A HbA1c mérésének új nemzetközi standardizációja hazánkban is bevezetésre kerül = Introducing the new laboratory standard of HbA1c determination in Hungary

Az International Federation of Clinical Chemistry and Laboratory Medicine új, specifikus HbA1c-standardot állított elő. A jövőben a HbA1c-méréseket a laboratóriumok világszerte az International Federation of Clinical Chemistry and Laboratory Medicine módszere szerint standardizált tesztekkel végzik. A HbA1c mértékegysége is megváltozik az új referencia-módszer szerint. Hazai laboratóriumokban a bevezetés időpontja 2011. április 1. A megvalósítandó cél, hogy valamennyi laboratórium a standardizált módszert használja, a HbA1c-eredményeket mmol/mol egységben és az ebből visszaszámolt Diabetes Control and Complication Trial/National Glycohemoglobin Standardization Program szerinti százalékos értékben adja ki. A standardizáció eredményeként lehetővé válik a HbA1c-értékek széles körű összehasonlítása. Orv. Hetil., 2011, 152, 555–558. | A new laboratory standard, specific for HbA1c was prepared by the International Federation of Clinical Chemistry and Laboratory Medicine. Consequently, manufacturers will supply their calibrators with the International Federation of Clinical Chemistry and Laboratory Medicine standard. Laboratories in Hungary switch to this new method in April 1, 2011. After this date, results of HbA1c measurements will be reported in International Federation of Clinical Chemistry and Laboratory Medicine units (mmol/mol) and in the derived National Glycohemoglobin Standardization Program units (%) calculated by master equation from the International Federation of Clinical Chemistry and Laboratory Medicine/National Glycohemoglobin Standardization Program methods. Using the new standardization the HbA1c measurements will be traceable to the International Federation of Clinical Chemistry and Laboratory Medicine reference method and interlaboratory comparisons will be possible. Orv. Hetil., 2011, 152, 555–558

Circulating cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia determined by multiplex suspension array

<p>Abstract</p> <p>Background</p> <p>Preeclampsia is a severe complication of pregnancy characterized by an excessive maternal systemic inflammatory response with activation of both the innate and adaptive arms of the immune system. Cytokines, chemokines and adhesion molecules are central to innate and adaptive immune processes. The purpose of this study was to determine circulating levels of cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia in a comprehensive manner, and to investigate their relationship to the clinical features and laboratory parameters of the study participants, including markers of overall inflammation (C-reactive protein), endothelial activation (von Willebrand factor antigen) and endothelial injury (fibronectin), oxidative stress (malondialdehyde) and trophoblast debris (cell-free fetal DNA).</p> <p>Results</p> <p>Serum levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-18, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, interferon-gamma-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 were measured in 60 preeclamptic patients, 60 healthy pregnant women and 59 healthy non-pregnant women by multiplex suspension array and ELISA. In normal pregnancy, the relative abundance of circulating IL-18 over IL-12p70 and the relative deficiency of the bioactive IL-12p70 in relation to IL-12p40 might favour Th2-type immunity. Although decreased IL-1ra, TNF-alpha and MCP-1 concentrations of healthy pregnant relative to non-pregnant women reflect anti-inflammatory changes in circulating cytokine profile, their decreased serum IL-10 and increased IP-10 levels might drive pro-inflammatory responses. In addition to a shift towards Th1-type immunity (expressed by the increased IL-2/IL-4 and IFN-gamma/IL-4 ratios), circulating levels of the pro-inflammatory cytokines IL-6 and TNF-alpha, the chemokines IL-8, IP-10 and MCP-1, as well as the adhesion molecules ICAM-1 and VCAM-1, were raised in preeclampsia compared with healthy pregnancy, resulting in an overall pro-inflammatory systemic environment. Increased IP-10, MCP-1, ICAM-1 and VCAM-1 concentrations of preeclamptic patients showed significant correlations with blood pressure values, renal and liver function parameters, as well as with CRP, malondialdehyde, von Willebrand factor antigen and fibronectin levels.</p> <p>Conclusions</p> <p>According to our findings, preeclampsia was associated with an overall pro-inflammatory systemic environment. Elevated amounts of pro-inflammatory cytokines, chemokines and adhesion molecules in the maternal circulation might play a central role in the excessive systemic inflammatory response, as well as in the generalized endothelial dysfunction characteristics of the maternal syndrome of preeclampsia.</p

Alacsony D-vitamin-szint a Semmelweis Egyetem betegei körében

Even in developed countries the prevalence of subjects with suboptimal vitamin D levels is high. The aim of this retrospective data analysis was to evaluate the prevalence of severe and moderate vitamin D deficiencies (defined as vitamin D levels<15 ng/ml and 15-30 ng/ml, respectively) among patients evaluated at Semmelweis University during a period between April, 2009 and March, 2010. Methods and results: The average vitamin D level of 5808 subjects (3936 women and 1872 men) was 25.5 +/- 10.9 ng/ml. The prevalence of moderate and severe vitamin D deficiency in whole population was 72% and 12%, respectively. Higher than normal vitamin D levels were measured in 0.8% of subjects. Female gender, older age and winter season were independent risk factors for vitamin D deficiency. Vitamin D levels were measured repeatedly in 1307 subjects. Interestingly, vitamin D levels measured later were lower compared to those measured at the first time (27.07+/-13.2 vs. 25.9+/-9.11 ng/ml, p<0.001). The prevalence of severe and moderate vitamin D deficiency was 8.1 and 71.5 per cent when vitamin D levels were measured at the second time. Of the 110 patients with severe vitamin D deficiency measured repeatedly only 11 patients (10%) presented with normal vitamin D levels at the second time. Conclusions: These data indicate that severe and moderate vitamin D deficiencies are common in patients evaluated at Semmelweis University. Repeated measurements of vitamin D levels raise the notion that the efficacy of supplementation used for correction of vitamin D levels is not optimal

Switching between parathormone (PTH) assays: the impact on the diagnosis of renal osteodystrophy

Background: Clinical guidelines for decision-making in chronic kidney disease (CKD) consider parathormone (PTH) levels. The measured PTH values differ if novel full length PTH(1-84) assays are used instead of earlier intact iPTH assays. In this study we analyzed how the classification of CKD patients alters when iPTH assays are switched to PTH(1-84) assays. Methods: Plasma samples were collected prior to dialysis sessions from 110 consecutive CKD patients on maintenance hemodialysis. PTH levels were determined with iPTH assays (Elecsys, Architect and DiaSorin Liaison N-tact) and PTH(1-84) assays (Elecsys and Liaison). Using KDIGO guidelines patients were classified as being below, above and in the recommended target range (RTR) of PTH. The results of classification with different assays were evaluated and, a novel calculation method of RTR was implemented. Results: The prevalence of patients with PTH in RTR is comparable with each assay, but the individual patients differed. PTH(1-84) Elecsys and Liaison assays classified more patients as being below RTR than iPTH Elecsys and Architect but not Liaison N-tact assay (27.3%, 22.7% vs. 41%, 31.8%, and 36.4%, respectively). In turn, PTH(1-84) Elecsys and Liaison assays identified less CKD patients with PTH above the RTR than iPTH except N-tact assays (6.4%, 10% vs. 16.3%, 19%, and 6.3%, respectively). Using our calculation method, our discrimination values for PTH(1-84) assays to achieve classification identical to that with iPTH Elecsys were lower than those recommended by the manufacturer. Conclusions: Current guidelines for the treatment of secondary hyperparathyroidism in CKD should consider the type of assays used for PTH measurement. Each laboratory should assess its own RTR for PTH tests to achieve comparable classification. The presented calculation is simple, it mimics an everyday situation, switching from one assay to another one, and provides useful RTR values for PTH tests

Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission

Abstract Background: Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker increasingly used for the assessment of systemic inflammation. We aimed to evaluate suPAR for the assessment of inflammatory activity in rheumatoid arthritis (RA) patients in remission. Methods: In our cross-sectional study we measured plasma suPAR and C-reactive protein (CRP) levels as well as erythrocyte sedimentation rate (ESR) in 120 RA patients at various stages of disease activity and 29 healthy age-matched controls. Results: suPAR, CRP and ESR values were higher in RA patients compared to healthy individuals. When suPAR levels were analyzed according to DAS28 scores of RA patients, suPAR level in the subgroup with DAS282.6, but still higher than in controls [4.45 (3.33-5.56) ng/mL vs. 3.66 (3.10-4.67) ng/mL vs. 2.80 (2.06-3.42) ng/mL, p<0.0001, median (interquartile range)]. In contrast, CRP and ESR values were comparable in the subgroup with DAS28</=2.6 and in healthy individuals. We further analyzed the correlation between the number of tender and/or swollen joints and suPAR levels in RA patients in remission. suPAR values were significantly higher in patients with four tender and/or swollen joints than in patients with 2-3 or 0-1 tender and/or swollen joints. Conclusions: While CRP and ESR values indicate remission of the chronic inflammatory process in RA, suPAR values are still elevated compared to healthy individuals. suPAR might be particularly valuable in the recognition of inflammatory activity in patients who are in remission according to DAS28 scores but have symptoms of tender and/or swollen joints

Over-representation of the G12S polymorphism of the SDHD gene in patients with MEN2A syndrome

OBJECTIVE: To evaluate whether germline variants of the succinate dehydrogenase genes might be phenotypic modifiers in patients with multiple endocrine neoplasia type 2. Mutations of genes encoding subunits of the succinate dehydrogenase are associated with hereditary paraganglioma/pheochromocytoma syndrome. Pheochromocytoma is one of the main manifestations of multiple endocrine neoplasia type 2 caused by germline mutation of the rearranged during transfection proto-oncogene. METHODS: Polymorphisms of the succinate dehydrogenase genes were analyzed in 77 rearranged during transfection mutation carriers, 47 patients with sporadic medullary thyroid cancer, 48 patients with sporadic Pheo, and 100 healthy individuals. Exons 10-16 of the rearranged during transfection proto-oncogene were analyzed by direct DNA sequencing, and all exons of the von Hippel-Lindau, succinate dehydrogenase B, and succinate dehydrogenase subunit D genes were tested by direct DNA sequencing and multiple ligation probe analysis. The G12S polymorphism of the succinate dehydrogenase subunit D gene was determined by restriction fragment length polymorphism. RESULTS: Of the 77 rearranged during transfection mutation carriers, 55 from 16 families had multiple endocrine neoplasia type 2A, three from three families had multiple endocrine neoplasia type 2B, and 19 from two families had familial medullary thyroid carcinoma. Eight of 55 (14.5%) patients with multiple endocrine neoplasia type 2A had this variant whereas it was absent in multiple endocrine neoplasia type 2B, familial medullary thyroid carcinoma, sporadic medullary thyroid carcinoma, and sporadic pheochromocytoma groups, and its prevalence in controls was 1% (p<0.002 multiple endocrine neoplasia type 2A versus controls). No associations between G12S and age of manifestation, incidence of pheochromocytoma or hyperparathyroidism, or level of serum calcitonin were observed. CONCLUSION: The high prevalence of the G12S variant in patients with multiple endocrine neoplasia type 2A raises questions about its role as a genetic modifier, but this proposal remains to be established

Serum leptin levels in relation to circulating cytokines, chemokines, adhesion molecules and angiogenic factors in normal pregnancy and preeclampsia

Objective: In this study, we determined circulating levels of C-reactive protein, several cytokines, chemokines, adhesion molecules and angiogenic factors along with those of leptin in healthy non-pregnant and pregnant women and preeclamptic patients, and investigated whether serum leptin levels were related to the clinical characteristics and measured laboratory parameters of the study participants.Methods: Sixty preeclamptic patients, 60 healthy pregnant women and 59 healthy non-pregnant women were involved in this case-control study. Levels of leptin and transforming growth factor (TGF)-beta1 in maternal sera were assessed by ELISA. Serum levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-18, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interferon-gamma-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 were determined by multiplex suspension array. Serum C-reactive protein (CRP) concentrations were measured by an autoanalyzer. Serum total soluble fms-like tyrosine kinase-1 (sFlt-1) and biologically active placental growth factor (PlGF) levels were determined by electrochemiluminescence immunoassay. For statistical analyses, non-parametric methods were applied.Results: There were significant differences in most of the measured laboratory parameters among the three study groups except for serum IL-1beta and TGF-beta1 levels. Serum leptin levels were significantly higher in preeclamptic patients and healthy pregnant women than in healthy non-pregnant women. Additionally, preeclamptic patients had significantly higher leptin levels as compared to healthy pregnant women. Serum leptin levels were independently associated with BMI in healthy non-pregnant women. In healthy pregnant women, both BMI and serum CRP concentrations showed significant positive linear association with leptin levels. There were significant positive correlations between serum leptin concentrations of healthy pregnant women and systolic blood pressure, as well as serum levels of IP-10, while their serum leptin levels correlated inversely with fetal birth weight. In preeclamptic patients, a significant positive correlation was observed between serum concentrations of leptin and IP-10. Furthermore, elevated serum leptin level and sFlt-1/PlGF ratio had an additive (joint) effect in the risk of preeclampsia, as shown by the substantially higher odds ratios of their combination than of either alone.Conclusions: Simultaneous measurement of leptin with several inflammatory molecules and angiogenic factors in this study enabled us to investigate their relationship, which can help to understand the role of circulating leptin in normal pregnancy and preeclampsia. © 2011 Molvarec et al; licensee BioMed Central Ltd

A Beta vulgaris L. ssp. esculenta var. rubra bioaktív vegyületeinek hatása metasztatikus prosztatarákban = Effects of bioactive molecules of Beta vulgaris L. ssp. esculenta var. rubra on metastatic prostate cancer

Számos közlemény beszámol tumoros betegek életminőségének javítására alkalmazott étrend-kiegészítők hatásáról, de mindezek élettani vizsgálata szegényes. A cékla számos, a szervezetben lezajló biokémiai reakcióutat, enzim- és metabolitszintézist befolyásol. Módszer: A szerzők hormonrezisztens és metasztatikus prosztatarák miatt taxán-kemoterápiában részesülő betegek életminőségének javítása érdekében kereskedelmi forgalomból származó természetes céklakészítményt adtak egy hónapon át 2×10 g dózisban 24 (életkor: 68±8 év) betegnek, akik 3,6±2,8 éve jelentkeztek először panaszaikkal. A kezelést követően 18 fő esetében tudták az adatokat kiértékelni. A rutin laboratóriumi vizsgálatok mellett a betegek PSA-, HbA 1c -értékeit, 9 citokin- és 3 növekedésifaktor-szintet, a redox-homeosztázis globális paramétereit, fémionháztartásuk néhány elemét, Zn- és szabadprotoporfirin-szintjét, transzmetiláló képességét a kezelés megkezdése előtt és egy hónap múlva határozták meg. Eredmények: Eredményeik azt mutatták, hogy a betegek döntő többségében a cékla kedvező hatása érvényre jutott, és a tumoros betegekre jellemző szignifikánsan magas Zn- és szabadprotoporfirin-szintek csökkentek, valamint a transzmetilezési folyamatok felgyorsultak. Következtetések: Eredményeik alapján úgy tűnik, hogy az általuk alkalmazott céklakészítmény mérsékelt és tartós fogyasztása kedvezően befolyásolja a betegek életminőségét, de több esetben megfigyelhető növekvő EGF-érték miatt szoros orvosi kontroll szükséges kemoterápiában részesülő prosztatarákos betegeknél. Orv. Hetil., 2010, 37, 1495–1503. | Several reports are known about the effects of nutrition supplements in the improvement of quality of life of patients with tumor, however, the physiological background remains largely unknown. Table beet affects numerous biochemical reactions, enzymes and metabolic-synthesis. Methods: Natural table beet product come from commercial service was given twice 10g daily for 1 month for 24 patients (mean age 68±8 years) with hormone-resistant and metastatic prostate cancer treated with taxan chemotherapy, who report themselves first, mean 3,6±2,8 years ago with their complains. 18 men’s data were amenable after treatment for evaluation. In addition to routine laboratory examination values of HbA1c, 9 cytokines and levels of 3 growth factors, the global parameters of redox-homeostasis, few elements of their metal-ions, Zn- and level of free protoporfirin, trans-metilating processes before and 1 month after treatment were determined. Results: In most of the patients, favorable impact of beet was enforced and significantly high levels of Zn- and free protoporfirin decreased; furthermore, trans-metilating processes fastened. Conclusions: According to results, it seems that moderate and permanent consumption of table beet product affects the life expectancy of patients favorably; however, due to the increasing values of EGF, medical control is necessary for patients with prostate cancer treated by chemotherapy. Orv. Hetil., 2010, 37, 1495–1503