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Biomedical subjects

L Larsson

Publications and source records attributed to L Larsson.

At least 109 records · Page 6Linked to original sources
PubMed1997

[Methicillin resistant Staphylococcus aureus. A problem also in Sweden].

Outbreaks of endemic MRSA are extremely rare in Swedish hospitals. During 1983-1996 209 patients with MRSA were identified at Sahlgrenska University Hospital, Göteborg. Retrospective DNA typing showed that 51 different strains were involved. Between 1990-1996 there was an increase in the number of imported MRSA-infected patients, probably a reflection of the situation in surrounding high prevalence countries. In addition four endemic outbreaks occurred during the 1990s involving a total of 121 patients, mainly in units for intensive care and urology. For effective control of MRSA, standard precautions should include the use of plastic aprons and hand disinfectants (70 per cent alcohol) when nursing patients with wounds, urinary catheter etc regardless of MRSA-status.

Adult↗
PubMed1997

Firing rate of the lower motoneuron and contractile properties of its muscle fibers after upper motoneuron lesion in man.

We studied motor unit (MU) firing rate and contractile properties and myosin isoform composition of single muscle fibers after upper motoneuron lesion. Single-MUs and surface electromyogram (EMG) were recorded during voluntary contractions and locomotion in the paretic (P) and nonparetic (NP) tibialis anterior (TA) of 15 hemiparetics. P TA low-threshold MUs fired within the lower end of their normal range. High-threshold MUs fired below their normal range or were not recruited. Surface EMG was abnormally low and high in the P TA and NP TA, respectively. On muscle cross sections stained with histochemical methods, type I fibers represented 99.4%, 74.3% and 66.6% of NP, P, and control TA, respectively. P TA fibers expressing type I myosin heavy chain (MyHC) were smaller, weaker, and slower. In conclusion, low MU firing rate and activity in the P TA was associated with slower type I MyHC fibers, while increased activity in NP TA resulted in homogenous expression of type I MyHC.

Adult↗
PubMed1997

Contractile studies of single human skeletal muscle fibers: a comparison of different muscles, permeabilization procedures, and storage techniques.

The study of single muscle fibers has improved our understanding of muscle physiology and pathology. To compare three techniques for fiber preparation and storage, biopsies were obtained from the tibialis anterior and vastus lateralis muscles of a hemiparetic patient and a control subject. Single fibers were prepared with: (1) chemical skinning (CS) and storage at -20 degrees C; (2) chemical skinning followed by sucrose (SU) incubation and storage at -80 degrees C; or (3) freeze-drying (FD) and -80 degrees C storage. Cross-sectional area (CSA), resting, maximal (P0), and specific tension (P0/CSA), and maximum shortening velocity (V0) were determined in 189 cells. CSA was similar in all groups. Resting tension was higher and P0 and P0/CSA lower after FD. In general, V0 was the same in all groups. Our data suggest that CS and SU preserve the properties of single muscle fibers better than FD. SU may allow longer storage of fibers.

Cell Membrane Permeability↗
PubMed1997

Use of gas chromatography-ion trap tandem mass spectrometry for the detection and characterization of microorganisms in complex samples.

Gas chromatography-mass spectrometry (GC-MS) can be applied to detect and characterize microorganisms in clinical and environmental samples, and microbial contaminants in biotechnological production cultures. With this approach, unique microbial monomeric compounds, known as chemical markers, are used as analytes. In the present article, two GC-MS-based techniques, viz. GC-ion trap tandem MS (GC-MS-MS) and conventional quadrupole GC-MS used in the selected ion monitoring mode, were compared regarding their ability to detect 3-hydroxy fatty acids, muramic acid, and ergosterol (markers for endotoxin, peptidoglycan, and fungal biomass, respectively) in complex matrices. When using GC-MS-MS, daughter ion spectra were obtained for all markers present in amounts close to the detection limit of the GC-MS. Ion-trap GC-MS-MS shows great promise as a chemical marker analysis technique for application in clinical diagnosis, occupational and public health care, and biotechnology.

Bacteria↗
PubMed1997

Long-acting beta(2)-agonists: how are they used in an optimal way?

Inhaled long-acting beta(2)-agonists are frequently used for the treatment of asthma. When introduced to the market, the drug was accompanied by a debate among physicians and scientists raising warnings against the use of beta(2)-agonists, leading to a risk of tachyphylaxis and worsening of asthma control. During recent years, much of these warnings have been counter proved and there has been a tendency to institute treatment with long-acting beta(2)-agonists somewhat earlier in the course than before. However, the exact place for long-acting beta(2)-agonists in the asthma treatment plans, still needs to be established. While beta(2)-agonists have been shown to have anti-inflammatory activity in vitro and after single allergen exposure, this effect seems to disappear with regular treatment. The same phenomena have been shown to protect against obstruction caused by metacholine inhalation or exercise. Although the protective effect diminishes or even disappears, no signs of rebound phenomena or increased susceptibility to provocative stimulus has been shown. Thus, in contrast to earlier reports after regular use of short-acting beta(2)-agonists, no signs of tachyphylaxis have been reported after use of long-acting beta(2)-agonists. Moreover, the bronchodilatatory effect seems to be fairly stable after regular treatment, even though some reports claims that this effect diminishes over time. The present article is a review of some data involved in this debate. The authors conclude that long-acting beta(2)-agonists are a valuable contribution to the asthma treatment repertoire. However, the drugs should be regarded as long-acting bronchodilatators, supplementing the use of inhaled corticosteroids. The rapid appearing tolerance towards allergen-induced and provoked bronchial obstruction prevents these drugs from being used as monotherapy; they should be used only in combination with sufficient anti-inflammatory treatment, i.e. inhaled corticosteroids.

Adrenergic beta-Agonists↗
PubMed1997

Bone mineral density in normal Swedish women.

We examined 429 women, aged 20-80 years, randomly selected from the population register to establish normal values for bone mineral density (BMD) in Swedish women. BMD of the spine and hip was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1000) and in the forearm by single photon absorptiometry (SPA; Molsgaard ND-1100). The recalled age of menarche was negatively correlated to BMD at all ages. There was no significant change in BMD from 20-49 years at any site except a slight decline at Ward's triangle. Bone loss was rapid at all sites during the first decade after menopause. Thereafter, BMD declined slowly in the trochanter and total hip but more rapidly in the forearm, femoral neck, and Ward's triangle. BMD in the spine even increased in the eighth decade probably due to osteoarthritis. The average change in forearm BMD during the 15 perimenopausal years comprising mean age for menopause +/- 2 SD (43-57 years) was -0.4% per year in premenopausal females and -1.6% per year in postmenopausal females. The corresponding annual percental change was, for the spine, +0.2 and -1.7; neck, -0.7 and -1.7; trochanter, +0.5 and -1.5; and Ward's triangle, -0.1% and -2.2%, respectively. Our normal values for lumbar spine BMD prior to menopause did not differ from published values or the manufacturer's normal values; however, our spine BMD values for the first decade after menopause were significantly lower (approximately 10%) than in other studies. Our femoral neck BMD values for younger women were, like those of several other groups, significantly lower than the manufacturer's normal values, but our sample of young women in this study was small. The prevalence of osteoporosis, if defined as t score < -2.5 is highly dependent on the sampling of the reference population of young adult women, and also on the choice of skeletal site. Further studies on bone mineral density in healthy young adult women are needed.

Absorptiometry, Photon↗
PubMed1997

Contractility and myosin isoform compositions of skeletal muscles and muscle cells from rats treated with thyroid hormone for 0, 4 and 8 weeks.

The effects of 4 and 8 weeks of thyroid hormone (3,5,3'-triiodothyronine, T3) treatment on skeletal muscles of young (3-6 months) male Wistar rats were investigated in the present study. In the slow-twitch soleus, contraction and half-relaxation times of the isometric twitch were significantly shorter in hyperthyroid rats than in the control group, and twitch duration was shorter in rats treated with T3 for 8 weeks than for 4 weeks. All single soleus muscle fibres from hyperthyroid rats co-expressed types I and IIA myosin heavy chains (type I/IIA fibres) or type I, IIA and IIX myosin heavy chains (type I/IIAX fibres), while only type I MyHC fibres were isolated from the controls. A significantly higher content of type IIA myosin heavy chain and fast myosin light chain isoforms was observed in soleus fibres from the 8-week than from 4-week T3 group. There was no significant difference in maximum velocity of unloaded shortening (V0) between type I myosin heavy chain fibres from controls (1.12 +/- 0.46 muscle lengths s-1, n = 48) and type I/IIA myosin heavy chain fibres from the 4-1.09 +/- 0.36 muscle length s-1, n = 33) and 8-week (1.03 +/- 0.31 muscle lengths s(-1), n = 31) groups, but type I/IIAX fibres from the 8-week T3 group had significantly higher V0 (1.56 +/- 0.10, n = 5) than type I from control and type I/IIA from hyperthyroid rats. In the fast-twitch extensor digitorum longus, neither myosin isoform composition, twitch duration nor V0 was affected by 4 or 8 weeks of T3 exposure. In conclusion, a dramatic and exposure duration-dependent change in the contractile speed of the isometric twitch and the expression of fast myosin isoforms was observed in soleus, but not in extensor digitorum longus, in response to T3 treatment. Long-term T3 treatment had relatively less influence, however, on V0 at the single cell level in spite of the dramatic increase in fast myosin isoforms.

Animals↗
PubMed1997

Logics and logistics of community intervention against osteoporosis: an evidence basis.

Under designations like small areas action research and intervention, directed 'ground-up' health promotion and prevention in the population form an important part of the ongoing medical systems development. There is recent evidence of the success of community intervention against cardiovascular disease. In osteoporosis, however, there is still a lack of conclusive data on both the logics and logistics of such an approach. Since 1988, a county health policy program has been formulated and implemented in Ostergötland, Sweden, following the principles and guidelines of the WHO HFA 2000 declaration. Vadstena (n approximately 7,600) was chosen for a local and generalizable osteoporosis prevention project mediated by the primary care organization by means of health promotion and education in the community. In the present report we emphasize that community intervention is an important new advancement of the medical systems, where the basic research questions include operational and management aspects as equally vital and measurable requisites and results as other performance and outcome variables. We found that a community intervention trial against osteoporosis is both motivated and feasible and in this report wish to provide evidence on these crucial issues of logics and logistics.

Adult↗
PubMed1997

Gender-related differences in the regulatory influence of thyroid hormone on the expression of myosin isoforms in young and old rats.

The effects of 4 weeks of thyroid hormone (3.5.3'-triiodothyronine. T3) treatment on the expression of myosin heavy chain (MyHC) isoforms were examined in young (3-6 months; and old (20-24 months) female rats, and compared with those in age-matched male rats (Larsson et al. 1995). In control rats ageing was associated with a type IIA to I MyHC isoform switching in the slow-twitch soleus and a type IIB to IIX MyHC isoform switching in the fast-twitch extensor digitorum longus muscle (EDL). Gender- and muscle-specific differences were observed in the regulation of MyHC isoforms by T3. In the soleus, dramatic downregulation of the type I and upregulation of the type IIA MyHC isoform were observed in both females and males, but upregulation of the IIX MyHC isoform was observed only in male rats. In EDL, T3 treatment had no significant influence on the MyHC isoform composition in the males irrespective of the age of the animal. In the females, on the other hand, T3 treatment resulted in a significant MyHC transformation from IIA to IIB, probably via IIX myosin, in spite of the fact that type IIA mRNA has been reported to be downregulated in both females and males. It is concluded that the regulation of MyHC isoforms by thyroid hormone differs between females and males, presumably as a result of a gender-related difference in the translational or post-translational regulation of MyHC synthesis.

Age Factors↗
PubMed1997

Influence of a beta2-agonist on physical performance at low temperature in elite athletes.

Beta2-agonists are frequently used by elite cross-country skiers, a group of athletes with a high prevalence of asthma. It has been claimed that beta2-agonists have a positive effect on physical performance. The aim of the present study was to investigate whether inhalation of a beta2-agonist increases physical performance at low temperature in healthy, nonasthmatic athletes with normal bronchial responsiveness. Twenty elite male athletes (cyclists, cross-country skiers, middle and long distance runners) with no history of allergy or airway disease and who had normal spirometry and methacholine bronchial provocation tests performed a maximal exercise test on a treadmill in a climate chamber at approximately 10 degrees C on two subsequent days. Before exercise they inhaled terbutaline (3 mg from MDI) or placebo in a randomized, single blind manner. After 10-min warm-up on the treadmill, a submaximal work preceded a stepwise increase of the workload until exhaustion. Lung function, ventilation, oxygen uptake, and heart rate were determined and blood samples for lactate and potassium analyses were drawn before, during, and after exercise. Terbutaline induced a significant bronchodilatation; FEV1 increased from 4.8 (4.4-5.1) L to 5.0 (4.6-5.4) L, mean (95% CI). There were no significant differences between the two treatments with regard to exercise time, 25.1 (24.3-25.8) min vs 24.9 (24.1-25.6) min, oxygen uptake and ventilation during exercise, or heart rate at maximal workload. Terbutaline induced an increase in serum lactate concentration but did not influence the lactate response to exercise. The serum potassium increase was attenuated at low workload but not at maximal work. The postexercise decrease in serum potassium concentration was significantly greater after terbutaline (-0.52 (-0.29 to -0.76) mmol x L-1) than after placebo (-0.13 (0.06 to -0.32) mmol x L-1 (P < 0.001). We conclude that inhalation of a beta2-agonist (terbutaline) in a dose that yields significant bronchodilatation does not influence physical performance at low temperature in healthy athletes. Acute inhalation of the beta2-agonist amplified the postexercise hypokalemia, a finding of unclear significance. Although there is a slight bronchodilatation and potential negative airways effect of cold air inhalation, a beta2-agonist does not increase physical performance in top athletes.

Adolescent↗
PubMed1997

Quantification of ergosterol and 3-hydroxy fatty acids in settled house dust by gas chromatography-mass spectrometry: comparison with fungal culture and determination of endotoxin by a Limulus amebocyte lysate assay.

Ergosterol and 3-hydroxy fatty acids, chemical markers for fungal biomass and the endotoxin of gram-negative bacteria, respectively, may be useful in studies of health effects of organic dusts, including domestic house dust. This paper reports a method for the combined determination of ergosterol and 3-hydroxy fatty acids in a single dust sample and a comparison of these chemical biomarkers determined by gas chromatography-mass spectrometry with results from fungal culture and Limulus assay. Analyses of replicate house dust samples resulted in correlations of 0.91 (ergosterol in six replicates; P < 0.01) and 0.94 (3-hydroxy fatty acids in nine replicates; P < 0.001). The amounts of ergosterol (range, 2 to 16.5 ng/mg of dust) correlated with those of total culturable fungi (range, 6 to 1,400 CFU/mg of dust) in 17 samples, (r = 0.65; P < 0.005). The amounts of endotoxin (range, 11 to 243 endotoxin units/mg of dust) measured with a modified chromogenic Limulus assay correlated with those of lipopolysaccharide (LPS) determined from 3-hydroxy fatty acid analysis of 15 samples. The correlation coefficient depended on the chain lengths of 3-hydroxy acids used to compute the LPS content. The correlation was high (r = 0.88 +/- 0.01; P < 0.001) when fatty acid chains of 10 to 14 carbon atoms were included; the correlation was much lower when hydroxy acids of 16- or 18-carbon chains were included. In conclusion, the results of the described extraction and analysis procedure for ergosterol and 3-hydroxy fatty acids are reproducible, and the results can be correlated with fungal culture and endotoxin activity of organic dust samples.

Bacteriological Techniques↗
PubMed1997

Diagnosis of invasive candidiasis in neutropenic children with cancer by determination of D-arabinitol/L-arabinitol ratios in urine.

Determination of D-arabinitol/L-arabinitol ratios (referred to as D/L-arabinitol ratios) in urine as a tool for the diagnosis of invasive candidiasis was investigated in a prospective study comprising 100 children with cancer. The analyses were made by gas chromatography. Positive D/L-arabinitol ratios were found for 10 of 10 children with confirmed invasive candidiasis, 12 of 23 patients undergoing empiric antifungal chemotherapy, and 4 of 67 children not receiving antifungal treatment. D/L-Arabinitol ratios were positive 3 to 31 days (median, 12 days) before the first culture-positive blood sample was drawn or empiric therapy was initiated. The regular monitoring of D/L-arabinitol ratios in urine holds great promise as a sensitive method for diagnosing invasive candidiasis in immunocompromised children with cancer. Moreover, it may be possible to use an early rise in D/L-arabinitol ratios as a basis for the institution of antifungal chemotherapy and as a means of avoiding unnecessary treatment with potentially toxic antifungal agents.

Adolescent↗
PubMed1997

Effects of aging on shortening velocity and myosin isoform composition in single human skeletal muscle cells.

Maximum unloaded shortening velocity (V0) and maximum force normalized to cross-sectional fiber area (specific tension) were determined in 400 single quadriceps muscle cells of young (n = 4, 25-31 yr) and old (n = 4, 73-81 yr) men. Two of the old men were physically very active, and the subjects were divided into young control, old control, and old physically active groups. The expressions of types I, IIa, and IIb myosin heavy chains (MHC) and essential and regulatory myosin light chains were determined by 6 and 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. V0 was highly dependent on the MHC isoform composition, and a gradient from slow to fast was observed in the sequence I, I-IIa, IIa, IIab, and IIb MHC cells. The V0 values and specific tensions of types I and IIa MHC fibers in the young control group were significantly higher than those in the old control and old physically active groups. Thus the present results provide evidence of qualitative changes in contractile properties of human skeletal muscle in old age, which probably play an important role in the age-related impairment of skeletal muscle function.

Adenosine Triphosphatases↗
PubMed1997

Lower limb skeletal muscle function after 6 wk of bed rest.

Force, electromyographic (EMG) activity, muscle mass, and fiber characteristics were studied in seven healthy men before and after 6 wk of bed rest. Maximum voluntary isometric and concentric knee extensor torque decreased (P < 0.05) uniformly across angular velocities by 25-30% after bed rest. Maximum quadricep rectified EMG decreased by 19 +/- 23%, whereas submaximum (100-Nm isometric action) EMG increased by 44 +/- 28%. Knee extensor muscle cross-sectional area (CSA), assessed by using magnetic resonance imaging, decreased by 14 +/- 4%. Maximum torque per knee extensor CSA decreased by 13 +/- 9%. Vastus lateralis fiber CSA decreased 18 +/- 14%. Neither type I, IIA, and IIB fiber percentages nor their relative proportions of myosin heavy chain (MHC) isoforms were altered after bed rest. Because the decline in strength could not be entirely accounted for by using decreased muscle CSA, it is suggested that the strength loss is also due to factors resulting in decreased neural input to muscle and/or reduced specific tension of muscle, as evidenced by decreased torque/EMG ratio. Additionally, it is concluded that muscle unloading in humans does not induce important changes in fiber type or MHC composition or in vivo muscle contractile properties.

Adult↗
PubMed1997

Detection of thymidylate synthase gene expression levels in formalin-fixed paraffin embedded tissue by semiquantitative, nonradioactive reverse transcriptase polymerase chain reaction.

We describe a new, simple and reliable semiautomated strategy for quantifying mRNA from archival specimens by using oligo(dT)25 paramagnetic beads and the reverse-transcriptase polymerase chain reaction (PCR) coupled with quantitative digital image analysis (Q-DIA). To evaluate the experimental conditions, we examined thymidylate synthase (TS) gene expression in mRNA isolated from both flash-frozen and formalin-fixed paraffin-embedded human biopsy samples using biopsy material obtained from 2 patients prior to chemotherapy with 5-fluorouracil. Following the electrophoretic separation of the PCR products through a 20% polyacrylamide gel, quantitation of the perimeters of the silver-nitrate-stained PCR products will be done by Q-DIA using a video frame-grabber board attached to a CCD camera using Image-Pro+ software. Validation of this approach will involve a comparison of the observed gene expression levels to TS protein levels obtained by tissue homogenization assays of TS, tetrahydrofolate, 5,10-methylenetetrahydrofolate, 2'-deoxyuridine-5'-monophosphate and 5-fluoro-2'-deoxyuridylate (FdUMP), by established [3H]FdUMP ligand-binding assays. The novelty of this method is that it offers a low-cost means whereby Q-DIA is performed directly from the gel to rapidly and accurately determine the level of TS gene expression, which is standardized against the beta-actin housekeeping gene. In the protocol described herein, gene expression studies can be done quickly and without the use of radioactive substances in both normal clinical samples shock frozen at the time of surgical excision and in formalin-fixed paraffin-embedded archival samples, which are commonly available in all hospital pathology departments. To demonstrate the utility of this method, mRNA was extracted from both nonpathological and tumor biopsies originating from both types of material from the same patients. TS gene expression in the flash-frozen and archival materials was compared to the level of TS intracellular enzyme activity in the same samples and a correlation of 89 and 80% between the shock-frozen and archival material relative to TS intracellular enzyme activity levels was observed. These findings suggest that routine semiautomated quantitative analysis of rare mRNA transcripts, e.g. TS, from archival material can be applied for retrospective studies.

DNA, Complementary↗
PubMed1997

Inhalation of swine dust induces cytokine release in the upper and lower airways.

In healthy subjects, acute inhalation of swine dust causes an influx of inflammatory cells into the airways and increased bronchial responsiveness. The exposure may also cause fever and generalized symptoms. It seems likely that proinflammatory cytokines are involved in the response to inhaled swine dust. Nasal and bronchoalveolar lavage (BAL) were performed before, and 7 and 24 h after the start of 3 h exposure to swine dust, during a period of work in a swine confinement building, in 22 healthy subjects. Lavage fluids were analysed with regard to the cellular response and concentrations of interleukin (IL)-1 alpha, IL-1 beta, IL-6 and tumour necrosis factor-alpha (TNF-alpha). Each subject carried personal samplers for exposure measurements. Inhalable dust and airborne endotoxin, 3-hydroxylated (2-OH) fatty acid and muramic acid were measured. Bronchial responsiveness to methacholine was investigated 1-2 weeks before and 7 h after the start of the exposure. Exposure caused fever (> 38 degrees C) in three subjects, and approximately 25% of the subjects experienced symptoms. Bronchial responsiveness to methacholine increased by 3.5 (1.6-4.8) doubling doses (median (25th-75th percentile)). Following exposure, granulocytes increased more than 50 fold in BAL fluid and more than 40 fold in nasal lavage fluid. IL-1 alpha and IL-1 beta increased significantly in BAL fluid (p < 0.05) and nasal lavage fluid (p < 0.01). IL-6 increased 25 fold in BAL and 15 fold in nasal lavage fluid (p < 0.001). TNF-alpha was below detection limit (0.25 ng.L-1) in most subjects before exposure and increased following exposure to 3.8 (2.4-5.7) and 1.3 (0.6-2.3) ng.L-1 in BAL and nasal lavage fluid, respectively, (p < 0.001). Total inhalable dust was 20.5 (14.6-30.0) mg.m-3 and the concentrations of airborne endotoxin, 3-OH fatty acid and muramic acid were 1.2 (0.8-1.4), 3.5 (2.2-4.5) and 0.9 (0.3-1.9) microgram.m-3, respectively. There was a significant correlation between the IL-6 response in BAL fluid and exposure to dust endotoxin activity and 3-OH fatty acids (p < 0.05). Otherwise, no significant correlations were found between exposure and the cytokine response. We conclude that exposure to swine dust causes an intense upper and lower airway inflammation, which involves the proinflammatory cytokines interleukin-1, interleukin-6 and tumour necrosis factor-alpha.

Adult↗
PubMed1997

Different responses of bone alkaline phosphatase isoforms during recombinant insulin-like growth factor-I (IGF-I) and during growth hormone therapy in adults with growth hormone deficiency.

We studied serum bone alkaline phosphatase (ALP) isoforms and other markers of bone turnover in growth hormone-deficient (GHD) adults (n = 22). The patients were followed during 1 week of insulin-like growth factor-I (IGF-I) administration, 40 micrograms/kg of body weight/day (n = 6), and during 24 months of growth hormone (GH) therapy, 0.125 IU/kg of body weight/week for the first month, and then 0.250 IU/kg of body weight/week (n = 20). Six ALP isoforms were separated and quantified by high-performance liquid chromatography: one bone/intestinal, two bone (B1, B22), and three liver ALP isoforms. At baseline, the mean levels of B1, B22, and osteocalcin were higher in GHD adults than in healthy adults. After 2 week of IGF-I administration and 1 month of GH therapy, only B1 was decreased. We suggest that the initial decrease of B1 during GH therapy could be an effect of endocrine IGF-I action mediated by GH. After 3 months of GH therapy, both B1 and B2 increased as compared with placebo. Osteocalcin, carboxy-terminal propeptide of type I procollagen (PICP), cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), and urinary pyridinoline cross-links/creatinine ratio increased during GH therapy. PICP increased significantly before bone ALP and osteocalcin, indicating early stimulation of type I collagen synthesis as previously demonstrated by in vitro models. Different responses of the bone ALP isoforms during IGF-I and during GH therapy suggest different regulations in vivo.

Adult↗