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1.
Eur J Clin Nutr ; 74(2): 231-247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31907366

RESUMO

Vitamin D deficiency and insufficiency has become a pandemic health problem with a consequent increase of requests for determining circulating levels of 25-hydroxyvitamin D [25(OH)D]. However, the analytical performance of these immunoassays, including radioimmunoassay and ELISA, is highly variable, and even mass spectrometric methods, which nowadays serves as the gold standard for the quantitatively determination of 25(OH)D, do not necessarily produce comparable results, creating limitations for the definition of normal vitamin D status ranges. To solve this problem, great efforts have been made to promote standardization of laboratory assays, which is important to achieve comparable results across different methods and manufacturers. In this review, we performed a systematic analysis evaluating critically the advantages and limits of the current assays available for the measure of vitamin D status, i.e., circulating 25(OH)D and its metabolites, making suggestions that could be used in the clinical practice. Moreover, we also suggest the use of alternatives to blood test, including standardized surveys that may be of value in alerting health-care professionals about the vitamin D status of their patients.

2.
Orv Hetil ; 161(2): 75-79, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31902232

RESUMO

The authors present the case of a multiplex endocrine neoplasia type 2A (MEN2A). The 55-year-old woman underwent detailed examinations for abdominal complaints. Bilateral adrenal masses and thyroid nodular goiter were found. Based on metanephrine excretion and MIBG imaging, bilateral phaeochromocytomas were diagnosed. The thyroid nodules were confirmed by thyroidectomy as bilateral medullary thyroid carcinoma. Asymptomatic primary hyperparathyroidism was also detected. Laparoscopic adrenalectomy and parathyroid adenoma removal were performed. Based on family history and the characteristic clinical presentation, MEN2A syndrome was confirmed by genetic testing. During genetic screening of first-degree relatives, the patient's 25-year-old daughter was shown to be a gene carrier. Preventive thyroidectomy was performed and histology proved multifocal medullary thyroid cancer. In addition to the importance of genetic testing, the authors emphasize the guideline-based, but individualized approach to patients with suspected MEN2A syndrome. Orv Hetil. 2020; 161(2): 75-79.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Feocromocitoma , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , 3-Iodobenzilguanidina , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Feminino , Bócio Nodular , Humanos , Metanefrina , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 2a/genética , Neoplasias das Paratireoides , Proteínas Ribossômicas , Neoplasias da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/patologia , Tireoidectomia
3.
Clin Rheumatol ; 39(1): 167-175, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522318

RESUMO

OBJECTIVES: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with generalized and localized bone loss. We conducted a comprehensive study using imaging (dual-energy X-ray absorptiometry, DXA) and laboratory biomarkers in order to determine bone health and to study the effects of anti-tumor necrosis factor (TNF) biologics in RA and AS. PATIENTS AND METHODS: Thirty-six RA and 17 AS patients undergoing 1-year etanercept (ETN) or certolizumab-pegol (CZP) therapy were studied. Bone density was assessed by DXA at baseline and after 12 months. Serum C-reactive protein (CRP), calcium, phosphate, parathyroid hormone (PTH), vitamin D3, osteocalcin, procollagen type I N-propeptide (P1NP), C-terminal telopeptide (ßCTX), osteoprotegerin, sclerostin (SOST), Dickkopf-1 (DKK-1), soluble receptor activator nuclear kappa B ligand (sRANKL), and cathepsin K (cathK) levels were determined at baseline and after 6 and 12 months. RESULTS: TNF-α inhibition was clinically effective. Anti-TNF-α halted further bone loss over 1 year. In general, anti-TNF therapy significantly increased P1NP, SOST levels, and the P1NP/ßCTX ratios, while decreased DKK-1 and CathK production at different time points in most patient subsets. In the full cohort and in RA, baseline and/or 12-month bone mineral density (BMD) at multiple sites exerted inverse relationships with CRP and ßCTX, and positive correlation with SOST. In AS, L2-4 BMD after 1-year biologic therapy inversely correlated with baseline ßCTX, while femoral neck BMD rather showed inverse correlations with CRP. CONCLUSIONS: Anti-TNF therapy slowed down generalized bone loss, in association with clinical improvements, in both diseases. TNF blockade may enhance bone formation and suppress joint destruction. Anti-TNF therapy may act inversely on DKK-1 and SOST. Independent predictors of BMD were SOST and ßCTX in RA, whilst CRP in AS.Key Points• One-year anti-TNF therapy halted generalized bone loss in association with clinical improvement in arthritides.• Anti-TNF therapy may inversely act on DKK-1 and SOST.• Independent predictors of BMD were SOST and ßCTX in RA, while CRP in AS.

4.
Arthritis Res Ther ; 21(1): 274, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823821

RESUMO

OBJECTIVE: We wished to determine bone alterations in systemic sclerosis (SSc) patients by conventional densitometry (DXA), peripheral quantitative computed tomography (pQCT), and bone biomarkers. METHODS: We included 44 SSc patients and 33 age-matched healthy controls. Lumbar spine and femoral neck bone mineral density (BMD) was assessed by DXA. Volumetric BMD was measured by pQCT at the radius. FRAX, 25-hydroxyvitamin-D3 (25-OH-D3), parathyroid hormone, osteocalcin, C-terminal collagen telopeptide, and procollagen type I amino-terminal propeptide were also assessed. RESULTS: SSc patients had lower L2-4 BMD (0.880 ± 0.108 vs. 0.996 ± 0.181 g/cm2; p = 0.019) and femoral neck (FN) BMD (0.786 ± 0.134 vs. 0.910 ± 0.090 g/cm2; p = 0.007) by DXA. In SSc vs. controls, pQCT indicated lower mean cortical (328.03 ± 103.32 vs. 487.06 ± 42.45 mg/cm3; p < 0.001) and trabecular density (150.93 ± 61.91 vs. 184.76 ± 33.03 mg/cm3; p = 0.037). Vitamin D3 deficiency was more common in SSc vs. controls (60.0% vs. 39.3%; p = 0.003). L2-4 (p = 0.002) and FN BMD (p = 0.015) positively correlated with BMI. pQCT assessments confirmed an inverse correlation between pulmonary manifestation and total (p = 0.024), trabecular (p = 0.035), and cortical density (p = 0.015). Anti-Scl70 positivity inversely correlated with pQCT total density (p = 0.015) and the presence of digital ulcers with cortical density (p = 0.001). We also found that vertebral and FN BMD as determined by DXA significantly correlated with pQCT total, trabecular, and cortical density (p < 0.05). CONCLUSION: The results of our study suggest that bone loss in SSc patients may be associated with lower BMI, anti-Scl70 positivity, and the presence of pulmonary manifestations and digital ulcers. Both DXA and pQCT are appropriate tools to evaluate the bone alterations in SSc patients.

5.
Curr Vasc Pharmacol ; 17(6): 610-617, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30963976

RESUMO

Vitamin D and calcium are considered crucial for the treatment of bone diseases. Both vitamin D and calcium contribute to bone homeostasis but also preserve muscle health by reducing the risk of falls and fractures. Low vitamin D concentrations result in secondary hyperparathyroidism and contribute to bone loss, although the development of secondary hyperparathyroidism varies, even in patients with severe vitamin D deficiency. Findings from observational studies have shown controversial results regarding the association between bone mineral density and vitamin D/calcium status, thus sparking a debate regarding optimum concentrations of 25-hydroxyvitamin D and calcium for the best possible skeletal health. Although most of the intervention studies reported a positive effect of supplementation with calcium and vitamin D on bone in patients with osteoporosis, this therapeutic approach has been a matter of debate regarding potential side effects on the cardiovascular (CV) system. Thus, the aim of this review is to consider the current evidence on the physiological role of vitamin D and calcium on bone and muscle health. Moreover, we provide an overview on observational and interventional studies that investigate the effect of vitamin D and calcium supplementation on bone health, also taking into account the possible CV side-effects. We also provide molecular insights on the effect of calcium plus vitamin D on the CV system.

6.
Magy Onkol ; 63(1): 16-25, 2019 Mar 19.
Artigo em Húngaro | MEDLINE | ID: mdl-30889617

RESUMO

Prostate cancer is one of the most frequently occurring malignancies in men. It is increasingly recognized in patients above 40 years of age. The discovery of prostate-specific antigen (PSA) nearly 50 years ago and the subsequent capability to measure it on automated immunoassay platforms have led to a widespread use in laboratory diagnostics. However, the plethora of the elevated PSA values resulted in premature invasive treatments in several cases, so the term 'overdiagnosis of prostate cancer' has been created. Beside the classical total PSA test, several new methods have emerged in the past years that considerably enhanced the specificity of PSA-based diagnostics and this paved the way for more adequate clinical decisions. Some of these new and complex laboratory tests are not yet financed in Hungary, but the techniques are already available. In addition to the measurement of various proteins by immunoassays, large attention is devoted to molecular tests that not only help to establish the underlying pathophysiological process, but may also aid in determining the proper prognostic subgroup.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/tendências , Neoplasias da Próstata/diagnóstico , Humanos , Hungria , Masculino , Prognóstico , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Sensibilidade e Especificidade
7.
Biochim Biophys Acta Mol Cell Biol Lipids ; 1863(11): 1399-1412, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30077797

RESUMO

There is a growing body of evidence that poly(ADP-ribose) polymerase-2 (PARP2), although originally described as a DNA repair protein, has a widespread role as a metabolic regulator. We show that the ablation of PARP2 induced characteristic changes in the lipidome. The silencing of PARP2 induced the expression of sterol regulatory element-binding protein-1 and -2 and initiated de novo cholesterol biosynthesis in skeletal muscle. Increased muscular cholesterol was shunted to muscular biosynthesis of dihydrotestosterone, an anabolic steroid. Thus, skeletal muscle fibers in PARP2-/- mice were stronger compared to those of their wild-type littermates. In addition, we detected changes in the dynamics of the cell membrane, suggesting that lipidome changes also affect the biophysical characteristics of the cell membrane. In in silico and wet chemistry studies, we identified lipid species that can decrease the expression of PARP2 and potentially phenocopy the genetic abruption of PARP2, including artificial steroids. In view of these observations, we propose a new role for PARP2 as a lipid-modulated regulator of lipid metabolism.


Assuntos
Colesterol/metabolismo , Técnicas de Inativação de Genes , Músculo Esquelético/metabolismo , Poli(ADP-Ribose) Polimerases/genética , Animais , Linhagem Celular , Membrana Celular/metabolismo , Di-Hidrotestosterona/metabolismo , Homeostase , Metabolismo dos Lipídeos , Masculino , Camundongos , Poli(ADP-Ribose) Polimerases/metabolismo , Ratos , Proteína de Ligação a Elemento Regulador de Esterol 1/genética
8.
EJIFCC ; 29(2): 111-116, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30050394

RESUMO

The role of vitamin D in calcium-phosphorus metabolism regulation is the most highlighted, nonetheless there is enormous literature on the extra-skeletal effects of vitamin D, and lately new insight into the role of vitamin D in endocrine disease mechanisms has seen light of day. The present narrative review gives an overview of the proposed roles of vitamin D in the etiology of Hashimoto's thyroiditis, Grave's disease, Addison's disease and primary hyperthyroidism. The implications as pertaining to the routine laboratory practice are readily applicable to this patient group as well, and do not pose any additional challenge.

9.
EJIFCC ; 29(2): 117-128, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30050395

RESUMO

With an aging population, there is a marked increase in prevalence of metabolic bone diseases, especially osteoporosis. Perhaps the most dreaded complication of metabolic bone disease, fractures typically impose a huge burden on the ailing body and are associated with high co-morbidity and mortality. The consequent public health and socioeconomic burden warrant timely diagnosis, treatment and follow-up of these disorders. Knowing the limitations of radiological techniques, biochemical markers of bone turnover measurements come handy since the changes in their levels readily reflect bone physiology. Bone biomarkers typically analyzed in high throughput automated routine laboratories are collagen degradation products, reflecting osteoclast activity, and the collagenous or non-collagenous proteins produced by the osteoblasts. Since bone biomarker levels vary considerably due to quite a few endogenous and exogenous pre-analytical factors, knowledge of these limitations is mandatory prior to clinical utilization since these variabilities complicate test result interpretation. Standardization to harmonize different assay methodologies is desired, and the primary aims of the IFCC/IOF bone marker standards working group are also presented. Current literature data advocate bone markers as best used in monitoring anti-osteoporosis therapy efficacy and compliance, nonetheless, there is abundant data supporting their role in predicting bone loss and fracture risk. Furthermore, they have widespread clinical utility in osteoporosis, renal osteodystrophy, and certain oncological conditions and rheumatic diseases.

10.
Clin Rheumatol ; 37(5): 1183-1188, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29383454

RESUMO

Assessment of intracranial vessels includes transcranial Doppler (TCD). TCD performance requires intact temporal acoustic windows (TAW). Failure of TAW (TAWF) is present in 8-20% of people. There have been no reports on TAWF in rheumatoid arthritis (RA). Altogether, 62 female RA patients were included. Among them, 20 were MTX-treated and biologic-free, 20 received infliximab, and 22 tocilizumab. The controls included 60 non-RA women. TAWF, temporal bone thickness, and texture were determined by ultrasound and CT. BMD and T-scores of multiple bones were determined by DEXA. Several bone biomarkers were assessed by ELISA. In RA, 54.8% of the patients had TAWF on at least one side. Neither TAW could be identified in 34% of RA subjects. In contrast, only 20.0% of control subjects had TAWF on either or both sides (p < 0.001). In RA vs controls, 53.0 vs 2.9% of subjects exerted the trilayer, "sandwich-like" structure of TAW (p < 0.001). Finally, in RA vs controls, the mean temporal bone thickness values of the right TAW were 3.58 ± 1.43 vs 2.92 ± 1.22 mm (p = NS), while those of the left TAW were 4.16 ± 1.56 vs 2.90 ± 1.16 mm (p = 0.001). There was close association between TAWF, bone thickness, and texture (p < 0.05). These TAW parameters all correlated with age; however, TAW failure and texture also correlated with serum osteoprotegerin. TAW bone thickness inversely correlated with hip BMD (p < 0.05). TAWF, thicker, and heterogeneous temporal bones were associated with RA. These features have been associated with bone loss and OPG production. Bone loss seen in RA may result in OPG release and stimulation of bone formation around TAW.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Densidade Óssea/fisiologia , Osso Temporal/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler Transcraniana
11.
Lasers Med Sci ; 33(6): 1225-1236, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29453616

RESUMO

Bone may be similar to geological formulations in many ways. Therefore, it may be logical to apply laser-based geological techniques in bone research. The mineral and element oxide composition of bioapatite can be estimated by mathematical models. Laser-induced plasma spectrometry (LIPS) has long been used in geology. This method may provide a possibility to determine the composition and concentration of element oxides forming the inorganic part of bones. In this study, we wished to standardize the LIPS technique and use mathematical calculations and models in order to determine CaO distribution and bone homogeneity using bovine shin bone samples. We used polished slices of five bovine shin bones. A portable LIPS instrument using high-power Nd++YAG laser pulses has been developed (OpLab, Budapest). Analysis of CaO distribution was carried out in a 10 × 10 sampling matrix applying 300-µm sampling intervals. We assessed both cortical and trabecular bone areas. Regions of interest (ROI) were determined under microscope. CaO peaks were identified in the 200-500 nm wavelength range. A mathematical formula was used to calculate the element oxide composition (wt%) of inorganic bone. We also applied two accepted mathematical approaches, the Bartlett's test and frequency distribution curve-based analysis, to determine the homogeneity of CaO distribution in bones. We were able to standardize the LIPS technique for bone research. CaO concentrations in the cortical and trabecular regions of B1-5 bones were 33.11 ± 3.99% (range 24.02-40.43%) and 27.60 ± 7.44% (range 3.58-39.51%), respectively. CaO concentrations highly corresponded to those routinely determined by ICP-OES. We were able to graphically demonstrate CaO distribution in both 2D and 3D. We also determined possible interrelations between laser-induced craters and bone structure units, which may reflect the bone structure and may influence the heterogeneity of CaO distributions. By using two different statistical methods, we could confirm if bone samples were homogeneous or not with respect to CaO concentration distribution. LIPS, a technique previously used in geology, may be included in bone research. Assessment of element oxide concentrations in the inorganic part of bone, as well as mathematical calculations may be useful to determine the content of CaO and other element oxides in bone, further analyze bone structure and homogeneity and possibly apply this research to normal, as well as diseased bones.


Assuntos
Densidade Óssea , Osso e Ossos/química , Geologia/instrumentação , Lasers , Gases em Plasma/química , Análise Espectral/métodos , Animais , Osso e Ossos/diagnóstico por imagem , Compostos de Cálcio/análise , Osso Esponjoso/química , Osso Esponjoso/diagnóstico por imagem , Bovinos , Modelos Biológicos , Modelos Teóricos , Óxidos/análise , Óxidos/química , Espectrofotometria Atômica , Estatística como Assunto , Tomografia Computadorizada por Raios X
12.
Matern Child Nutr ; 14(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28593684

RESUMO

Pregnant women are prone to iodine deficiency due to the increased need for iodine during gestation. Progress has recently occurred in establishing serum thyroglobulin (Tg) as an iodine status biomarker, but there is no accepted reference range for iodine sufficiency during pregnancy. An observational study was conducted in 164 pregnant women. At week 16 of gestation urinary iodine concentration (UIC), serum Tg, and thyroid functions were measured, and information on the type of iodine supplementation and smoking were recorded. The parameters of those who started iodine supplementation (≥150 µg/day) at least 4 weeks before pregnancy (n = 27), who started at the detection of pregnancy (n = 51), and who had no iodine supplementation (n = 74) were compared. Sufficient iodine supply was found in the studied population based on median UIC (162 µg/L). Iodine supplementation ≥150 µg/day resulted in higher median UIC regardless of its duration (nonusers: 130 µg/L vs. prepregnancy iodine starters: 240 µg/L, and pregnancy iodine starters: 205 µg/L, p < .001, and p = .023, respectively). Median Tg value of pregnancy starters was identical to that of nonusers (14.5 vs. 14.6 µg/L), whereas prepregnancy starters had lower median Tg (9.1 µg/L, p = .018). Serum Tg concentration at week 16 of pregnancy showed negative relationship (p = .010) with duration of iodine supplementation and positive relationship (p = .008) with smoking, a known interfering factor of iodine metabolism, by multiple regression analysis. Serum Tg at week 16 of pregnancy may be a promising biomarker of preconceptual and first trimester maternal iodine status, the critical early phase of foetal brain development.


Assuntos
Deficiências Nutricionais/prevenção & controle , Iodo/uso terapêutico , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Cuidado Pré-Concepcional , Complicações na Gravidez/prevenção & controle , Tireoglobulina/sangue , Adulto , Biomarcadores/sangue , Biomarcadores/urina , Deficiências Nutricionais/sangue , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/urina , Suplementos Nutricionais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hungria , Iodo/deficiência , Iodo/urina , Cooperação do Paciente , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/etiologia , Complicações na Gravidez/urina , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Valores de Referência , Autorrelato , Fumar/efeitos adversos , Cloreto de Sódio na Dieta/uso terapêutico
13.
Arthritis Res Ther ; 19(1): 213, 2017 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-28950911

RESUMO

BACKGROUND: Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI). METHODS: Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI. RESULTS: MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis. CONCLUSIONS: To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.


Assuntos
Artrite Reumatoide/complicações , Artéria Basilar/patologia , Encéfalo/patologia , Transtornos Cerebrovasculares/etiologia , Artéria Cerebral Média/patologia , Adulto , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artéria Basilar/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/patologia , Feminino , Humanos , Infliximab/uso terapêutico , Imagem por Ressonância Magnética , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Ultrassonografia/métodos , Ultrassonografia Doppler Transcraniana
14.
Autoimmun Rev ; 16(3): 313-320, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28159704

RESUMO

Inflammatory arthritides, such as rheumatoid arthritis (RA) and spondyloarthritides (SpA) have been associated with both localized bone resorption and/or formation, and generalized osteoporosis. Systemic inflammation may be the major driver for bone loss in arthritis. In RA and peripheral SpA the RANK-RANKL-OPG network is involved in bone resorption, while in axial SpA the Wnt-ß-catenin axis and its inhibitors (DKK-1, sclerostin) are the most relevant. Targeted therapies including biologics and small molecule tyrosine kinase inhibitors may interfere with inflammatory bone metabolism. Most of these compounds are able to slow down radiographic progression and osteoporosis in arthritides. In very early cases of non-radiological SpA, there may be a window of opportunity allowing to prevent syndesmophyte formation. The inability of targeted therapies to increase the production of DKK-1 and sclerostin may explain the lack of efficacy of TNF inhibitors to halt syndesmophyte formation in SpA. Further clinical trials are needed to better understand the bone effects of targeted therapies.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Osso e Ossos/metabolismo , Espondilartrite/tratamento farmacológico , Osso e Ossos/patologia , Humanos
15.
Int J Cardiol ; 230: 577-584, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28043680

RESUMO

There continues to be interest in understanding the role of vitamin D in the pathogenesis, epidemiology and prevention of cardiovascular disease (CVD). In fact vitamin D deficiency has been associated to an increased risk of developing CVD given to the relationship between low vitamin D levels and obesity, diabetes mellitus, dyslipidaemia, endothelial dysfunction and hypertension. However, although vitamin D has been identified as a potentially important marker of CVD, the mechanisms through which vitamin D deficiency leads from endothelial dysfunction to myocardial infarction and stroke are not fully understood. Thus, the goal of this review is to provide an updated review of the literature on the basic science of how vitamin D may affect the cardiovascular system and in particular to analyze the role that vitamin D may have in the whole dynamic process from the initiation of endothelial dysfunction to the development of myocardial infarction and stroke.


Assuntos
Aterosclerose/tratamento farmacológico , Infarto do Miocárdio/etiologia , Acidente Vascular Cerebral/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/uso terapêutico , Aterosclerose/complicações , Humanos , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
16.
J Steroid Biochem Mol Biol ; 173: 5-12, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28088363

RESUMO

Death rates in the U.S. show a pronounced seasonality. The broad seasonal variation shows about 25% higher death rates in winter than in summer with an additional few percent increase associated with the Christmas and New Year's holidays. A pronounced increase in death rates also starts in mid-September, shortly after the school year begins. The causes of death with large contributions to the observed seasonality include diseases of the circulatory system; the respiratory system; the digestive system; and endocrine, nutritional, and metabolic diseases. Researchers have identified several factors showing seasonal variation that could possibly explain the seasonal variations in mortality rate. These factors include seasonal variations in solar ultraviolet-B(UVB) doses and serum 25-hydroxyvitamin D [25(OH)D] concentrations, gene expression, ambient temperature and humidity, UVB effects on environmental pathogen load, environmental pollutants and allergens, and photoperiod (or length of day). The factors with the strongest support in this analysis are seasonal variations in solar UVB doses and 25(OH)D concentrations. In the U.S., population mean 25(OH)D concentrations range from 21ng/mL in March to 28ng/mL in August. Measures to ensure that all people had 25(OH)D concentrations >36ng/mL year round would probably reduce death rates significantly.


Assuntos
Mortalidade , Estações do Ano , Vitamina D/análogos & derivados , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/mortalidade , Doenças do Sistema Digestório/sangue , Doenças do Sistema Digestório/genética , Doenças do Sistema Digestório/mortalidade , Poluentes Ambientais/efeitos adversos , Expressão Gênica , Humanos , Doenças Metabólicas/sangue , Doenças Metabólicas/genética , Doenças Metabólicas/mortalidade , Transtornos Nutricionais/sangue , Transtornos Nutricionais/genética , Transtornos Nutricionais/mortalidade , Material Particulado/efeitos adversos , Infecções Respiratórias/sangue , Infecções Respiratórias/genética , Infecções Respiratórias/mortalidade , Luz Solar , Raios Ultravioleta , Estados Unidos/epidemiologia , Vitamina D/sangue
17.
Rev Endocr Metab Disord ; 18(3): 363-371, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28032296

RESUMO

Perhaps the role of Vitamin D supplementation has been most exhaustively studied in calcium absorption, skeletal wellbeing, muscular potency, balance and risk of falling. Nonetheless, new data has emerged and the recent research on sarcopenia makes the topic increasingly interesting. Given the socioeconomic burden of the musculoskeletal consequences of hypovitaminosis D it is vital to keep abreast with the latest literature in the field. The recommended Vitamin D supplementation dose should suffice to increase the serum 25 hydroxyvitamin D level to 30 ng/mL (75 nmol/L) and this level should be optimally maintained with a maintenance dose, particularly for those diagnosed with osteoporosis.


Assuntos
Densidade Óssea/fisiologia , Fenômenos Fisiológicos Musculoesqueléticos , Vitamina D/fisiologia , Animais , Densidade Óssea/efeitos dos fármacos , Cálcio na Dieta/farmacologia , Suplementos Nutricionais , Saúde , Humanos , Fenômenos Fisiológicos Musculoesqueléticos/efeitos dos fármacos , Osteoporose/dietoterapia , Osteoporose/prevenção & controle , Vitamina D/farmacologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações
18.
Gynecol Endocrinol ; 33(1): 34-38, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27468791

RESUMO

The aim of this study was to utilize various insulin resistance measuring methods to determine whether insulin resistance and other parameters impact the serum lipid levels of polycystic ovary syndrome (PCOS) patients and how the serum lipid levels in these patients are affected by the body mass index (BMI). Our dataset included patients between the ages of 16 and 42 (N = 228) from the outpatient endocrinology clinic of the Department of Obstetrics and Gynecology, who demonstrated increased hair growth and bleeding disorders and came for a routine oral glucose tolerance test (OGTT). Differences in the serum lipid levels were evaluated by t-test and linear regression analysis after adjusting for BMI. A stepwise regression model was constructed to evaluate the influence of each variable on the lipid levels. In PCOS patients, we found that dyslipidemia is more prevalent among hyperinsulinemic women compared with normoinsulinemic women, even after normalizing for BMI. PCOS patients with insulin resistance, determined by the insulin sensitivity index (ISI) method, showed more significant lipid abnormalities such as low high-density lipoprotein (HDL) and apo-A levels and high total cholesterol, low-density lipoprotein (LDL) and apo-B levels than if insulin resistance (IR) determination was based on insulin level or homeostatic model assessment (HOMA).


Assuntos
Doenças Cardiovasculares/sangue , Hiperinsulinismo/sangue , Resistência à Insulina , Obesidade/sangue , Síndrome do Ovário Policístico/sangue , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hiperinsulinismo/epidemiologia , Obesidade/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Fatores de Risco , Adulto Jovem
20.
BMC Nephrol ; 17(1): 147, 2016 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-27737645

RESUMO

BACKGROUND: Mortality in patients with end-stage renal disorders is often a consequence of cardiovascular complications. Renal replacement therapies may contribute to this morbidity by promoting cellular activation. In renal failure patients peripheral blood samples were investigated for platelet and endothelial cell activation markers to compare the effects of haemodiafiltration (HDF) and haemodialysis (HD). METHODS: Overall 28 patients were included in the study. Platelet P-selectin and leukocyte - platelet heterotypic aggregates were studied by flow cytometry. Soluble P- and E-selectin values were determined by ELISA, while von Willebrand factor (vWF) antigen levels were measured by immunoturbidimetry. Statistical analysis was done by the SPSS v22 software. RESULTS: Platelet surface P-selectin was below 3.0 % in healthy controls, but it was higher during the dialysis after 4 h, 8 % and 14.3 % in HDF and HD, respectively. Monocyte-platelet heterotypic aggregates were significantly elevated after 4 h in both treatments, up to 69.2 % in HDF and to 82.9 % in HD. Soluble P-selectin levels were also significantly elevated by the end of both treatment procedures (p < 0.001), vWF antigen values, however, showed elevation only during HD treatment. CONCLUSIONS: The attenuated platelet activating effects of HDF compared to HD may contribute to a less unfavourable vascular effect in this treatment modality.


Assuntos
Hemodiafiltração , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Ativação Plaquetária , Adolescente , Adulto , Idoso , Anticoagulantes/farmacologia , Biomarcadores/sangue , Selectina E/sangue , Células Endoteliais/fisiologia , Feminino , Heparina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/fisiologia , Selectina-P/sangue , Ativação Plaquetária/efeitos dos fármacos , Diálise Renal , Adulto Jovem , Fator de von Willebrand/metabolismo
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