Stable isotopes 2H and 18O in the diagnosis and study of obesity

Pretilost je bolest u kojoj dolazi do prekomjernog nakupljanja masnog tkiva, što rezultira negativnim utjecajem na zdravlje pojedinca I skraćenim životnim vijekom. Jedan od najvažnijih problema u dijagnostici i istraživanju pretilosti je odabir najboljih metoda za njeno određivanje. Upotrebom vode obilježene stabilnim izotopima vodika i kisika (2H i 18O) moguće je precizno determinirati količinu masne mase u ukupnoj tjelesnoj masi i pouzdano odrediti ukupnu potrošnju energije organizma u višednevnom kontinuiranom periodu. U razjašnjavanju patofiziologije i etiopatogeneze pretilosti od posebnog je značaja i korištenje 2H i/ili 18O u praćenju metabolizma lipida, osobito masnih kiselina i triglicerida. Primjena metoda u kojima se koristi voda obilježena izotopima 2H i 18O ne zahtijeva hospitalizaciju ispitanika, pogodna je za terenska istraživanja na velikom broju ispitanika i primjenjiva je u svim dobnim skupinama. Unatoč mnogobrojnim prednostima, metode koje koriste vodu obilježenu 2H i 18O u istraživanju pretilosti u nas još uvijek nisu dovoljno poznate. Cilj ovog rada je pojasniti i približiti ih hrvatskoj liječničkoj struci, ali i ostalim zainteresiranim znanstvenicima i stručnjacima, kako bi se što uspješnije mogli pratiti svjetski trendovi pristupa problemu prekomjerne tjelesne mase i pretilosti. Osim toga, u radu su kritički razmotrene i druge metode koje se najčešće koriste u dijagnostici i istraživanju pretilosti.Obesity is a disease characterized by excessive accumulation of body fat, resulting in negative impact on an individual’s health and shortened life span. One of the most important problems in the diagnosis and study of obesity is the selection of the best methods for its determination. Using water labeled with stable isotopes of hydrogen and oxygen (2H and 18O) it is possible to accurately determine the share of adipose tissue in body mass and reliably determine total energy expenditure of the organism in a continuous period of several days. The use of 2H and/or 18O is of special importance in clarifying the pathophysiology and etiopathogenesis of obesity as well as in monitoring the metabolism of lipids, particularly fatty acids and triglycerides. Application of the method in which water labeled with isotopes 2H and 18O is used does not require the hospitalization of participants, is suitable for field research on a large number of subjects, and is applicable to all age groups. Despite many advantages, the methods in which 2H and 18O labeled water is used for the study of obesity are still not common in Croatia. The aim of this paper is to familiarize the Croatian medical profession, as well as other interested scientists and experts with the methods, in order to successfully follow global trends in the approach to the problem of excessive body weight and obesity. In addition, the paper critically discusses some other methods that are commonly used in the diagnosis and study of obesity

KOŠTANI MORFOGENETSKI PROTEINI I KOLOREKTALNI KARCINOM

Rak debelog crijeva po pojavnosti je jedan od najucestalijih zlocudnih oboljenja i najcešci uzrok smrti meu malignim bolestima u svijetu. Neki od cimbenika rizika za nastanak ovoga karcinoma su genetska sklonost te loše životne i prehrambene navike. Koštani morfogenetski proteini (BMPs) su dobili ime po tome što su prvotno izolirani iz kosti, ali pokazuju ucinak i na druga tkiva i organe. Istraživanje provedeno na 10 uzoraka karcinoma debelog crijeva je pokazalo da se karcinom debelog crijeva cešce javlja u muškaraca (70%) i osoba starije životne dobi (od 55 do 74 godine). Najcešci tip tumora je bio adenokarcinom, umjereno diferenciranog stadija B ili C prema Dukesovom sustavu. Sigmoidni kolon i rektum su bile najcešce lokalizacije tumora. Izražaj BMP4 i BMP7 je prisutan u svim uzorcima karcinoma debelog crijeva. Ekspresija BMP4 je ujednacena u svim uzorcima, dok ekspresija BMP7 se smanjuje s napredovanjem bolesti. Ovi rezultati pokazuju da bi se BMPs mogli koristiti kao moguci pokazatelji malignosti bolesti.Colorectal cancer is the one of the most commonly cancers in the world and one of the leading causes of cancer-related mortality. Some of the risk factors for developing of colorectal cancer are genetic suspectibility, life style and dietery habits. Bone morphogenetic proteins (BMPs) are named because they are primarely isolated from bone. They exert their function beyond the bone on the other tissues and organs. The analysis of 10 samples of colorectal cancer revealed that colorectal cancer is occured more frequently in male (70%) and in older individuals (from 55 to 74 yrs). The most common histological type of carcinoma was adenocarcinoma, moderate differentiated Dukes stage B or C. Sigmoid colon and rectum was the most common localization of colorectal cancer. According to BMP expression, BMP4 and BMP7 were expressed in all examined samples. BMP4 showed unchanging expression in all samples whereas BMP7 expression decerased during the progression of the disease. These results suggested that BMPs can be used as possible markers for malignity

KOŠTANI MORFOGENETSKI PROTEINI I KOLOREKTALNI KARCINOM

Rak debelog crijeva po pojavnosti je jedan od najucestalijih zlocudnih oboljenja i najcešci uzrok smrti meu malignim bolestima u svijetu. Neki od cimbenika rizika za nastanak ovoga karcinoma su genetska sklonost te loše životne i prehrambene navike. Koštani morfogenetski proteini (BMPs) su dobili ime po tome što su prvotno izolirani iz kosti, ali pokazuju ucinak i na druga tkiva i organe. Istraživanje provedeno na 10 uzoraka karcinoma debelog crijeva je pokazalo da se karcinom debelog crijeva cešce javlja u muškaraca (70%) i osoba starije životne dobi (od 55 do 74 godine). Najcešci tip tumora je bio adenokarcinom, umjereno diferenciranog stadija B ili C prema Dukesovom sustavu. Sigmoidni kolon i rektum su bile najcešce lokalizacije tumora. Izražaj BMP4 i BMP7 je prisutan u svim uzorcima karcinoma debelog crijeva. Ekspresija BMP4 je ujednacena u svim uzorcima, dok ekspresija BMP7 se smanjuje s napredovanjem bolesti. Ovi rezultati pokazuju da bi se BMPs mogli koristiti kao moguci pokazatelji malignosti bolesti.Colorectal cancer is the one of the most commonly cancers in the world and one of the leading causes of cancer-related mortality. Some of the risk factors for developing of colorectal cancer are genetic suspectibility, life style and dietery habits. Bone morphogenetic proteins (BMPs) are named because they are primarely isolated from bone. They exert their function beyond the bone on the other tissues and organs. The analysis of 10 samples of colorectal cancer revealed that colorectal cancer is occured more frequently in male (70%) and in older individuals (from 55 to 74 yrs). The most common histological type of carcinoma was adenocarcinoma, moderate differentiated Dukes stage B or C. Sigmoid colon and rectum was the most common localization of colorectal cancer. According to BMP expression, BMP4 and BMP7 were expressed in all examined samples. BMP4 showed unchanging expression in all samples whereas BMP7 expression decerased during the progression of the disease. These results suggested that BMPs can be used as possible markers for malignity

KOŠTANI MORFOGENETSKI PROTEINI I KOLOREKTALNI KARCINOM

Rak debelog crijeva po pojavnosti je jedan od najucestalijih zlocudnih oboljenja i najcešci uzrok smrti meu malignim bolestima u svijetu. Neki od cimbenika rizika za nastanak ovoga karcinoma su genetska sklonost te loše životne i prehrambene navike. Koštani morfogenetski proteini (BMPs) su dobili ime po tome što su prvotno izolirani iz kosti, ali pokazuju ucinak i na druga tkiva i organe. Istraživanje provedeno na 10 uzoraka karcinoma debelog crijeva je pokazalo da se karcinom debelog crijeva cešce javlja u muškaraca (70%) i osoba starije životne dobi (od 55 do 74 godine). Najcešci tip tumora je bio adenokarcinom, umjereno diferenciranog stadija B ili C prema Dukesovom sustavu. Sigmoidni kolon i rektum su bile najcešce lokalizacije tumora. Izražaj BMP4 i BMP7 je prisutan u svim uzorcima karcinoma debelog crijeva. Ekspresija BMP4 je ujednacena u svim uzorcima, dok ekspresija BMP7 se smanjuje s napredovanjem bolesti. Ovi rezultati pokazuju da bi se BMPs mogli koristiti kao moguci pokazatelji malignosti bolesti.Colorectal cancer is the one of the most commonly cancers in the world and one of the leading causes of cancer-related mortality. Some of the risk factors for developing of colorectal cancer are genetic suspectibility, life style and dietery habits. Bone morphogenetic proteins (BMPs) are named because they are primarely isolated from bone. They exert their function beyond the bone on the other tissues and organs. The analysis of 10 samples of colorectal cancer revealed that colorectal cancer is occured more frequently in male (70%) and in older individuals (from 55 to 74 yrs). The most common histological type of carcinoma was adenocarcinoma, moderate differentiated Dukes stage B or C. Sigmoid colon and rectum was the most common localization of colorectal cancer. According to BMP expression, BMP4 and BMP7 were expressed in all examined samples. BMP4 showed unchanging expression in all samples whereas BMP7 expression decerased during the progression of the disease. These results suggested that BMPs can be used as possible markers for malignity

Prognostic factors for in-hospital mortality of patients hospitalized for acutely decompensated heart failure

Objectives: Despite improved treatment during last 20 years, prognosis for patients hospitalized for acutely decompensated heart failure (ADHF) is poor and mortality rates reported for these patients are high. Laboratory results can assist clinicians in evaluation and triaging of patients on hospital admission, and are important for the medical decision-making and prognosis assessments. Recently, new guidelines for the diagnosis and treatment of acute and chronic HF patients were published introducing a new group of patients with mid-range left ventricular ejection fraction (LVEF). Methods: In order to explore the prognostic value for the in-hospital mortality of ADHF patients we analyzed laboratory test results for 165 emergency hospitalized patients regarding the survival and LVEF. Results: In-hospital mortality was 16%. Patients who died were older than survivals (p=0.003). There were no differences in LVEF between survivals and non-survivals. Patients who survived had significantly lower N-terminal pro-B-type natriuretic peptide (NT- proBNP), high-sensitivity cardiac troponin T (hs-cTnT), uric acid, urea, creatinine, and red blood cell distribution width (RDW) than patients who died (p<0.001). All these tests had a good discrimination power between survivals and non-survivals (p<0.001), but their incremental addition to NT-proBNP didn’t improve its overall prognostic value. There was only a very weak correlation between NT-proBNP concentrations and LVEF. Groups with different LVEF status showed significant difference in number of erythrocytes, RDW and hemoglobin concentrations. Conclusions: NT-proBNP had the best discriminatory power between survivals and nonsurvivals. Some routine laboratory test results, like RDW, uric acid, urea, and creatinine, have potentially significant value

Prognostic factors for in-hospital mortality of patients hospitalized for acutely decompensated heart failure

Objectives: Despite improved treatment during last 20 years, prognosis for patients hospitalized for acutely decompensated heart failure (ADHF) is poor and mortality rates reported for these patients are high. Laboratory results can assist clinicians in evaluation and triaging of patients on hospital admission, and are important for the medical decision-making and prognosis assessments. Recently, new guidelines for the diagnosis and treatment of acute and chronic HF patients were published introducing a new group of patients with mid-range left ventricular ejection fraction (LVEF). Methods: In order to explore the prognostic value for the in-hospital mortality of ADHF patients we analyzed laboratory test results for 165 emergency hospitalized patients regarding the survival and LVEF. Results: In-hospital mortality was 16%. Patients who died were older than survivals (p=0.003). There were no differences in LVEF between survivals and non-survivals. Patients who survived had significantly lower N-terminal pro-B-type natriuretic peptide (NT- proBNP), high-sensitivity cardiac troponin T (hs-cTnT), uric acid, urea, creatinine, and red blood cell distribution width (RDW) than patients who died (p<0.001). All these tests had a good discrimination power between survivals and non-survivals (p<0.001), but their incremental addition to NT-proBNP didn’t improve its overall prognostic value. There was only a very weak correlation between NT-proBNP concentrations and LVEF. Groups with different LVEF status showed significant difference in number of erythrocytes, RDW and hemoglobin concentrations. Conclusions: NT-proBNP had the best discriminatory power between survivals and nonsurvivals. Some routine laboratory test results, like RDW, uric acid, urea, and creatinine, have potentially significant value

A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure

Background: An assessing of the in-hospital mortality risk for an emergency hospitalized patient with acutely decompensated heart failure (ADHF) is challenging task. Simple formula can help. Methods: On the base of six indicators identified in derivation group, simple formula for assessing the risk for in-hospital mortality of ADHF patients was derived and later tested in validation group. Results: The retrospective analysis of a derivation group (533 survivors, 121 deceased) identified six risk indicators: age, heart rate (HR), systolic blood pressure (SBP) and serum concentrations of urea, sodium (Na) and uric acid (UA). The final formula was created ([age/10]2 HR/SBP)+(Urea-Na/10)+UA/100 and formula result of 53 was established as cut-off result. In the derivation group, at the cut-off point of 53, area under the ROC curve (AUC) was 0.741 (95% CI 0.7010.776) ; with sensitivity 54% and specificity 83%. The discriminative capacity of the formula was significantly higher than each of its components. In the validation group of 591 patients (527 survived, 64 died) AUC was also 0.741 (95% CI 0.7060.774), sensitivity was 66% and specificity 76%. Positive predictive value (PPV) of the developed formula was modest (34%), but negative predictive value (NPV) was 95%. N-terminal pro-B type natriuretic peptide and troponin I were determined, but not included into formula. Conclusions: The developed formula enables simple, rapid and inexpensive risk assessment, but its disadvantage is a low PPV. However, a high NPV permits the identification of patients with a low risk of in-hospital mortality, which could lead to a more rational patient treatment