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3D-chiral quadratic indices of the 'molecular pseudograph's atom adjacency matrix' and their application to central chirality codification: classification of ACE inhibitors and prediction of sigma-receptor antagonist activities.

Quadratic indices of the 'molecular pseudograph's atom adjacency matrix' have been generalized to codify chemical structure information for chiral drugs. These 3D-chiral quadratic indices make use of a trigonometric 3D-chirality correction factor. These indices are nonsymmetric and reduced to classical (2D) descriptors when symmetry is not codified. By this reason, it is expected that they will be useful to predict symmetry-dependent properties. 3D-Chirality quadratic indices are real numbers and thus, can be easily calculated in TOMOCOMD-CARDD software. These descriptors circumvent the inability of conventional 2D quadratic indices (Molecules 2003, 8, 687-726. http://www.mdpi.org) and other (chirality insensitive) topological indices to distinguish sigma-stereoisomers. In this paper, we extend our earlier work by applying 3D-chirality quadratic indices to two data sets containing chiral compounds. Consequently, in order to test the potential of this novel approach in drug design we have modelled the angiotesin-converting enzyme inhibitory activity of perindoprilate's sigma-stereoisomers combinatorial library. Two linear discriminant analysis (LDA) models were obtained. The first one model was performed considering all data set as training series and classifies correctly 88.89% of active compounds and 100.00% of nonactive one for a global good classification of 96.87%. The second one LDA-QSAR model classified correctly 83.33% of the active and 100.00% of the inactive compounds in a training set, result that represent a total of 95.65% accuracy in classification. On the other hand, the model classifies 100.00% of these compounds in the test set. Similar predictive behaviour was observed in a leave-one-out cross-validation procedure for both equations. Canonical regression analysis corroborated the statistical quality of these models (R(can) of 0.82 and of 0.76, respectively) and was also used to compute biology activity canonical scores for each compound. Finally, prediction of the biological activities of chiral 3-(3-hydroxyphenyl)piperidines, which are sigma-receptor antagonists, by linear multiple regression analysis was carried out. Two statistically significant QSAR models were obtained (R2=0.940, s=0.270 and R2=0.977, s=0.175). These models showed high stability to data variation in the leave-one-out cross-validation procedure (q2=0.912, scv=0.289 and q2=0.957, scv=0.211). The results of this study compare favourably with those obtained with other chirality descriptors applied to the same data set. The 3D-chiral TOMOCOMD-CARDD approach provides a powerful alternative to 3D-QSAR.

Angiotensin-Converting Enzyme Inhibitors↗

Appropriate and inappropriate use of day-hospital care in Italy.

This study describes the extent of inappropriate day-hospital assistance and the effect of different variables on such inappropriateness. A random sample of patients admitted to pediatric and adult day-hospital care during the period Janurary--December 2000 in three hospitals located in the area of Catanzaro, Italy were reviewed. Assessment of appropriateness was made for the first access and for each of the following accesses in day-hospital. A total of 826 patients were reviewed. Overall, 23.8% of the first access in day-hospital care was judged to be inappropriate and 49.7% of the sample showed at least one inappropriate access for day-hospital care with a mean of 1.4 inappropriate accesses. Multiple logistic regression analysis indicated that the inappropriateness of the first access significantly increased with relation to lower distance from hospital to patient's home; admission to general medicine wards; first access from Monday to Thursday; lower number of patient's diagnostic procedures and medical examinations in the first access. Stepwise multiple linear regression analysis showed that the number of inappropriate accesses was significantly higher for general medicine and surgery and trauma/orthopedics wards; in patients who the first access was inappropriate; in those who received a lower number of diagnostic procedures and medical examinations; in patients who showed a higher length of care in day-hospital. The findings suggest the need for standardized diagnostic and therapeutic guidelines for day-hospital care.

Adolescent↗

The relationship of nonspecific bronchial responsiveness to the occurrence of respiratory symptoms and decreased levels of pulmonary function. The Normative Aging Study.

Nonspecific bronchial responsiveness was assessed by an abbreviated methacholine challenge test in 458 male participants of the Normative Aging Study, who also completed a respiratory questionnaire and spirometry. A positive response to the methacholine challenge test was defined as a greater than or equal to 20% decline in FEV1 during the test. Cigarette smoking was significantly associated with a positive methacholine response (p less than 0.001). Logistic regression analyses indicated that there was a significant association between a positive response to methacholine and both any wheeze (p = 0.002) and persistent wheeze (p less than 0.001) after taking into account smoking status and age; an association between responsiveness and chronic cough was of borderline significance (p = 0.06). Multiple linear regression analyses indicated that positive methacholine responsiveness was independently associated with lower levels of FEV1 (p less than 0.001) and FEF25-75 (p less than 0.001). Using the log of the dose-response slope rather than a dichotomous variable to characterize responder status yielded very similar results in the linear and logistic models. The findings of this cross-sectional study suggest that increased level of nonspecific responsiveness is significantly associated with wheeze and cough symptoms and decreased levels of pulmonary function in adult men. Longitudinal follow-up of these men should shed light on the importance of nonspecific responsiveness as a risk factor for the subsequent development of chronic obstructive pulmonary disease.

Adult↗

Measuring visual acuity--mesopic or photopic conditions, and high or low contrast letters?

PURPOSE: To develop single-valued wavefront aberration metrics that correlate strongly with visual performance. The purpose of this study is to explore whether photopic high contrast visual acuity (VA) is an appropriate visual performance reference and whether mesopic and/or low contrast testing provides any advantage. METHODS: Subjects from the Texas Investigation of Cataract Optics study (N = 148) ranged in age from 21.6 to 83.8 years and from clear lens to dense nuclear cataract. Visual acuity was measured under four conditions: photopic high (VA(PHC)) and low (VA(PLC)) contrast, mesopic high (VA(MHC)) and low (VA(MLC)) contrast (photopic = 280 cd/m(2), mesopic = 0.75 cd/m(2)). Variables were tested for compliance with normality (-2.00 < skew and kurtosis < 2.00) and transformed if required. Linear regression and Bland-Altman 95% limits of agreement (+/-1.96 SD) were used to examine relationships between VA variables and between VA and wavefront aberration metrics. RESULTS: The two photopic measures VA(PHC) (skew = 2.57, kurtosis = 12.2) and VA(PLC) (1.67, 5.41) were poorly distributed, but the two mesopic measures VA(MHC) (0.88, 1.67) and VA(MLC) (0.29, -0.18) were normally distributed. Strong correlations existed between the (transformed) VA variables (R: 0.53 to 0.84). However, limits of agreement ranged over 0.30 to 0.42 logMAR, whereas retest data suggested a range of 0.15. All four were offered in stepwise multiple linear regression for 30 wavefront metrics: 20 included VA(MLC) alone, two included VA(PLC), two included VA(MHC) and six included both VA(MLC) and VA(MHC); R(2) averaged 25%. CONCLUSION: Although strongly correlated, low contrast and/or mesopic VA testing provides different information. Wave aberration metrics correlates better with VA(MLC) making this the visual performance test of choice.

Adult↗

Diazepam plasma binding in the perinatal period: influence of nonesterified fatty acids.

The plasma binding of diazepam was determined serially in 24 women undergoing either elective induction of labour (vaginal or emergency caesarean delivery) or elective caesarean section at term and in 5 nonpregnant women requiring abdominal surgery. In the majority of pregnant patients, a marked increase in diazepam percentage free was observed during labour or prior to caesarean section, reaching a maximum, 1.6 to 3.2 fold increase at delivery or within 4 h postpartum; by the fifth day postpartum, diazepam percentage free was lower than on admission to hospital. In contrast, little change in diazepam percentage free was observed during the perisurgical period in nonpregnant patients. In parturient and surgical patients, the time courses of diazepam percentage free and plasma nonesterified fatty acid (NEFA) concentration were parallel. Bivariate regression analyses of pooled data demonstrated a strong correlation (r = 0.642, p = less than 0.010 between diazepam percentage free and corresponding NEFA concentration and a weaker correlation between diazepam percentage free and both albumin (r = 0.319, p less than 0.02) or total protein (r = 0.438, p less than 0.01). From multiple linear regression it was demonstrated that 54% of the variability in diazepam percentage free could be attributed to plasma NEFA and albumin concentrations. NEFA displacement of plasma bound diazepam was substantiated using crystalline human serum albumin. An approximate 65% increase in plasma alpha 1 acid glycoprotein levels was observed posttrauma in both parturient and surgical patients but was unrelated to diazepam binding events. A relationship between diazepam plasma binding changes and concurrently altered disposition of diazepam during parturition is postulated.

Adult↗

Accelerated vertebral bone loss in relation to the menopause: a cross-sectional study on lumbar bone density in 286 women of 46 to 55 years of age.

Bone mineral density (BMD) of the lumbar spine was measured in 286 women (46-55 years of age) using dual photon absorptiometry. The women were classified in three categories: premenopausal, perimenopausal and postmenopausal. The postmenopausal group was subdivided according to the number of years since the last uterine bleeding. With multiple linear regression analysis of lumbar BMD on age and menopausal status, an acceleration of bone loss was observed during the perimenopausal period and the following first two postmenopausal years. No significant bone loss was detected in relation to age or during the later postmenopausal years. Applying both an additive and a multiplicative model of bone loss, the mean perimenopausal bone loss was 0.061 gram-equivalents hydroxyapatite (geqHA)/cm2 and 6.4%, respectively. In the first 2 postmenopausal years the mean bone loss was 0.044 geqHA/cm2 and 5.1% per year. These results suggest a substantial menopause related acceleration of lumbar bone loss in a relatively short time span with its onset in the perimenopausal period.

Bone and Bones↗

Homocysteine, circulating vascular cell adhesion molecule and carotid atherosclerosis in postmenopausal vegetarian women and omnivores.

Since the adoption of vegetarian diets as a healthy lifestyle has become popular, the cardiovascular effects of long-term vegetarianism need to be explored. The present study aimed to compare the presence and severity of carotid atherosclerosis (CA), and the blood levels of Vitamin B12, homocysteine (Hcy) and soluble vascular cell adhesion molecule-1 (sVCAM-1) between 57 healthy postmenopausal vegetarians and 61 age-matched omnivores. Carotid atherosclerosis, as measured by ultrasound, was found to be of no significant difference between the two groups. Yet, fasting blood glucose, low-density lipoprotein cholesterol, and Vitamin B12 were significantly lower, while Hcy and sVCAM-1 were higher in the vegetarians as comparing with the omnivores. Multivariate regression analysis showed that the level of Vitamin B12 was negatively associated with the level of Hcy. Vegetarianism itself and Hcy level were significantly associated with sVCAM-1 level in univariate analysis; however, after adjustment for covariates, we identified age but not vegetarianism as the determinant of sVCAM-1 level. Multiple linear regression analysis identified age and systolic blood pressure, but not vegetarianism, as determinants of common carotid artery IMT. In conclusion, there was no significant difference in CA between apparently healthy postmenopausal vegetarians and omnivores. The findings of elevated Hcy in vegetarians indicate the importance of prevention of Vitamin B12 deficiency.

Biomarkers↗

Measurement of the concentrations of glucose and lactic acid in peritoneal dialysis solutions using near-infrared spectroscopy.

Near-infrared spectroscopy (NIR), a nondestructive analytical technique, was employed for the simultaneous determination of the concentrations of glucose and lactic acid in peritoneal dialysis solutions. Solutions were placed in a near-infrared spectrophotometer and the absorbance at wavelengths between 400 and 2500 nm was measured at 2 nm intervals. To obtain calibration equations, multiple linear regression (MLR) was carried out on the NIR spectral data and on the glucose and lactic acid concentrations obtained by enzymatic methods using a calibration sample set. The value of the simple correlation coefficient (r) was 0.996 when using a wavelength of 2270 nm for glucose. The value of the multiple correlation coefficient (R) for lactic acid was 0.997 when using wavelengths of 1688 and 1268 nm. To validate the calibration equations obtained, glucose and lactic acid concentrations in a prediction sample set which was not used for calibration were calculated using the calibration equation and compared with the concentrations measured by the enzymatic method. Excellent agreement between the results of the enzymatic method and of NIR was observed for both constituents. Concentrations of glucose and lactic acid in the peritoneal dialysis solutions were analyzed simultaneously by NIR. The procedure for NIR was simple, and the operation time required to determine the concentrations was a few minutes. These results indicate that NIR may be a useful method for monitoring of the production of peritoneal dialysis solutions.

Journal Article↗

Altitude as a risk indicator of dental fluorosis in children residing in areas with 0.5 and 2.5 mg fluoride per litre in drinking water.

The purpose of this study was to assess the association between altitude and dental fluorosis among Ugandan children in two fluoride (F) districts while controlling for other factors related to fluorosis. A random sample of 481 children aged 10-14 years was examined for fluorosis using the Thylstrup and Fejerskov (TF) index. The prevalence and severity of dental fluorosis increased significantly with increase in altitude (900 vs. 2,200 m in the low- and 1,750 vs. 2,800 m in the high-F district) and in F concentration in the drinking water. In bivariate correlation analyses, F exposure from liquid (FEL), altitude, infant formula, vegetarianism and storing of drinking water in earthenware pots were significantly associated with the tooth prevalence of fluorosis (TPF), i.e. at a severity of TF score >/=1 (p<0.05); age and gender were not. The stepwise multiple linear regression explained 35 and 55% of the variance in TPF within the low- and high-F districts, respectively. The change in R2 due to FEL was 28 and 51% points compared with 5 and 4% points due to altitude. The significant effect of FEL and altitude was confirmed by multiple logistic regression analyses. Thus, although most of the variation in the prevalence and severity of dental fluorosis was explained by the F intake from liquid, altitude was a significant risk indicator after controlling for potential confounders.

Adolescent↗

Blood pressure and performance on the Mini-Mental State Examination in the very old. Cross-sectional and longitudinal data from the Kungsholmen Project.

The authors examined the association of blood pressure with cognitive function as assessed by the Mini-Mental State Examination (MMSE) in a community-based Swedish cohort of 1,736 people aged 75-101 years. Age, sex, education, antihypertensive medication use, heart disease, and stroke were considered as covariates. Multiple linear regression analysis indicated that both systolic and diastolic blood pressure, measured in 1987-1989, were positively and significantly related to baseline MMSE score; baseline systolic pressure was also positively and significantly related to follow-up MMSE score, measured after an average period of 40.5 months among subjects who were not taking antihypertensive medication at baseline. Furthermore, in the nontreated group, multiple logistic regression showed that individuals with a baseline systolic pressure less than 130 mmHg had an odds ratio of 1.88 (p = 0.05) for follow-up cognitive impairment (MMSE score < 24) compared with those whose systolic pressure was 130-159 mmHg. An increased but not statistically significant risk of cognitive impairment was associated with high blood pressure (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) only in persons taking antihypertensive medication at baseline. Subjects with systolic pressure of 160-179 mmHg tended to be at lower risk of cognitive impairment. These results may support the view that a certain blood pressure level, particularly a systolic pressure of at least 130 mmHg, is important to the maintenance of cognitive functioning in the very old. They also suggest that severe hypertension that is not well controlled (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) is still a threat to cognitive function in this age group. However, the use of blood pressure measurements made at a single visit and the relatively short follow-up period should be considered when interpreting these results.

Aged↗

Influence of alcohol intake on risk for increased low-density lipoprotein cholesterol in middle-aged Japanese men.

BACKGROUND: Decreased low-density lipoprotein (LDL) cholesterol in chronic alcoholics is well known. However, the importance of light to moderate alcohol consumption is less certain. METHODS: We investigated the association of alcohol intake with risk for increased LDL cholesterol over 5 years in a cohort of 933 Japanese male office workers aged 35 to 54 years who had LDL cholesterol levels less than 140 mg/dl and were not taking medication for dyslipidemia, hypertension, diabetes, liver disease, or hyperuricemia at study entry. Incident-increased LDL cholesterol was defined by an LDL cholesterol level of 140 mg/dl or more or use of medication for dyslipidemia. Each individual's slope for LDL cholesterol was also calculated with a simple linear regression model. RESULTS: Three hundred twenty-one men developed increased LDL cholesterol during 3785 person-years of follow-up. After controlling for potential predictors of increased LDL cholesterol, the relative risk for increased LDL cholesterol compared with nondrinkers was 0.89 for those who drank 0.1 to 22.9 g/day of ethanol, 0.74 for those who drank 23.0 to 45.9 g/day of ethanol, 0.64 for those who drank 46.0 to 59.9 g/day of ethanol, and 0.54 for those who drank 69.0 g/day or more of ethanol (p < 0.001). Slopes of LDL cholesterol level decreased significantly as alcohol intake increased. From multiple linear regression analyses, alcohol intake remained as an independent negative factor for slopes of LDL cholesterol level. CONCLUSIONS: Alcohol intake is negatively associated with development of increased LDL cholesterol in middle-aged Japanese men.

Adult↗

Red blood cell and plasma phospholipid arachidonic and docosahexaenoic acid levels at birth and cognitive development at 4 years of age.

OBJECTIVE: The long-chain polyunsaturated fatty acids (LCPUFAs) docosahexaenoic acid (DHA) and arachidonic acid (AA) have biophysical properties that may mediate behavioral outcome, especially cognitive development. This study examined the relationship between the LCPUFA-status at birth and cognitive development at 4 years of age. METHODS: Cognitive development of 128 full-term neonates, whose umbilical venous plasma and/or red blood cell phospholipid DHA and AA levels were known, was assessed at 4 years of age. Pearson correlation coefficients were calculated between cognitive development and DHA, AA, maternal intelligence, birth weight, duration of breast-feeding and paternal educational attainment. Multiple linear regressions were employed with cognitive development as the dependent variable and whereby the above-mentioned covariables were entered in step one while each of the four LCPUFAs was entered in step two. RESULTS: In bivariate analysis, maternal intelligence, birth weight, maternal smoking habits during pregnancy, paternal education and duration of breast-feeding showed significant correlations with cognitive development (p<0.01). The association of cognitive development with DHA and AA measured zero in bivariate analysis (plasma levels: r=0.03 and r=-0.03, respectively; erythrocyte levels: r=0.01 and r=0.05) and in multiple regression analysis (plasma DHA r=0.01, p=0.88; plasma AA r=0.02, p=0.80; erythrocyte DHA r=-0.01, p=0.95) except for erythrocyte AA (r=0.15, p=0.09). CONCLUSION: No evidence was found for an association of the DHA or AA-status at birth with cognitive development at 4 years of age.

Arachidonic Acid↗

Diet and gastric cancer in Portugal--a multivariate model.

Diet and gastric cancer mortality in Portugal was studied using a multivariate ecological model. The factors investigated over 18 districts were the relationship between gastric cancer mortality (1994-96), dietary habits, and socio-economic factors (1980-81). Mortality geographical pattern was established using age-standardized mortality rates, per capita dietary consumption of foodstuffs and nutrients was obtained from the National Alimentary Survey (1980-81), and data on socio-economic factors from the 1981 National Census. Pearson correlation coefficients and simple and multiple linear regression models were used. The mortality geographical pattern resembled a north-south gradient, and dietary habits and socio-economic factors had great variability throughout the country. The highest negative correlation coefficients between dietary consumption and gastric cancer mortality were obtained for vegetables, fruit, vitamin A and carotene consumption, and the highest positive coefficients were for rice, wine and carbohydrate consumption. No significant correlations were obtained for socio-economic factors. In multiple regression analysis, vegetable and rice consumption could account for 79% of the gastric cancer mortality variability for males, and vegetable and meat consumption could account for 69% of this variability for females. Interestingly, meat consumption was found to be protective. A mean increase of 100 g/person/day in vegetable consumption would imply a mean predicted decrease of 10 (95% CI 6-14) and 5 (95% CI 3-7) gastric cancer deaths per 100,000 persons/year, for males and females respectively, in simple regression analysis. Such a decrease represents about one-third of the mean national gastric cancer mortality rate. Therefore, an increase in vegetable consumption is strongly recommended.

Animals↗

Prediction of left ventricular ejection fraction using a unique method of chest x-ray and ECG analysis: a noninvasive index of cardiac performance based on the concept of heart volume and mass interrelationship.

A reasonably accurate, simple, inexpensive, noninvasive method of determining ejection fraction (EF) is necessary to evaluate left ventricular function in epidemiologic studies and individual patients. Using the concepts of left ventricular mass reflected by precordial R wave summation (M) and left ventricular volume (V) estimated by chest roentgenography in 114 patients with myocardial disease undergoing left ventriculography, EF was predicted with the formula: EF = 63.74 - (2.16.V) + (0.34.M); R2 = 0.69; standard error of the estimate (SEE) = 11. Because angiographic inferior wall motion (IWM) abnormalities significantly affected the results, but inferior Q waves were usually only present in patients having one infarct, a noninvasive technique to predict the presence of inferior wall motion abnormality (IMA) in patients having multiple infarcts was developed and based on the relationship of precordial R wave summation (M) and roentgenographic heart volumenometry (V). By combining V, M, and IMA (which predicted IWM) to determine EF, multiple linear regression analysis showed that EF = 67.30 - (1.56.V) + (0.23.M) - (14.18 IMA) (R2 = 0.77; SEE = 9). Prospective validation of the formula was then done in 139 consecutive individuals, with R2 = 0.49 and SEE = 9. This study demonstrates that routinely performed, simple, inexpensive clinical tests provide data that can be combined by multiple regression analysis to predict resting EF in patients with heart disease affecting the left ventricle. This unique method may allow inexpensive ventricular function screening in large population studies and in addition might provide an independent index of myocardial performance for clinical use, since it reflects the amount of contractile mass per unit of left ventricular volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of Western Samoan men.

Previously reported associations between abdominal adiposity and coronary heart disease (CHD) may be mediated through serum lipids. In the present longitudinal study, 43 Western Samoan men who participated in a 1982 study were recontacted for a second determination of anthropometric and serum lipoprotein cholesterol levels. The men showed dramatic increases in weight (mean change +/- SD: 10.5 +/- 8.8 kg), abdominal circumference (10.0 +/- 7.6 cm), total cholesterol (49.5 +/- 26.4 mg/dl), and non-HDL cholesterol (53.1 +/- 26.6 mg/dl). A new indicator was used to estimate changes in abdominal adiposity: the residual from the regression of change in the abdominal circumference on change in body weight (the AR). The AR was significantly correlated with changes in total (r = 0.38) and non-HDL cholesterol (r = 0.39). Changes in HDL cholesterol were correlated with changes in weight only (r = -0.37). These bivariate relations remained significant in multiple linear regression analyses. These longitudinal results are the first to suggest changes in abdominal adiposity are related to changes in total and non-HDL cholesterol levels.

Abdomen↗

Predictors of left ventricular hypertrophy in patients with essential hypertension.

The purpose of this study was to assess clinical variables which might be predictive of echocardiographic left ventricular hypertrophy in mildly hypertensive patients. Eighteen patients (mean age 51) were studied following four weeks of hydrochlorothiazide monotherapy. Variables assessed included age, duration of hypertension, body surface area, serum cholesterol, alcohol consumption, smoking, maximum systolic and mean blood pressures, and variability of blood pressure determined from hourly measurements taken 12 hours after hydrochlorothiazide dosing. Using stepwise multiple linear regression (with left ventricular mass index analyzed as a continuous variable), the variability of blood pressure was predictive of an elevated left ventricular mass index (p less than 0.0003, r2 = 0.61). The duration of hypertension added significantly to the variability in predicting an elevated left ventricular mass index (p less than 0.004, multiple r = 0.74). In conclusion, echocardiographic left ventricular hypertrophy was significantly related to the variability of blood pressure recorded hourly for 12 h after subjects received 50 mg of hydrochlorothiazide.

Blood Pressure↗

Use of near-infrared reflectance spectroscopy in predicting nitrogen, phosphorus and calcium contents in heterogeneous woody plant species.

Near-infrared reflectance spectroscopy was applied to determine nitrogen (N), phosphorus (P) and calcium (Ca) content in leaf samples of 18 woody species. A total of 183 samples from mountain, riparian and dry areas from the Central-Western Iberian Peninsula were collected for this purpose. The wide intervals of variation observed in nutrient concentrations (6.6-45.0 g kg(-1) for N, 0.24-2.97 g kg(-1) for P, and 1.00-20.06 g kg(-1) for Ca) were due to the great heterogeneity of the samples. To develop calibration equations, multiple linear regression, and partial least-squares regression (PLSR) were used. In both cases, three mathematical transformations of the data were applied: log1/R and first and second derivatives. The best calibration statistics were obtained using PLSR and derivative transformations (second derivative for N and first derivative for P and Ca). The following coefficients of multiple determination (R2) and standard errors of cross validation were obtained: 0.99 and 0.93 for N, 0.94 and 0.15 for P, and 0.95 and 0.88 for Ca. In the external validation the standard errors of prediction obtained were 0.76 (N), 0.11 (P) and 0.60 (Ca).

Calcium↗

Vitamin D status in female patients with primary hyperparathyroidism: does it play a role in skeletal damage?

OBJECTIVE: Vitamin D deficiency, even subclinical, has been considered to worsen the skeletal damage in primary hyperparathyroidism (PHPT). Our study aimed to investigate the impact of vitamin D status on skeletal involvement in PHPT. DESIGN AND MEASUREMENTS: A cross-sectional study was designed involving 62 female patients with PHPT. Serum total calcium (tCa), phosphate (P), creatinine (Cr) and total alkaline phosphatase activity (AP), together with 24-h (uCa 24 h) and spot fasting (uCa/Cr) urinary calcium, were measured by autoanalyser; ionized calcium (iCa) was assessed by an ion-specific electrode; intact parathyroid hormone (PTH) was measured by immunoradiometric assay (IRMA) and 25-hydroxyvitamin D (25-OHD) by radioimmunoassay (RIA). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at lumbar spine in 58 patients, and at femoral neck, Ward's triangle, greater trochanter, intertrochanteric line and total hip in 56 patients. The associations of all variables with age, 25-OHD, body mass index (BMI) and PTH were studied by linear multiple regression analysis, using progressively restricted models. RESULTS: The model including age, 25-OHD, PTH and BMI showed significant regression with BMD values. PTH, age and BMI exerted a leading role in determining such a significance, while no significant regression was found between the parameters studied and 25-OHD; this was confirmed by Pearson's linear correlation analysis. The progressively restricted models showed significant regression of BMD at femoral neck, femoral intertrochanteric line and total hip with age, BMI and PTH. BMD measured at the Ward's triangle and greater trochanter showed significant regression with age and BMI, and that measured at lumbar spine with age. CONCLUSIONS: Our data indicate that in primary hyperparathyroidism patients the influence of 25-hydroxyvitamin D levels on bone mineral density, if any, was overwhelmed by the effects of parathyroid hormone excess, age and body mass index. The latter unequally affected bone mineral density of various measured sites with different composition.

Body Mass Index↗