[Can sleep urine calcium concentration corrected by osmolality as a screening test identify subjects with risk to develop osteoporosis?].

The reliability of overnight (sleep) urine (SU) and 2nd morning urine (2MU) were compared with that of 24-hour urine (24 U) for the evaluation of bone resorption markers. A total of 50 women were subjected to the study was were divided into two groups according to their lumbar bone mineral density, namely 25 females with normal BMD (mean age 47) and 25 women with low BMD (mean age 78). Calcium (Ca), collagen degradation products crosslaps (CTx), pyridinoline (Pyr) and deoxypyridinoline (D-Pyr) were measured in 24 U, SU and 2MU and corrected for urine volume with creatinine (Cr) and osmolality(Osm). Among these four components, the corrected values tended to be higher in SU than 2MU, regardless of the method of correction and BMD level. Ca, CTx, Pyr and D-Pyr concentrations in spot urine were always significantly correlated with total excretion/body weight (Kg) regardless of the method of correction and BMD level. In low BMD subjects, Ca, CTx and D-Pyr concentrations corrected by Osm with further correction by body weight as an index of body size in the SU were significantly correlated with BMD. The SU may be a sensitive indicator of augmented nighttime bone resorption replacing 24 U especially on correction by Osm to eliminate the influence of sodium intake as an extraskeletal factor. In 51 women with normal BMD (A) with a mean age of 56, 16 with osteopenia (B) with a mean age of 64 and 35 with osteoporosis (C) with a mean age of 71, correlation coefficients were calculated between lumbar BMD and Ca/Osm, Ca/Osm/Kg, Ca/Cr and Ca/Cr/Kg in SU. Although no significant difference of mean urine Ca values were found between A and B groups, Ca values in C were significantly higher than that of A regardless of the correction method. The mean value of Ca/Osm/Kg in C was significantly higher than that of B. Ca/Osm/Kg showed a significant negative correlation with BMD in C. On examination of the correlation between % change of BMD in 23 women with a mean age of 59 and Ca concentration in SU corrected by urine volume and body weight, Ca/Osm was -0.427 (p = 0.0419), Ca/Osm/Kg -0.450 (p = 0.0313), Ca/Cr -0.400 (p = 0.058) and Ca/Cr/Kg -0.420 (p = 0.0462), suggesting the usefulness of Ca/Osm/Kg as an indicator of low BMD in screening.

Heated oyster shell with algal ingredient (AAACa) decreases urinary oxalate excretion.

In nine normal subjects, four men and five women between 23 and 49 years of age, 800mg calcium was orally administered as active absorbable algal calcium (AAA Ca) (A) and calcium carbonate (CaCO3) (B), to compare with non-calcium-containing placebo (C) in a crossover design. Calcium, oxalate, osmolality, creatinine, and pH were measured in the first three morning urine samples and Ca/osmolality, Ca/osmolality/body weight, Ca/creatinine, and oxalate/ osmolality were calculated to correct for urine dilution. Ca x oxalate product was also calculated, and Ca oxalate crystal in the sediment was microscopically examined, semiquantitatively estimated as -, +, ++, or , and numerically expressed as 0, 1, 2, or 3, respectively. Urinary Ca excretion was similar in groups A and B, but significantly larger than in group C, regardless of the method of correction for dilution. Urinary oxalate excretion with correction for osmolality, however, was significantly lower in A than in B and C, which gave similar values. Urine pH was similar among all three groups. Ca x oxalate product was significantly higher in C than in A, but A and B were not significantly different. AAA Ca appeared to decrease urinary oxalate excretion and Ca x oxalate product more efficiently than CaCO3, suggesting the possibility of inhibiting the formation of Ca x oxalate kidney stones.

[Calcium decreases urinary oxalate].

The effects of calcium supplementation on urinary oxalate excretion was tested in 9 normal subjects, 4 males and 5 females between 23 and 49 years of age. In a crossover study 800 mg calcium was orally administered as active absorbable algal calcium (AAACa) (A) and calcium carbonate (B), and compared with non-calcium containing placebo (C). Calcium, oxalate, osmolality, creatinine and pH were measured in the first three morning urine samples and Ca/osmolality, Ca/osmolality/body weight, Ca/creatinine and oxalate/osmolality were calculated to correct for urine dilution. Ca x oxalate product was also calculated and Ca oxalate crystal in the sediment was microscopically examined and semiquantitatively estimated as -, +, ++, and +++ expressed as 0, 1, 2 and 3 respectively. Urinary Ca excretion was similar in A and B, but significantly larger than C, regardless of the method of correction for dilution. Urinary oxalate excretion tended to be lower in A than in B and C. Urine pH was similar among all three groups. Ca x oxalate product was higher in C than in A and B. AAACa, unlike calcium carbonate, appeared to decrease urinary oxalate excretion and Ca x oxalate product more efficiently than Ca carbonate, suggesting a possibility of inhibiting the formation of Ca x oxalate kidney stones. Formation of calcium oxalate was also tested in vitro by adding oxalate to urine samples and aqueous calcium solution.

Fall of blood ionized calcium on watching a provocative TV program and its prevention by active absorbable algal calcium (AAA Ca).

In December 1997, more than 680 children developed convulsive seizures while watching a notorious audiovisually provocative TV program, "Pocket Monster." Emotional stimulation via hyperventilation may cause respiratory alkalosis, fall of blood ionized calcium (Ca), and sensitization of the nervous system to excessive emotional stress. A study was therefore undertaken to follow the changes of blood ionized Ca in eight healthy volunteers after watching the "Pocket Monster" and also a quiet program, "Classical Music," as a control for 20min from 4 P.M. Although neither marked hyperventilation nor convulsions developed in any of these adult volunteers, blood ionized Ca showed a significantly more pronounced fall during and after watching "Pocket Monster," and their plasma intact parathyroid hormone (iPTH) was significantly higher 120min after the beginning of "Pocket Monster" than the "Classical Music" program. Plasma total Ca, pH, and albumin were free of detectable changes. Ingestion of 600mg Ca as active absorbable algal Ca (AAA Ca) with high bioavailability completely prevented the fall of ionized Ca and suppressed iPTH. Plama osteocalcin was also significantly suppressed after ingestion of AAA Ca. It may be worthwhile to ingest AAA Ca before anticipated emotional stress such as watching a provocative TV program to prevent possible neuromuscular instability.

Overnight suppression of parathyroid hormone and bone resorption markers by active absorbable algae calcium. A double-blind crossover study.

In order to study the effect of Ca supplementation on the nocturnal rise of PTH and bone resorption, a double-blind, placebo-controlled study was carried out on 9 healthy male volunteers. Regimen A consisted of an oral dose of 150 mg Ca as AAACa after each meal and 450 mg at bedtime; B consisted of 300 mg after each meal and C was placebo. Plasma ionized Ca was significantly higher in A than in B at 6 a.m. the next morning and urinary Ca/Cr after 5 days was higher in A than in B and C. Plasma intact PTH fell by 19 +/- 4 pg/ml in A, 8 +/- 7 in B, and 1 +/- 7 after 1 day, and significantly decreased by 29 +/- 8 in A, increased by 11 +/- 11 in B, and 5 +/- 7 in C after 5 days (A and B, and A and C, p = 0.0242 and 0.0433, respectively), with increases of % tubular reabsorption of phosphorus. Urinary excretion of cross-linked collagen degradation product (Crosslaps) was 40 +/- 10% of the baseline in A, 97 +/- 22 in B, and 173 +/- 30 in C (A and C, P = 0.0061) after 5 days. Systolic blood pressure at 6 a.m. fell by 17 +/- 4 mmHg A, 24 +/- 3 in B, and 4 +/- 2 in C. Highly biologically available AAACa effectively suppressed nocturnal rise of PTH and bone resorption markers in 5 days.

[Correction of urinary calcium levels for urine osmotic pressure].

The usefulness of the urinary calcium/creatinine (Ca/Cr) ratio, the oldest marker of bone resorption, is limited because of the influence of sodium intake and urine volume. The urinary Ca/Cr ratio was therefore compared with urinary calcium corrected for the urine osmotic pressure (Ca/OSM). Significant correlations are found between the Ca/Cr ratio and both creatinine (r = -0.386) and osmotic pressure (r = -0.473) in random urine samples from normal subjects, but similar correlations were not found for urine Ca/OSM. No significant correlation was found between Ca/OSM and Na/OSM, but the correlation coefficient between Ca/Cr ratio and Na/Cr ratio was 0.399. Thus, the Ca/Cr ratio is affected by urinary volume and sodium concentration, but the Ca/OSM ratio is not. The Ca/OSM ratio may therefore be a more accurate marker of bone resorption, because one of the main components of urinary osmotic pressure is sodium that inhibits tubular calcium reabsorption. The Ca/OSM ratios measured from 24-hour urine samples were found to be strongly correlated with the values measured from samples obtained during sleep (sleep urine, 0.823) and were slightly less strongly correlated with the values measured from second morning samples (0.641). Because bone resorption is especially active at night, the Ca/OSM ratio in sleep urine may be the most sensitive marker of bone resorption. The Ca/OSM ratio in sleep urine samples increased with age in normal women.

[Effects of calcium supplementation using AAACa or milk on nocturnal bone resorption in young women].

In order to study the effect of calcium supplementation on bone resorption, a randomized controlled crossover study was carried out on eight healthy 18-19 year old female volunteers using either AAACa heated oyster shell with vacuum-heated seaweed or milk. Regimen A consisted of an oral dose of 200 mg calcium in the form of AAACa. B 200 ml milk after breakfast and supper and at bedtime, and C control with no calcium supplement. Early morning fasting blood and urine sampling was carried out after 7 days of calcium supplementation. Serum calcium was higher in groups A and B than in C, and serum intact parathyroid hormone (PTH) was significantly lower in group A than in groups B and C, according to a paired t-test. Urinary excretion of crosslinked collagen degradation product, pyridinoline and deoxypyridinoline showed a similar decrease in groups A and B but not in C. The more effective suppression of PTH by AAACa than by milk may be due to its higher bioavailability and the absence of phosphate stimulating PTH secretion.

[Metabolic response in the acute stage of cerebral infarction--with special reference to oxygen consumption and resting metabolic expenditure].

Oxygen consumption, carbon dioxide production, respiratory quotients, and resting metabolic expenditure were measured in 23 patients with cerebral infarction in their acute stage. Metabolic measurement were carried out with the technique of indirect calorimetry on their admission within two days from the onsets. At the same time, urine was collected twenty-four hours to measure urinary catecholamine excretion. Mean value of resting metabolic expenditure was 115.1% and this positively correlated with urinary catecholamine, especially noradrenaline excretion. Maximum value of resting metabolic expenditure was up to 187.1% of that expected for an uninjured resting person of equivalent age, sex, and body surface area. Oxygen consumption and carbon dioxide production also positively correlated to urinary catecholamine excretion. On the other hand, respiratory quotients did not have any significant correlation with oxygen consumption, carbon dioxide production, resting metabolic expenditure, or urinary catecholamine excretion. From those facts, it was implied that overactivity of sympathetic nervous system existed in their acute stage of cerebral infarction, and the overflow might directly influence oxygen consumption, carbon dioxide production, and resting metabolic expenditure, and moreover we had to take into consideration of hyper-metabolic state to manage patients with ischemic cerebrovascular diseases as malnutrition might cause weight loss and immune incompetence.

Rapid emergency testing using blood plasma.

A method of blood analysis, using plasma instead of serum, is very valuable in shortening the time for reporting an emergency test by about 50-60%, by eliminating the serum separation step. Good correlation between plasma and serum was obtained for common chemical analyses.