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Introduction: Fetuin-A plays an important role in bone turnover and vascular calcification., Aim: The aim of the study was to assess the relationship between serum fetuin-A concentrations, inflammatory and bone turnover markers of patients on maintenance hemodialysis., Materials and Methods: The study was performed in 71 patients (21 women, 40 men) aged 60 ± 12 years on chronic dialysis because of end-stage renal failure for a period of 75 ± 57.2 months. The routine laboratory tests were performed with Modular P analyzer (Roche Diagnostics), serum concentrations of iPTH were measured using Nichols method, hsCRP and IL-6 using nephelometric techniques while fetuin-A, bone-specific alkaline phosphatase (bALP), fully carboxylated osteocalcin (cOC), undercarboxylated osteocalcin (ucOC), and fibroblast growth factor-23 (FGF-23) were measured using commercially available ELISA kits., Results: Concentrations of fetuin-A were significantly positively correlated with albumin (r=0.37, p=0.003) and negatively associated with patients age (r=26, p=0.04), log (iPTH) (r=0.31, p=0.02), log (CRP) (r=0.31, p=0.02), log (IL-6) (r=0.41, p=0.001), log (ucOC) (r=-0.29, p=0.02), and log (FGF-23) (r=0.27, p=0.04)., Conclusions: 1. Patients on maintenance hemodialysis suffer from severe disturbances of bone turnover. 2. Low serum fetuin-A levels are associated with increase markers of bone turnover and inflammation.

During last decade, many new biomarkers have been proposed for early diagnosis of acute pancreatitis and prognosis of its severity. However clinical availability of many markers are limited due to costly and time. consuming laboratory methods used, for their assessment, including ELISA technique. Recent studies revealed the usefulness of red cell distribution width (RDW), as a predictor of unfa vorable prognosis in many disease states. RDW is an easily available index generated automatically as a part of standard complete blood count In our group of 40 acute pancreatitis patients, RDW values assessed du ring first 5 days of disease, correlated positively with the duration of hospital stay and the severity of disease as well as with the concentration of selected inflammatory markers. Patients who died had significantly higher RDW comparing to survivors. Our results indicate that RDW may be helpful in early prediction of clinical course of acute pancreatitis.

Despite new diagnostic methods, including novel laboratory parameters and imaging techniques, and growing knowledge on pathogenesis of acute pancreatitis, early assessment of severity remains the main factor influencing prognosis in the disease. The aim of the study was the evaluation of diagnostic accuracy of interleukins (IL): 6 and 18 and acute phase proteins: C-reactive protein (CRP) and serum amyloid A (SAA), together with Glasgow prognostic score during first 48 hours after diagnosing acute pancreatitis in a group of 40 patients treated in the I-st Department of General and Gastrointestinal Surgery University Hospital in Cracow. All the studied inflammatory markers were significantly higher in patients with moderate and severe acute pancreatitis versus patients with mild form of the disease on the first 48 hours of the disease. Expanding Glasgow score with IL-6, IL-18, SAA or CRP determinations resulted in better accuracy for diagnosing severe clinical course of acute pancreatitis.

Unlabelled: TRAIL (TNF-related apoptosis-inducing ligand) acts as a soluble cytokine interacting with transmembrane receptors belonging to the TNF-receptor family. TRAIL can activate both apoptotic and anti-apoptotic signals. Lower levels of serum sTRAIL were inversely associated with a higher risk of all-cause mortality in CKD population. A strong association between malnutrition, inflammation and atherosclerosis, have been observed in CKD patients. The aim of the study was to investigate the relationship between sTRAIL and nutritional markers and adipose tissue metabolism indices in patients on maintenance hemodialysis. The study was performed in group of 76 patients (36 female and 40 male) of average age 60 +/- 12 years on hemodialysis (74.8 +/- 58.0 months). sTRAIL, leptin and adiponectin were determined by ELISA, BMI based on Quetelet formula and serum albumin level using colorimetric bromokrezol green method. The following values of studied parameters were obtained: sTRAIL = 959.6 +/- 204.0 pg/ml, BMI = 24.5 +/- 4.8, leptin = 36.42 +/- 57.94 ng/ml, adiponectin = 17.55 +/- 10.52 microg/ml, leptin/ adiponectin (x10(-3)) = 2.1 +/- 4.5 and albumin = 38.5 +/- 4.5 g/l. sTRAIL correlate negatively with adiponectin and positively with the remaining studied parameters: BMI, albumin, leptin and leptin/adiponectin ratio., Conclusion: The observed interrelations between sTRAIL and nutritional parameters as well as studied adipokines may indicate the modulating role of sTRAIL in metabolic regulation.

Acquisition of scientific data needed to make rational decisions about health policy has became an important tool in determining the validity of the financing methods of treatment from public funds under the health technology assessment (HTA). The primary source of scientific evidence for health technology assessment are randomized controlled trials (RCTs, explanatory trials evaluating the efficacy), because of their features reducing methodological bias (e.g. randomization or blindness). These features may become a disadvantage, which seriously reduces the possibility of transfer of the results and conclusions to the level of routine practice. In this situation an important role begin to play studies that provide data on effectiveness-observational studies, registries and pragmatic randomized controlled trials (pRCTs).

The aim of this study was to analyze osteopontin (OPN) concentrations in patients with acute pancreatitis (AP) and its suitability for diagnosis and prediction of severity during the first 3 days from admission to hospital. The study group consisted of 40 patients admitted and hospitalized at I-st and II-nd Depatments of Surgery Jagiellonian University Collegium Medicum in Krakow. All laboratory tests necessary for diagnosis and monitoring of patients were performed in the Diagnostic Dept. of University Hospital, other immunochemistry parameters were assesed in the Diagnostic Dept. of Clinical Biochemistry Jagiellonian University using ELISA kits. The concentrations of OPN in severe acute pancreatitis were significantly higher than in patients with mild form of disease in the whole observation period. Simultaneously, we observed that increased in OPN concentrations in consecutive days of AP may be helpful in prediction of severity and compilations during AP.

Unlabelled: The aim of the study was to compare 4 non-invasive biochemical scores of liver fibrosis (age/PLT; AST/ALT; APRI and FORNS) with results of hepatic biopsies classified according to Batts-Ludwig scale. The study included a total of 99 patients: 44 (44.4%) women with mean +/- SD age of 42 +/- 11.9 years and 55 (55.6%) men (43 +/- 12.2) treated for chronic hepatitis C., Results: Levels of several markers changed significantly after 3 months of treatment (with interferon alpha and ribavirin) comparing to values on admission to hospital: we observed statistically significant differences of ALT: 32.6 +/- 15.7 vs. 61.5 +/- 35.6 (U/l), p<0.001; AST: 34.1 +/- 11.1 vs. 48.2 +/- 26.5 (U/l), p<0.05 and total cholesterol concentration: 4.0 +/- 0.4 vs. 4.9 +/- 0.9 (mmol/l), p<0.01 in women; AST/ALT ratio in both men (0,8 +/- 0,3 vs. 0.69 +/- 0.25; p<0.05) and women (1.2 +/- 0.4 vs. 0.84 +/- 0.24; p<0.001) and age/PLT score: 0.4 +/- 0.3 vs. 0.28 +/- 0.12 (p<0.01) in men., Conclusions: Non-invasive biochemical scores: age/PLT, APRI and FORNS showed acceptable compliance with liver morphological status characterized in Batts-Ludwig scale as we observed significant differences between F0-F1 and F3-F4 groups. Age/PLT, APRI and FORNS seems to be helpful in prediction of early stage of liver fibrosis in patients with chronic hepatitis C. After 3 months of standard antiviral therapy (interferon alpha and ribavirin) we did not observe statistically significant differences in values of FORNS and APRI scores. Simultaneously, we noticed significant decrease in activity of aminotransferases and AST/ALT ratio recognized by clinicians as standard markers of inflammatory and necrosis processes.

About 15% of cases of nonspecific inflammatory bowel diseases are difficult to diagnose based on clinical, radiological and histopatological criteria. In this study we tried to find a biochemical marker helpful in differential diagnostics and assessment of activity of Leśniowski-Crohn's disease and ulcerative colitis. Plasma concentrations of leukocyte elastase and calprotectin (neutrophiles' proteins), eotaxin (eosinophils chemoatractant) and C-reactive protein were measured in 22 patients with Leśniowski-Crohn's disease and 28 patients witch ulcerative colitis. Significantly higher plasma levels of leukocyte elastase and calprotectin in patients witch ulcerative colitis as compared to Leśniowski-Crohn's disease were found. Thus leukocyte elastase and calprotectin can be considered additional markers differentiating these two diseases. Moreover, plasma concentrations of CRP and leukocyte elastase were associated with the clinical activity of Leśniowski-Crohn's disease whereas CRP and calprotectin concentrations were related to the clinical activity of colitis ulcerosa.

Blood glucose is one of the most frequently ordered laboratory tests used mainly for diagnosis and monitoring of diabetes treatment. However, disturbances of glucose metabolism occur also in patients without diabetes in critical illnesses of various etiopathogenesis, including acute coronary syndrome, multi-organ injuries, sepsis, septic shock, burns or post-surgery trauma. The disturbances are caused by increased secretion of stress hormones and inflammatory cytokines resulting in insulin resistance and hyperglycemia. These changes worsen the course of the disease and prognosis. The management of critically ill patients should include the control of glycemia and maintaining it in the target range. The treatment includes intravenous insulin and glucose administration with monitoring of glycemia. Other abnormalities of glucose metabolism observed in various diseases are hypoglycemic states including neonatal hypoglycemia. Assays of blood glucose in critically ill patients treated in intensive care units should be performed using point-of-care testing (POCT) techniques. Measurements of real time glycemia provide the base for rapid achievement and maintaining glucose target values. It is particularly important when glucose concentrations decide on immediate physician's action, e.g. change in insulin dosage or compensation of hypoglycemia. POCT glucose assays are now included in critical care tests panel and glucose assays may be performed using various dedicated analyzers. This kind of test has its specificity associated with the kind of employed material and the measurement techniques adjusted to "fresh" blood as material of testing, distinguishing results of glucose POCT assays and results obtained in the laboratory. Tests are performed in the blood samples immediately after collection sample and take no longer than a few minutes. Real time glycemia control in intensive care unit patients has become an important part of present medical procedures.

The environmental iodine deficiency has been a serious problem in the Polish health care system for many years. In many European countries the prevention of iodine deficiency-related health deficits in population scale is based on edible salt supplementation with KI. In the decade of the 80-ties the iodine supplementation program in Poland was stopped, which has caused a subsequent increase in prevalence of goiter and iodine deficiency-related hypothyreosis. These diseases were observed in many regions of Poland, including the areas beyond regions of formerly known iodine deficiency endemias. In order to control the whole Polish population, iodine consumption deficit in1991 the "Polish Program of Iodine Deficiency Control and Prevention of Iodine Deficiency-related Disorders" has been established in the year 1991. In 1992--1996 a common iodine supplementation of salt used for general consumption was 20 mg KI/kg of NaCl, and in 1997 the mandatory supplementation of salt was 30 (+10) per kg of salt which has been introduced for the whole country. This paper reports the results of iodine excretion assays in school children 6-12 years old, in the years 1993--94, 1996--97 and 1999--2002 respectively. The obtained collections of iodine urine concentrations have shown distributions with a remarkable rightward skewness. Normalization of distributions required logarythmic transformation. The quartile values obtained for data collections from years 1992--94, 1996--97 and 1999--2002 have shown that in 5-7 years of iodine deficiency prevention program yielded increase in iodine excretion in morning urine samples by about 37.8 microg, while the iodine excretion median values increased from 63.5 mg/L in years 1992--1994 to 94.0 mg/L in years 1999--2001, respectively. The lower limits of iodine excretion ranges calculated as the mean value minus 2SD of transformed data for the years 1992--1994 amounted to: 7.74 mg/L and for the years 1999--2001 amounted to 14.1 microg/l, respectively. Assessing percent of children obtaining low iodine suplementation then recommended (below 50 mg/L in urine sample) amounted to 35.8% in years 1992--1994 and 15.4% in years 1999--2001 respectively.

Unlabelled: In the last few years much attention is being given to the problem of diabetes mellitus, to it's development, prevalence and progression of chronic complications. The aim of the study was to 1. evaluate correction of metabolic disturbances in patients with long-term type 1 diabetes mellitus; 2. evaluate occurrence of diabetic nephropathy and excretion function in patients with long-term type 1 diabetes mellitus; 3. evaluate function of the cardiovascular autonomic nervous system in patients with long-term type 1 diabetes mellitus; 4. search for connections between the type and change dynamics in the cardiovascular system and degree of diabetic nephropathy advancement. The study was performed in a group consisting of 31 patients with type 1 diabetes mellitus (20 women, 11 males). Mean age of the study group equaled 37.6 +/- 10.75 years, duration of diabetes mellitus 21.3 +/- 9.55 years. Concentration of cystatin C in the study group was 0.98 +/- 0.23 ng/ml, in the group of patients with diabetic retinopathy 1.13 +/- 0.30 ng/ml, while in the group without diabetic retinopathy 0.89 +/- 0.13 ng/ml. Concentration of cystatin C (p <0.05) and calculated GFR according to equations proposed by F.J. Hoeck [GFR/1.73 m2 = -4.32 + 80.3/plasma cystatin] (p < 0.01) also G.D. Tan [GFR -10 = (87.1/plasma cystine) - 6.87] (p < 0.01) significantly differentiated the discussed groups., Conclusions: despite normal levels of blood creatinine in the studied patients, decreased glomerular filtration was calculated for plasma cystatin C. Plasma cystatin C concentrations and calculated glomerular clearance significantly differentiated the group with retinopathy from the group without diabetic retinopathy. Determining cystatin C concentrations as a protein which probably does not undergo glycation in plasma, may play a role in the detection of early diabetic nephropathy, when as well as plasma creatinine levels and albumin/creatinine index calculated from a sample of morning urine do not differentiate the studied group of patients.

During past years a significant progress in improving and introducing personal insulin pumps into diabetic treatment has been observed. In the article indications of use the personal insulin pumps were presented, emphasized benefits resulting from this treatment modality.

Cardiovascular complications are the main cause of disability and deaths in insulin dependent diabetic patients. The main aim of the EURODIAB IDDM Complications Study was to assess the prevalence of diabetes complications and of risk factors of these complications. In this study the data on cardiovascular diseases and their risk factors in patients included in the EURODIAB IDDM Complications Study--Krakow are presented. The study population included insulin dependent clinic attenders, aged 15-60 years, diagnosed before the age of 36 years. A random sample of up to 140 patients stratified by age, sex and duration of diabetes was chosen. Within each centre the study population consisted of all eligible IDDM patients living in a defined catchement area, who had attended the center at least once during the preceding 12 months. The studied sample included 120 patients (61 men and 59 women). Mean (sd) age of patients was 34.0 (9.6) years, mean duration of diabetes 14.2 (9.8) years, mean Hb A1c concentration 6.6 (1.5)%. The prevalence of cardiovascular diseases was assessed using standardized questionnaire and resting electrocardiogram. Blood pressure was measured with "random zero" sphygmomanometer. Electrocardiogram was assessed according to Minnesota code. Serum cholesterol and triglyceride concentration were determined by enzymatic methods. Albumin excretion rate was determined in 24 hours urine collection. Albumin concentration was assayed by immunoturbidimetry. Cardiovascular diseases were observed in 8.3% of patients. Arterial hypertension (WHO dfn) was found in 11.7% of patients, systolic blood pressure > or = 140 mm Hg in 9.2% of patients and diastolic blood pressure > or = 90 mm Hg in about 5% of men and 2% of women. Hypercholesterolemia (serum cholesterol > or = 6.5 mmol/l) was found in about 20% of patients, hypertriglyceridemia (serum triglyceride 2.2 mmol/1) in 16.4% of men and 10.2% of women. 41.0% of men and 28.8% of women were current cigarette smokers. Microalbuminuria (defined as albumin excretion rate 20-200 micrograms/min) was observed in 23% of men and 15.3% of women.(ABSTRACT TRUNCATED AT 250 WORDS)