Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture †.

The relation between vitamin-D (VD) status and healing after hip fracture had not been sufficiently addressed. Currently serum total 25-hydroxy-VD (t-25OHD) is the most widely used indicator of VD status. It is unclear whether free or bioavailable VD are better markers of 25OHD availability for tissues. Validity of overall cut-off values of t-25OHD is limited. OBJECTIVES: (1) Assess serum levels of circulating forms of 25OHD in patients with hip fracture (PwHF: N = 199) compared to active controls without history of fracture (N = 102); (2) determine relationship between 25OHD fractions and functional performance after surgery (FPAS) and survival. The t-25OHD; VD binding protein and albumin levels were measured. Comorbidities; lifestyle; FPAS and survival were recorded at seven months. VD deficiency occurred more frequently in PwHF than in controls (72% vs. 38%). Patients with better FPAS showed higher 25OHD in all fractions than with poor FPAS. Controlled by lifestyle; 25OHD levels were independent predictive factors (p < 0.001). Good FPAS values forecasted longer survival (OR: 6.5CI:3.2⁻13.3; p < 0.0001). All 25OHD forms showed a tendency to predict survival. Mortality rate decreased to 8% in individuals with t-25OHD levels of >22.6⁻39.5 nmol/L and increased to 14% with >40 nmol/L. These observations highlight the importance of serum 25OHD assessment and moderate VD substitution for healing and survival.

[Vitamin D and calcium supplementation in elderly patients with hip fracture]. / D-vitamin és kalciumpótlás az idoskori csípotáji törések megelozésében.

Vitamin D plays an important role in maintaining calcium and bone metabolism, a risk factor of osteoporosis, fall and fracture in old age. Reduction in D-vitamin levels associated with compensatory increased level of parathyroid hormone causes significant loss of bone matrix, so substitutions of vitamin D and calcium are very important. Many authors publish their recommended doses used for prevention of hip fracture during the last years. Some authors are satisfied only with vitamin D supplementation while others have better experiences with vitamin D and calcium substitution. On the other hand, some metaanalyses give contradictory results and propose further investigations. It is important to consider the patients' eating habits and lifestyle as well as the risk of cardiovascular and other chronic diseases. Further trials should be done in different age groups in order to examine the effects of different doses of vitamin D without and with calcium to make a final decision. Orv Hetil. 2017; 158(43): 1699-1707.

[Vitamin D supply of patients with hip fracture]. / A csípotáji csonttörést szenvedett betegek D-vitamin-ellátottsága.

INTRODUCTION: Vitamin D deficiency is an important risk factor for fractures. However, there are few data available only on the relationship between serum 25-hydroxyvitamin D levels and recovery after surgery for hip fracture. AIM: The authors investigate the vitamin D supply of patients with hip fractures. METHOD: Between February and September 2013, serum 25-hydroxyvitamin D and parathyroid hormone levels were determined in 203 patients with hip fracture (74.8±11.5 ys; 67 men and 136 women) and in 74 control subjects. RESULTS: Vitamin D deficiency and secondary hyperparathyroidism occurred significantly more frequently in patients with hip fracture than in control subjects (72% vs. 45%, and 33% vs. 17%, respectively). Patients with better condition after surgery showed higher 25-hydroxyvitamin D levels (p<0.001) than those with poor condition. Serum 25-hydroxyvitamin D were lower in the 31 patients who died [median of survival time: 19 (5-52) days] compared to those who survived [22.6 (9.5-45.0) vs. 33.0 (16.5-56.6) nmol/l]. CONCLUSIONS: The association between vitamin-D deficiency and mortality as well as the positive correlation between serum 25-hydroxyvitamin D levels and better postoperative condition confirm the importance of proper vitamin D supply in the prevention and cure of hip fractures, what is more in the increase of the chance of survival.

[The role of vitamin D deficiency in the pathogenesis of falls and fractures]. / A D-vitamin-hiány szerepe az elesések és csonttörések patogenezisében.

The diverse effects of vitamin D in human body became known during the last years. Vitamin D deficiency causes many problems in medical care. Important roles of vitamin D are the regulation of calcium metabolism and the effect on bone metabolism. The authors review literature data on vitamin D deficiency recognized as an important risk factor in the pathogenesis of falls and fractures and they call attention of Hungarian physicians to the importance of vitamin D substitution. Supplementation of vitamin D deficiency is particularly important in the elderly age-group.

[The role of adult bone marrow derived mesenchymal stem cells in the repair of tissue injuries]. / Felnottkori csontvelobol származó mesenchymalis ossejtek szerepe a reparatív folyamatokban.

Mesenchymal stem cells, which reside in adult bone marrow are multipotent, have an excellent regeneration potential for tissue repair. These cells are able to differentiate in cell culture not only into mesodermal lineages but also into other lineages of ectodermal and endodermal cells. This regenerative process is assisted by application of bioactive molecules, specific growth factors and biomaterials (scaffolds). The cell therapy is successfully used in the treatment of bone defects, nonunions, osteoblasts formed from the mesenchymal stem cells. At present, there are encouraging data in the clinical practice. The mesenchymal stem cell seems to be successful in the regeneration of articular cartilage. There are further promising data for the application of mesenchymal stem cells in the treatment of myocardial infarction, neurologic diseases, liver and kidney diseases and injuries and diabetes mellitus. The aim of this review is to survey the molecular characteristics of mesenchymal stem cells and specific growth factors using the data of preclinical investigations and to call attention to their possible clinical application.

[Use of mesenchymal stem cells from adult bone marrow for injured tissue repair]. / A felnottkori csontvelobol származó mesenchymalis ossejtek felhasználása sérült szövetek pótlására.

Mesenchymal stem cells are known as being multipotent and exhibit the potential for differentiation into different cells/tissue lineages, including cartilage, bone, adipose tissue, tendon, and ligament. These pluripotent mesenchymal progenitor cells are denoted as stromal or mesenchymal stem cells. Bone marrow contains two main cell types: hematopoietic cells and stromal cells. The stem cells for non hematopoietic tissues are referred as mesenchymal cells because of their ability to differentiate as mesenchymal or stromal cells. Mesenchymal cells are easily obtainable from bone marrow by means of minimally invasive approach and can be expanded in culture and permitted to differentiate into the desired lineage. The differentiation can be reached by the application of bioactive signaling molecules, specific growth factors. The transforming growth factor beta (TGF-beta) superfamily member proteins such as the bone morphogenetic proteins (BMP-s) are the most important factors of chondrogenic and osteogenic differentiation of mesenchymal stem cells. From the series of recently identified factors, BMP 2,4 and 7 may play an important role in chondrogenic and osteogenic differentiation proteins. Little is known, however, about the signaling pathway involved in tenogenesis of mesenchymal stem cells, but there are some encouraging data about fibroblastic differentiation. The success of growth factor therapy needs a delivery system with biomaterials. Mesenchymal stem cells have become promising vehicles for gene therapy, cell therapy and tissue engineering. In present review, authors deal with the experimental investigations and with the clinical application of the adult bone marrow derived mesenchymal stem cells with bioactive molecules, growth factors.

The role of adult bone marrow derived mesenchymal stem cells, growth factors and carriers in the treatment of cartilage and bone defects.

Human mesenchymal stem cells, which reside in adult bone marrow, have an excellent regeneration potential for tissue repair. These cells can expand in culture into lineages of mesenchymal tissues and they are able to differentiate into cartilage, bone and other tissues. This regenerative process is assisted by application of bioactive molecules, specific growth factors, signaling molecules and biomaterials (scaffolds). An articular cartilage defect has only limited capacity for healing. Presently no methods have successfully repaired cartilage. The result of preclinical in vitro and in vivo investigations using mesenchymal stem cells, inductive biomolecules or carriers is encouraging for the future clinical applications. Bone defects can be treated with traditional methods using autologous bone grafting, but these procedures are often material limited and can cause donor side morbidity. The formation of bone in small or large defects after injury requires mesenchymal stem cells capable of differentiation in osteoblasts, moreover growth factors that direct these cells into the defect. According to in vitro and in vivo animal investigations and some clinical experiments with the application of cultured mesenchymal cells, growth factors, first of all bone morphogenetic proteins (BMP-s), successful reparative results can be achieved. The application of recombinant human BMP-s is a novel therapy using osteoinductive signaling of a number of gene expression pathways involving differentiation of mesenchymal progenitor cells. The aim of this review is to study the results of preclinical investigations during the last two decades and to deal with the potential clinical application.

[Role of fibroblasts in physiologic, reparative and pathologic processes]. / A fibroblastok szerepe fiziológiás, reparatív és patológiás folyamatokban.

Fibroblast is counted as one of the important cell of the connective tissue. At the present time many phenotypes are known taking part in normal, repair and pathological processes, meanwhile cellular and molecular events occur, where fibroblasts play essential role. Among molecular factors, first of all integrins, growth factors, cytokines and matrix molecules are discussed. The aim of this work is to summarize the morphological, biochemical and functional role of fibroblasts in addition to the physiological process, wound repair and in such pathological processes as Dupuytren's disease, rheumatoid arthritis, Graves' ophthalmopathy and carcinogenesis. It becomes known that fibroblasts participate in dynamic interplay with other cells and with the extracellular matrix. The results of the new investigations clarify better the physiological and pathological processes of the tissue, at the same time give potential help to the therapy of some illnesses. The authors summarise the important data of the subject on the basis of international literature and of their own investigations.