolumetric relaxation time IRT, isovolumetric contraction time ICT, ejection time ET, and the combined index of myocardial performance [total isovolumic ejection time index = IRT + ICT/ET], wete calculated by echocardiography Doppler for both the right and left ventricle

Results: This study showed that there were statistically higher values of left ventricular parameters as left ventricular end diastolic diameter LVEDD, left ventricular mass LVM with a normal left ventricular ejection fraction LVEF and left ventricular fractional shortening LVFS in both groups with a statistical significant difference. Regarding the diastolic function by E/A ratio, there was non significant difference between patients with APGN and controls [p<0.3]. There was also statistically higher value of right ventricular end diastolic diameter RVEDD in cases when compared to control children. There was a statistically significant difference between cases and controls for both the right and the left global myocardial function estimated by Tei index. However the combined myocardial performance unmasked presence of both left and right ventricular dysfunction. There were four pateints with pericardial effusion in study children, although there was no case with severe hypertension or renal impairment during the acute phase of illness

Conclusion: The study concluded that, there is cardiac involvement, in the acute phase of APGN without frank signs of heart failure and without evidence of associated severe hypertension or renal failure. This may pay the attention to the importance of performing of echocardiography early in the disease and follow up after the acute phase. Total isovolumic ejection time index could be a sensitive index for detecting early changes in both right and left ventricular combined performance in acute poststreptococcal glomerulonephritis [APGN] patients. This new echocardiographic technique can be incorporated into a conventional transthoracic study

Estimation of vascular endothelial growth factor in serum of ankylosing spondylitis patients and its relation to disease activity

Angiogenesis is involved in the inflammatory joint diseases such as Ankylosing spondylitis [AS]. Vascular endothelial growth factor [VEGF] plays a critical role in angiogenesis. Ankylosing spondylitis is characterized by sacroiliitis and enthesitis in which new blood vessels formation participates. The aim of this study was to estimate the serum VEGF in AS patients and its relation to disease activity. Sera were collected from 20 AS patients and 20 healthy controls of matched age and sex. Disease activity was assessed using both ankylosing spondylitis disease activity index [BASDAI] and laboratory markers of inflammations [ESR, CRP]. Serum VEGF levels were significantly higher in AS patient [28.785 +/- 18.712 pg/ml] compared to controls [11.785 +/- 7.0191 pg/ml]. In AS patients' serum VEGF levels were correlated with disease activity indices. These results suggest that VEGF and therefore angiogenesis my play a role in AS pathogenesis and may serve as a disease activity marker in AS

Helicobacter pylori infection and chronic persistent cough: is there an association?

Chronic persistent cough is a common clinical problem that sometimes remains without an identifiable cause. To study a potential association between Helicobacter pylori infection and chronic persistent cough. A clinical observational study with symptom analysis, including 162 patients whose main presenting complaint was chronic persistent cough of an unidentifiable cause [study group] and 42 patients with chronic nonspecific laryngopharyngeal manifestations not including chronic cough [control group]. H. pylori active infection was present in 86.4 per cent [140/162] of patients in the chronic cough group opposed to 45.2 per cent [19/42] in the control group as confirmed by detection of H. pylori antigen in stool specimens. This difference was statistically significant [P < 0.001]. There was a significant improvement of chronic cough in 75.4 per cent [98/130] of patients after successful H. pylori eradication using appropriate medical therapy [P < 0.001]. H. pylori infection might lead to laryngopharyngeal irritation with several manifestations including chronic persistent cough; the exact mechanism of which still needs further research

Physiopathologic role of plasma homocysteine concentration, folic acid and vitamin B[12] levels in patients with thrombotic stroke: relation to helicobacter pylori infection

To establish the link between serum homocysteine [Hcyst], folic acid and vitamin B[12] levels and Helicobacter pylori [H pylori] infection in the pathogenesis of thrombotic cerebrovascular stroke [CVS]. Subjects and Fourty patients with thrombotic CVS were selected at the Main Alexandria Hospital compared with 10 healthy subjects of matched age as a control group. Serum folate, vitamin B[12] and total Hcyst levels were determined. Also, serum anti-H pylori IgG was estimated in all included subjects. in thrombotic stroke patients; both serum folic acid and B[12] levels were significantly decreased while serum Hcyst level was significantly elevated compared to controls. Patients with hyper homocysteinemia [> 15 micro mol/l] had significantly lower levels of serum folate and vitamin B[12] and significantly higher levels of H pylori IgG than patients with normal serum Hcyst level. Serum Hcyst in stroke patients was significantly positively correlated to H pylori IgG levels and inversely correlated to serum folate and vitamin B[12]. Also, H pylori IgG level was significantly inversely correlated to serum folate and vitamin B[12]. H pylori infection may decrease serum folate and vitamin B[12] levels possibly through impairment of their absorption. This could lead to hyperhomocysteinemia due to abnormal Hcyst metabolism. Hcyst is toxic to endothelial cells and results in atherothrombosis and its sequelae

Assessment of thyroid status in children with type 1 diabetes mellitus in Ismailia

Diabetes mellitus is defined as a syndrome of disturbed energy homeostasis caused by deficiency of insulin or its action and resulting in abnormal metabolism of carbohydrate, protein and fat. It is the most common endocrine disorder in childhood and adolescence with important consequence on emotional development. Type I diabetes is frequently associated with autoimmune diseases, such as hyperthyroidism, Hashimoto thyroiditis, pernicious anemia, Addison disease, vitiligo, hypoparathyroidism, and myasthenia gravis, thyroid autoimmunity is a remarkably frequent concomitant of type 1 diabetes in childhood. Genetic susceptibility to autoantibody formation in association with autoimmune thyroid diseases [AITD] and type 1 diabetes mellitus has been described with varying frequencies. So the present study is designed to assess thyroid autoimmunity and dysfunction in children with type 1 diabetes mellitus and recognition of possible risk factors. This study is a descriptive study carried out on 64 children with type 1 diabetes mellitus aged 2-18 yr. complete history, physical examination and laboratory testing were done for diabetic children as follows: age and sex, history of diabetes mellitus: duration, complications, and therapy, history suggestive of autoimmune disease: vitiligo, Addison's disease, pernicious anemia, celiac disease and others, family history :paternal consanguinity, history of diabetes mellitus and other endocrinopathy, history of autoimmune diseases, history of thyroid dysfunction and symptoms of hypothyroidism or symptoms of hyperthyroidism. Assessment of thyroid autoantibodies by indirect fluorescent antibody technique [IFA], free T4 and TSH assay were done. Thyroid autoimmunity was detected in 10.9% of diabetic patients [7 patients]. In seven diabetic children, thyroid antibodies levels were elevated on one occasion, whereas 57 patients were antibodies-negative during observation period. In conclusion, these data support and extend the previous findings documenting the high prevalence of thyroid autoimmunity in children and adolescent screened for autoimmune with type 1 diabetes. Also these data support the recommendation for regular testing of thyroid auto antibodies and thyroid hormones

Ropivacaine combined with sufentanil for intrathecal labor analgesia; a comparion with bupivacaine

To compare the onset, duration and quality of analgesia as wall a' the side effects between ropivacaine and bupivacaine, combined with sufentanil, when injected intrathecally as a part of combined spinal epidural technique for labor analgesia. This controlled double-blinded study included 60 primiparous women ASA physical status I/II, in early labor [cervical dilatation 2-5 cm] where they received labor analgesia using, combined spinal epidural technique. They were randomly assigned into 3 equal groups [20 women in each] to receive one of the three intrathecal study solutions; BS Group: bupivacaine 2.5 mg and sufentanil 10 micro g. RS2.5 Group: [n =20] ropivacaine 2.5 mg and sufentanil 10 micro g, RS4 Group: ropivacaine 4 mg and sufentanil 10 micro g. Every 5 mm for the first 30 mm then every 15 mm until first analgesic request, blood pressure, pulse rate and respiratory rate were recorded and pain was assessed using a 4-point verbal rating score. Motor block was assessed before and 20 mm after injection using 4-point modified Bromage score. Fetal heart rate and uterine activity were monitored. The use of prostaglandins [PGE[2]] or oxytocin was recorded The mode of delivery, 1-mm and 5-mm Apgar scores and umbilical artery pH were also recorded. The duration of analgesia was not significant different between groups. The duration of analgesia in BS Group was [105 +/- 26 mm] compared to [97 +/- 19 mm] in RS2.5 Group and [110 +/- 23 mm] in RS4 Group. Motor impairment was significantly more in BS group [40%] compared to both ropivacaine groups [0% and 15%]. Analgesia was adequate in all groups but the quality of analgesia was considered superior in 85 Group as more pain assessments were grade 0 compared to both ropivacaine groups and the difference was significant when compared to the group given the equivalent ropivacaine dose [2.5 mg]. [1 Intrathecal ropivacaine [2.5 mg] has the same onset and duration or analgesia as bupivacaine [2.5 mg] when either of them is added to sufentanil. 10 micro g for labor analgesia. However, ropivacaine has the advantage of less motor block. [2] Increasing the dose of IT ropivacaine to 4 mg with sufenil has no advantage over 2.5 mg dose. [3] The IT technique and drugs used were well tolerated and safe for both mothers and babies

Autoimmune Thyroiditis is in type I versus type 2 diabetics

to determine the prevalence of autoimmune thyroiditis [AIT] as evidenced by thyroid peroxidase antibodies [TPO-ABs] in both types of diabetes Seventy five subjects from the Main Alexandria University Hospital were selected and divided into 3 groups. Group I included 30 type 1 diabetics. Group II included 30 type 2 diabetics, while group III included 15 healthy subjects of matched age and sex. Thorough history taking and physical examination were done. Fasting plasma glucose [FPG] and glycated haemoglobin [HbA1c] were estimated the following parameters were measured in serum: TPO-ABs, tyrosine phosphate-like proteins antibodies [IA2-ABs] and glutamic acid decarboxylase antibodies [GAD-ABs], Also, thyroid stimulating hormone [TSH] and free thyroxine [FT4 levels were measured in all subjects. Type l diabetics had the highest frequency of TPO-ABs positivity [26.7%], while in type 2, it was 10% vs control 6.7%, but it did not reach significant levels. TPO-ABs positivity was significantly associated with higher levels of IA2-ABs and GAD-ABs. It was also significantly associated with elevated TSH levels and insignificantly related to low free T4 levels. Conclusions: AIT, as evidenced by TPO-Abs, was present in type 1 diabetics and some type 2 with late life onset [LADA], a/though it did not reach significant levels. Results obtained were encouraging for diabetes and AIT prediction and for immunointervention measures to be used in high risk subjects

Leptin and Andropause

To determine whether circulating leptin levels change in andropausal Egyptian men. Subjects and Forty elderly nondiabetic nonobese Egyptian men [aged 65 to 75 years] [group I] were included. Subjects were non obese with BMI <25 kg/m2. Twenty healthy adult men served as controls [group II]. Estimation of fasting serum level of leptin, DHEAS and free testosterone were done using ELISA technique. Mean fasting serum leptin was significantly higher in elderly and ropause men when compared to adult men [P<0.001]. Mean fasting serum free testosterone and DHEAS ware significantly lower in group I when compared to group II [t = 18.15, P < 0.001, and t = 25 - 16, P < 0.001, respectively]. Significant negative correlation was found between serum free testosterone and serum leptin in group I [r=-0.692, P < 0.001]. Our data confirmed increased serum leptin concentration in andropausal elderly Egyptian men. An inverse correlation between serum leptin and testosterone was illustrated. Testosterone replacement therapy may be of benefit in suppressing hyperleptinemia in elderly men with subsequent break of hypogonadal-obesity cycle and prevention of development of CHAOS Complex. Further studies examining the effect of other hormonal changes during aging on serum leptin are recommended

Study of bone turnover in elder men

To evaluate the correlation of serum testosterone with the markers of bone turnover: serum alkaline phosphatase and serum osteocalcin as markers of bone formation and urinary deoxypyridinoline to creatinine ratio [DPD/Cr] as a marker of bone resorption in elderly men. Subjects and To achieve this goal, we selected 20 healthy men aged from 60 to70 years [M1], and 10 aged above 70 [M2]. All were with body mass index [BMI] of less than 25 kg/m2 to exclude the effect of increased BMI on bone turnover. Any subject with a systemic disease or on a drug that could affect bone metabolism was excluded. Ten healthy young men served as controls [C], All subjects were subjected to thorough history taking, thorough clinical examination and laboratory investigations in addition to some bone remodeling markers [serum ALP, serum osteocalcin, and urinary DPD/Cr ratio] and serum testosterone, The mean level of serum total alkaline phosphatase was significantly higher in the elderly groups, although it did not exceed the normal range [P<0.001]. Mean serum osteocalcin level was significantly higher in both elderly groups than that in the young group, and its mean level was also significantly higher in M2 group as compared to that in Ml group [P<0.001]. Mean urinary DPD/Cr levels were significantly higher in M1 and M2 groups as compared to those in group C [P<0.001]. Again, its mean level in M2 group was still significantly higher than that in M1 group [P <0.001]. Mean serum testosterone levels in both elderly groups were significantly lower than those in the young group [P< 0.001]. Its mean level in M2 group was also significantly lower than that in M1 group [P <0.005]. A significant negative correlation was found between serum testosterone and all markers of bone turnover under study in M2 group [P<0.05]. However, in M1 group, there was a significant negative correlation between serum testosterone and both urinary DPD/Cr ratio [P<0.001] and serum ALP [P<0.05], but not with serum osteocalcin [P>0.05]. This indicates that the correlation between serum testosterone and osteocalcin attains a significant level with advancement of age. Again, a significant positive correlation was displayed between urinary DPD/CR ratio and both serum ALP and serum osteocalcin [P<0.001] in M1 group. In M2 group, this positive correlation attained a statistical significance with serum ALP [P<0.05], but not with serum osteocalcin [P>0.05]. Conclusions: Serum ALP, serum osteocalcin and urinary DPD/Cr ratio are increased in elderly men above the age of 60 and become higher with advancement of age indicating that bone turnover is a progressive process with aging. Serum testosterone is significantly lower in elderly men. A significant negative correlation was observed between serum testosterone and bone turnover markers in elderly men. Correction of testosterone deficiency may have an important role in prevention of osteoporosis in men

Correlation of bone mineral density with peripheral neuropathy in patients with insulin dependent diabetes mellitus

To investigate whether peripheral neuropathy [PN], as part of the microangiopathic complex, can affect bone mineral density [BMD] of the axial skeleton in patients with type 1 diabetes. Three studied groups where examined. Group 1 comprised 15 males with type 1 diabetes and severe PN with a mean duration of diabetes of 11.07 +/- 2.31 years and an HbA1c% of 9.40+ 1.01.Group2 comprised 15 males type 1 diabetic patients with absent or mild PN matched to patients of group 1 regarding age, weight, and duration of diabetes. Group3 comprised 15 control subjects. BMD was measured by dual energy x-ray absorptiometry [DEXA] of the axial skeleton. In group 1, BMD was significantly reduced in the axial skeleton compared with an expected Z score of 0 [spine, -1.26 +/- 0.52]. To a lesser exlent, but still significantly, group 2 also showed reduced BMD values [spine, -0.54 +/- 0.16],whereas group 3 had normal BMD values [spine, -0.19 +/- 0.23]. Group 1 had lower mean BMD level than group 2 and group 3 at the measured sites which was statistically significant [analysis of variance, P< 0.001]. No significant differences in physical activity levels or serum calcium, serum phosphorus, alkaline phosphatase, were demonstrated between the two patient groups. The present results suggest that in patients with type 1 diabetes PN may be an independent risk factor for reduced BMD in the axial skeleton

Relation between leptin and metabolic control in elderly diabetics

An inverse correlation of serum leptin level with hemoglobin A1c has been found in adults with diabetes mellitus. To assess this relation as well as the leptin levels in elderly with diabetes mellitus type 2, this study included twenty diabetic patients aged above sixty on oral hypoglycemic medications, in addition to two control groups; fifteen healthy elderly and fifteen young adults. All subjects were studies as regards serum leptin levels and other biochemical parameters such as serum uric acid, cholesterol, triglycerides, fasting blood suger, postprandial blood sugar, hemoglobin A1c. The results in both diabetic and health elderly as well as young controls were compared. Serum liptin levels were not affected by presence of diabetes but were inversely correlated with glyemic control and hemoglobin A1c. There was no significant difference as regards serum leptin levels in elderly compared to young adult controls. Serum leptin level were directly correlated with body mass index in young adults as well as in elderly, however, this correlation was disrupted in presence uncontrolled diabetes mellitus