We performed a prospective study of bone mineral density (BMD) in 38 women during their first full-term pregnancy until 12 months postpartum. BMD measurements at lumbar spine [L2-L4 (LS)] and forearm [distal 33% (RD) and ultradistal (RUD) region of the radius] were made within 3 months before conception, after delivery, and at 6 and 12 months postpartum. In mid-pregnancy the DXA examination was carried out only at the forearm. Patients were grouped according to duration of lactation as group I, II or III (0-1, 1-6, 6-12 months respectively). During pregnancy there was a significant difference between baseline and delivery (p< 0.001) in the LS, RUD and RD BMD values. In group I there was no statistically significant difference in LS BMD between visits following pregnancy. The RUD BMD loss was recovered by 6 months postpartum (PP6). Group II showed continuous bone loss from delivery until PP6 at LS and RUD. In group III the LS BMD loss continued throughout the lactation period. The RUD BMD dropped (4.9%) until PP6 then increased by 3.0% as measured at 12 months postpartum (PP12). There was no significant change in RD BMD in any of three groups during lactation. At LS bone loss between delivery and PP12 correlated well with the duration of lactation (r = -0.727; p<0.001). We suggest that calcium needed for fetal skeletal growth during pregnancy was gained from maternal trabecular and cortical sites and that calcium needed for infant growth during lactation was drawn mainly from the maternal trabecular skeleton in our patients. The effect of pregnancy and lactation on the maternal bone mass was spontaneously compensated after weaning.

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A high prevalence of hypovitaminosis D and low BMD were observed in the studied Hungarian male population. This is the first study reporting higher 10-year hip and major osteoporotic fracture probability using the country-specific FRAX algorithm in individuals with hypovitaminosis D.

Introduction Pregnancy is associated with an increased risk of venous thromboembolism (VTE) which is even more pronounced in the presence of inherited thrombophilia. Despite the well-established relation between thrombophilic pregnancies and VTE, there is no consensus on the optimal approach for thromboprophylaxis in this population. There is growing evidence that thrombin generation correlates with the overall procoagulant state of the plasma leading to elevated thrombosis risk. The aim of this study was to evaluate thrombin generation over the course of pregnancy in women with inherited thrombophilia compared to healthy pregnant women. We also aimed to investigate the effectiveness of low molecular weight heparin (LMWH) prophylaxis in pregnancy by measuring thrombin generation and anti-Factor-Xa activity. Methods In this cohort study women with severe (n=8) and mild (n=47) thrombophilia were followed throughout their pregnancies. In addition, healthy pregnant women (n=15) were recruited as control subjects. Thrombin generation was evaluated in each trimester as well as 5 days after delivery and 8 weeks postpartum (baseline). In order to assess the effect of LMWH therapy at each stage of the pregnancy, thrombin generation and anti-Factor-Xa activity were measured just before and 4 hours after administration of the drug (peak and trough effect). Thrombin generation was determined using Technothrombin TGA assay system, and the results were evaluated with the provided software. For analysis, the median peak thrombin and endogenous thrombin potential were determined. The anti-Factor-Xa activity was measured by a commercially available chromogenic assay. Results In all the 3 study groups, both peak thrombin and endogenous thrombin potential were increased over the course of pregnancy compared to the non-pregnant state. Peak thrombin and endogenous thrombin potential were higher in the severe thrombophilia group than in the other 2 groups in every trimester and also after delivery. There was no distinct difference in thrombin generation between the mild group and the controls. In women undergoing LMWH prophylaxis a decrease was observed in both the peak thrombin and endogenous thrombin potential after the drug was administered. Over the course of pregnancy the extent of this decrease reduced in a stepwise fashion. The difference between the 2 measurements (before and after LMWH) was smallest in the third trimester and increased again after delivery. Anti-Factor-Xa activity appeared to be enhanced at the peak effect of LMWH. However, the difference between the anti-Factor-Xa activity before and after LMWH administration remained unchanged over the progression of pregnancy. None of the women suffered from VTE or had any bleeding complications during the observation period. Conclusions Our results show that thrombin generation is increased during pregnancy, with higher levels in women with severe thrombophilic defects. In addition, our data demonstrate a decrease in the effect of LMWH with advancing stages of pregnancy. Until now no studies evaluated prospectively the effect of LMWH prophylaxis on thrombin generation over pregnancy. Our findings contribute to the ongoing debate about the necessity and intensity of thromboprophylaxis during pregnancy, providing new information about the coagulable state of mild and severe thrombophilic pregnant women. The decreasing antithrombotic effect of LMWH over pregnancy suggests a need for dose adjustment in late gestational weeks. Furthermore, our results imply that thrombin generation as a global coagulation test may demonstrate more sensitively the effect of LMWH than the anti-Factor-Xa activity assay. Disclosures: No relevant conflicts of interest to declare.

Study objectives Obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep-related breathing disorder, characterized by excessive daytime sleepiness (EDS), paralleled by intermittent collapse of the upper airway. EDS may be the symptom of OSAHS per se but may also be due to the alteration of central circadian regulation. Irisin is a putative myokine and has been shown to induce BDNF expression in several sites of the brain. BDNF is a key factor regulating photic entrainment and consequent circadian alignment and adaptation to the environment. Therefore, we hypothesized that EDS accompanying OSAHS is reflected by alteration of irisin/BDNF axis. Methods Case history, routine laboratory parameters, serum irisin and BDNF levels, polysomnographic measures and Epworth Sleepiness Scale questionnaire (ESS) were performed in a cohort of OSAHS patients ( n = 69). Simple and then multiple linear regression was used to evaluate data. Results We found that EDS reflected by the ESS is associated with higher serum irisin and BDNF levels; β: 1.53; CI: 0.35, 6.15; p = 0.012 and β: 0.014; CI: 0.0.005, 0.023; p = 0.02, respectively. Furthermore, influence of irisin and BDNF was significant even if the model accounted for their interaction ( p = 0.006 for the terms serum irisin, serum BDNF and their interaction). Furthermore, a concentration-dependent effect of both serum irisin and BDNF was evidenced with respect to their influence on the ESS. Conclusions These results suggest that the irisin-BDNF axis influences subjective daytime sleepiness in OSAS patients reflected by the ESS. These results further imply the possible disruption of the circadian regulation in OSAHS. Future interventional studies are needed to confirm this observation.

Pregnancy is associated with increased risk of venous thromboembolism, especially in the presence of thrombophilia. However, there is no consensus on the optimal approach for thromboprophylaxis in this population. Recent evidence suggests that thrombin generation correlates with the overall procoagulant state of the plasma. Our aim was to evaluate thrombin generation in a prospective cohort of thrombophilic pregnant women, and investigate the effectiveness of low-molecular-weight heparin (LMWH) prophylaxis in pregnancy. Women with severe (n=8), mild (n=47) and no (n=15) thrombophilia were followed throughout their pregnancies. Thrombin generation was evaluated in each trimester as well as five days and eight weeks postpartum (as a reference category). In women undergoing LMWH prophylaxis, thrombin generation and anti-Factor-Xa activity were measured just before and 4 hours after administration (peak effect). Thrombin generation was determined using Technothrombin TGA assay system. For the analysis, median peak thrombin and endogenous thrombin potential were used. Peak thrombin and endogenous thrombin potential were increased during pregnancy compared to the non-pregnant state with the highest results in the severe thrombophilia group. In women receiving LMWH prophylaxis a decrease was observed in thrombin generation at peak effect but over the progression of pregnancy the extent of this decrease reduced in a stepwise fashion. Our results show that thrombin generation demonstrates the hypercoagulable state in thrombophilic pregnancies. In addition, we found the effect of LMWH prophylaxis to progressively decrease with advancing stages of pregnancy.

Introduction: The term “diseasome of physical inactivity” was coined by Pedersen to explain clustering of chronic diseases linked to physical inactivity. Accordingly, physical inactivity per se contributes to the accumulation of visceral fat, which, generates chronic low-grade systemic inflammation, contributes to emergence of chronic, non-communicable diseases. Diversity of these disorders posits the possible involvement of a supraphysiological system.Methods: Hypothesis driven literature search and deductive reasoning was used to review relevant literature and formulate a novel theory.Results: We have identified the circadian system, omnipresent in virtually every cell, as a possible vehicle for brain muscle crosstalk, explaining some aspects of the diseasome of physical inactivity This system is hierarchically organized, with the suprachiasmatic nucleus (SCN) being the master clock that entrains to the dark/light cycle and synchronizes subsidiary molecular clocks in the periphery. Insufficient photic entrainment also causes chronic disease evolution. The recently identified irisin, was shown to induce brain-derived neurotrophic factor (BDNF) production in several brain areas. BDNF assumes significant role in gating light's influence in the retinohypothalamic synapse, by having a permissive effect on glutamate signal transduction underlying photic entrainment.Conclusions: Here we provide theoretical evidence to support the hypothesis that irisin may facilitate photic entrainment of the SCN, via BDNF. By this irisin opens up possible pathways for peripheral non-photic entrainment signals to exert influence on the master clock that is otherwise resistant to these. Furthermore, we suggest that intertwining processes of circadian, redox, inflammatory, and myokine systems lay underneath the diseasome of physical inactivity.

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