Massive Gastrointestinal Bleeding and Obstruction of the Ureter Caused by the Migration of a Swallowed Toothpick from the Sigmoid Colon – A Case Report

In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks, and thus, we insist on a physical examination, as the best indicator of injury

Rad ne sadrži naslov na drugom jeziku.

Uvod: Adropin je novi peptid povezan s homeostazom energije i vaskularnom zaštitom. Prema našem saznanju, za sada nema studija koje su istraživale vezu adropina i upalnih bolesti crijeva (IBD). Matriks Gla protein je peptid ovisan o vitaminu K sa značajnom ulogom u zaustavljanju vaskularne kalcifikacije. Nedavne studije ukazuju na moguću poveznicu između imunomodulatornog učinka MGP-a i upalne bolesti crijeva. Cilj: Cilj ove studije je usporedba serumske razine adropina oboljelih od upalnih bolesti crijeva i zdrave kontrolne skupine. Nadalje, istraživali smo povezanost razine adropina sa zbirovima aktivnosti IBD-a, CRP-om, fekalnim kalprotektinom, glukozom na tašte i razinom inzulina. Cilj druge studije je bila uspredba razine inaktivnog MGP između oboljelih od IBD i zdrave kontrolne skupine. Dodatno, namjera je bila istražiti povezanost razine inaktivnog MGP s kliničkim i laboratorijskim parametrima. Metode: Presječna studija evaluacije serumske razine adropina provedena je na 55 bolesnika s IBD (30 bolesnika s ulceroznim kolitisom, 25 bolesnika s Crohnovom bolesti) uspoređujući s kontrolnom skupinom podudarnih dobnih i spolnih značajki. Presječno istraživanje serumske razine inaktivnog MGP provedena je na 70 bolesnika s IBD-om (30 bolesnika s ulceroznim kolitisom , 40 s Crohnovom bolesti) te na 60 zdravih isipitanika koji pripadaju kontrolnoj skupini podudarnih dobnih i spolnih značajki. Serumska razina adropina određivana je ELISA metodom (dual enzyme-linked immunosorbent assay) za humani adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), prema uputama proizvođača. Razina inaktivnog MGP analizirana je CLIA metodom koristeći IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) prema uputama proizvođača. Razina fekalnog kalprotektina određivana je turbidimetrijskom imunoesej metodom koristeći Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Ostali parametri određivani su standardnim laboratorijskim procedurama. Rezultati: Serumska razina adropina bila je značajno niža u bolesnika s IBD uspoređujući s kontrolnom skupinom (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), dok nije bilo značajne razlike između oboljelih od ulceroznog kolitis i oboljelih od Crohnove bolesti (P=0.585). Nadalje, pronađena je značajna negativna korelacija između adropina i fekalnog kalprotektina (r= -0.303, P=0.025). U ukupnoj populaciji ispitanika pronađena je značajna negativna korelacija razine adropina i glukoze na tašte (r= -0.222, P=0.023). Multivarijatna logisitička regresija pokazala je vrijednost adropin kao značajnog prediktora pozitivnog IBD statusa, navedena s drugim temeljnim značajkama (OR 0.455, 95% CI 0.251-0.823, P=0.009). Razina inaktivnog MGP bila je značajno viša u bolesnika s IBD uspoređujući s kontrolnom skupinom (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), a statistički značajne razlike između skupina bolesnika s ulceroznim kolitisom i bolesnika s Crohnovom bolesti nije bilo (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Nadalje, utvrđena je značajna pozitivna korelacija između razine inaktivnog MGP i fekalnog kalprotektina (r = 0.396, P < 0.001) kao i između inaktivnog MGP-a i CRP-a (r = 0.477, P < 0.001). Multipla linearna regresijska analiza zadržava statistički značajnu povezanost s fekalnim kalprotektinom (β ± SE, 0.06 ± 0.02, P = 0.003). Zaključak: Rezultati istraživanja daju naslutiti kako bi adropin mogao biti uključen u složeni patofiziološki proces upalnih bolesti crijeva, ali su potrebna daljna istraživanja koja bi to dodatno potvrdila. Nadalje, rezultati istraživanja razine inaktivnog MGP-a potvrđuju eksperimentalno dobivene podatke o imunomodulacijskom učinku MGP-a na IBD te ukazuju na mogući značaj u nastanku upalnih bolesti crijeva i ekstraintestinalnih manifestacija.Background: Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). Matrix Gla protein (MGP) is a vitamin K dependent peptide which has an established role in suppression of vascular calcification. Recent studies have pointed to a possible link between immunomodulatory effect of MGP and inflammatory bowel disease. Aim: The aim of this study was to compare serum adropin levels between patients with IBD and healthy controls. Furthermore, we explored adropin levels correlations with IBD severity scores, hsCRP, fecal calprotectin and fasting glucose and insulin levels. The aim of the second study was to compare serum levels of inactive, dephosphorylated and uncarboxylated MGP form (dp-ucMGP) between patients with IBD and healthy controls. The additional goal was to investigate the association of plasma dp-ucMGP levels with the anthropometric, clinical and laboratory parameters. Methods: This cross-sectional evaluation study of serum adropin levels was conducted on 55 patients with IBD (30 Ulcerative colitis patients, 25 Crohn’s disease patients) in comparison with 50 age and gender matched controls. Furthermore, cross-sectional study of serum dp-ucMGP levels was conducted on 70 patients with IBD (30 patients with ulcerative colitis and 40 patients with Crohn’s disease) and 60 age and gender matching healthy controls. Serum concentrations of adropin were determined using the dual enzyme-linked immunosorbent assay (ELISA) of human adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), according to the manufacturer's instructions. Plasma dp-ucMGP levels were analyzed from blood samples by CLIA method using IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) according to the manufacturer's instructions. FC levels were determined from stool samples by turbidimetric immunoassay method using Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Other parameters were analyzed according to the standard laboratory procedures. Results: Serum adropin levels were significantly lower in patients with IBD in comparison with 50 controls (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), while there was no significant difference in comparison of UC patients with CD patients (P=0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r= -0.303, P=0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r= -0.222, P=0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251-0.823, P=0.009). Plasma levels of dp-ucMGP were significantly higher in patients with IBD compared to the control group (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), and there was no significant difference between patients with Crohn’s disease and patients with ulcerative colitis (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Furthermore, a significant positive correlation of plasma dp-ucMGP levels was found with both fecal calprotectin (FC) levels (r = 0.396, P < 0.001) and high sensitivity C-reactive protein (hsCRP) levels (r = 0.477, P < 0.001). Multiple linear regression analysis showed that dp-ucMGP levels retained significant association with FC (β ± SE, 0.06 ± 0.02, P = 0.003). Conclusion: Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings. Moreover, results with inactive MGP support experimental data of MGP immunomodulatory IBD effect and indicate potential involvement in the pathophysiology of the disease, and possibly extraintestinal manifestations

Rad ne sadrži naslov na drugom jeziku.

Uvod: Adropin je novi peptid povezan s homeostazom energije i vaskularnom zaštitom. Prema našem saznanju, za sada nema studija koje su istraživale vezu adropina i upalnih bolesti crijeva (IBD). Matriks Gla protein je peptid ovisan o vitaminu K sa značajnom ulogom u zaustavljanju vaskularne kalcifikacije. Nedavne studije ukazuju na moguću poveznicu između imunomodulatornog učinka MGP-a i upalne bolesti crijeva. Cilj: Cilj ove studije je usporedba serumske razine adropina oboljelih od upalnih bolesti crijeva i zdrave kontrolne skupine. Nadalje, istraživali smo povezanost razine adropina sa zbirovima aktivnosti IBD-a, CRP-om, fekalnim kalprotektinom, glukozom na tašte i razinom inzulina. Cilj druge studije je bila uspredba razine inaktivnog MGP između oboljelih od IBD i zdrave kontrolne skupine. Dodatno, namjera je bila istražiti povezanost razine inaktivnog MGP s kliničkim i laboratorijskim parametrima. Metode: Presječna studija evaluacije serumske razine adropina provedena je na 55 bolesnika s IBD (30 bolesnika s ulceroznim kolitisom, 25 bolesnika s Crohnovom bolesti) uspoređujući s kontrolnom skupinom podudarnih dobnih i spolnih značajki. Presječno istraživanje serumske razine inaktivnog MGP provedena je na 70 bolesnika s IBD-om (30 bolesnika s ulceroznim kolitisom , 40 s Crohnovom bolesti) te na 60 zdravih isipitanika koji pripadaju kontrolnoj skupini podudarnih dobnih i spolnih značajki. Serumska razina adropina određivana je ELISA metodom (dual enzyme-linked immunosorbent assay) za humani adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), prema uputama proizvođača. Razina inaktivnog MGP analizirana je CLIA metodom koristeći IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) prema uputama proizvođača. Razina fekalnog kalprotektina određivana je turbidimetrijskom imunoesej metodom koristeći Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Ostali parametri određivani su standardnim laboratorijskim procedurama. Rezultati: Serumska razina adropina bila je značajno niža u bolesnika s IBD uspoređujući s kontrolnom skupinom (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), dok nije bilo značajne razlike između oboljelih od ulceroznog kolitis i oboljelih od Crohnove bolesti (P=0.585). Nadalje, pronađena je značajna negativna korelacija između adropina i fekalnog kalprotektina (r= -0.303, P=0.025). U ukupnoj populaciji ispitanika pronađena je značajna negativna korelacija razine adropina i glukoze na tašte (r= -0.222, P=0.023). Multivarijatna logisitička regresija pokazala je vrijednost adropin kao značajnog prediktora pozitivnog IBD statusa, navedena s drugim temeljnim značajkama (OR 0.455, 95% CI 0.251-0.823, P=0.009). Razina inaktivnog MGP bila je značajno viša u bolesnika s IBD uspoređujući s kontrolnom skupinom (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), a statistički značajne razlike između skupina bolesnika s ulceroznim kolitisom i bolesnika s Crohnovom bolesti nije bilo (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Nadalje, utvrđena je značajna pozitivna korelacija između razine inaktivnog MGP i fekalnog kalprotektina (r = 0.396, P < 0.001) kao i između inaktivnog MGP-a i CRP-a (r = 0.477, P < 0.001). Multipla linearna regresijska analiza zadržava statistički značajnu povezanost s fekalnim kalprotektinom (β ± SE, 0.06 ± 0.02, P = 0.003). Zaključak: Rezultati istraživanja daju naslutiti kako bi adropin mogao biti uključen u složeni patofiziološki proces upalnih bolesti crijeva, ali su potrebna daljna istraživanja koja bi to dodatno potvrdila. Nadalje, rezultati istraživanja razine inaktivnog MGP-a potvrđuju eksperimentalno dobivene podatke o imunomodulacijskom učinku MGP-a na IBD te ukazuju na mogući značaj u nastanku upalnih bolesti crijeva i ekstraintestinalnih manifestacija.Background: Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). Matrix Gla protein (MGP) is a vitamin K dependent peptide which has an established role in suppression of vascular calcification. Recent studies have pointed to a possible link between immunomodulatory effect of MGP and inflammatory bowel disease. Aim: The aim of this study was to compare serum adropin levels between patients with IBD and healthy controls. Furthermore, we explored adropin levels correlations with IBD severity scores, hsCRP, fecal calprotectin and fasting glucose and insulin levels. The aim of the second study was to compare serum levels of inactive, dephosphorylated and uncarboxylated MGP form (dp-ucMGP) between patients with IBD and healthy controls. The additional goal was to investigate the association of plasma dp-ucMGP levels with the anthropometric, clinical and laboratory parameters. Methods: This cross-sectional evaluation study of serum adropin levels was conducted on 55 patients with IBD (30 Ulcerative colitis patients, 25 Crohn’s disease patients) in comparison with 50 age and gender matched controls. Furthermore, cross-sectional study of serum dp-ucMGP levels was conducted on 70 patients with IBD (30 patients with ulcerative colitis and 40 patients with Crohn’s disease) and 60 age and gender matching healthy controls. Serum concentrations of adropin were determined using the dual enzyme-linked immunosorbent assay (ELISA) of human adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), according to the manufacturer's instructions. Plasma dp-ucMGP levels were analyzed from blood samples by CLIA method using IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) according to the manufacturer's instructions. FC levels were determined from stool samples by turbidimetric immunoassay method using Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Other parameters were analyzed according to the standard laboratory procedures. Results: Serum adropin levels were significantly lower in patients with IBD in comparison with 50 controls (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), while there was no significant difference in comparison of UC patients with CD patients (P=0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r= -0.303, P=0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r= -0.222, P=0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251-0.823, P=0.009). Plasma levels of dp-ucMGP were significantly higher in patients with IBD compared to the control group (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), and there was no significant difference between patients with Crohn’s disease and patients with ulcerative colitis (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Furthermore, a significant positive correlation of plasma dp-ucMGP levels was found with both fecal calprotectin (FC) levels (r = 0.396, P < 0.001) and high sensitivity C-reactive protein (hsCRP) levels (r = 0.477, P < 0.001). Multiple linear regression analysis showed that dp-ucMGP levels retained significant association with FC (β ± SE, 0.06 ± 0.02, P = 0.003). Conclusion: Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings. Moreover, results with inactive MGP support experimental data of MGP immunomodulatory IBD effect and indicate potential involvement in the pathophysiology of the disease, and possibly extraintestinal manifestations

Rad ne sadrži naslov na drugom jeziku.

Uvod: Adropin je novi peptid povezan s homeostazom energije i vaskularnom zaštitom. Prema našem saznanju, za sada nema studija koje su istraživale vezu adropina i upalnih bolesti crijeva (IBD). Matriks Gla protein je peptid ovisan o vitaminu K sa značajnom ulogom u zaustavljanju vaskularne kalcifikacije. Nedavne studije ukazuju na moguću poveznicu između imunomodulatornog učinka MGP-a i upalne bolesti crijeva. Cilj: Cilj ove studije je usporedba serumske razine adropina oboljelih od upalnih bolesti crijeva i zdrave kontrolne skupine. Nadalje, istraživali smo povezanost razine adropina sa zbirovima aktivnosti IBD-a, CRP-om, fekalnim kalprotektinom, glukozom na tašte i razinom inzulina. Cilj druge studije je bila uspredba razine inaktivnog MGP između oboljelih od IBD i zdrave kontrolne skupine. Dodatno, namjera je bila istražiti povezanost razine inaktivnog MGP s kliničkim i laboratorijskim parametrima. Metode: Presječna studija evaluacije serumske razine adropina provedena je na 55 bolesnika s IBD (30 bolesnika s ulceroznim kolitisom, 25 bolesnika s Crohnovom bolesti) uspoređujući s kontrolnom skupinom podudarnih dobnih i spolnih značajki. Presječno istraživanje serumske razine inaktivnog MGP provedena je na 70 bolesnika s IBD-om (30 bolesnika s ulceroznim kolitisom , 40 s Crohnovom bolesti) te na 60 zdravih isipitanika koji pripadaju kontrolnoj skupini podudarnih dobnih i spolnih značajki. Serumska razina adropina određivana je ELISA metodom (dual enzyme-linked immunosorbent assay) za humani adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), prema uputama proizvođača. Razina inaktivnog MGP analizirana je CLIA metodom koristeći IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) prema uputama proizvođača. Razina fekalnog kalprotektina određivana je turbidimetrijskom imunoesej metodom koristeći Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Ostali parametri određivani su standardnim laboratorijskim procedurama. Rezultati: Serumska razina adropina bila je značajno niža u bolesnika s IBD uspoređujući s kontrolnom skupinom (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), dok nije bilo značajne razlike između oboljelih od ulceroznog kolitis i oboljelih od Crohnove bolesti (P=0.585). Nadalje, pronađena je značajna negativna korelacija između adropina i fekalnog kalprotektina (r= -0.303, P=0.025). U ukupnoj populaciji ispitanika pronađena je značajna negativna korelacija razine adropina i glukoze na tašte (r= -0.222, P=0.023). Multivarijatna logisitička regresija pokazala je vrijednost adropin kao značajnog prediktora pozitivnog IBD statusa, navedena s drugim temeljnim značajkama (OR 0.455, 95% CI 0.251-0.823, P=0.009). Razina inaktivnog MGP bila je značajno viša u bolesnika s IBD uspoređujući s kontrolnom skupinom (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), a statistički značajne razlike između skupina bolesnika s ulceroznim kolitisom i bolesnika s Crohnovom bolesti nije bilo (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Nadalje, utvrđena je značajna pozitivna korelacija između razine inaktivnog MGP i fekalnog kalprotektina (r = 0.396, P < 0.001) kao i između inaktivnog MGP-a i CRP-a (r = 0.477, P < 0.001). Multipla linearna regresijska analiza zadržava statistički značajnu povezanost s fekalnim kalprotektinom (β ± SE, 0.06 ± 0.02, P = 0.003). Zaključak: Rezultati istraživanja daju naslutiti kako bi adropin mogao biti uključen u složeni patofiziološki proces upalnih bolesti crijeva, ali su potrebna daljna istraživanja koja bi to dodatno potvrdila. Nadalje, rezultati istraživanja razine inaktivnog MGP-a potvrđuju eksperimentalno dobivene podatke o imunomodulacijskom učinku MGP-a na IBD te ukazuju na mogući značaj u nastanku upalnih bolesti crijeva i ekstraintestinalnih manifestacija.Background: Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). Matrix Gla protein (MGP) is a vitamin K dependent peptide which has an established role in suppression of vascular calcification. Recent studies have pointed to a possible link between immunomodulatory effect of MGP and inflammatory bowel disease. Aim: The aim of this study was to compare serum adropin levels between patients with IBD and healthy controls. Furthermore, we explored adropin levels correlations with IBD severity scores, hsCRP, fecal calprotectin and fasting glucose and insulin levels. The aim of the second study was to compare serum levels of inactive, dephosphorylated and uncarboxylated MGP form (dp-ucMGP) between patients with IBD and healthy controls. The additional goal was to investigate the association of plasma dp-ucMGP levels with the anthropometric, clinical and laboratory parameters. Methods: This cross-sectional evaluation study of serum adropin levels was conducted on 55 patients with IBD (30 Ulcerative colitis patients, 25 Crohn’s disease patients) in comparison with 50 age and gender matched controls. Furthermore, cross-sectional study of serum dp-ucMGP levels was conducted on 70 patients with IBD (30 patients with ulcerative colitis and 40 patients with Crohn’s disease) and 60 age and gender matching healthy controls. Serum concentrations of adropin were determined using the dual enzyme-linked immunosorbent assay (ELISA) of human adropin (Phoenix Pharmaceuticals, Burlingame, CA, USA), according to the manufacturer's instructions. Plasma dp-ucMGP levels were analyzed from blood samples by CLIA method using IDS-iSYS InaKtif MGP (Immunodiagnostic Systems, Frankfurt, Germany) according to the manufacturer's instructions. FC levels were determined from stool samples by turbidimetric immunoassay method using Buhlmann fCAL turbo assay (Buhlmann Laboratories AG, Schonenbuch, Switzerland). Other parameters were analyzed according to the standard laboratory procedures. Results: Serum adropin levels were significantly lower in patients with IBD in comparison with 50 controls (2.89±0.94 vs 3.37±0.60 ng/mL, P=0.002), while there was no significant difference in comparison of UC patients with CD patients (P=0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r= -0.303, P=0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r= -0.222, P=0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251-0.823, P=0.009). Plasma levels of dp-ucMGP were significantly higher in patients with IBD compared to the control group (629.83 ± 124.20 vs 546.7 ± 122.09 pmol/mL, P < 0.001), and there was no significant difference between patients with Crohn’s disease and patients with ulcerative colitis (640.02 ± 131.88 vs 616.23 ± 113.92 pmol/mL, P = 0.432). Furthermore, a significant positive correlation of plasma dp-ucMGP levels was found with both fecal calprotectin (FC) levels (r = 0.396, P < 0.001) and high sensitivity C-reactive protein (hsCRP) levels (r = 0.477, P < 0.001). Multiple linear regression analysis showed that dp-ucMGP levels retained significant association with FC (β ± SE, 0.06 ± 0.02, P = 0.003). Conclusion: Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings. Moreover, results with inactive MGP support experimental data of MGP immunomodulatory IBD effect and indicate potential involvement in the pathophysiology of the disease, and possibly extraintestinal manifestations

Serum adropin levels are reduced in patients with inflammatory bowel diseases

Abstract Adropin is a novel peptide mostly associated with energy homeostasis and vascular protection. To our knowledge, there are no studies that investigated its relationship with inflammatory bowel diseases (IBD). The aim of this study was to compare serum adropin levels between 55 patients with IBD (30 Ulcerative colitis (UC) patients, 25 Crohn’s disease (CD) patients) and 50 age/gender matched controls. Furthermore, we explored adropin correlations with IBD severity scores, hsCRP, fecal calprotectin, fasting glucose and insulin levels. Serum adropin levels were significantly lower in patients with IBD in comparison with the control group (2.89 ± 0.94 vs 3.37 ± 0.60 ng/mL, P = 0.002), while there was no significant difference in comparison of UC patients with CD patients (P = 0.585). Furthermore, there was a negative correlation between adropin and fecal calprotectin (r = −0.303, P = 0.025), whereas in the total study population, we found a significant negative correlation with fasting glucose levels (r = −0.222, P = 0.023). A multivariable logistic regression showed that serum adropin was a significant predictor of positive IBD status when enumerated along with baseline characteristics (OR 0.455, 95% CI 0.251–0.823, P = 0.009). Our findings imply that adropin could be involved in complex pathophysiology of IBD, but further larger scale studies are needed to address these findings

Stenoza spinalnog kanala slabinske kralježnice – od epidemiologije do rehabilitacije [Lumbar spinal stenosis – from epidemiology to rehabilitation]

Lumbar spinal stenosis (LSS) is becoming an increasingly prevalent condition due to trends of aging population. That is because, although etiologically heterogenous, it is most often the consequence of degenerative changes of the spine. There is no generally accepted classification of LSS. To make the diagnosis of LSS it is crucial to interrelate history, clinical examination and imaging alongside with neurophysiological findings. The treatment of patients with LSS may be conservative (pharmacological and non-pharmacological) and surgical, and in this respect in the latter minimally invasive techniques are preferred lately. In this paper we comprehensively present a state-of-the-art view on LSS