Associations between the serum levels of selected bone turnover markers and biological traits in nursing home women aged 80+ without inflammation. A pilot study.

BACKGROUND: Bone turnover markers (BTM) reflect the status of bone remodeling processes responsible for bone mineral density. The existing body of evidence that osseous tissue can interact with many other body tissues and organs suggests that the cross-talks can lead to different relationships. The biological traits associated with BTMs have not been thoroughly studied in the elderly despite bone turnover being known to increase with age. OBJECTIVE: To determine whether the C-terminal crosslinking telopeptides of type I collagen (CTXI) and the serum levels of total (TAP) and bone-specific (BAP) alkaline phosphatase are associated with the biological traits in nursing home women aged 80-92 years without inflammation and, if so, to indicate the best predictors of these BTM's blood concentrations. METHODS: A group of 64 female volunteers aged 80 years and older, the residents of nursing homes, were screened for the study. Fifty two women were ineligible as they met the exclusion criteria. As a result, the study group consisted of 12 participants (85.1 ± 3.9 years; 58.1 ± 8.7 kg; 1.52 ± 0.06 m), all having blood C-reactive protein (CRP) levels below 3 mg/l. Also assessed were the participants' morphology, glucose and insulin levels, lipid profiles, CTXI, TAP, and BAP. Other measured parameters included body composition, resting heart rate and arterial blood pressure, isometric knee extension peak torque (IKEPT), and walking capacity (6-min walk test). The statistical analysis was performed using Pearson's correlation coefficients, the Benjamini-Hochberg procedure, and a stepwise multiple regression analysis with backward elimination. RESULTS: Inverse correlations were found between CTX-I and hemoglobin concentration (HGB) (r = -0.680; p = .015), red blood cells count (RBC) (r = -0.664; p = .019), fat-free mass (r = -0.633; p = .027), body weight (r = -0.589; p = .044), and total cholesterol (r = -0.581; p = .048). The multiple regression analysis of CTX-I showed that body weight was the only independent variable that was statistically significant (r2 = 0.346; p < .05; SEE = 0.347 ng/ml). BAP was positively correlated with double product (DP) (r = 0.742; p = .006), RBC (r = 0.650; p = .022), HGB (r = 0.637; p = .026), mean arterial pressure (MAP) (r = 0.622; p = .031), diastolic blood pressure (DBP) (r = 0.612; p = .034), body height (r = 0.603; p = .038), IKEPT (r = 0.565; p = .056), and systolic blood pressure (SBP) (r = 0.538; p = .071). BAP, a dependent variable, was the most closely correlated with DP (r2 = 0.550; p < .01; SEE = 9.161 U/l). TAP was also significantly associated with DP (r = 0.775; p = .003), with the association being stronger than between BAP and DP (r2 = 0.600; p < .01; SEE = 1000.5 beats/min*mm Hg). CONCLUSIONS: In relatively healthy the oldest-old nursing home women without inflammation, total body weight was the best predictor of bone resorption shown by the CTX-I concentration, whereas the rate pressure product (DP) turned out to best predict osteoblastic activity determinable from serum alkaline phosphatase activity. The results of the study suggest that the activity of serum TAP and BAP can be enhanced by different mechanisms.

Pressure Injuries Treated With Anodal and Cathodal High-voltage Electrical Stimulation: the Effect on Blood Serum Concentration of Cytokines and Growth Factors in Patients With Neurological Injuries. A Randomized Clinical Study.

It remains unclear whether electrical currents can affect biological factors that determine chronic wound healing in humans. PURPOSE: The aim of this study was to determine whether anodal and cathodal high-voltage monophasic pulsed currents (HVMPC) provided to the area of a pressure injury (PI) change the blood level of cytokines (interleukin [IL]-1ß, IL-10, and tumor necrosis factor [TNF]-α) and growth factors (insulin-like growth factor [IGF]-1 and transforming growth factor [TGF]-ß1) in patients with neurological injuries and whether the level of circulatory cytokines and growth factors correlates with PI healing progression. METHODS: This study was part of a randomized clinical trial on the effects of HVMPC on PI healing. All patients with neurological injuries (spinal cord injury, ischemic stroke, and blunt trauma to the head) and a stage 2, stage 3, or stage 4 PI of at least 4 weeks' duration hospitalized in one rehabilitation center were eligible to participate if older than 18 years of age and willing to consent to donating blood samples. Exclusion criteria included local contraindications to electrical stimulation (cancer, electronic implants, osteomyelitis, tunneling, necrotic wounds), PIs requiring surgical intervention, patients with poorly controlled diabetes mellitus (HbA1C > 7%), critical wound infection, and/or allergies to standard wound treatment. Participants were randomly assigned to 1 of 3 groups: anodal (AG) or cathodal (CG) HVMPC treatment (154 µs; 100 Hz; 360 µC/sec; 1.08 C/day) or a placebo (PG, sham) applied for 50 minutes a day, 5 days per week, for 8 weeks. TNF-α, IL-1ß, IL-10, TGF-ß1, and IGF-1 levels in blood serum were assessed using the immunoenzyme method (ELISA) and by chemiluminescence, respectively, at baseline and week 4. Wound surface area measurements were obtained at baseline and week 4 and analyzed using a digitizer connected to a personal computer. Statistical analyses were performed using the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation; the level of significance was set at P ≤.05. RESULTS: Among the 43 participants, 15 were randomized to AG (mean age 53.87 ± 13.30 years), 13 to CG (mean age 51.08 ± 20.43 years), and 15 to PG treatment (mean age 51.20 ± 14.47 years). Most PIs were located in the sacral region (12, 74.42%) and were stage 3 (11, 67.44%). Wound surface area baseline size ranged from 1.00 cm2 to 58.04 cm2. At baseline, none of the variables were significantly different. After 4 weeks, the concentration of IL-10 decreased in all groups (AG: 9.8%, CG: 38.54%, PG: 27.42%), but the decrease was smaller in the AG than CG group (P = .0046). The ratio of pro-inflammatory IL-10 to anti-inflammatory TNF-α increased 27.29% in the AG and decreased 26.79% in the CG and 18.56% in the PG groups. Differences between AG and CG and AG and PG were significant (AG compared to CG, P = .0009; AG compared to PG, P = .0054). Other percentage changes in cytokine and growth factor concentration were not statistically significant between groups. In the AG, the decrease of TNF-α and IL-1ß concentrations correlated positively with the decrease of PI size (P <.05). CONCLUSION: Anodal HVMPC elevates IL-10/TNF-α in blood serum. The decrease of TNF-α and IL-1ß concentrations in blood serum correlates with a decrease of PI wound area. More research is needed to determine whether the changes induced by anodal HVMPC improve PI healing and to determine whether and how different electrical currents affect the activity of biological agents responsible for specific wound healing phases, both within wounds and in patients' blood. In clinical practice, anodal HVMPC should be used to increase the ratio of anti-inflammatory IL-10 to pro-inflammatory TNF-α , which may promote healing.

The relationship between selected body fatness indices and the level of blood interleukin-6 in female nursing home residents aged 80+ years without inflammation: A pilot study.

BACKGROUND: Interleukin-6 (IL-6) production facilitates a shift from acute to chronic inflammation that may induce the development of some diseases and aging. Several studies have suggested that adiposity is closely related to serum IL-6 level, but their authors examined relatively young older adults (aged 60-80 years), so it is not clear whether this association would also occur in people at a more advanced age. OBJECTIVE: to assess whether in elderly women without inflammation the widely used anthropometric obesity indices are associated with serum IL-6 level and, if so, to determine the best anthropometric predictor of this inflammatory biomarker. METHODS: The sample consisted of 12 women (85.1 ±â€¯3.9 years; 58.1 ±â€¯8.7 kg; 151.9 ±â€¯6.3 cm), the residents of nursing homes, who did not use anti-inflammatory drugs, statins or diuretics and whose blood C-reactive protein (CRP) concentration was lower than 3 mg/l. To determine CRP and IL-6 concentrations, venous blood samples were collected in the morning in a fasted state. The following anthropometric measurements were made in all participants: body weight, body height, the circumferences of waist, hip and neck. Body fat percentage and visceral fat rating (VFR) were determined by bioelectrical impedance analysis. The measurements were then used to calculate body mass index (BMI), body fat mass index (BFMI), body adiposity index (BAI), the waist-hip ratio (WHR) and the waist-height ratio (WHtR). In the statistical analysis, Pearson's correlation coefficients and stepwise multiple regression analysis with backward elimination were used. RESULTS: A direct relationship was established between IL-6 and CRP levels (r = 0.639; p < 0.05). Moreover, IL-6 significantly and positively correlated with hip and neck circumferences, BMI, BFMI, and BAI, as well as with VFR (r range 0.597-0.704; p < 0.05). The multiple regression analysis for IL-6 showed that the neck circumference was the only statistically significant independent variable (r2 = 0.496; p < 0.05; SEE = 0.554 pg/ml). CONCLUSIONS: The results suggest that of all popular indices of adiposity neck circumference is the best predictor of serum IL-6 concentration in the oldest old women without inflammation.

Serum concentration of surfactant protein D in patients with systemic sclerosis: The potential marker of the interstitial lung disease severity.

Pulmonary involvement is a severe manifestation of systemic sclerosis (SSc). The study was designed to determine the serum level of surfactant protein D (SP-D) in patients with SSc in relation to clinical and laboratory parameters as well as to analyze dynamics of changes of these indices within one year of observation. SP-D was assayed in 41 patients with SSc and 15 healthy controls. Additionally, pulmonary function tests, chest high-resolution computed tomography (HRCT), and inflammatory markers were assessed. All tests were performed twice: at entry and repeated after one year of observation. The serum level of SP-D was significantly higher in patients with SSc than in healthy controls. Serum concentration of SP-D was significantly higher in patients with systemic sclerosis-related interstitial lung disease (SSc-ILD) than in those without SSc-ILD. SP-D was found to correlate with lung involvement evaluated with the Medsger score (diffusing capacity of the lung for carbon monoxide (DLCO), forced vital capacity, radiological changes, and estimated pressure in the pulmonary artery in echocardiography). SP-D correlated with the honeycombing and/or reticular pattern in HRCT and ground glass opacification pattern. Serum concentration of SP-D was elevated in patients with a decreased DLCO. Furthermore, SP-D was higher in patients with diffuse cutaneous type (dcSSc) of the disease than in those with SSc limited type (lcSSc). Because of the small size of the group, it was not possible to perform a statistical analysis for patients who had different results in HRCT, VC, and Medsger score between the first and the second evaluation. SP-D seems to be an index for assessing lung involvement. It reflects the state of pulmonary fibrosis but not the dynamics of the pulmonary fibrosis progression. Further studies are needed to evaluate clinical application of the index, and currently, there is no evidence for the recommendation of the application of SP-D in routine evaluation of patients with SSc.