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Introduction: GnRH-analogs induce bone loss. We aimed to investigate the effects of goserelin-induced menstrual cessation (MC) and subsequent menstrual restoration (MR) on bone metabolism (BM). Methods: In this prospective cohort study, premenopausal women (PMW) with histologically verified endometriosis (n = 21) received goserelin monthly for 6 months (6 m) resulting in MC and were followed up for another 6 m after MR (12 m). Age- and BMI-matched healthy PMW (n = 20) served as controls for bone mineral density (BMD) measurements. The primary endpoint was changes in lumbar spine (LS)-BMD at 6 m and 12 m; Secondary endpoints were changes in femoral neck (FN)-BMD, bone turnover markers (P1NP and CΤx), sclerostin, and expression of bone-related circulating microRNAs (miRNAs) at 6 m and 12 m. Results: Goserelin-induced MC reduced LS- and FN-BMD at 6 m (both p < 0.001). From 6 m to 12 m, LS-BMD increased (p < 0.001) but remained below baseline values (p = 0.012), whereas FN-BMD remained stable (p = 1.000). CTx and P1NP levels increased at 6 m (both p < 0.001) and decreased at 12 m (p < 0.001 and p = 0.013, respectively), while CTx (p = 1.000) alone and not P1NP (p = 0.020) returned to baseline. Sclerostin levels did not change. Relative expression of miRNAs targeting RUNX 2 and beta-catenin was significantly downregulated at 6 m compared to baseline (p < 0.001), while the expression of miRNAs targeting osteoblast and osteoclast function at both directions demonstrated a robust increase (up to 400fold) at 12 m (p < 0.001). Conclusions: Six months of goserelin-induced MC lead to significant bone loss associated with increased bone turnover and changes in the expression of bone-related miRNAs, changes that are only partially reversed at 6 m after MR. © 2022 Elsevier Inc.

GnRH-analogs induce bone loss. We aimed to investigate the effects of goserelin-induced menstrual cessation (MC) and subsequent menstrual restoration (MR) on bone metabolism (BM).In this prospective cohort study, premenopausal women (PMW) with histologically verified endometriosis (n = 21) received goserelin monthly for 6 months (6 m) resulting in MC and were followed up for another 6 m after MR (12 m). Age- and BMI-matched healthy PMW (n = 20) served as controls for bone mineral density (BMD) measurements. The primary endpoint was changes in lumbar spine (LS)-BMD at 6 m and 12 m; Secondary endpoints were changes in femoral neck (FN)-BMD, bone turnover markers (P1NP and CΤx), sclerostin, and expression of bone-related circulating microRNAs (miRNAs) at 6 m and 12 m.Goserelin-induced MC reduced LS- and FN-BMD at 6 m (both p 0.001). From 6 m to 12 m, LS-BMD increased (p 0.001) but remained below baseline values (p = 0.012), whereas FN-BMD remained stable (p = 1.000). CTx and P1NP levels increased at 6 m (both p 0.001) and decreased at 12 m (p 0.001 and p = 0.013, respectively), while CTx (p = 1.000) alone and not P1NP (p = 0.020) returned to baseline. Sclerostin levels did not change. Relative expression of miRNAs targeting RUNX 2 and beta-catenin was significantly downregulated at 6 m compared to baseline (p 0.001), while the expression of miRNAs targeting osteoblast and osteoclast function at both directions demonstrated a robust increase (up to 400fold) at 12 m (p 0.001).Six months of goserelin-induced MC lead to significant bone loss associated with increased bone turnover and changes in the expression of bone-related miRNAs, changes that are only partially reversed at 6 m after MR.

Ο σχολικός εκφοβισμός είναι ένα παγκόσμιο φαινόμενο γνωστό από πολύ παλιά. Η χρήση της νέας τεχνολογίας οδήγησε στην εμφάνιση μίας νέας μορφής εκφοβισμού, του ηλεκτρονικού. Ο ηλεκτρονικός εκφοβισμός αποτελεί για κάποιους μία εξέλιξη της παλιότερης μορφής με μόνη βασική διαφορά το μέσο, που χρησιμοποιείται, ενώ για κάποιους άλλους ερευνητές είναι ένα εντελώς καινούριο φαινόμενο. Ένας αρκετά ολοκληρωμένος ορισμός είναι αυτός, που δίνεται από ένα οργανισμό κατά του ηλεκτρονικού εκφοβισμού και δηλώνει ότι cyberbullying είναι όταν ένα παιδί στην εφηβεία ή στην προεφηβεία βασανίζεται, απειλείται, παρενοχλείται, ταπεινώνεται, έρχεται σε αμηχανία ή στοχοθετείται από άλλο παιδί, στην εφηβεία ή στην προεφηβεία, μέσω ίντερνετ, διαδραστικών και ψηφιακών τεχνολογιών ή κινητών τηλεφώνων. Έχει πέντε βασικά χαρακτηριστικά: την ανισότητα δυνάμεων, την πρόθεση, την επανάληψη του φαινομένου, την ανωνυμία και τη δημοσιοποίηση του επεισοδίου. Σκοπός της παρούσας μελέτης ήταν να διερευνηθεί η παρουσία του ηλεκτρονικού εκφοβισμού σε εφήβους ηλικίας 13-16 ετών στον ελληνικό χώρο. Η ηλικιακή ομάδα επιλέχθηκε καθώς σε αυτή την περίοδο της ζωής σχεδόν όλα τα παιδιά έχουν επαφή με το διαδίκτυο και επιπλέον συμπίπτει με τη μετάβαση από την παιδική ηλικία και την πρωτοβάθμια εκπαίδευση, στην εφηβεία και τη δευτεροβάθμια εκπαίδευση. Βασικός στόχος της έρευνας ήταν η μελέτη των επιπτώσεων, που έχει το φαινόμενο στην υγεία των εφήβων. Ελέγχθηκαν πιθανές αλλαγές στη διατροφή, στον ύπνο και στη συμπεριφορά και διερευνήθηκαν επεισόδια εμφάνισης ψυχοσωματικών εκδηλώσεων. Τέλος στόχος ήταν και η μελέτη του τρόπου αντιμετώπισης του φαινομένου και των επιπτώσεών του.Η μελέτη πραγματοποιήθηκε με τη χρήση ερωτηματολογίου, το οποίο μοιράσθηκε σε 24 σχολεία του Νομού και της πόλης της Θεσσαλονίκης και απαντήθηκε από 4504 μαθητές ηλικίας 13-16 ετών. Το ερωτηματολόγιο είχε 5 μέρη: 1)το πρώτο αφορούσε καταγραφή δημογραφικών χαρακτηριστικών, 2)το δεύτερο ερευνούσε τη χρήση του κινητού και του διαδικτύου, 3) το τρίτο αφορούσε το επεισόδιο ηλεκτρονικού εκφοβισμού και τα χαρακτηριστικά του, 4) το τέταρτο τις επιπτώσεις του επεισοδίου στον ύπνο, στη διατροφή και στη συμπεριφορά του μαθητή και 5) το πέμπτο μέρος διερευνούσε σε ποιο άτομο θα απευθυνόταν τα θύματα σε επόμενο επεισόδιο ενώ στο τέλος υπήρχε κενός χώρος για να προσθέσουν ελεύθερα ότι σχετικό σχόλιο ή πρόταση ήθελαν οι συμμετέχοντες. Από τη μελέτη προέκυψε ότι μέχρι την ηλικία των 14 ετών σχεδόν όλα τα παιδιά (98,6%) χρησιμοποιούν το διαδίκτυο και έχουν κινητό τηλέφωνο. Οι λόγοι χρήσης του διαδικτύου στο μεγαλύτερο ποσοστό είναι η ψυχαγωγία και η επικοινωνία.Σε ποσοστό 59,4% οι έφηβοι έχουν πέσει θύματα ηλεκτρονικού εκφοβισμού και το 63,1% των περιστατικών ήταν μέσω του κινητού τηλεφώνου. Οι μισοί μαθητές, που υπήρξαν θύματα δεν ήξεραν την ταυτότητα του δράστη ενώ το 70% δήλωσε ότι το αντιμετώπισαν μόνοι τους και μόλις 15 στους 100 το είπαν στους γονείς τους.Η πλειοψηφία των μαθητών ανέφερε ότι δεν αντιμετώπισαν προβλήματα διατροφής, ύπνου και συμπεριφοράς. Παρόλα αυτά υπήρξαν και 2 στους 10, που αλλοιώθηκε η ποιότητα ή η ποσότητα του ύπνου τους ενώ και 16,2% δήλωσαν ότι άλλαξε η ποιότητα ή η ποσότητα των γευμάτων τους. Ακόμη 18 στους 100 εφήβους, που είχαν πέσει θύματα ηλεκτρονικού εκφοβισμού, παρουσίασαν ψυχοσωματικές εκδηλώσεις-όπως ταχυκαρδία, κεφαλαλγία, ναυτία - που οι ίδιοι τις συσχέτισαν με το περιστατικό ενώ ένα μικρό ποσοστό δήλωσε ότι άλλαξε η καθημερινότητά του σε διάφορους τομείς, όπως η χρήση του διαδικτύου, οι σχέσεις με τους φίλους και το άλλο φύλο και η διάθεση για το σχολείο. Επίσης πάνω από 1 στα 10 θύματα δήλωσαν πως σκέφτηκαν να κάνουν κακό στον εαυτό τους, 14,4% δήλωσαν ότι θέλουν να κάνουν κακό στους άλλους και πάνω από 15% ανέφεραν ότι είναι πιο νευρικοί και μαλώνουν με τους δικούς τους περισσότερο. Τέλος στην υποθετική ερώτηση εάν ξανά συνέβαινε παρόμοιο περιστατικό σε ποιον θα απευθυνόταν περίπου 1 στους 2 απάντησε και πάλι σε κανένα.Στη συγκριτική μελέτη των δύο φύλων δεν προέκυψαν στατιστικά σημαντικές διαφορές. Επίσης σημαντικές διαφορές δεν προέκυψαν ούτε όταν συγκρίθηκαν οι διάφορες τάξεις-άρα και ηλικίες- μεταξύ τους, αλλά και ούτε όταν συγκρίθηκαν μαθητές από την Ελλάδα σε σχέση με αλλοδαπούς μαθητές. Καταλήγοντας συμπεραίνουμε ότι η χρήση του διαδικτύου είναι εξαιρετικά διαδεδομένη στην εφηβική ηλικία και οι κίνδυνοι, που αυτή ελλοχεύει, πολλοί. Η συχνότητα του ηλεκτρονικού εκφοβισμού στους εφήβους της Ελλάδας είναι υψηλή και συμπίπτει με αυτές άλλων χωρών. Τα συγκεκριμένα περιστατικά ευτυχώς σε μικρό ποσοστό αλλά παρόλα αυτά υπαρκτό, μπορούν να επηρεάσουν τη διατροφή, τον ύπνο και τη συμπεριφορά κάποιων παιδιών. Το φαινόμενο επομένως αυτό είναι ιδιαιτέρως ανησυχητικό και θα πρέπει να ευαισθητοποιήσει όλους όσους εμπλέκονται στη φροντίδα υγείας αλλά και στην εκπαίδευση των νέων.

Η κύηση χαρακτηρίζεται από βαθμιαία αύξηση της ινσουλινικής αντίστασης και επακόλουθη αύξηση της έκκρισης ινσουλίνης προκειμένου να διατηρηθεί ευγλυκαιμία. Αδυναμία του οργανισμού να αντισταθμίσει αυτή την αύξηση της ινσουλινικής αντίστασης οδηγεί στην εμφάνιση ΣΔΚ. Η κατάσταση αυτή φυσιολογικά αποκαθίσταται μετά τον τοκετό. Η λιποκίνη βασπίνη θεωρείται ότι βελτιώνει την ευαισθησία στην ινσουλίνη, συνεπώς θα μπορούσε να εμπλέκεται στην ενδογενή ρύθμιση του μεταβολισμού της γλυκόζης στην εγκυμοσύνη ενώ μεταβολές της θα μπορούσαν να σχετίζονται με την εμφάνιση ΣΔΚ. Στόχος της παρούσας μελέτης ήταν να εκτιμηθεί η μεταβολή των επιπέδων της βασπίνης στην κυκλοφορία κατά τη διάρκεια της κύησης και στην λοχεία, σε εγκύους με ΣΔΚ σε σύγκριση με εγκύους με φυσιολογική ανοχή γλυκόζης, καθώς και τυχόν συσχετίσεις της με γνωστούς δείκτες ινσουλινικής αντίστασης και με τα λιπίδια, σε μια προσπάθεια να αξιολογήσουμε το ρόλο της βασπίνης στην διαταραχή του μεταβολισμού των υδατανθράκων που παρατηρείται τόσο στην φυσιολογική κύηση όσο και στον ΣΔΚ. Επιπλέον, συγκρίναμε τις ασθενείς με ΣΔΚ που αντιμετωπίστηκαν μόνο με δίαιτα ή με δίαιτα και ινσουλίνη, προσπαθώντας να εκτιμήσουμε την επίδραση του βαθμού διαταραχής του μεταβολισμού των υδατανθράκων καθώς και τύπου της θεραπευτικής παρέμβασης στα επίπεδα βασπίνης.Μελετήθηκαν ογδονταοκτώ εγκυμονούσες γυναίκες. Οι μισές (n=44) είχαν διαγνωσθεί να πάσχουν από ΣΔΚ ενώ οι υπόλοιπες μισές (n=44) είχαν φυσιολογική ανοχή γλυκόζης. Οι γυναίκες με ΣΔΚ διαιρέθηκαν επιπλέον σε 2 υποομάδες: αυτές στις οποίες ο ΣΔΚ αντιμετωπίστηκε μόνο με δίαιτα (n=20) και αυτές στις οποίες απαιτήθηκε επιπλέον χορήγηση και ινσουλίνης (n=24). Μετρήθηκαν τα επίπεδα βασπίνης, ινσουλίνης, γλυκόζης και λιπιδίων ορού και προσδιορίστηκε ο δείκτης ινσουλινικής ευαισθησίας QUICKI και ο δείκτης ινσουλινικής αντίστασης HOMA-IR σε 3 χρονικά στιγμιότυπα: στο 2ο τρίμηνο της κύησης, στο 3ο τρίμηνο και στην λοχεία.Τα επίπεδα βασπίνης ορού μειώθηκαν σημαντικά στη λοχεία σε σύγκριση με το 2ο και 3ο τρίμηνο της κύησης σε όλες τις ομάδες εγκύων γυναικών, χωρίς να διαφέρουν μεταξύ των ομάδων ή των υποομάδων σε κανένα χρονικό στιγμιότυπο. Στο 3ο τρίμηνο η βασπίνη σχετιζόταν θετικά με την ινσουλίνη, το HOMA-IR και τα τριλγυκερίδια και αρνητικά με το QUICKI στις γυναίκες με ΣΔΚ αλλά όχι και στις μάρτυρες. Οι συσχετίσεις αυτές δεν παρατηρήθηκαν στο 2ο τρίμηνο ή στην λοχεία. Σε μοντέλα λογιστικής παλινδρόμησης, η βασπίνη δεν μπορούσε να προβλέψει ανεξάρτητα την εμφάνιση ΣΔΚ, σε αντίθεση με το HOMA-IR. Στις υποομάδα των εγκύων με ΣΔΚ όπου χρειάστηκε ινσουλινοθεραπεία, η χορήγηση ινσουλίνης δεν επηρέασε τα επίπεδα βασπίνης ορού.Τα δεδομένα μας συνηγορούν ότι, κατά την κύηση τα επίπεδα κυκλοφορούσας βασπίνης μειώνονται βαθμιαία από το 2ο τρίμηνο ως τη λοχεία. Ωστόσο, οι μεταβολές αυτές είναι παρόμοιες μεταξύ εγκύων με ή χωρίς ΣΔΚ καθώς και μεταξύ γυναικών με ΣΔΚ υπό δίαιτα μόνο ή δίαιτα και ινσουλίνη. Τα επίπεδα βασπίνης στον ορό κατά το 2ο τρίμηνο της κύησης δεν μπορούν να προβλέψουν τον κίνδυνο εμφάνισης ΣΔΚ. Τέλος, σε γυναίκες με ΣΔΚ τα επίπεδα κυκλοφορούσας βασπίνης δεν επηρεάζονται από τον βαθμό της διαταραχής του μεταβολισμού των υδατανθράκων ούτε από την θεραπευτική χορήγηση ή η ινσουλίνης, όπως προκύπτει από την έλλειψη διαφορών μεταξύ των δύο υποομάδων εγκύων με ΣΔΚ.Οι γυναίκες με ΣΔΚ είχαν σαφώς υψηλότερα επίπεδα γλυκόζης, τριγλυκεριδίων και ινσουλίνης και υψηλότερο δείκτη HOMA-IR και χαμηλότερο δείκτη QUICKI, ενδεικτικά της εντονότερης ινσουλινοαντίστασης σε σύγκριση με τις μάρτυρες, τόσο κατά τη διάρκεια της κύησης όσο και στη λοχεία, υποδηλώνοντας ότι το ελάττωμα στην ινσουλινική ευαισθησία και τον μεταβολισμό γλυκόζης που οδηγεί στην ανάπτυξη ΣΔΚ στην κύηση παραμένει σε κάποιο βαθμό και μετά τον τοκετό.

SummaryObjective Patients treated with intravenous zoledronate frequently experience an acute phase reaction (APR) characterized by flu-like symptoms and increased levels of inflammatory cytokines. We aimed to define the role of various cytokines/adipocytokines in zoledronate-induced APR and develop a prognostic model for its prediction. Patients and Measurements Fifty-one postmenopausal women with low bone mass were subjected to zoledronate intravenous infusion. Patients were divided into those who experienced APR (APR+) and those who did not (APR−). APR was clinically defined by body temperature and the visual analogue pain scale for musculoskeletal symptoms. White blood cell count, leucocytic subpopulations, C-reactive protein, interleukin-6, tumour necrosis factor-alpha, visfatin, resistin and leptin were measured before and 48 h following the infusion. The quantitative insulin sensitivity check index (QUICKI) and homoeostasis model of assessment – insulin resistance (HOMA-IR) were calculated to assess insulin sensitivity and resistance, respectively. Results (APR+) patients were younger and had lower baseline visfatin and higher baseline lymphocytes and phosphate compared with APR− patients. QUICKI decreased and HOMA-IR increased in APR+ patients while remained unchanged in APR− patients. In binary logistic regression analysis, a model containing previous bisphosphonate treatment, age, body mass index, lymphocytes and visfatin, which predicted zoledronate-induced APR with 82·1% sensitivity and 73·9% specificity, was selected. In this model, lymphocytes (P = 0·010) and visfatin (P = 0·029) at baseline could independently predict APR. Conclusions Zoledronate-induced APR is associated with serum increases of pro-inflammatory cytokines and an increase of insulin resistance. Patients with higher lymphocytes and lower visfatin levels at baseline are at higher risk for APR.

Summary Objective Apelin is an adipokine secreted from adipose and other tissues with increased expression in obesity, role in glucose metabolism and atherosclerosis, as well as in oxidative stress. Pregnancy is considered a state of hyperlipidemia, oxidative stress and decreased insulin sensitivity. The aim of the present study is to investigate the levels of apelin in human pregnancy and its relation to insulin sensitivity. Patients and measurements One hundred and six pregnant women (24th–28th week of gestation), aged 27·9 ± 0·4 years, were compared to 106 age-matched healthy, nonpregnant women (controls). Measured parameters included serum levels of glucose, insulin, apelin, adiponectin, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglycerides and oxidized LDL (ox-LDL). The body mass index (BMI) and the quantitative insulin sensitivity check index (QUICKI) were calculated as well. Results BMI, serum lipids and insulin levels were significantly higher, whereas serum apelin and glucose levels were lower in the pregnancy group compared to the control group. There was a significant negative correlation between apelin and adiponectin, in both groups. Additionally, apelin was negatively correlated with ox-LDL and HDL-cholesterol in the pregnancy group. Conclusions Although strongly correlated with adiponectin, apelin cannot be used as a marker of insulin sensitivity, but it could serve as a marker of oxidative stress in pregnancy.

The aim of the present study was to investigate whether normal pregnancy represents a complex state of oxidative stress, inflammation and insulin resistance.One hundred and six pregnant women, between 24th and 28th week of pregnancy (age 27.9 ± 0.4 years) (study group) and one hundred and six age-matched, healthy, non-pregnant women (control group) participated in the study. Serum levels of glucose, insulin, adiponectin, oxidized LDL (oxLDL) and lipid parameters, i.e. total cholesterol (TC), triglycerides (TG), HDL and LDL, were determined. Body mass index (BMI) and QUantitative Insulin sensitivity ChecK Index (QUICKI) were also calculated.Pregnant women presented higher BMI values, insulin and oxLDL serum levels and lower glucose serum levels than controls. Serum levels of lipids (TC, TG, LDL and HDL) were higher in pregnant women. There was a significant positive correlation of oxLDL to adiponectin (p0.01) in the study group, but not in the controls, and no other significant correlation with any of the other parameters, in either of groups.Pregnancy is a state of insulin resistance, oxidative stress and pro-atherogenic hyperlipidemia. Adiponectin may, though, have cardioprotective role in pregnant women.

Objective: The evaluation of circulating semaphorin-4D (sema4D) and plexin-B1 in postmenopausal women with low bone mass and the effect of antiresorptive or osteoanabolic treatment.Methods: Serum samples were obtained from postmenopausal women with low bone mass at baseline and 3 months after zoledronic acid infusion (n = 30), denosumab injection (n = 30) or teriparatide initiation (n = 28) and from controls matched for age, age at menopause and body mass index (n = 30) at the same time points.Main outcome measures: Circulating sema4D and plexin-B1.Results: Circulating sema4D increased following denosumab (p = 0.026), whereas decreased following teriparatide (p = 0.013). Sema4D/plexin-B1 ratio increased following denosumab (p = 0.004). At baseline, sema4D and plexin-B1 levels were higher in patients pre-treated with bisphosphonates compared to naïve ones (p < 0.001 and p = 0.001, respectively). In bivariate correlations sema4D was inversely correlated with serum carboxyterminal telopeptide of type 1 collagen (rs-0.282, p = 0.002), intact parathyroid hormone (rs-0.388, p < 0.001) and 25(OH)D (rs-0.316, p < 0.001), whereas there was a trend towards correlation with lumbar spine bone mineral density (rs-0.191, p = 0.053).Conclusions: Sema4D levels are independently associated with previous bisphosphonate treatment, intact parathyroid hormone and 25(OH)D levels. Denosumab and teriparatide seem to exert an opposite effect on circulating sema4D levels. Further studies are needed to evaluate whether sema4D mediates the coupling effect that occurs following both antiresorptive and osteoanabolic treatment. © 2014 Informa UK, Ltd.

The evaluation of circulating semaphorin-4D (sema4D) and plexin-B1 in postmenopausal women with low bone mass and the effect of antiresorptive or osteoanabolic treatment.Serum samples were obtained from postmenopausal women with low bone mass at baseline and 3 months after zoledronic acid infusion (n = 30), denosumab injection (n = 30) or teriparatide initiation (n = 28) and from controls matched for age, age at menopause and body mass index (n = 30) at the same time points.Circulating sema4D and plexin-B1.Circulating sema4D increased following denosumab (p = 0.026), whereas decreased following teriparatide (p = 0.013). Sema4D/plexin-B1 ratio increased following denosumab (p = 0.004). At baseline, sema4D and plexin-B1 levels were higher in patients pre-treated with bisphosphonates compared to naïve ones (p0.001 and p = 0.001, respectively). In bivariate correlations sema4D was inversely correlated with serum carboxyterminal telopeptide of type 1 collagen (rs -0.282, p = 0.002), intact parathyroid hormone (rs -0.388, p0.001) and 25(OH)D (rs -0.316, p0.001), whereas there was a trend towards correlation with lumbar spine bone mineral density (rs -0.191, p = 0.053).Sema4D levels are independently associated with previous bisphosphonate treatment, intact parathyroid hormone and 25(OH)D levels. Denosumab and teriparatide seem to exert an opposite effect on circulating sema4D levels. Further studies are needed to evaluate whether sema4D mediates the coupling effect that occurs following both antiresorptive and osteoanabolic treatment.

In vitro data suggest that myokine irisin may affect bone metabolism by promoting osteoblast differentiation while inhibiting osteoclast differentiation. In this study, circulating irisin levels were associated with previous osteoporotic fractures but not with bone mass and were not affected by denosumab or teriparatide treatment for 3 months. This study aimed to evaluate predictors of circulating irisin in postmenopausal women with low bone mass and to assess a potential effect of denosumab or teriparatide treatment for 3 months. Serum samples for irisin measurement were obtained from (a) postmenopausal women with low bone mass (lumbar spinal [LS] or femoral neck [FN] bone mineral density [BMD] T-score ≤−2.0) and their age-matched controls at baseline and 3 months after denosumab (Dmab) injection (Dmab group, n = 50; Dmab control group, n = 25) and (b) women with more severe disease (LS or FN BMD T-score ≤−2.8) and their age-matched controls at the above-mentioned time points after teriparatide (TPTD) initiation (TPTD group, n = 25; TPTD control group, n = 25). At baseline, irisin levels were inversely correlated with age (partial coefficient (r p ) = −0.24; p = 0.009), parathyroid hormone (PTH) (r p = −0.30; p = 0.001), and creatinine (r p = −0.23; p = 0.016) in univariate analysis, and were lower in women with (n = 26; 41.6 ± 2.7 ng/dL) than without previous osteoporotic fracture(s) (n = 99; 51.0 ± 1.6 ng/dL; p = 0.007). In multiple linear regression, previous osteoporotic fracture(s) and PTH were independently negatively associated with irisin [p = 0.04, CI −16.1 to −0.4 and p = 0.002, CI −0.3 to −0.07, respectively], but only the association with PTH remained after controlling for creatinine levels. Serum irisin levels were not different between women with or without low bone mass and were not affected by either Dmab or TPTD treatment for 3 months. Circulating irisin levels were associated with previous osteoporotic fracture(s); whether this association is independent or is due to confounding by lower muscle mass, potentially reflected by lower creatinine levels, remains to be fully clarified.

The gastrointestinal tract has a major role in digestion and absorption of nutrients while playing a leading role in defense of the body. It forms a shield against the invasion of various microorganisms or their products (e.g. antigens, toxins) and therefore it is important to establish its integrity and functionality. That depends on the route of administration and the composition of the artificial nutrition. This study concentrates on the influences of different kinds of artificial nutrition in the functionality of the intestinal mucosal barriers. It seems that full macromolecular solutions of enteral nutrition ensure an adequate mucous immune response, while a lack of nutritional stimulus in the lumen leads rapidly to a dysfunction of gastric-associated lymphatic tissue and mucosal immune system. This dysfunction renders the patients susceptible to infections in distant organs, hospital pneumonia, and multiorgan failure of non-infectious etiology. In patients with indication of total parenteral nutrition administration, addition of bombesin or glutamine preserves mucosal immune response and may limit the adverse effects.

Periostin is a secreted extracellular matrix protein preferentially expressed in bone by osteocytes and periosteal osteoblasts. Reduced periostin expression may affect osteoblast differentiation and collagen type I synthesis and predispose to osteoporosis and increased fracture risk. We aimed to evaluate circulating periostin levels in postmenopausal women with low bone mass, their possible correlations with clinical and laboratory parameters, as well as the 3-month effect of zoledronic acid. Serum samples for periostin, 25-hydroxyvitamin D, parathyroid hormone (PTH), C-terminal telopeptide of type I collagen (CTx), and total alkaline phosphatase (tALP) were obtained from 46 postmenopausal women with low bone mass at baseline and 3 months after zoledronic acid infusion and from 30 age-matched, postmenopausal controls with normal bone mass at baseline. There was no difference in periostin levels between women with normal and low bone mass (250±15 vs. 272±14 ng/ml, respectively; p=0.279). Periostin remained essentially unchanged after zoledronic acid infusion (262±18 ng/ml; p=0.130). Serum periostin levels at baseline were not affected by previous bisphosphonate treatment, and were correlated only to tALP (rs=0.351; p=0.018). In multiple linear regression analysis, tALP (B=3.17; 95% CI=0.59–5.79; p=0.018) was associated with serum periostin levels at baseline, independently from previous anti-osteoporotic treatment, age, body mass index, and 25-hydroxyvitamin D. In conclusion, serum periostin levels do not differ between postmenopausal women with normal and low bone mass and are not affected by zoledronic acid treatment. Women with higher tALP have independently higher periostin levels.

Decreased bone formation due to a coupling effect limits bone mass increases after antiresorptive treatment.The purpose of this study was to compare the effects of 2 potent antiresorptive agents with different mechanism of action on serum levels of Wnt antagonists, sclerostin and dickkopf-1 (Dkk-1).This was an interventional, parallel assignment, open-label, randomized clinical trial.The study was conducted at the outpatient clinics for metabolic bone diseases of 424 General Military Hospital, Thessaloniki, Greece.Naive postmenopausal women with low bone mass were assigned to zoledronic acid infusion (n = 46) or denosumab injection (n = 46). One woman in the zoledronic acid group was lost to follow-up.Serum sclerostin and Dkk-1 levels were the main outcomes. Secondary measurements were serum osteoprotegerin, receptor activator of nuclear factor κB ligand, procollagen type 1 N-terminal propeptide, and C-terminal cross-linking telopeptide of type 1 collagen.Serum sclerostin levels significantly decreased in the zoledronic acid (P.001) but increased in the denosumab group (P = .003). Dkk-1 levels significantly decreased in the zoledronic acid group (P = .006) but did not change in the denosumab group (P = .402). Serum osteoprotegerin remained essentially unchanged in either group, whereas receptor activator of nuclear factor κB ligand decreased in the zoledronic acid group (P = .004) but increased in the denosumab group (P = .037). Bone markers (procollagen type 1 N-terminal propeptide, C-terminal cross-linking telopeptide of type 1 collagen, and total serum alkaline phosphatase) decreased in both groups (all P.001).Although they both decrease bone resorption, zoledronic acid and denosumab exert opposite effects on Wnt signaling: the former decreases serum levels of both sclerostin and Dkk-1, whereas the latter increases sclerostin and does not affect Dkk-1.

Activin-A is expressed in bone and seems to regulate osteoclastogenesis. In this study, serum activin-A was increased in postmenopausal women with low bone mass and was positively correlated to age and negatively to lumbar spinal bone mineral density (BMD). Serum activin-A levels did not change 3 months after zoledronic acid infusion. The aims of the study were to evaluate prospectively the circulating activin-A levels in postmenopausal women with low bone mass and explore possible correlations with clinical and laboratory data, as well as the 3-month effect of zoledronic acid infusion. Postmenopausal women with low bone mass assigned to receive zoledronic acid infusion (Patients, n = 47) and age-matched, postmenopausal women with normal bone mass (Controls, n = 27) were recruited on an outpatient basis. Main outcome measurement was serum activin-A levels. Serum activin-A was higher in patients at baseline compared to controls (p < 0.001) and activin-A in the serum of patients and controls was positively correlated with age (Spearman’s coefficient of correlation [rs] = 0.325; p = 0.005) and negatively with lumbar spinal (LS) BMD (rs = -0.425; p < 0.001). In multiple linear regression analysis, only age (B = 8.93; 95 % CI = 4.39-13.46; p < 0.001) was associated with serum activin-A levels at baseline, independent from group (patients or controls), previous anti-osteoporotic treatment, LS BMD and follicle-stimulating hormone. Circulating activin-A levels were not affected 3 months after zoledronic acid infusion. Serum activin-A is increased in postmenopausal women with low bone mass compared with postmenopausal women with normal bone mass and is positively correlated to age and negatively to LS BMD.

Background Struma ovarii is a rare cause of hyperthyroidism, while coexistence with Graves’ disease has been scarcely reported. Patient Findings We report a patient with Graves’ disease and unilateral benign functioning struma ovarii, accompanied by ascites, pleural effusion and elevated cancer antigen-125 (CA-125) levels. In subsequent thyroidectomy, incidental papillary thyroid carcinoma was also identified. The functionality of struma ovarii tissue in our patient was supported by the immunohistochemical identification of TSH receptors (TSHR), which may stimulate growth and thyroid hormone production in the presence of circulating TSHR stimulating antibodies (TSHR-Ab). Review of the literature A systematic review of reported cases of coexistent Graves’ disease and struma ovarii was performed. Conclusions The diagnosis of struma ovarii may be masked by Graves’ disease and, therefore, be delayed for several years. Furthermore, ascites, pleural effusion and increased CA-125 may result from a benign struma ovarii. The presence of TSHR in the struma ovarii tissue along with their absence in the surrounding ovarian tissue indirectly suggests that struma ovarii is functional. It is unclear whether TSHR-Ab play a role in the development of thyroid carcinomas in such patients.

Activin-A is expressed in bone and seems to regulate osteoclastogenesis. In this study, serum activin-A was increased in postmenopausal women with low bone mass and was positively correlated to age and negatively to lumbar spinal bone mineral density (BMD). Serum activin-A levels did not change 3 months after zoledronic acid infusion.The aims of the study were to evaluate prospectively the circulating activin-A levels in postmenopausal women with low bone mass and explore possible correlations with clinical and laboratory data, as well as the 3-month effect of zoledronic acid infusion.Postmenopausal women with low bone mass assigned to receive zoledronic acid infusion (Patients, n = 47) and age-matched, postmenopausal women with normal bone mass (Controls, n = 27) were recruited on an outpatient basis. Main outcome measurement was serum activin-A levels.Serum activin-A was higher in patients at baseline compared to controls (p 0.001) and activin-A in the serum of patients and controls was positively correlated with age (Spearman's coefficient of correlation [rs] = 0.325; p = 0.005) and negatively with lumbar spinal (LS) BMD (rs = -0.425; p 0.001). In multiple linear regression analysis, only age (B = 8.93; 95 % CI = 4.39-13.46; p 0.001) was associated with serum activin-A levels at baseline, independent from group (patients or controls), previous anti-osteoporotic treatment, LS BMD and follicle-stimulating hormone. Circulating activin-A levels were not affected 3 months after zoledronic acid infusion.Serum activin-A is increased in postmenopausal women with low bone mass compared with postmenopausal women with normal bone mass and is positively correlated to age and negatively to LS BMD.

Although vaspin is regarded an insulin-sensitizing adipokine, its role in gestational diabetes mellitus (GDM) is currently unknown. We aimed to evaluate serum vaspin levels and their correlation with insulin resistance in women with and without GDM. Forty-four women with GDM [GDM Group - 20 managed with diet only (GDM-diet) and 24 with diet plus insulin (GDM-insulin)] and 44 age-matched pregnant women with normal glucose tolerance (Control Group) were studied. Serum glucose, lipids, uric acid, insulin and vaspin were measured at the 2nd and 3rd trimester of pregnancy and postpartum. The quantitative insulin sensitivity check index (QUICKI) and homeostasis model of assessment-insulin resistance (HOMA-IR) were calculated. Circulating vaspin levels decreased significantly postpartum in all groups (p