High Serum Alkaline Phosphatase Research Articles

Higher Serum Alkaline Phosphatase is Risk for Death and Fracture: A Nationwide Cohort Study of Japanese Dialysis Patients.

Monitoring of serum alkaline phosphatase (ALP) is recommended in the management of chronic kidney disease (CKD)-mineral bone disorder (MBD) because of associations with poor outcome among dialysis patients. However, such associations may have changed with several advances in the management of CKD-MBD over the last decade. Baseline data for 241,670 dialysis patients (mean age, 69 ± 12 years; male, 65.9%; median dialysis duration, 68 months) were extracted from a nationwide dialysis registry in Japan at the end of 2019. Outcomes, including all-cause and cardiovascular (CV) mortality and hip fracture, were evaluated using the registry at the end of 2020 and 2021. All-cause mortality was assessed using Cox regression analysis, whereas CV mortality and new hip fracture were assessed using competing-risks regression analysis. Multiple imputation for missing values was performed. Within the 2-year study period, a total of 40,449 patients (16.7%) died, including 13,562 (5.6%) CV deaths. Of the 168,836 patients with no history of hip fracture at the end of 2019, 4,136 (2.4%) suffered hip fracture within 2 years. Higher serum ALP was independently associated with higher all-cause and CV mortality and new hip fracture, but the association with CV mortality was marginal (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.18-1.24; sub-HR [SHR] 1.07, 95%CI 1.03-1.12; and SHR 1.28, 95%CI 1.19-1.38, respectively). There is a linier association between serum ALP and all-cause mortality among the lower- parathyroid hormone (PTH) group, whereas lower serum ALP tended to have higher all-cause mortality than intermediate serum ALP among patients in the higher-PTH group. Higher serum ALP was independently and linearly associated with higher all-cause and CV mortality and new hip fracture in Japanese dialysis patients. Higher serum ALP and higher intact PTH were synergistic in increasing all-cause and CV mortality but not with new hip fracture.

Clinical characteristics and surgical outcomes of vertebral lesions associated with tumor-induced osteomalacia: report of 16 patients and review of the literature

SummaryVertebral tumors in patients with tumor-induced osteomalacia (TIO) have a low diagnostic rate and poor postoperative outcomes. The application of 68 Ga-DOTATATE-PET/CT significantly increased the detection rate. Compared with tumor curettage, segmental resection was recommended as the preferred surgical type due to its high recovery rate.PurposeTumor-induced osteomalacia (TIO) is an acquired hypophosphatemic osteomalacia, and surgery is the first-line therapy. Most TIO tumors are found in the bones of the appendicular skeleton, cranium, and paranasal sinuses but rarely in the vertebrae. Tumor curettage and segmental resection are the two main surgical options for vertebral TIO patients. However, research on the clinical characteristics and surgical prognosis of vertebral TIO patients is rare. In the present study, for the first time, we investigated the clinical characteristics of 16 vertebral TIO patients and compared the surgical outcomes of patients who underwent surgery via two different surgical methods.MethodsThis was a retrospective cohort study. In this study, we included 16 adult TIO patients with lesions in vertebrae from Peking Union Medical College Hospital (PUMCH), all of whom underwent surgery. Baseline laboratory data were collected through medical records review. Technetium-99 m octreotide scintigraphy (99Tcm-OCT) and 68gallium-DOTA-TATE-positron emission tomography/computed tomography (68 Ga-DOTATATE-PET/CT) were conducted at the Department of Nuclear Medicine of PUMCH. The tumor histopathology was confirmed by a senior pathologist at our center.ResultsVertebral TIO patients had lower serum phosphorus and TmP/GFR and higher serum alkaline phosphatase (ALP), serum parathyroid hormone (PTH), and serum C-terminal cross-linked telopeptide of type I collagen (β-CTX) levels than the normal range. The sensitivity of 68 Ga‒DOTATATE PET/CT was 100%, significantly greater than that of 99Tcm-OCT (40%). After comparing the outcomes between the two surgical methods, we found that the recovery rate after segmental resection (62.5%) was greater than that after tumor curettage (12.5%). In the thoracic and sacral vertebrae, segmental resection surgery had a good prognosis.Conclusion68 Ga-DOTATATE PET/CT could serve as the first diagnostic tool in patients with vertebral TIO, and segmental resection could be used as the preferred surgery. This study would raise awareness of the clinical features and management of these rare vertebral TIO patients.

Benign transient hyperphosphatasemia in the pediatric population: a single center cohort study.

Alkaline phosphatase (ALP) can be increased in a benign condition known as benign-transient hyperphosphatasemia (BTH). We aimed to evaluate the demographic, and clinical characteristics of infants and children with BTH. In our retrospective study, infants and children diagnosed with BTH between September 2019 and September 2023 were included. Of 249 children with elevated ALP levels, 95 (38.1 %) had BTH. The mean age at diagnosis of children with BTH was 2.4±1.3 years (min 0.6- max 6.2 years). ALP mean value was 2,587±1252 U/L (min 972- max 5757 U/L). ALP value was an average 7.4±3.6 times higher than the corresponding upper limit of normal. The second measurement was made after an average of 13.2±6days, and a statistically significant difference was detected compared to the first value, with a decrease of 61±23 % in the ALP value (p<0.001). ALP value returned to normal in an average of 44±29.2days. Elevated ALP was detected during infection in 49 (51.6 %) children. When the sample was divided into those under 2 years of age and aged 2 and over, no statistical difference was observed in ALP levels in the time it took for ALP levels to return to the normal range (p=0.480). BTH should be kept in mind if high serum ALP is detected in children without clinical or laboratory suspicion of bone or liver disease. In the follow up detecting a significant decrease trend compared to the first value may be guiding for BTH.

Biopsies from patients with sacral insufficiency fracture are characterized by low bone matrix mineralization and high turnover.

Sacral insufficiency fractures are known to occur primarily in older women without adequate trauma. While an association with low bone mineral density (ie, osteoporosis) has been reported, more detailed information on local bone quality properties in affected patients is not available. In the present study, core biopsies were obtained from the S1 sacral ala in patients with a bilateral sacral insufficiency fracture (type IV according to the fragility fractures of the pelvis classification) who required surgical stabilization. Dual energy X-ray absorptiometry (DXA) and laboratory bone metabolism analyses were performed. For comparison, control biopsies were acquired from skeletally intact age- and sex-matched donors during autopsy. A total of 31 biopsies (fracture: n = 19; control: n = 12) were evaluated by micro-computed tomography, histomorphometry on undecalcified sections, and quantitative backscattered electron imaging (qBEI). DXA measurements showed mean T-scores in the range of osteoporosis in the fracture cohort (T-scoremin -2.6 ± 0.8). Biochemical analysis of bone metabolism parameters revealed high serum alkaline phosphatase and urinary deoxypyridinoline/creatinine levels. In the biopsies, a loss of trabecular microstructure along with increased osteoid values were detected in the fracture patients compared with controls (osteoid volume per bone volume 5.9 ± 3.5 vs. 0.9 ± 0.5%, p <.001). We also found evidence of microfractures with chronic healing processes (ie, microcallus) as well as pronounced hypomineralization in the biopsies of the fracture cohort compared with the controls as evidenced by lower CaMean measured by qBEI (22.5 ± 1.6 vs. 24.2 ± 0.5wt%, p =.003). In conclusion, this high-resolution biopsy study provides evidence of local hypomineralization in patients with sacral insufficiency fractures, pointing to reduced fracture resistance but also a distinct phenotype other than the predominant loss of trabeculae as in postmenopausal osteoporosis. Our data highlight the importance of therapies that promote bone mineralization to optimally treat and prevent sacral insufficiency fractures.

Osteoinductive effect of the nanoparticulate form of Cissus quadrangularis ethanolic extract on implant surface in experimental animals

BackgroundThe purpose of this study was to evaluate the effect of nanoparticles (NPs) of a plant extract on implant osseointegration in vivo. NPs of the Cissus quadrangularis (CQ) extract were synthesized. Twenty Wistar rats were included in the study. The test group (n = 5) had NPs-incorporated, the control group (n = 5) had no incorporation of NPs, and the sham group (n = 5) did not have implants placed. The toxicity profile of NPs was carried out by biochemical analysis before and after the implant placement. The rate of integration was assessed using Cone Beam Computed Tomography (CBCT), Digital X-ray, histology, and scanning electron microscopy (SEM) at intervals of 2, 4, and 6 weeks. Statistical significance between the groups was determined by Analysis of Variance (ANOVA) (p < 0.05) and the differences were uncovered with post hoc Tukey’s test.ResultsRadiographs showed that the bone density around implants with NPs was considerably higher than those without NPs. The osteoid seam along the implant surface was found to be considerably higher in the test group. A noteworthy increase was observed in the bone formation around the implants in bone samples belonging to the test group. Comparing the values at different time intervals, the highest serum Alkaline phosphatase (ALP) activity was noted in the test group after six weeks and the lowest serum Acid phosphatase (ACP) activity was documented in the test group after 6 weeks.ConclusionThe test group samples exhibited an osseointegration rate of less than 2 weeks thus demonstrating CQ NPs to be a potent osteoinductive agent.Graphical abstract

Prevalence of high and low serum alkaline phosphatase levels and the associated factors in patients with rheumatoid arthritis: Results from the IORRA cohort study.

Prevalence of high and low serum alkaline phosphatase levels and the associated factors in patients with rheumatoid arthritis: Results from the IORRA cohort study.

Utility of the "BATS" Score in Predicting Choledocholithiasis in Patients With Gall Bladder Stones.

Background and aim The role of expensive, risky, and unnecessaryendoscopic interventions can be avoided by the use of non-invasive tests to predict common bile duct (CBD) stones. Therefore, our aim was to identify non-invasive predictors of choledocholithiasis (CL) in patients and further to predict a model and assess its diagnostic accuracy in predicting CL. Methods This cross-sectional study was carried out from June 1, 2020, to December 31, 2021. Patients having gall bladder stones on percutaneous transabdominal sonography and fulfilling intermediate probability criteria of CL were enrolled. These patients then underwent radial endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) for detecting CBD stones. Univariate logistic regression analysis, followed by multivariate logistic regression analysis, was performed to ascertain the independent predictors of CBD stone in patients with intermediate probability. A model was proposed, and the diagnostic accuracy was calculated at an optimal cutoff. The model was then internally validated in the patients with intermediate probability and was also compared with the pre-existing score. Results Out of 131 patients included in the study, CBD stone was noted in 85 (66%) and 88 (67.2%) patients on EUS and ERCP, respectively. On multivariate analysis, high serum bilirubin (>2 mg/dL) and alkaline phosphatase (200 IU) and dilated CBD (>6 mm) on transabdominal sonography at baseline were significant predictors of CBD stone in these patients. Using these variables, a scoring system (BATS score) was developed, which had an area under the receiver operating curve (AUROC) of 0.98 in predicting the presence of CBD stone with a sensitivity of 93.18%, a specificity of 76.74%, and a diagnostic accuracy of 87.79%. In the validation cohort, a BATS score of ≥5 had a diagnostic accuracy of 95.91% in predicting CL. Conclusion TheBATS scoreshowed excellent sensitivity and good diagnostic accuracy in predicting the CBD stonewith excellent results on internal validation. However, external validation of our results is required to recommend this model on a larger scale.

Association of bone mineralization markers with dietary nutrient intake in adolescents with and without biochemical osteomalacia.

Dietary intake is widely known to play a crucial role in achieving peak bone mass among children and adolescents. Unfortunately, this information is lacking among Arab adolescents, an understudied demographic that has recently been observed to have a high prevalence of abnormal mineralization markers [low serum 25(OH)D, high serum alkaline phosphatase (ALP), low calcium (Ca) and/or inorganic phosphate (Pi)] suggestive of biochemical osteomalacia (OM, defined as any 2 of the 4 parameters). In order to fill this gap, we aimed to evaluate the associations of serum markers of biochemical OM with dietary intake of macronutrients, vitamins and trace minerals. Saudi adolescents (N = 2,938, 57.8% girls), aged 12-17 years from 60 different schools in Riyadh, Saudi Arabia were included. Dietary intake of nutrients was calculated following a semi-quantitative 24 h dietary recall over 3 weekdays and 1 weekend-day using a validated food frequency questionnaire. Compliance to reference daily intake (RDI) of macronutrients, vitamins and trace minerals were calculated. Fasting blood samples were collected and circulating levels of 25(OH)D, ALP, Ca, and Pi were analyzed. A total of 1819 (1,083 girls and 736 boys) adolescents provided the dietary recall data. Biochemical OM was identified in 175 (9.6%) participants (13.5% in girls, 3.9% in boys, p < 0.01) while the rest served as controls (N = 1,644). All participants had serum 25(OH)D levels <50 nmoL/L. Most participants had very low dietary intakes of Ca (median ~ 290 mg) and vitamin D (median ~ 4 μg) which are far below the RDI of 1,300 mg/day and 20 μg/day, respectively. In contrast, excess dietary intakes of Pi, Na, K, and Fe were observed in all participants. In the biochemical OM group, thiamine and protein intake were significant predictors of serum 25(OH)D, explaining 4.3% of the variance perceived (r = 0.23, adjusted r2 = 4.3%, p = 0.01). Among controls, dietary vitamin C and vitamin D explained 0.6% of the total variation in serum 25(OH)D (r = 0.09, adjusted r2 = 0.6%, p = 0.004). Arab adolescents do not meet the RDI for dietary Ca and vitamin D, and none have sufficient vitamin D status (25(OH)D levels >50 nmol/L) but they exceed the RDI for dietary Pi. Interpreting these data in the light of the increased prevalence of rickets in Arab countries, food fortification to optimise vitamin D and Ca intake in Saudi adolescents should be considered.

Osteomalacia Prevalence, Biochemical Profile, and Histology in Patients with Low-Energy Hip Fractures Over the Age of 45.

Our objective was to determine the prevalence of osteomalacia in low-energy hip fracture patients over the age of 45, based on biochemical and histological measures. This cross-sectional study included 72 patients over 45 with low-energy mechanism hip fractures. Samples of fasting venous blood were taken for hemograms and serum biochemistry analyses. Bicortical biopsies of the iliac crest were obtained, processed, and evaluated by an expert pathologist for osteomalacia. Biochemical osteomalacia (b-OM) is defined according to a distinct criterion. A low level of serum calcium, phosphorus, albumin, and 25OHD was found in 43.1, 16.7, 73.6, and 59.7% of patients, respectively. 50.0% of patients had high serum alkaline phosphatase (ALP) levels. b-OM was found in 30 (41.7%), and no significant association was found with PTH, Cr, Alb, age, sex, fracture type, side of the trauma, and season were not associated with osteomalacia. Osteomalacia was diagnosed on histopathological analysis in 19/72 (26.7%), and 54/72 (75.0%) of all cases fulfilled b-OM criteria. In the histologic evaluation, osteoid seam width, osteoid surface, and osteoid volume were 28.5µm, 25.6, and 12.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the biochemical test for detecting osteomalacia were 73.6, 64.2, 42.4, 87.2, and 66.7%, respectively. Up to 30% of elderly patients with low-energy hip fractures are affected by osteomalacia. A biochemical screening along with a bone biopsy and histopathologic evaluation may be logical in a high-risk population for osteomalacia diagnosis.

Association of Major Depressive Disorder in Hyperparathyroidism: A Systematic Review.

Major depressive disorder (MDD) is a common neuropsychiatry manifestation that is more prevalent lately. Many contributing factors are present (for example, neurochemical, physiological, pathophysiological, and endocrinological factors). Patients with increased serum parathyroid levels are usually linked to psychosis symptoms but not to depressive symptoms. We conducted this systematic review to explore a correlation between depressive disorder and increased serum parathyroid levels, a major endocrinological pathology, and help establish mental wellness in patients suffering from hyperparathyroidism. We conducted a thorough literature search using five major databases, MEDLINE, PubMed, PubMed Central (PMC), ScienceDirect, and Google Scholar, using three keywords-MDD, depression, and hyperparathyroidism. We included mixed method studies, including observational studies, non-randomized controlled trials, case reports, and review articles published in the last ten years, focusing on the adult and geriatric population (>18 years) and on depressive and anxiety symptoms associated with patients with hyperparathyroidism.We included 11 articles (seven observational studies + four case reports) for qualitative synthesis after screening the literature. The reviewed studies showed an association between high serum parathyroid level, high serum calcium level, high serum alkaline phosphatase level, low serum phosphorous level, and increased depressive neurocognitive symptoms. After a patient with hyperparathyroidism is treated for hypercalcemia or undergoes parathyroidectomy and the serum parathyroid levels are lowered, a decrease in severe depressive symptoms is noted. The qualitative analysis of the reviewed literature showed an association between major depressive disorder and hyperparathyroidism. This paper can guide clinicians to assess patients with increased serum parathyroid levels for depressive neuropsychiatric symptoms and plan treatment, as treatment of their hyperparathyroidism can significantly lower their depressive symptoms.More randomized controlled trials should be conducted to find the treatment effectiveness of depression in patients with hyperparathyroidism.

Benign transient hyperphosphatasemia in infants and children: a retrospective database study.

Benign transient hyperphosphatasemia seems to be a disorder described among otherwise healthy infants and children, which resolves spontaneously. Other known causes of markedly elevated serum ALP should be excluded, especially bone and liver disease. Higher awareness and recognition of this benign condition are important in order to avoid unnecessary tests and parental anxiety. • Benign transient hyperphosphatasemia is a benign condition characterized by greatly increased serum alkaline phosphatase without laboratory or clinical evidence of underlying bone or liver disease, which usually resolves spontaneously, with no intervention. • In the case of an incidental finding of high serum alkaline phosphatase in an otherwise healthy infant or child with no other clinical or laboratory suspicion of bone or liver disease, we recommend repeating the alkaline phosphatase level within a few months in order to confirm the resolution of this condition. • When benign transient hyperphosphatasemia is suspected, a "wait and see" approach is optimal in order to avoid unnecessary investigations and parental anxiety.

Identification of the potential ferroptosis key genes in lung cancer with bone metastasis.

To identify the potential key genes of ferroptosis in the pathogenesis of lung cancer with bone metastasis (LCBM) by bioinformatics analysis to provide new targets for treating LCBM and an indicator for early monitoring. We first obtained differentially expressed genes (DEGs) associated with ferroptosis from the Gene Expression Omnibus (GEO) database. MiRWalk 2.0 was used to predict the key microRNAs (miRNAs) and construct related gene-miRNA interaction networks. The functional enrichment analysis of key miRNAs was performed using the miEAA database. Finally, the clinical data of 105 lung cancer patients were retrospectively analyzed, and logistic regression analysis was conducted to assess the relationship between serum alkaline phosphatase (ALP), neuron-specific enolase (NSE), and bone metastasis in lung cancer patients, and a receiver operating characteristic (ROC) curve was drawn. We identified 15 ferroptosis-related genes that were differentially expressed in lung cancer bone metastasis. GO and KEGG enrichment analyses suggested that these genes may affect the oxidative stress response, hypoxia response, rough endoplasmic reticulum, mitochondrial outer membrane, iron-sulfur cluster binding, virus receptor activity, central carbon metabolism in cancer, the interleukin-17 (IL-17) signaling pathway, and other aspects to participate in the occurrence and development of lung cancer bone metastasis. Among the 105 lung cancer patients included in the study, 39 cases had bone metastasis, and the incidence rate was 37.14%. A high Eastern Cooperative Oncology Group (ECOG) score and serum ALP and NSE overexpression were associated with bone metastasis in patients with lung cancer. By assessing the risk of bone metastasis in patients with lung cancer, we found that the Area Under Curves (AUCs) of serum ALP and NSE alone and combined were >0.70. The differentially expressed ferroptosis-related genes and predicted miRNA regulatory network in lung cancer bone metastasis and the related functional enrichment analysis provide new targets for the treatment of lung cancer bone metastasis. At the same time, from a serological perspective, it was found that early monitoring of serum ALP and NSE expression in patients with lung cancer could be considered to assess the risk of bone metastasis in the future.

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism.

Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816-0.916) and 0.867 (95% CI, 0.793-0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%-78.4%) and 75.0% (58.6%-88.5%), and negative predictive values of the nomogram were 90.0% (82.9%-93.6%) and 86.4% (73.5%-94.0%) for the training and validation cohorts, respectively. We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.

Can Bone-Specific Alkaline Phosphatase be a Marker of Vascular Calcification in Type 2 Diabetes Mellitus?

Alkaline phosphatase (ALP) enzyme has been linked to vascular calcification. Unexplained elevations in serum ALP levels have been reported in patients with type 2 diabetes mellitus (T2DM). We assessed bone-specific alkaline phosphatase (BAP) levels in patients with T2DM who had unexplained ALP elevations and studied the association between BAP and other markers of vascular calcification. Patients with T2DM who had high serum ALP in the absence of known causes of ALP elevation were studied. The control group was T2DM patients with normal ALP. We measured the serum levels of BAP along with the leptin, fetuin-A, and vitamin K2 levels. Ankle-brachial index (ABI) was also measured in both groups. Serum BAP levels were significantly higher in the group with high ALP when compared with the normal ALP group. A significant positive correlation was present between BAP and serum fetuin-A as well as between BAP and Vit K2 levels. There was no correlation between BAP and serum leptin. ABI was comparable between the two groups. Patients with T2DM may have unexplained elevation in ALP due to an increase in BAP. Elevation in BAP may be associated with other markers of vascular calcification suggesting an increased risk of vascular calcification.

Differentiating Ductal Adenocarcinoma of the Pancreas from Benign Conditions Using Routine Health Records: A Prospective Case-Control Study.

The study aimed to develop a prediction model for differentiating suspected PDAC from benign conditions. We used a prospective cohort of patients with pancreatic disease (n = 762) enrolled at the Barts Pancreas Tissue Bank (2008-2021) and performed a case-control study examining the association of PDAC (n = 340) with predictor variables including demographics, comorbidities, lifestyle factors, presenting symptoms and commonly performed blood tests. Age (over 55), weight loss in hypertensive patients, recent symptoms of jaundice, high serum bilirubin, low serum creatinine, high serum alkaline phosphatase, low red blood cell count and low serum sodium were identified as the most important features. These predictors were then used for training several machine-learning-based risk-prediction models on 75% of the cohort. Models were assessed on the remaining 25%. A logistic regression-based model had the best overall performance in the validation cohort (area-under-the-curve = 0.90; Spiegelhalter's z = -1·82, p = 0.07). Setting a probability threshold of 0.15 guided by the maximum F2-score of 0.855, 96.8% sensitivity was reached in the full cohort, which could lead to earlier detection of 84.7% of the PDAC patients. The prediction model has the potential to be applied in primary, secondary and emergency care settings for the early distinction of suspected PDAC patients and expedited referral to specialist hepato-pancreatico-biliary services.

Effects of Dietary Phosphorus Deficiency and High Phosphorus Content on the Growth Performance, Serum Variables, and Tibia Development in Goslings

Understanding how dietary phosphorus (P) regulates the growth and skeletal development of goslings is essential for fully utilizing P in the production of geese. We aimed to study the effects of dietary P deficiency and high P content on growth performance, serum variables, tibia quality, and mRNA expression of osteogenesis-related genes in tibia to reveal how dietary P regulates bone development in goslings. Two hundred and sixteen one-day-old Jiangnan White male geese were fed corn-soybean meal diets for 14 days. The diets were set with the same calcium (Ca) level (0.80%) and three non-phytate P (NPP) levels: 0.08% (P deficiency), 0.38% (P control), and 0.80% (P high content). Each treatment consisted of six replicates with 12 goslings in each replicate. The P deficient group had a high cumulative mortality of 26.67% with lower body weight (BW), average daily feed intake (ADFI), average daily gain (ADG), serum P contents, tibia width, tibia length, tibia fresh weight at d 14 as compared with the control and high P content group (p ≤ 0.05). Dietary P deficiency caused a reduction in the goslings’ tibia strength, tibia ash content, tibia Ca content, and tibia P content during d 4–d 14 (p &lt; 0.05). The P deficiency reduced tibia mRNA expression of osteoprotegerin (OPG) and runt-related transcription factor 2 (Runx2) on d 7 (p &lt; 0.05), whereas up-regulated serum alkaline phosphatase (ALP) activity, calcitonin (CT) content, and the tibia mRNA ratio of receptor activator of NF-κB ligand (RNAKL)/OPG during d 7–d 14 (p &lt; 0.05). The serum 1,25-(OH2)D3 content, serum bone Gla-protein (BGP), and the mRNA relative expression of RNAKL and BGP in tibia were decreased in the NPP 0.08% and 0.80% groups compared with the control on d 14 (p &lt; 0.05). In conclusion, dietary P deficiency induced acute rickets in goslings as early as the fourth day. A P deficiency hindered the tibia and body growth partly due to poor skeletal calcification caused by a down-expression of osteogenesis-related genes regulated by high serum ALP activity and calcitonin contents and lower serum BGP and skeletal P contents.

Primary sclerosing cholangitis-A long night's journey into day.

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Differences in the Clinical Presentation and Biochemical Profile of the Patients with Primary Hyperparathyroidism with regard to their Serum Vitamin D Levels: a Single-center Experience.

The association between vitamin D deficiency and primary hyperparathyroidism (PHPT) is common and has clear implications. Vitamin D deficiency is commonly seen in PHPT population and exacerbates its severity with skeletal and metabolic effects. Retrospective data collection and review were done in patients who underwent surgery for PHPT at a tertiary care hospital in India between January 2011 and December 2020. A total of 150 subjects were included in the study and were divided into group 1 (vitamin D < 20ng/ml, deficient), group 2 (vitamin D 21-29ng/ml, insufficient), and group 3 (vitamin D > 30ng/ml, sufficient). There was no difference in the duration of symptoms or the symptomatology between the three groups. Mean pre-operative serum calcium and serum phosphorous levels were also comparable in all the three groups. Mean pre-operative parathyroid hormone (PTH) levels in the three groups were 703 ± 996 vs 343.6 ± 396 vs 343.6 ± 396pg/ml, respectively (P = 0.009). There was a statistically significant difference in group 1 vs groups 2 and 3 in their mean weight of the parathyroid gland (P = 0.018) and high alkaline phosphatase (ALP) levels (P = 0.047). Post-operative symptomatic hypocalcemia was observed in 17.3% of patients. Post-operative hungry bone syndrome occurred in 4 patients, all in group 1. PHPT in patients with low serum vitamin D was associated with higher serum PTH levels, increased frequency of high serum ALP levels, and higher weight of the excised gland, with no difference in the serum calcium and phosphorous.

S37 The Impact of Early Detection of Malignant Biliary Obstruction by Endoscopic Ultrasound on Clinical Outcomes After Surgical Resection

Introduction: Computerized tomography (CT) scan and endoscopic ultrasound (EUS) are the main diagnostic tools for detecting periampullary cancers. EUS allows the detection of small tumors missed by CT scan in patients presenting with bile duct obstruction. However, the impact of EUS in diagnosing small tumors on clinical outcomes is yet to be explored. This study aimed to compare the tumor recurrence rate and survival benefit of patients following pancreaticoduodenectomy (PD) for periampullary cancers detected by abdominal CT vs. EUS after negative CT. Methods: A retrospective review of the EUS and surgery database from 2009 to 2021. The patients who underwent PD for periampullary cancer were recruited. The patients were divided into CT-guided surgery group (CT group) and EUS-guided surgery group (EUS group). The clinical outcomes between the 2 groups were compared. Results: 429 patients were enrolled. 372 patients were diagnosed by CT scan, and EUS diagnosed 57 patients after CT scans failed to detect the cause of bile duct obstruction. The mean age was 64.7+ 11.9 years. The common presentations included jaundice (79.0 %) and weight loss (66.9%). Pancreatic adenocarcinoma (PDAC) was the most common cancer (43.6%), followed by ampullary cancer (32.4%), distal cholangiocarcinoma (14.2%), and duodenal cancer (9.8%). There were no differences in patient demographics between the two groups regarding age, gender, and underlying diseases. Patients in the CT group had higher serum bilirubin (p=0.025), higher serum alkaline phosphatase (p=0.047), lower serum hematocrit (p=0.043), and larger CBD diameter (p=0.005) compared to the EUS group. The T and M staging were not different between the two groups; however, the percentage of patients with nodal metastasis was higher in the CT group (p=0.014). Multivariate analysis showed a trend towards higher recurrence and 5-year mortality rate in the CT group with odds ratios (OR) of 1.33 (95% CI, 0.82-2.13) and 1.43 (95% CI, 0.84-2.42), respectively. Subgroup analysis of PDAC and cholangiocarcinoma demonstrated a significantly higher mortality rate of patients in the CT group with an OR of 2.82 (95% CI, 1.14-6.99, p=0.026) and a trend toward a higher recurrence rate after surgery with the OR of 1.45 (95% CI, 0.80-2.66) compared to the EUS group. Conclusion: EUS added a diagnostic value in the early detection of periampullary cancers, which may lead to a survival benefit, especially in PDAC and cholangiocarcinoma.

Effects of dietary inclusion of Xanthoceras sorbifolia Bunge leaves on growth performance, gastrointestinal development, digestive function and gut microbial flora of rabbits

This study aimed to investigate the effects of dietary inclusion of Xanthoceras sorbifolia Bunge (X sorbifolia) leaves (XSL) or solid-state fermented X sorbifolia leaves (FXSL) on the growth performance, gastrointestinal tract development, serum metabolites, intestinal mucosa morphology, cecal fermentation and microflora enumeration of rabbits. A total of 192 healthy New Zealand White male rabbits weighing (940 ± 11 g) were randomly allocated to 3 dietary treatments, with 8 replicates of 8 rabbits each and designated as control, XSL, and FXSL groups. The rabbits in the XSL and FXSL groups were fed diets containing 150 g/kg XSL and FXSL in the basal diets to replace the same level of alfalfa hay, respectively for 42 days. Compared with the control or XSL group, the FXSL rabbits showed increased average daily weight gain (P < 0.05) and final body weight, as well as a decreased feed to gain ratio (P < 0.05). They had increased small intestine weight, small intestine relative weight (P < 0.05), cecum weight, cecum relative weight, and decreased urea nitrogen (UN) content (P < 0.05). Rabbits in the XSL and FXSL groups had lower serum alanine aminotransferase (ALT) (P < 0.05) and aspartate aminotransferase (AST) activities, as well as higher serum alkaline phosphatase (AKP) activity (P < 0.05). Compared to the other two groups, the total volatile fatty acids, the ratio of acetic acid, as well as Lactobacilli and Bifidobacterium populations in the cecal content was increased (P < 0.05) in the FXSL group, while the cecal pH, NH3-N, the ratio of butyric acid, Escherichia coli as well as Clostridium perfringens populations were decreased (P < 0.05). Further, the rabbits from the FXSL group showed higher (P < 0.05) villus height (VH) and VH/crypt depth (CD) both in the jejunum and duodenum. In conclusion, adding 150 g/kg XSL to the diet can replace the same amount of alfalfa powder, simultaneously, adding 150 g/kg FXSL can improve the growth and gastrointestinal tract development, as well as the cecal environment and microbiota balance.