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The effects of pamidronate and alendronate on bone resorption in Paget’s disease have been measured in patients in long-term remission. Serum and urinary biochemical markers of bone resorption in control patients were compared with those obtained after 30 days’ intravenous infusions of bisphosphonate. Serum calcium, parathyroid hormone (PTH), and osteocalcin concentrations were similar in control and bisphosphonate-treated patients. Urinary calcium and deoxypyridinoline concentrations were significantly increased after both bisphosphonates and pre-therapy. Osteocalcin concentrations tended to be lower, and urinary pyridinoline concentrations higher, in control subjects. The degree of suppression of bone resorption in patients with Paget’s disease after pamidronate and alendronate infusions was similar to that achieved after surgical removal of the disease lesions, confirming previous in vitro observations. These data demonstrate that the selective suppression of resorptive activity in Paget’s disease could represent a novel therapeutic approach.Biomarkers of oxidative stress in critically ill children: not just for adults.
Childhood and infant mortality resulting from sepsis are currently a major cause of childhood morbidity and mortality. Although several biomarkers for oxidative stress have been identified and investigated in critically ill children, the clinical utility and prognostic value of these biomarkers remains uncertain. Although under-powered, there are only two studies that evaluated the prognostic value of biomarkers of oxidative stress, and both were randomized controlled trials of antioxidants in sepsis. While it is possible that antioxidants may alter prognosis, this requires evaluation in randomized controlled trials. As these are unethical, at present it is unclear if antioxidant therapy in critically ill children can be of benefit to critically ill children, or if we need to focus our efforts on other therapeutic targets in the management of critically ill children.BLACKSBURG — The game isn’t a thing anymore. It’s the thing.
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