Blood pressure (BP) was recorded with an aneroid sphygmomanometer and waist circumference (WC) was determined. Carotid intima–media thickness (CIMT) and microalbuminuria were analysed to determine TOD.Urbanisation is associated with obesity, hypertension and development of the metabolic syndrome (MS). We aimed to assess the use of different coping styles and their influence on increases in MS indicators and target end-organ damage (TOD) in urban black African men. A sample of 53 men was classified as clear high active (AC, Fasting serum and eight-hour urine samples revealed elevated MS indicators in AC men. Strong associations existed between MS indicators and TOD in AC but not PC men. To conclude, only BP and seeking social support were positively associated with TOD in urban PC African men, while in urban AC African men, most MS indicators were positively associated with TOD, i.e. sub-clinical atherosclerosis and renal impairment. Malan In accord with van Rhenen, Obrist stated that an AC style is associated with problem solving, perception of control and central cardiac β-adrenergic response patterns .12According to the International Diabetes Federation (2006), there are five cardiovascular risk factors underlying the development of the metabolic syndrome. These are abdominal obesity, diabetes, high blood pressure, and high levels of blood glucose and high-density lipoprotein (HDL).14Atherogenic dyslipidaemia is generally observed in MS patients.18In the present study, the main aim was to assess whether a relationship could be observed between individual risk factors that may constitute the MS in urban African men, and the utilisation of specific coping styles. The hypotheses are then, firstly, that utilising an AC style will be associated with negative changes in individual indicators of the MS in urban African men, and secondly, that the changes in MS indicators will be associated with target end-organ damage, depicted by carotid intima–media thickness and microalbuminuria.The SABPA study (Sympathetic Activity and Ambulatory Blood Pressure in Africans), a target population study on black South African teachers, was conducted from February to May 2008. It included 101 recruited urban black African males aged between 25 and 60 years, with the same socio-economic status, and complying with the inclusion criteria. They were selected from one of the four Dr Kenneth Kaunda education districts of the North West province, South Africa. To assimilate the sample, the following exclusion criteria were proposed: users of α- and β-blockers, participants with body temperatures higher than 37.5°C, and those who had been vaccinated or had donated blood three months prior to participation.n = 30) or passive coping  responders, using the Amirkhan African validated coping style indicator.19For the purpose of our sub-study, we included only 53 men of the 101 SABPA black males after they had been classified as clear high active  in the privacy of their rooms. Transportation back to school followed breakfast and referral to a physician, where applicable.The coping strategy indicator (CSI), developed by Amirkhan (1990), was essential in predicting each participant’s predominant or habitual coping style.21n = 48) were excluded. Unfortunately this could not be prevented and was a limitation of the sub-study.Participants rated the 33 items of the questionnaire on a threepoint Likert scale: a lot (3), a little (2), or not at all (1), with a recent stressful event in mind. The higher scores were indicative of preference for a specific coping style, with the cut-off points for high use pertaining to: problem solving or AC (31), avoidance or PC (23), and seeking social support (28).The global physical activity questionnaire (GPAQ) as predictor of the subjects’ physical activity was completed and assessed.2 from the height and weight.Registered level II biokinetisists took measurements of each participant in triplicate to ensure accuracy. Measurement of waist circumference (WC) was perpendicular to the long axis of the trunk, at the midpoint between the lower costal border and iliac crest. The cut-off points for WC determining obesity were values of ≥ 94 cm  and ≥ 80 cm .Actical® accelerometers  on the waist measured physical activity (PAI) in kilocalories per 24 hours, and participants were classified as high activity (PAI-3) according to their active energy expenditure. PAI-3 was equivalent to strenuous activity for three days a week (achieving a minimum of 1 500 MET-minutes), or any activity accruing at least 3 000 MET-minutes for seven days a week.22The Cardiotens®  apparatus obtained 24-hour blood pressure measurements. This programmed apparatus measures ambulatory blood pressure oscillometrically at intervals of 30 minutes during the day and 60 minutes at night. A suitable obese or non-obese cuff of the Cardiotens® apparatus was fastened to each subject’s non-dominant arm.After overnight sleep and anthropometrical measurements, two mercury sphygmomanometer blood pressure readings using Korotkoff IV or V for diastolic BP followed while the partici- pants rested for five minutes in the semi-fowler position, with a three- to five-minute rest in between measurements. Participants were defined as hypertensive with a 24-hour blood pressure of > 125–130/> 80 mm Hg, according to the ESH guidelines (2007).23A high-resolution ultrasound scan with CIMT images from at least two optimal angles of the left and right common carotid artery, carotid bulb and internal carotid arterial (ICA) segments were obtained using a Sonosite Micromaxx ultrasound system  and 6–13 MHz linear array transducer using the Rudy Meijer protocol. The digitised images were imported into the AMS automated software for analysis of CIMT. A maximal 10-mm segment with good image quality was chosen for analysis. The program automatically identifies the borders of the CIMT of the near and far wall.Fasting resting serum and sodium fluoride (glucose) blood samples were obtained by a registered nurse from the brachial vein branches of the participant’s dominant arm, with a winged infusion set. Blood samples were centrifuged at 3 700 revolutions per minute for 10 minutes, separated and frozen at –80°C until analysis.An overnight (eight-hour) collected fasting urine sample was used for the assessment of microalbuminuria to indicate target end-organ damage (TOD). Measurement of albumin excretion followed by means of immune precipitation, enhanced by polyethylene glycol at 450 nm  and the Pareekshak test  to determine the participants’ status.T-tests followed to determine significant differences in age, BMI, alcohol consumption, smoking and PAI between coping style groups. Chi-square tests (χ2) determined the prevalence of each factor. Analysis of covariance (ANCOVA), adjusting for alcohol consumption as co-factor, was used to compare MS data between AC and PC African men.Data were analysed using the Statistica 8.0 software . Normal distributions of the variables determined with the Kolmogorov-Smirnov test revealed symmetrical data, but microalbuminuria data were not evenly distributed and therefore logarithmic transformation was performed. According to the International Diabetes Federation (2006), central obesity should be present together with two or more of the following factors, in order to diagnose the MS: increased triglyceride levels (> 1.7 mmol/l); reduced HDL cholesterol (< 1.03 mmol/l in men and < 1.29 mmol/l in women); raised fasting plasma glucose concentrations (> 5.6 mmol/l); and hypertension (> 130/> 80 mmHg).13f). For CIMTf, additional adjustments for BP and lipids were done. Significant values were noted as p ≤ 0.05, r ≥ 0.35, and adjusted r2 ≥ 0.25.Partial correlations  were performed between MS indicators and markers of target end-organ damage. Multiple regression analyses using MS indicators as independent variables were performed to explain microalbuminuria and carotid intima–media thickness of the far wall  with SBP (r = 0.57), DBP (r = 0.49), glucose (r = 0.39) and triglyceride levels (r = 0.46). Additionally, highly significance correlations (p ≤ 0.05) were observed in AC men between WC and TOD, respective correlations for microalbuminuria (r = 0.46) and CIMTf (r = 0.53). However, in PC men In p ≤ 0.05) with SBP (r = –0.45), DBP (r = –0.40) and CIMTf (r = –0.49). Strong correlations (p ≤ 0.05) also existed between microalbuminuria and glucose (r = 0.50) as well as triglyceride levels (r = 0.56). Another significant (p ≤ 0.05) correlation existed between glucose levels and CIMTf (r = 0.63). In r = –0.53; p ≤ 0.05). Correlations also existed between microalbuminuria and SBP as well as DBP, with significant p-values (p ≤ 0.05).In f and microalbuminuria. Furthermore, in PC men, significant associations existed between social support (r = 0.531) and augmented CIMTf values, whereas SBP (r = 0.596) and lower WC (r = –0.408) were associated with microalbuminuria.In The main purpose of this sub-study was to determine whether different coping styles were associated with MS indicators in urban African men, as sedentary lifestyles, dietary intake and psychosocial stress are on the increase.3In the abovementioned study, the adoption of an AC style was stated to be a cardiovascular risk factor and this was confirmed in the SABPA study.10According to the IDF criteria,24Abdominal obesity is the essential prerequisite for diagnosis of the MS, but no group had values significantly higher than 94 cm.+.17The proposed mechanism for established MS could be that visceral adiposity is associated with impaired glucose tolerance and atherogenic dyslipidaemia, which is a combination of increased triglyceride and reduced HDL levels as well as LDL particles.Dually noted, Africans are usually salt sensitive and reveal sympathetic over-activity, and this could probably be the link between the aforementioned mechanism and augmented prevalence of hypertension in Africans.The HDL findings in AC men are of major significance, as HDL levels correlated negatively with blood pressure and sub-clinical atherosclerosis, which is indicative of atherogenic dyslipidaemia, found in both type 2 diabetes and the MS.r = 0.53). PC has been implicated in depression. Therefore, it could be that these PC men had already reached avoidance, withdrawal and depression, to the point that social support became a stress factor, rather than a way of coping.12Africans and African-Americans are collectivistic population groups, who view the experience of social support from their extended families as important, and social support possibly has a protective effect on their cardiovascular status.Both hypotheses were accepted as, firstly, utilising an AC style was associated with increases in MS indicator values in urban African men. Secondly, a synergistic effect was illustrated in urban AC African men by positive associations, which existed between MS indicators and target end-organ damage depicted by carotid intima–media thickness and microalbuminuria. The SABPA study therefore indeed indicates that an AC style is associated with risk of pathology rather than being a health promoter.3The SABPA study was limited with respect to the number of male participants. Enlarging the sample of participants would enhance identification of the influence of the specific coping styles on increased MS indicators and future development of the MS. The second recommendation is that seeking social support as a coping strategy should be further investigated, as well as its different effects in AC and PC men. Furthermore, indication of biological markers for smoking (Cotinin) and alcohol consumption (gamma glutamyl transferase) is essential. One last recommendation is to do a comparative study of Caucasian and African men utilising different coping styles, so as to show differences in population groups in accordance with development of the metabolic syndrome.Only BP and social support were associated with target endorgan damage in PC men, while in urban AC men, most MS indicators were positively associated with target end-organ damage, depicted by sub-clinical atherosclerosis and renal impairment.


In patients with locally advanced or recurrent pelvic malignancies, total pelvic exenteration (TPE) may be necessary for curative treatment. Despite improvements in mortality rates since TPE was first described, morbidity rates remain high due to the extensive resection and the aggressiveness of these tumors. We have studied the outcomes of TPE surgery performed at our institution.n = 36) versus non-colorectal (n = 17) malignancies. Demographics, operative reports, pathology reports, periprocedural events, and outcomes were analyzed. Comparison of the two groups was performed using student’s t-test and Fisher’s exact test. Survival curves were constructed using the Kaplan–Meier method and compared using the log rank test.Fifty-three patients with various pelvic pathologies underwent TPE between 2004 and 2010. Patients were divided into two groups based on pathology: colorectal (P = 0.04). Complication rates were similar: 86% in the colorectal group and 76% in the non-colorectal group. In the colorectal group, 27.8% of patients developed perineal abscesses, whereas no patients developed these complications in the non-colorectal group (P = 0.02). No survival difference was seen in primary versus recurrent colorectal tumors; however, within the colorectal group there was a survival advantage when comparing R0 resection to R1 and R2 resection combined. Median survival rates were 27.3 months for R0 resection and 10.7 months for R1 and R2 resection combined. The median survival was 21.4 months for the colorectal group and 6.9 months for the non-colorectal group (P = 0.002).The colorectal and non-colorectal groups were similar in demographics, operative times, length of stay, estimated blood loss, and rates of preoperative and intraoperative radiation use. Chemotherapy use was increased in the colorectal group compared with the non-colorectal group (55.6% vs. 23.5%, Patients undergoing TPE for colorectal tumors have improved survival when compared with patients undergoing exenteration for pelvic malignancies of other origins. Within the colorectal group, the extent of resection demonstrated a significant survival benefit of an R0 resection compared with R1 and R2 resections. Despite TPE carrying a high morbidity rate, mortality rates have improved and careful patient selection can optimize outcomes. In patients with advanced primary or recurrent pelvic malignancies without metastatic disease, extensive aggressive surgery such as total pelvic exenteration (TPE) may be necessary for curative treatment. TPE can also be considered in the setting of suspected disease recurrence, complications due to radiation treatment, and for palliative treatment of metastatic disease with severe pelvic symptomatology. Although initially performed at the Ellis Fischel Cancer Center in the 1940s, this highly morbid procedure was originally described by Brunschwig for patients with advanced pelvic malignancies in 1948  the doubEarly TPE series reported mortality rates of up to 30% -11. MoreOur study describes the results of a single institution experience with TPE over a 6-year period, with a detailed examination of operative related complications. In addition, morbidity, mortality, and survival were evaluated for patients undergoing TPE for colorectal and non-colorectal malignancies and their results compared.Fifty-three patients underwent TPE between January 2004 and August 2010 at the Arthur G. James Cancer Hospital by surgeons from the divisions of surgical oncology, urology, and gynecologic oncology. This procedure was indicated for patients with locally advanced primary, recurrent, or suspected recurrent pelvic malignancies. After obtaining permission from The Ohio State University Institutional Review Board, the medical records of these patients were retrospectively reviewed.TPE included resection of the distal sigmoid colon, rectum, anal canal, distal ureters, bladder, internal reproductive organs, and pelvic lymph nodes. Urinary diversion was achieved by construction of an ileal conduit  or a douTPE patients were divided into two groups, those who underwent TPE for colorectal cancer and those who underwent the surgery for non-colorectal cancer. Demographics including age, gender, and comorbidities were compared between the two groups. Preoperative treatment data including neoadjuvant chemotherapy and radiation were analyzed. Operative reports were reviewed to assess operative time, estimated blood loss, and administration of intraoperative radiation therapy. Intraoperative radiation therapy was indicated when there was concern of pelvic sidewall or sacral invasion by the tumor after gross tumor resection. It was contraindicated in patients who had already received a prohibitive dose of preoperative radiation to the pelvis, as determined by the consultant radiation oncologist. Periprocedural events, outcomes, and survival data were investigated for each of the two groups.Tumors were categorized as primary, recurrent, or suspected recurrence. Suspected recurrences consisted of patients who had radiographic evidence of tumor recurrence with no pathological evidence of viable tumor on examination of the specimen. Operative and pathology reports of all patients were analyzed to determine the completeness of tumor resection. Completeness of resection was divided into R0 (complete resection of tumor), R1 (microscopic tumor in specimen margin), R2 , and suspected recurrence/complication. Postoperative and follow-up data collected included length of stay, morbidity, and mortality. Survival was calculated as the time from TPE to the time of death.t-test for comparison of independent groups and a non-parametric alternative (Wilcoxon rank sum test) for data not distributed normally. Contingency table analysis (chi-square and Fisher’s exact test) was used, when appropriate, for discrete data. A P value <0.05 was considered statistically significant. Statistical analysis was performed with SPSS Statistics 17.0 . Survival was calculated using the Kaplan–Meier method and compared using the log-rank test. Survival analysis was performed with JMP 9 .Descriptive statistics were used to summarize data. Continuous variables were compared by student’s n = 36) and a non-colorectal (n = 17) group for analysis. Demographics including age, gender, and number of comorbidities were similar between the two groups (Table P = 0.48). There were sixteen males and twenty females in the colorectal group, and five males and twelve females in the non-colorectal group (P = 0.37). Estimated blood loss, operative time, and length of stay were similar between the two groups. Mean length of stay was 17 days overall, 15.8 (± 9.9) days in the colorectal group and 19.5 (± 11.5) days in the non-colorectal group (P = 0.23). There was no significant difference in preoperative radiation and intraoperative radiation treatment rates between the two groups. Twenty-eight patients (78%) in the colorectal group and nine patients (53%) in the non-colorectal group underwent preoperative radiation treatment (P = 0.23). A majority of patients were referred to our institution for surgical intervention but received preoperative radiation at outside institutions. Preoperative radiation doses were available for 23 of the 37 patients. In the colorectal group, the 17patients for whom data was available received a mean dose of 5265 cGy preoperatively. In the non-colorectal group, data was available for six of the nine patients. They received a mean preoperative dose of 6990 cGy. Sixteen patients (44%) in the colorectal group and four patients (24%) in the non-colorectal group underwent intraoperative radiation treatment (P = 0.11). Significantly more patients  underwent chemotherapy in the colorectal group compared with the non-colorectal group  (P = 0.04).During the study period, 53 patients – 21 males and 32 females – underwent TPE for advanced primary, recurrent, or suspected recurrent pelvic malignancies. Based on pathology, patients were divided into a colorectal  had primary disease, thirty-four patients (64.2%) had recurrent disease, and seven patients (13.2%) had suspected recurrence or complications from previous therapy. Within the colorectal group, nine, twenty-two, and five patients had primary disease, recurrent disease, and suspected recurrence, respectively. Within the non-colorectal group, three, twelve, and two patients had primary disease, recurrent disease, and suspected recurrence, respectively. Table 2.6% had P = 0.04)  compared with the non-colorectal group (n = 0) (P = 0.02). Among the 53 patients, 17 underwent pelvic reconstruction with a rectus abdominus myocutaneous flap, whereas 36 underwent primary closure. There was no difference in operative time, blood loss, length of stay or overall wound complications between the two groups. In both groups, 47% developed pelvic abscesses. In those patients who underwent flap placement, two (12%) developed perineal abscesses, compared with eight (22%) in those who underwent primary closure (P = 0.47). Within the colorectal group, 13 patients underwent reconstruction with a rectus abdominus myocutaneous flap. Among the patients who underwent exenteration for colorectal cancer, two of thirteen (15.4%) with flap reconstruction developed a perineal abscess, compared with eight of twenty-three patients (34.8%) who underwent primary closure (P = 0.27).Among both groups, there were nineteen R0 resections, twenty R1 resections, seven R2 resections, and seven resections of suspected recurrence/complication with no evidence of malignancy. Within the non-colorectal group, ten patients (58.8%) underwent R1 resection, which was significantly higher than in the colorectal group in which ten patients (27.8%) underwent R1 resection 4) Table . There w Table . P = 0.002)   had no difference in survival from those whose disease was unresectable, whereas those who underwent complete sarcoma resection had significantly improved outcome, with a median survival of 103 months [Our series demonstrated a statistically significant improved survival for patients undergoing TPE for cancer of colorectal origin compared with patients undergoing TPE for non-colorectal malignancies. Within the non-colorectal group, there were three patients with pelvic sarcomas. These tumors are rare, with prognosis based on the histologic grade and completeness of resection . In our  5 years . Althoug 5 years ,26. In a3 months . Therefoet al.’s study of 44 patients who underwent pelvic exenteration for recurrent endometrial cancer resulted in a 5-year survival rate of 20%, with a major morbidity rate of 80% [In contrast to sarcomas, chemoradiation is the treatment of choice for locally advanced primary cervical malignancies. Most TPEs performed for gynecological cancer are performed for recurrent cervical cancer, -29 becaue of 80% . Only 23et al. found that completeness of resection was the only variable with a significant impact on survival [et al.[The importance of resection status is demonstrated both between the non-colorectal and colorectal groups, as well as within the colorectal group. In patients who underwent TPE for colorectal cancer, our results demonstrated a significant survival advantage for patients with R0 resection, with a median survival of 27.3 months, compared with those who had R1/R2 resection with a median survival of 10.7 months. This is consistent with previous studies that have demonstrated that complete resection is an important prognostic indicator of both improved disease-free and overall survival ,20,21,39survival . Kraybill [et al. describeet al.[et al. described a 5-year survival rate of 64% in patients who underwent TPE for primary colorectal cancer, and a rate of less than 11% in those who underwent TPE for recurrent colorectal cancer. Only one of nine patients with recurrent malignancy lived longer than 24 months, and this patient was alive at the last follow-up at 47 months [et al. reported 5-year survival rates of 66% and 8% for patients who underwent TPE for primary and recurrent rectal cancer, respectively [Resection status may partially explain our results with regards to survival for primary and recurrent colorectal cancer. Our results did not demonstrate any difference in survival between patients undergoing TPE for primary advanced and recurrent colorectal tumors, with a median survival of 25.2 months and 20.2 months, respectively. Other series, however, have demonstrated improved survival for patients with cancers of primary colorectal origin compared with recurrent, with 5-year survival rates ranging from 30 to 77% for primary ,39,41-44et al. found me7 months . In theiectively . R0 reseThe group of seven patients who underwent TPE for suspected recurrence or complications from radiation therapy is an interesting subset of patients. Six of the seven had undergone preoperative radiation treatment to the pelvis. Five of these, as well as the one patient who did not undergo radiation, underwent chemotherapy prior to surgery. Of these patients, four had frozen section analysis that showed no evidence of malignancy. The other three patients had some type of fistula prior to surgery: enterocutaneous, colovaginal, or colovesical. In two patients, permanent specimen analysis revealed extensive necrosis with no viable tumor, consistent with treatment effect. The remaining pathological analyses showed densely fibrotic tissue or necrotic tissue. Although no viable tumor was found on pathological analysis, it is obvious that their previous malignancy and their preoperative treatment – chemotherapy, radiation, surgery, or a combination – contributed to the patients’ symptoms, with patients having fibrotic areas with associated fistulas, hydronephrosis, or other obstruction. Two of these patients died a year postoperatively, one died at two years, and the remainder are still alive two, four, six, and seven years postoperatively. In this group of patients, all had severe preoperative pelvic symptomatology; therefore, although their pathology was considered benign, or at least without viable tumor, their extensive symptomatology would have been the indication for TPE.Morbidity rates were substantial among all patients, with similar rates of 86% and 76% in the colorectal and non-colorectal groups, respectively. These rates are high compared with those reported in the literature, which ranged from 13 to 78% -16,18-23This study is limited by its retrospective nature, leading to the inability to establish a cause and effect relationship. It is also limited due to its small sample size. Within the non-colorectal cancer group, there were too few patients with each type of histology to make conclusions about patients who undergo TPE for any other particular type of pelvic malignancy, such as cervical cancer, endometrial cancer, or bladder cancer. A prospective study including a larger sample size of patients who have each of the various other pelvic cancers would allow us to make conclusions related to their respective malignancies. It would also be beneficial to include an assessment of quality of life, especially because our results showed such a short median survival for patients in the non-colorectal cancer group.Patients who undergo TPE for colorectal cancer have improved survival compared with patients who undergo this extensive surgery for pelvic malignancies of other origins. The results show improved survival for colorectal cancer patients with complete R0 resection of tumor. Although the procedure is still associated with significant morbidity, mortality rates are acceptable. Careful patient selection can optimize outcomes in patients undergoing TPE. Future studies may seek to predict which colorectal patients could potentially undergo TPE with successful R0 resection, leading to the best overall survival benefit from this procedure.CT: Computed tomography; PET: Positron emission tomography; TPE: Total pelvic exenteration.The authors have no competing interests to declare.MK participated in conception of the study, data collection and analysis, and drafted the manuscript. RC participated in conception of the study, data collection and analysis, and helped draft the manuscript. DA participated in conception of the study. EM participated in conception of the study, design and coordination, data analysis, and helped draft the manuscript. All authors read and approved the final manuscript.


Creatinine and eGFR exhibited closer correlations with the SDMA/ADMA ratio  than with SDMA . Neither creatinine nor eGFR correlated with ADMA or L-arginine. Adjustment for age or height only slightly attenuated the associations between the SDMA/ADMA ratio and eGFR or creatinine. Our findings suggest the superiority of the SDMA/ADMA ratio over SDMA as a renal function index in healthy children. Thus, further studies are warranted to verify our preliminary results in a larger group of subjects below 18 years of age.The structural isomer of asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), is eliminated almost entirely by urinary excretion and considered a sensitive index of glomerular filtration rate (GFR). However, reports on this relationship in healthy subjects younger than 18 years of age are rare. Therefore, our aim was to investigate relations between endogenous dimethylarginines and renal function indices in healthy children and adolescents. We studied 40 subjects aged 3–18 years free of coexistent diseases or subclinical carotid atherosclerosis. A serum creatinine-derived estimated GFR (eGFR) was calculated by the revised bedside Schwartz equation. L-arginine, ADMA and SDMA were measured by liquid chromatography-tandem mass spectrometry. Mean eGFR was 122 ± 22 (SD) mL/min per 1.73 m IrrespeHowever, out of 17 full-text source publications underlying this meta-analysis, only one dealt with subjects below 18 years of age . AdditioTherefore, our aim was to investigate relations between endogenous dimethylarginines and indices of renal function in healthy children and adolescents.Characteristics of the study subjects and plasma levels of L-arginine, ADMA and SDMA are shown in r = 0.61, p < 0.0001). SDMA and estimated GFR (eGFR) correlated with homocysteine , and a weak tendency towards a negative relationship between ADMA and age was observed . Averaged intima-media thickness (IMT) of the common carotid artery was unrelated to ADMA, SDMA and eGFR (p > 0.25).ADMA and SDMA were mutually interrelated (2 (SDMA/ADMA vs. ln (creatinine): r = 0.62, p < 0.0001; SDMA vs. ln (creatinine): r = 0.22, p = 0.18; SDMA/ADMA vs. eGFR: r = −0.63, p < 0.0001; SDMA vs. eGFR: r = −0.28, p = 0.09). Neither creatinine nor eGFR correlated significantly with ADMA or L-arginine (p ≥ 0.17) (Creatinine and eGFR exhibited stronger correlations with the SDMA to ADMA ratio  than wit ≥ 0.17) .The associations between the indices of renal function and SDMA or the SDMA/ADMA ratio were only slightly attenuated upon adjustment for age or height . The obsOur salient observation was a closer association of renal function indices with the SDMA/ADMA ratio than with SDMA in children and adolescents free of coexistent diseases or subclinical carotid atherosclerosis.Plasma L-arginine, ADMA and SDMA levels in the study participants were similar to those previously reported for liquid or gas chromatography–tandem mass spectrometry in healthy children ,12–14. Aet al.[r = −0.73), SDMA/ADMA ratio (r = −0.74) and only weakly with ADMA (r ≈ −0.33) in data pooled from 28 children and adolescents aged 13 ± 1 years with stage 2–3 CKD and 10 healthy age-matched siblings. Intriguingly, 15 years ago an early paper by Goonasekera et al.[r = −0.77) than SDMA (r = −0.38) with eGFR derived from plasma creatinine by the Morris formula in 38 hypertensive children and adolescents aged 1–18 years  with mainly nephrogenic hypertension and mildly depressed eGFR.Our findings are partially consistent with the report by Brooks et al. who obsera et al. describer = −0.35) than estimated according to a meta-analysis by Kielstein et al.[et al.[r-value (−0.38) between SDMA and plasma clearance of Inutest—branched chain polyfructosan with a Stokes radius profile equivalent to inulin—in 183 children aged 14.8 ± 4.1 years with type 1 diabetes and a mean eGFR of 149 ± 32 mL/min per 1.73 m2 of body-surface area. Thus, the present study has extended the evidence supporting potential utility and limitations of an assay of endogenous dimethylarginines as an index of eGFR to healthy children. Nevertheless, our preliminary data require validation in a larger group of subjects.We observed a weaker correlation between eGFR and SDMA r = −0.3 than estl.[et al. who repoi.e., independently of GFR.A close inverse correlation between eGFR and the SDMA/ADMA ratio might appear unexpected because an elevated ADMA/SDMA ratio had been previously suggested as a hallmark of depressed activity of cytosolic dimethylarginine dimethylaminohydrolases (DDAHs) ,15, a faet al.[In the present study, eGFR and ADMA were unrelated, whereas SDMA and ADMA were positively and moderately correlated with each other. As pointed out by Kielstein et al., both ADet al., it has et al.,26. Theret al., whereaset al.[et al.[et al.[That we have based eGFR exclusively on serum creatinine, constitutes a major limitation of the present study, in addition to a small number of the study participants. Tutarel et al. demonstrl.[et al. reportedl.[et al. suggestel.[et al., considel.[et al.–31. TherAlthough exclusively healthy children were entered into the study, it cannot be excluded that some of them might have exhibited accelerated early atherogenesis, known to be associated with increased ADMA levels not only in adults  but alsoWe studied 40 healthy children and adolescents (33 boys and seven girls) aged 3.4–17.9 years . Exclusion criteria included congenital heart or pulmonary defects, clinical or biochemical evidence of renal or hepatic pathology, hypertension, diabetes, obesity, and any other significant chronic coexistent diseases, acute disorders or relevant abnormalities in routine blood or urine analyses. Additionally, those with ultrasound evidence of atherosclerotic plaques in carotid arteries were also excluded.The study was performed in accordance with the Helsinki Declaration, the protocol had been approved by the ethics committee of the Medical University of Silesia and written informed consent was obtained from the parents of each participant.Demographical data and medical history were recorded according to a pre-specified questionnaire and anthropometric measurements  were performed. Additionally, ultrasonography of carotid arteries was performed to confirm the absence of atherosclerotic plaques.On a separate day in the morning, about 10 mL of blood was drawn from an antecubital vein after overnight fast into sampling tubes containing ethylenediaminetetraacetic acid or no anticoagulant, centrifuged and the collected portions of serum and plasma were frozen initially at −20 °C (and −70 °C in case of prolonged storage of samples) until assayed.Biochemical analyses included lipids, creatinine, glucose, homocysteine and CRP. Creatinine was measured by the Jaffe assay with the isotope dilution mass spectrometry (IDMS)-traceable calibration . This method exhibited a percent bias  of no more than 5% with the reference to IDMS for serum creatinine below 150 μmol/L . CRP andPlasma concentrations of L-arginine, ADMA and SDMA were measured by means of liquid chromatography-electrospray tandem mass spectrometry methods with an isotope-labeled internal standard as described in detail elsewhere . The impAn eGFR was calculated from serum creatinine and the height by the revised bedside Schwartz equation , which hThe common carotid artery, carotid bulb and internal carotid artery were visualized on both sides by B-mode imaging in the longitudinal plane using a high-resolution ultrasound device  with a 12-MHz linear digital ultrasound probe by an investigator (Jarosław Rycaj) who was unaware of characteristics of the subjects. The image was recorded and stored for off-line analysis by manual tracing to measure IMT. As proposed previously , plaquesr). In order to obtain a normal distribution, logarithmic transformation  was applied when necessary. To test an independent relationship between selected parameters, multiple regression was applied and mean standardized regression coefficients (β), their standard errors (SEM) and respective p-values for individual variables were shown. A p-value below 0.05 was inferred significant. All statistical tests were performed using STATISTICA .Values are expressed as means ± SD (standard deviation) for continuous variables with normal distribution, medians (interquartile range) for not normally distributed continuous data, and numbers (%) for categorical variables. The accordance with a normal distribution was checked by the Lilliefors test. Bivariate correlations were estimated by Pearson’s correlation coefficients (Our findings suggest the superiority of the SDMA/ADMA ratio over SDMA as an index of renal function in healthy children and adolescents. Nevertheless, further studies are warranted to verify these preliminary results in a large cohort of subjects below 18 years of age.


Environmental stresses, which acts synergistically, disturbs the photosynthesis. The OJIP test, elaborated by Strasser and co-workers, enables comparison of the physiological status of plants grown on polluted vs. control areas. The paper shows that the Chl a measurements are very useful tool in evaluating of heavy metal ions influence on perennial grasses, tested as potential phytoremediators. Among 5 cultivars tested, the highest concentration of Cd and Zn ions, not associated with the yield reduction, was detected in the biomass of tall fescue cv. Rahela. Chl a fluorescence interpreted as double normalized curves pointed out Rahela as the outstanding cultivar under the HM ions stress.Chlorophyll  Even though the amount of fluorescence usually makes no more than 1–8% of total light absorbed, the fact that light induced processes are as communicating vessels and the increase in the efficiency of one of them results in the decrease in the yield of the other two, measurement of Chl a fluorescence gives information about changes in the efficiency of photochemistry and heat scattering i/direct interaction of HM ions with protein thioyl-, histidyl- and carboxyl-groups; ii/formation of reactive oxygen species (ROS); and/or iii/displacement of essential cations in protein active centers. Some ions such as Hg, Cu, Cd, Ni or Zn may substitute the central Mn ion in chlorophyll molecule, forming chlorophyll-metal complexes and thus lower PSII quantum efficiency V/F0 and FV/Fm are the most widely known and used, the interpretation of double normalized curves, based on JIP test is an increasingly popular approach in applied, environmental studies A, the electron acceptor a fluorescence measurements, which are the result of in-depth knowledge accumulated over the years, still needs the further studies a fluorescence into convenient and reliable tool for outdoor, environmental studies Chl a fluorescence reflects theirs cumulative effect. For phytoremediation - revealing plants of better physiological activity on contaminated soils, in parallel with higher concentration of HM ions in aerial parts, is the goal. However it should be considered that good physiological state of the plant detected in contaminated rural areas can be misleading, since health risk for organisms in the food chain. The phytotoxicity of some metals has been long established In the field studies, the experimental system is complex. All environmental stimuli: contaminants in parallel with weather fluctuations act synergistically, so Chl a fluorescence as a method for phytoremediation studies in field experiments on five perennial grass species grown on naturally HM contaminated soils. The acquired knowledge is to be used in planning of biomass processing systems and, in parallel, in phytoremediation of polluted soils, using cultivation of energy plants as a main concept.The aim of our research was to evaluate the usefulness of Chl oN/018.9oE). Plots were established in the vicinity of a closed-down cadmium/lead/zinc/ore mine and processing plant, which operated for more than 100 years and had significant impact on local soils. Reference site (uncontaminated soil) was located in a distance of 25 km North from above, (50.6oN/018.88oE) on field with similar forecrop history. Permission was not required for research activities on both locations. No endangered or protected species were involved in our field studies.The experiment was located on contaminated soil on Silesia, southern Poland (50.4Arrhentherum elatius L. (Ae.) ‘Wiwena’; rescuegrass, Bromus carinathus Hooker et Arn (Bc.) ‘Broma’; tall wheat grass, Elytrigia elongata Nevski (Ee.) ‘Bamar’; smooth brome grass, Bromus inermis Leyss (Bi.) ‘Brudzynska’ and tall fescue, Festuca arundinacea Schreb. (Fa.) ‘Rahela’ were sown at the end of June 2010 on 1×1 m plots, in 3 replications per variety on both locations. No further treatments such as: fertilization, herbicides or watering were applied, despite of collecting aboveground biomass at the end of growing seasons in 2010 and 2011. All observations and measurements: plant height , generative shoots abundance  per plot area and yield  as well as Chl a fluorescence were conducted at the first year after the sowing (2011) at both locations: all parameters were measured in June, beside the biomass yield which was measured in October.Five perennial grass cultivars: tall oat grass, Five representative soil samples were collected from 0–30 cm horizon at each site for chemical analysis. Large chunks of soil were spread out to dry in a forced air oven at 35°C and then were grounded to pass a 60 mesh screen.2O (1∶2.5) suspension  and electrical conductivity (EC) e in water extract (1∶2.5) after 24 h of equilibration; the fraction of bioavailable metals was obtained by extraction of 3 g of air-dried soil (ground to <0.25 mm) with 30 ml 0.01 M CaCl2 for 5 h; total metal concentrations by extraction of air-dried soil ground to <0.25 mm with concentrated HClO4 and HF.Soil pH was measured in 1 M KCl and HConcentrations of metals in soil extracts were detected using inductive coupled plasma spectrometry (ICP-AES) .oC for 3 days. One g of dried, ground material was wet-ashed using concentrated nitric acid (Merck) in a microwave system . Concentration of lead, cadmium and zinc ions in plant material was also detected using inductive coupled plasma spectrometry (ICP-AES).Plant material was washed with tap water and then with deionised water in an ultrasonic washer to remove all soil particles followed by drying at 70a fluorescence was measured using PocketPEA portable fluorometers . Recordings were performed simultaneously on both locations at 10–12 a.m. UMT on the first fully developed leaf, (3 leaves per 5 plants per replication). Dark adaptation (0.5 hour) of the middle part of abaxial leaf blade preceded the measurement. Fluorescence was induced by saturating, red actinic light with energy of 3.500 µmol m−2 s−1, and first 3 seconds of transient fluorescence, covering more than its exponential growing part, was registered with time intervals increasing from 10 µs within first 300 µs of the measurement up to 100 ms intervals for times longer than 0.3 sec. Additionally, collected data points were double normalized between points O-I, O-J, O-K and a kinetic differences ΔWOI, ΔWOJ and ΔWOK were calculated and analyzed as graphs on logarithmic time scale Chl List of measured parameters:O≈F50 µsF [minimal fluorescence];1F, 2F, 3F, 4F, 5F ;M = FPF [maximal recorded fluorescence];FMt ;Area [total complementary area between the fluorescence induction curve and FM of OJIP curve].Calculated parameters:a) listed by PocketPEA software:VF [maximal variable fluorescence calculated as FM–FO];V/FMF [force of the light reactions];RC/ABS [the amount of active reaction centers per absorption];J)/VJ not listed by PocketPEA software:OI, WOJW and OKW double normalized fluorescence readings at points O-I, O-J, O-K ;OI, ΔWOJΔW and OKΔW [difference of: [WOI(reference)−WOI(control)], [WOJ(reference)−WOJ(control)] and [WOK(reference)−WOK(control)], respectively]. Calculated separately for each cultivar.http://klimat.icm.edu.pl/serv_climate.php), where air temperature and precipitation data for current and past periods can be projected for given geographic coordinates in Poland  between means were calculated according to the Duncan honesty test and significance of difference between means was tested with the probability of 95%. Divergence among tested cultivars was estimated using Principal Component Analysis (PCA) analysis, based on correlation matrix algorithm for Chl a fluorescence was useful in studies of the effect of HM polluted soil in natural agro-ecosystem, localizations with the most similar soil composition (beside HM ions concentration) were chosen to run the experiment. Soils did not differ much in organic matter content: 4% on contaminated area vs. 3.5% on reference place. The pH of contaminated soil was nearly neutral (6.8), whereas the reference one was slightly acidic (5.2). Although the content of silt and clay were on similar level, the reference soil was 1.6 times more sandy than contaminated soil. The amount of HM ions in polluted soil exceeded by almost 2 orders of magnitude the concentration of Cd and Zn ions and about 50 times of Pb ions when compared to reference place  and cv. Broma (1.1 t·ha−1), grown on polluted site. High biomass yields of cv. Wiewena and cv. Rahela were associated with the significantly lower GS value, as compared to the reference site. No significant differences in GS values were detected for other cultivars grown on both sites. Cultivar Bamar grown on the polluted soil did not differ significantly from that grown on the reference one, beside minor disparity in the Chl a fluorescence parameters.It is very likely that the elevated concentration of Pb, Cd and Zn ions in the soil affected plant growth . BiomassThe differences in HM ions sequestration were detected as well . The higM, FV and F5 the recorded data were the smallest for cv. Rahela, whereas for shorter times (from F1 to F4) cv. Bamar. was characterized by the weakest signal. Also the FV/FM ratio as well as the other calculated parameters were the lowest for cv. Rahela.Inhibition of the plant growth as a reaction on HM ions stress was the result of disturbances in the plant cell metabolism affecting also the chloroplasts and reflected in changes of the fluorescence parameters . Fluoresst –54.6% of total variation explained, and was highly correlated with measured values: FO, FM, FV, F1–F5; 2nd explaining 31.7% of total variation, was highly correlated with parameters: RC/ABS, (1–Vj)/Vj and PI (a parameters (vs. polluted site could be easily distinguished on the basis of location on x-axis (measured parameters of Chl a fluorescence).Principal Component Analysis (PCA) enabled reduction in dimension of multivariate fluorescence data set. The first two components, accounted about 86% of total variation: 1j and PI . The mulrameters . CultivaSplits of the cultivars into groups on PCA diagrams induced the idea for calculation of mean values of fluorescence data points for each of plant group: those from polluted soil and those from reference one, in order to present the average values on logarithmic time scale. The fluorescence transient of plants grown on HM ion contaminated soil were lower than those of plants grown on the reference site. Points of inflection: J at 2.0 ms and I at 30 ms, important for the results interpretation, are visible there . Other pNormalization procedure at points O and J, and differentiation of results from polluted and reference soils, visualized the K-band, the most expressed with minus sign, for cv. Wiwena and the weakest for cultivars: Brudzynska (with the negative sign) and Rahela (with positive one) . Normalia fluorescence measurements were rainy and water availability did not limited the plant growth, opened the opportunity to interpret the differences in grasses performance as the response to HM. More sand in soil at reference site might negatively affect the plant growth and performance but mostly during the low precipitation periods. In March, April and May, three months prior to Chl a measurements, polluted and reference site received 107% and 91% of rainfall long term average (1971–2000), respectively, which periods are defined as to average precipitation periods in Poland −1 Cd, 304.5 mg·kg−1 Pb, and of 1677.5 mg·kg−1 Zn ; ii/growing plants which produce high biomass, despite lower ability of HM sequestration Many plant species has been already screened for their ability to accumulate HM. For this purpose two strategies have been tested: a/b ratio is also affected by Cd ions. Zinc and cobalt divalent cations have the ability to replace Mn+2 or Fe+2 in chloroplast proteins active centers, decreasing theirs functional activity Dynamics of HM ions absorption, transport and neutralization influence theirs toxicity. It was shown, that dose dependent relative cadmium toxicity is 4-fold higher than zinc and 3-fold higher than lead, for the onion epidermal cells used as a model. The way of HM inactivation affects theirs toxicity: HM ions can be stored in vacuoles, Cd ions can form the complexes with the cell wall polymers, Pb can be locked in endoplasmic reticulum vesicles a fluorescence reveals the disturbances. At the beginning, the fluorescence of dark-adapted leaf rises rapidly from the minimal level (O), typically recorded at 50 microsecond, to the maximum (marked as ‘M’ or ‘P’), usually appearing at about one second. Minimal fluorescence reflects the oxidized state of quinone QA, whereas the maximal one – the completely reduced state of the whole plastoquinone pool (PQ) Thus the HM impact on the plant interferes with photosynthesis and the measurement of Chl 2, F3, F4 and F5 at times: 0.15, 0.30, 2.0 and 30 ms responds to L, K, J, I points of inflections, on fluorescence transient curve. Usually under the stress conditions the fluorescence transient curve becomes flatter, i.e.: the FM decreases a fluorescence induction parameters  were found to be affected by HM concentration in different plant species M entails changes of the other F’s, which is well documented and as a consequence affects the values of calculated parameters Fluorescence values FFv/Fm measured on the reference area was slightly lower than respected for the healthy plants (0.83 vs. 0.79) and decreased upon reference side conditions (0.76). It indicated a decline of the maximum efficiency at which light absorbed by plants grown on the polluted soil is used for the reduction of QAv/Fm parameter, which can happen et al.M value (TFM), reduced plastoquinone pool size (Area) and the vitality index of PSII (PI) were more sensitive for action of the stress than commonly used parameters of maximal quantum yield of PSII: FV/FM and FV/FO.Our data distinguished cv. Rahela as the cultivar which reached the highest HM ions concentration in aerial parts and its photosynthesis was the most influenced by them. The maximum quantum yield of PSII photochemical reaction described by parameter M, FV, F1–F5, while the second on calculated parameters: RC/ABS, (1–Vj)/Vj and PI. Grouping of cultivars calculated on bases of 2 principal components which explained 85% of differentiation, gave logical results. Cultivars were grouped in sub-classes as “polluted” and “reference” ; high relative fluorescence means slowing of electron flow from the chlorophyll Reaction Centers (RC) of Photosystem II (PSII) as a result of lower activity of PS II Oxygen Evolving Complex (OEC) and slower water splitting a fluorescence is a good tool in phytoremediation studies.Chl a fluorescence as well as plant growth.The combined effects of elevated concentration of lead, cadmium and zinc in soil was manifested in alteration of some parameters of Chl Bromus inermis ‘Brudzynska’ and B. carinathus ‘Broma’.Heavy metal soil contamination resulted in biomass yield reduction of cultivars of Festuca arundinacea ‘Rahela’, may absorb relatively high amount of HM ions from the soil, without significant reduction of biomass yield, what is expected in the case of bioremediation practices. Mentioned cultivar could be regarded as a good species for the phytoextraction of Cd-contaminated soil.


Objective. Mallotus oppositifolius (Geiseler) Müll. Arg. (Euphorbiaceae) is folklorically used to “treat” diabetic conditions in some parts of Nigeria therefore the study, to investigate the extract of the leaves for activities on hyperglycaemia, lipid peroxidation, and increased cholesterol levels in vivo in alloxan diabetic rats as well as its potential antioxidant activity in vitro. Methods. Albino rats (240–280 g) were given an injection of 120 mg/kg body weight, i.p. of alloxan monohydrate. After 8 days, diabetic animals with elevated fasting blood glucose levels (>9 mmol/L) were considered and selected for the study. Results. Oral treatment with the extract administered every 12 h by gavage at doses of 100, 200, and 400 mg/kg of the extract to the test rats, for 14 days, resulted in a significant dose-dependent decrease in blood glucose levels from 12.82 ± 1.02 mmol/dL to 4.92 ± 2.01 mmol/dL at the highest dose of 400 mg/kg compared to the control drug and glibenclamide as well as attendant significant decline in diabetic rats employed in the study. Conclusion. The extract also showed in vitro concentration-dependent antioxidant activity following the 1,1-diphenyl-2-picryl-hydrazyl (DPPH) and ferric reducing assays. Findings further suggest the presence of active antidiabetic and antioxidant principles in M. oppositifolius leaves. Diabetes mellitus (DM) is a multifactorial syndrome resulting from a variable interaction of hereditary and environmental factors. It is characterized by inapt hyperglycaemia caused by damaged  factors , 2. DM a factors , NigeriaWith on-going researches in diabetes and oral hypoglycaemic agents (OHA), the management of DM is still a global problem. One important area in diabetes management receiving particular attention today is that of herbal hypoglycaemic agents. Several factors such as dyslipidemia or hyperlipidemia which are involved in the microvascular and macrovascular complications as well as hyperglycemia are associated with the diabetes disease which is the major cause of morbidity and death . There aMallotus oppositifolius (Geiseler) Müll. Arg. (Euphorbiaceae), locally known as “Ukpo,” is an edible plant to the South-Eastern part of Nigeria. The seed is a special soup thickener in the region. The leaves have ingredients of common antidysentery, antimalarial, and anti-inflammatory remedies [M. oppositifolius (MP) revealed the presence of secondary metabolites such as alkaloids, phenols, flavonoids, anthraquinones, and cardenolides [Mallotus japonicus. MP is also claimed to have antidiabetic activity by local healers in the South-East area of Nigeria. The present study was carried out to evaluate the antihyperglycemic, antioxidant, cholesterol lowering, and lipid peroxidation properties of MP in the rat model. remedies . Prelimienolides , 9. Iwu enolides  reportedM. oppositifolius leaves (MP) were obtained in May 2010 from the demonstration Botanical garden of the University of Nigeria, Nsukka, and authenticated by Mr. A. Ozioko, a Taxonomist with the Biodiversity Development Centre Program (BDCP), Nsukka. Voucher samples were deposited in the herbarium of the Department of Veterinary Physiology and Pharmacology, University of Nigeria, Nsukka, where the research was carried out for reference (UN/VPP-08216). The leaves were air dried on the bench, pulverized into coarse powder, and kept in polythene bags at room temperature (23–25°C), ready for extraction. Fresh The dried pulverized leaves (1500 g) were extracted with 80% methanol in water for 48 h with intermittent shaking every 2 h. The mixtures were filtered with Whatman number 1 filter paper. The filtrates were concentrated using a rotary evaporator at 38–40°C. The water was removed using a vacuum lyophilizer, yielding 35.1 g of brownish-green powder. The powder was resuspended in distilled water before use.ad libitum with standardized rat cubes (Argo). The rats were fasted overnight before experimentation but were allowed free access to water. Ethical guidelines in animal handling and use were strictly adhered to in the execution of the study.Male albino Wistar rats (240–280 g) procured from the Animal Farm of the Faculty of Veterinary Medicine, University of Nigeria, Nsukka, were used for the study. They were kept under the following conditions temperature (25–30°C), relative humidity (40–60%) and 12 h lighting cycle, and were fed Diabetes was induced by a single intraperitoneal injection of 120 mg/kg body weight of alloxan monohydrate  freshly dissolved in distilled water . After 8Thirty mature male albino rats were randomly divided into 5 groups . TreatmeAfter 14 days, being the end of the treatment period, the fasting blood glucose level of each rat was measured at 0, 1, 6, and 12 h by a snip-cut at the tip of the tail under mild anaesthesia with the aid of a glucometer (AccuChek Advantage II) as previously described . The ratTwo (2) gram weight of liver tissues were homogenised with 20 milliliters of phosphate buffered saline (PBS), using Sonic Dismembrator . The homogenised liver tissues were used to measure lipid peroxidation using malondialdehyde (MDA) levels as markers . Total cMallotus oppositifolius (MP) extract was estimated by the ferric reducing antioxidant power (FRAP) assay [The total antioxidant activity of the P) assay  and the P) assay . The proP ≤ 0.05.All data were analysed using SPSS version 15  and descriptive data were expressed as mean ± SEM. Differences between the groups were separated by post hoc LSD. Using one-way ANOVA, values were considered significant at Mallotus oppositifolius was brownish-green in colour. The yield of the extract was 2.34% w/w.The powder of the 80% methanol in water extract of P ≤ 0.05), in a dose-dependent manner   levels.  > 0.05) .P > 0.05).The total cholesterol levels of experimental animals treated with the methanol extract of MP leaves is presented in μg/mL), the extract exhibited a mean antioxidant activity of 38% while ascorbic acid produced 72.6% , the extract had 78.7% antioxidant activity compared to 80.0% with ascorbic acid at the same concentration.MP demonstrated appreciable antioxidant activity with DPPH radical scavenging method. At the lowest concentration  value was 0.3 μM. The value however increased significantly between 100 μg/mL and 400 μg/mL from 1.1 μM to 1.6 μM, respectively (μg/mL ascorbic acid (2.0 μM). All free radical scavenging assays were carried out in triplicates and the results shown in the figures represent a mean of the values obtained.The ferric reducing ability of plasma, a measure of the antioxidant ability, showed that MP produced a dose dependent antioxidant effect. At 10 ectively . The fraThe diabetes disease is snowballing very fast and huge amounts of resources are spent in almost all countries to combat this multifactorial metabolic disease.in vivo and in vitro, respectively.Alloxan, from the literature, has been shown to cause hyperglycaemia in laboratory animals due to increased oxidative stress by elaborated free radicals , thus a in vitro both in the DPPH and the ferric reducing assay. Diabetes which is associated with impaired glucose metabolism leads to oxidative stress which with an attendant protein glycation will produce free radicals [The results showed that MP significantly reduced the blood glucose and was found to possess significant antioxidant potentials radicals . The lipEarlier phytochemical studies on the MP indicates the presence of large amounts of bitter tasting secondary metabolites known as alkaloids, as well as some phenolics, flavonoids and quinines in the leaves than in the roots , 10. Revin vitro and in vivo, respectively.Reactive oxygen species (ROS) have been implicated in many pathologies such as heart diseases, cancers, arteriosclerosis, diabetes mellitus, and arthritis . Phenol S. gilo fruit have been linked with the improvement in the symptoms of diabetes mellitus; also those of Momordica charantia have been reported to improve the diabetes condition [Alkaloids of plant origin such as Solanine from ondition , 26. HenFurthermore, increased glycogenesis, glycolysis, decreased glycogenolysis, and reduced carbohydrate breakdown as well as potential reduction in glucose absorption are further proposed as possible mechanisms of antidiabetes activity with MP.M. oppositifolius. Also, close correlations between cholesterol levels in blood and the diabetes have been previously reported , 28. EleMallotus oppositifolius a probable plant for drug discoveries.The findings with MP extract in this study confirm its folkloric uses in the management of diabetes, thus making M. oppositifolius may suggest multiple mechanisms of action in the control of blood and cholesterol levels.Bioactive components of the leaf extracts of Further studies will be needed to isolate and purify the bioactive compound(s) in the extract for bioassay-guided experiments in a view to pin-point its mechanisms of antidiabetic action. MP poses as a potential for ground-breaking diabetes study.


Objective. Adiponectin is known to be decreased in insulin resistance (IR) and metabolic syndrome (MS) which can be present in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to evaluate the relationship between adiponectin level, MS, and insulin sensitivity in T1DM.Research Design and Methods. The study included 77 T1DM patients divided into two groups based on the total plasma adiponectin median value. Insulin sensitivity was calculated with the equation for eGDR, and MS was defined according to International Diabetes Federation criteria.Results. Patients with higher adiponectin level (n = 39) had significantly lower waist circumference (P < 0.002), fasting venous glucose levels (P < 0.001), higher HDL3-cholesterol (P = 0.011), and eGDR (P = 0.003) in comparison to the group with lower adiponectin who showed higher prevalence of MS (P = 0.045). eGDR increased for 1.09 mg/kg−1 min−1 by each increase of 1 µg/mL total fasting plasma adiponectin (P = 0.003). In the logistic regression model, adiponectin was inversely associated with the presence of MS (P = 0.014). Conclusion. Higher adiponectin concentration is associated with lower prevalence of MS in T1DM. Whether higher adiponectin concentration has a protective role in the development of the MS in T1DM needs to be clarified in future follow-up studies. It has been increasingly recognised as an important endocrine organ that secretes a number of biologically active “adipokines” like tumor necrosis factor-ponectin , 3. Accoponectin , 5. Addiponectin . MS reprponectin . Adiponeponectin . Consequponectin , 11, butponectin . In addiponectin , 13. TheThis cross-sectional study was undertaken at the University Clinic for Diabetes, Endocrinology, and Metabolic Diseases Vuk Vrhovac, Zagreb, Croatia. The study population consisted of 77 T1DM patients coming for their comprehensive annual review with following characteristics: age of 18–65 years, minimum duration of type 1 diabetes of 1 year, no medical history of cardiovascular diseases or electrocardiogram (ECG) evidence of ischemic heart disease, absence of any systemic disease, and absence of any infections in the previous month. T1DM was defined as age at onset of diabetes younger than 35 years, positive autoantibodies, and time to definite insulin therapy less than a year. Patients were excluded from the study if they had taken any of the following: thyroid hormone therapy, medications that might affect glucose metabolism and insulin sensitivity such as glucocorticoids, oral contraceptives, and patients taking oral glucose-lowering medication. They could be using antihypertensive or lipid lowering drugs . Acute and chronic inflammation was excluded on the basis of medical history, physical examination, and routine laboratory tests, including measurement of temperature and urinalysis.2). Blood pressure was measured in the sitting position with a mercury sphygmomanometer after a resting period of 10 minutes and expressed in mmHg. Fasting venous blood samples were collected for the determination of biochemistry panel, lipid profile status, HbA1c, liver biochemistry, and adiponectin. HbA1c was measured spectrophotometrically by turbidimetric immunoinhibition . Glucose, cholesterol, and triglycerides in serum were measured by an enzymatic colorimetric method. Total fasting adiponectin was measured using BioVendor's Human ELISA (sandwich) commercial kit for research use only. Insulin sensitivity was calculated using the equation derived from euglycemic-hyperinsulinemic clamp studies estimated glucose disposal rate (eGDR): 24.31 − 12.2X(WHR) − 3.29X(AHT) − 0.57X(HbA1c), where the units are mg/kg−1min−1, WHR indicates the waist to hip ratio, AHT indicates blood pressure and is expressed as 0—no, 1—yes. Those on blood pressure medications or with blood pressure >140/90 mmHg were considered to have hypertension [All subjects were studied in the morning between 08:00 am and 09:30 am after an overnight fast. Waist circumference was measured on bare skin as the narrowest circumference between the 10th rib and the iliac crest with tailor meter. Weight was measured by the physician using a balanced-beam scale with light clothing without shoes and expressed in kilograms (kg). Height was measured using a wall-mounted stadiometer and expressed in centimetres (cm). Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters  or nonparametric tests (Mann-Whitney). Correlations between parameters of adiponectin with anthropometric and metabolic variables were determined using Pearson's or Spearman's correlation coefficient. The association between total fasting adiponectin concentrations and eGDR value was further evaluated in univariate linear regression, and in order to evaluate the association of total fasting adiponectin concentration with MS presence, we constructed multivariable binary logistic regression models to assess whether circulating total adiponectin concentration was independently associated with MS. Adjustments were performed for age, gender, disease duration, and the use of statins since they are shown to affect adiponectin secretion [Baseline data were reported using descriptive statistics. Normality of distribution for continuous variables was analysed using Shapiro-Wilk test. Normally distributed variables were described with mean and standard deviation (SD), while variables that were not normally distributed were described with median, minimum, and maximum. The nominal variables were reported with absolute numbers and/or percentages. Differences between groups were examined, depending on the nature of the data, using parametric  were using antihypertensive therapy and 33 (42.9%) hypolipedemic medications. Patients were divided according to the median adiponectin value (14.1 (3.4–31.4) μg/mL). The group of patients (n = 38) with lower adiponectin concentrations (<14.1 μg/mL) had significantly shorter disease duration, higher weight, BMI, waist circumference, GGT, and fasting venous glucose levels , while lower HDL3-cholesterol and eGDR compared to the group (n = 39) with higher adiponectin concentrations (>14.1 μg/mL) (The characteristics of the study subjects are listed in 1 μg/mL) . No sign−1 min−1 by each increase of 1 μg/mL total plasma adiponectin (CI (1.03–1.16), P = 0.003). In the multivariate binary logistic regression, total fasting plasma adiponectin was inversely associated with presence of MS after adjustment for age, sex, disease duration, and the statin use .In linear regression model, the unadjusted eGDR increased for 1.09 mg/kgatin use . The othβ cells, increased IR has an important role in the development of so called “double diabetes” and greater risk for micro- and macrovascular complications [Although pathophysiology of T1DM is defined with an autoimmune destruction of pancreatic ications . MS and ications –21. The ications –7, 22. Our results show that patients with higher plasma adiponectin concentrations had significantly lower BMI and waist circumference and higher HDL 3 cholesterol. The levels of systolic blood pressure, fasting plasma glucose, and triglyceride were also lower although they did not reach statistical significance. Additionally, the group with higher plasma adiponectin showed higher eGDR levels indicating higher insulin sensitivity which is in accordance with Pereira et al. 2012)  who repo  who repAdiponectin has been shown to have insulin-sensitizing effects through activation of AMPK in the peripheral tissues . These eMoreover, our finding of lower LDL cholesterol and TG as well as higher total HDL, HDL2, and HDL3 cholesterol in the group with higher plasma adiponectin is in accordance with a growing body of literature data suggesting that adiponectin has a direct effect on the regulation of lipid metabolism. Decreased adiponectin concentrations have been linked to higher LDL cholesterol and TG concentrations probably due to adiponectin directly affecting lipoprotein lipase , 32. DatThere are several studies suggesting the inverse correlation of circulating adiponectin concentrations and elevated arterial blood pressure levels in healthy subjects as well as in diabetic population which is also in concordance with our results , 40. It γ-glutamyltransferase (GGT), and alkaline phosphatase (ALP). This is with accordance with the results of López-Bermejo et al. (2004) who reported that adiponectin concentrations were associated with plasma concentrations of various liver function tests in healthy humans suggesting that adiponectin deficiency is an important risk factor for the development of fatty liver, steatohepatitis, and other forms of liver injury [Additionally, in agreement with adiponectin modulating liver function previosly mentioned, we also found a negative correlation between plasma adiponectin concentrations and hepatic biomarkers, that is, aspartate aminotransferase (AST), alanine aminotransferase (ALT), r injury . The present study has a number of potential limitations. First, our study was cross-sectional, which limited our ability to infer a causal relation between adiponectin concentrations and development of MS in T1DM. Second, we measured insulin sensitivity using clinical parameters with eGDR and did not have access to direct, detailed measures of insulin resistance using euglycemic-hyperinsulinemic clamp test. Third, our analyses were based on a single measurement of total fasting adiponectin that may not reflect the relation over time.In conclusion, our results highlight the importance of the relationship between adiponectin, IR, and the presence of the MS in T1DM. Whether adiponectin is a marker of MS as well as all components of MS according to the IDF criteria in T1DM patients and whether higher adiponectin concentrations have a protective role in the development of the MS in T1DM need to be clarified in future follow-up studies.


Aboriginal populations living in Canada’s northern regions are exposed to a number of persistent organic pollutants through their traditional diet which includes substantial amounts of predator fish species. Exposure to dioxin-like compounds (DLCs) can cause a variety of toxic effects including adverse effects on bone tissue. This descriptive cross-sectional study was conducted to investigate the relationship between plasma concentrations of DLCs and bone quality parameters in Cree women of Eastern James Bay (Canada).. Several factors known to be associated with osteoporosis were documented by questionnaire. Multiple linear regression models were constructed for the three ultrasound parameters.Two hundred and forty-nine Cree women from seven communities in Eastern James Bay (Canada), aged 35 to 74 years old, participated in the study. In order to determine the total DLC concentration in plasma samples of participants, we measured the aryl hydrocarbon receptor-mediated transcriptional activity elicited by plasma sample extracts using a luciferase reporter gene assay. Plasma concentrations of mono-ortho-substituted dioxin-like polychlorinated biphenyls (DL-PCBs) 105, 118 and 156 were measured by gas chromatography–mass spectrometry. Bone quality parameters  were assessed by quantitative ultrasound at the right calcaneus with the Achilles InSight systemDL-PCBs 105 and 118 concentrations, but not the global DLC concentration, were inversely associated with the stiffness index, even after adjusting for several confounding factors. The stiffness index (log) decreased by −0.22% (p=0.0414) and −0.04% (p=0.0483) with an increase of one μg/L in plasma concentrations of DL-PCB 105 and DL-PCB 118, respectively. Other factors, including age, height, smoking status, menopausal status and the percentage of omega-6 polyunsaturated fatty acids (PUFAs) in erythrocyte membranes were negatively associated with one of the ultrasound parameters, while the percentage of omega-3 PUFAs in these membranes and levels of physical activity and education were positively associated with them.Our results show that an increase in plasma concentrations of DL-PCBs 105 and 118 was negatively associated with stiffness index, a measure of bone quality/strength, in women of this population. In addition to environmental contaminants, future studies should also consider PUFA intake as a factor influencing bone quality. Osteoporosis is “a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures” . It is aVery little information is available on bone mineral density (BMD), fracture risk and their determinants among Canada’s First Nations people. The only existing publications focus on Manitoba’s Aboriginal population -12. Retrp-dioxin (TCDD), which are lipophilic, resistant to biodegradation and therefore bioaccumulate and bioamplify in aquatic food chains, where Aboriginals obtain part of their diet [in vitro studies [Moreover, Aboriginal populations living in the northern regions of the globe are exposed to persistent organic pollutants through their traditional diet . These ieir diet . Yet the studies  and expe studies -19 show  studies -22.The objective of this study was to investigate the relationship between plasma concentrations of DLCs or certain dioxin-like mono-ortho-substituted PCBs  and calcaneal QUS parameters in Cree women of Eastern James Bay (Canada). Ultrasound bone measurement is a method used to assess bone strength that provides information that is complementary to BMD . Recent th parallel north, in the Eastern James Bay region of the province of Quebec (Canada). The objective of this study was to investigate the health of these Aboriginal populations and the risk factors affecting them [An environmental and health survey, entitled “Nituuchischaayihtitaau Aschii. Multi-community Environment- and Health Longitudinal Study in Eeyou Istchee”, was conducted from summer 2005 to summer 2009 in seven Cree communities located north of the 49ing them ,27.Participants, stratified by age  and gender, were selected using simple random sampling, without replacement, from the Beneficiary List in each community to create lists of potential participants to be contacted by recruiters. A weighting was attributed to each stratum to ensure that inferences could be drawn about the population. An initial list of subjects to be contacted was drawn up and all these people were contacted and asked to participate in the study. If they refused, a second list of participants was randomly created and recruitment continued in order to ensure the required number of subjects in each age group . Owing tEeyou Ayimuwin or English and administered by the research staff or interviewers  [All participants (aged 8 years and over) completed a series of questionnaires in raining) ,31. TheyAll women aged 35 to 74 years who participated in the clinical examination were eligible for the calcaneal ultrasound measurement. A total of 254 women had QUS parameters measured. The volume of plasma collected from 249 women was sufficient to allow testing for DLCs and DL-PCBs.In vitro accuracy was assessed by taking a number of repeated measurements with the manufacturer’s phantom: the mean coefficients of variation (CVs) recorded for the SOS parameter ranged from 0.05 to 0.12% depending on the community.Two QUS parameters were measured at the right calcaneus of Cree women using a portable Achilles Insight system : 1) speed of sound  and 2) broadband ultrasound attenuation  . The StiBody composition was measured using a bioelectric impedance analyzer . Weight, lean body mass and body fat (kg), height, sitting height, waist and hip circumference (cm) were measured by research nurses using standardized techniques.Plasma samples were tested for DLCs and DL-PCBs at INSPQ’s Toxicology Laboratory . The luciferase reporter gene cell assay described by Medehouenou et al.  was usedDL-PCBs  were measured by gas chromatography–mass spectrometry (GC-MS) as described extensively in the project reports ,35. For Concentrations of total lipids in plasma samples were calculated using Phillips et al.’s formula : Total .Levels of omega-3 and omega-6 PUFAs were measured in erythrocyte membranes by liquid gas chromatography with flame ionisation detection at the Centre de Recherche sur les Maladies Lipidiques, CHU de Québec as previously described . Omega-3Apolipoprotein B (Apo B) was measured by nephelometry using a BN ProSpec station . Control levels of 0.46 and 1.44 g/L for Apo B showed interassay CVs of 3.2% and 1.8% .Blood mercury levels (nmol/L) were measured by cold vapour atomic absorption spectrometry (Pharmacia) . CadmiumGlucose was measured by a hexokinase enzymatic assay employing the Roche Modular system. Interassay CVs were 1.6% and 1.4% for glucose at control values of 4.74 and 15.66 mmol/L respectively . Alpha-tQuestionnaires were used to collect information about participants’ socio-demographic characteristics , their lifestyle habits , their gynaecological history  and their personal fracture history (yes/no). Women were considered menopausal if they had had no menstrual periods for one year before recruitment. Sodium intake (≤ 2300 mg vs > 2300 mg/day) was compiled based on answers to the 24-hour dietary recall and data on the sodium content of foods .We consulted the medical records of participants to document causes of secondary osteoporosis (CSO: yes/no), namely the use of certain medications in the last year  or the diagnosis of diseases  that may contribute to bone loss .Physical activity (PA) was assessed using the short form of the International Physical Activity Questionnaire . A dichoOur database comprised 249 participants. DLC concentrations were below the LOD (30 pg TCDD-EQ/L) for 16 participants. In these cases, we imputed a value between 0 and the LOD selected by simple random sampling with replacement. Of the 44 participants from the first community visited, four had DL-PCB 105 concentrations below the LOD, while one participant had a concentration of DL-PCB 156 below the LOD (LOD = 0.02 μg/L). Plasma concentrations of DL-PCBs 105, 118 and 156 below the LOD (0.01 μg/L) were obtained in 45, 7 and 12 participants respectively among the 205 residents of the other six communities. In these cases, we imputed a value equal to LOD/2, that is, 0.01 μg/L for participants from the first community and 0.005 μg/L for participants from the other communities.Descriptive statistics  of the variables were generated for all participants.The association between DLCs or each DL-PCB and QUS parameters was examined by simple and multiple linear regressions. Box-Cox procedures were used to resolve problems encountered with the hypotheses of normality and/or homoscedasticity in the multiple regression models for the dependent variables SOS and SI, which were subsequently log-transformed. Pearson’s correlation coefficients were calculated between the QUS parameters and the main exposure variables. The confounding effect of different factors on the relation between DLCs or DL-PCBs and QUS parameters was investigated. Secondary independent variables were tested to determine whether or not they should be included in the initial multiple regression models. Only those with a p value ≤ 0.20  were included. Multicollinearity between the variables of the initial regression models was tested to ensure that variables were not redundant. To avoid multicollinearity caused by the introduction of highly intercorrelated variables in the same linear regression model, we proposed for each dependent variable  separate models that comprised only one of the main exposure variables . All potentially confounding variables were entered in the multiple regression model and those that did not change the value of β coefficient of the main exposure variable by more than 10% were removed one by one, starting with the variable that accounted for the least variation in the dependent variable. In the case of highly intercorrelated anthropometric variables, when one of these variables was not identified as a confounding factor, and therefore not retained in the final model, the initial model was rebuilt with the other variable.The final adjustment of the models was for the total plasma lipid concentration . We alsoThe project was approved by the Research Ethics Committees of Université Laval and McGill University, in partnership with McMaster University, and by the Research Committee of the Cree Board of Health and Social Services of James Bay. Participation in the study was voluntary and a consent form was signed by each participant. All information concerning the participants was kept strictly confidential.With the weighting applied, the sample of 249 women  could be extrapolated to a population of 2056 women .QUS parameters, plasma DLC and DL-PCB concentrations as well as selected characteristics of the Cree women are shown in Table 2), according to Health Canada criteria [2) and 77.3% were obese (BMI ≥ 30 kg/m2). Among Cree women, 9.0% had a height of less than 153 cm, which has been associated with osteoporosis [Most of the Cree women (96.9%) had a waist circumference ≥ 88 cm  ; the medcriteria , only 3.oporosis .The maximum blood lead level of 0.32 μmol/L noted in women from the Quebec City area was exceeded by 26.9% of Cree women , while 1With regard to blood mercury levels, 64.5% of Cree women exceeded the maximum blood mercury level of 16 nmol/L observed in women from the Quebec City area , whereasOnly 1.9% of participants exhibited a blood selenium concentration exceeding the maximum level (3.6 μmol/L) recorded in women from the Quebec City area  and 1.8%With respect to serum levels of vitamin D (25OHD), 2.3% of Cree women had a level considered as critical (< 27.5 nmol/L) ; 14.6% dFasting glucose levels were considered normal (< 6.1 mmol/L) in 56.0% of Cree women, while 44.0% had levels corresponding to hyperglycemia (≥ 6.1 mmol/L). For 26.7% of Cree women, glucose levels could correspond to type 2 diabetes (≥ 7.0 mmol/L) according to the Canadian Diabetes Association .Pearson’s r correlation coefficients revealed that QUS parameters were negatively and significantly correlated with DLCs, DL-PCBs and age, while the three DL-PCBs were positively and significantly correlated with one another and with age , are presented in Tables Several variables were identified as confounders of associations between exposure variables and QUS parameters. Some confounding factors were significantly associated with SOS (log): age , level of education , height , PA (DL-PCB 105 and DL-PCB 118 models), smoking status and menopausal status (DL-PCB 105 model) Table . In geneAge , level of education  and % of omega-6 PUFAs (DLC model) were significantly associated with BUA Table . In geneLastly, age , level of education  and % of omega-3 PUFAs (DL-PCB 118 model) were significantly associated with SI Table . In geneThis is the first population study to investigate the relationship between total DLC concentration measured with an AhR responsive reporter gene assay and bone quality parameters . In CreeThree studies have been conducted on the relation between DL-PCBs and QUS bone parameters, with quite controversial findings. In a group of Swedish men from the general population , Glynn et al.  reportedExploratory multivariate analyses conducted by Côté et al.  revealedHodgson et al.  found a In additional analyses, we performed logistic regression using medians for SI (91%), DL-PCB 105 (0.03 μg/L) and DL-PCB 118 (0.18 μg/L) as cut-off values between “low” and “high” categories. Statistically-significant odds ratios (OR) of 1.69 for low SI at high DL-PCB 105 exposure (95% CI: 1.34-2.13) and 1.36 for low SI at high DL-PCB 118 exposure (95% CI: 1.06-1.73) were obtained in models adjusted for all variables indicated in Table The geometric means (GMs) of plasma DL-PCB concentrations among Cree women were higher than those reported in the 2007–2009 Canadian Health Measures Survey for women aged 40 to 79 years and representative of the general Canadian population . HoweverExplanatory multivariate analyses revealed that several other factors were significantly associated with QUS parameters. Negative associations were found with age, height, smoking status, menopausal status and omega-6 PUFAs, whereas positive associations were noted with level of education, PA and % of omega-3 PUFAs.Omega-3 PUFAs measured as a % of total fatty acids in erythrocyte membrane phospholipids in Cree women were positively and significantly associated with SI, while the % of omega-6 PUFAs was negatively associated with the BUA parameter. As observed following additional analyses, the omega-3/omega-6 PUFA ratio was positively and significantly associated with BUA and SI (log). To our knowledge, associations between omega-3 and omega-6 PUFAs and calcaneal QUS parameters have not been reported previously. A high ratio of omega-6 to omega-3 PUFAs has been associated with low BMD , while aOur study has several strengths. Firstly, the representativeness of our population sample was assured by the recruitment strategy and the weighting scheme of the study, which took non-response and refusal to participate rates into account. Hence the findings can be generalized to the entire female Cree population aged 35 to 74 years living in Eastern James Bay communities. Secondly, we took into consideration a large number of potential confounding factors of the association between the main exposure variables  and QUS parameters. Several of these factors were investigated for the first time . Thirdly, measurement biases in the dependent variables or exposure variables are relatively unlikely. Data collection in the field  was performed by research nurses using standardized techniques. Completed questionnaires were reviewed by members of the research team to ensure that all the questions had been completely and properly answered ,31. IndiOur study has also certain limitations. Firstly, the main methodological limitation is its cross-sectional design, with exposure and the dependent variable measured at the same time (a single measurement for each subject), such that the temporal sequence of cause and effect cannot be determined. However, due to the fact that DLCs and DL-PCBs accumulate in the body with age, plasma concentrations in Cree women reflect their lifelong exposure. Secondly, the participation rate in the study varied largely between communities, which may suggest a selection bias. However, this bias is quantitatively unimportant, since it is unlikely that the characteristics of the subjects included in the study are different from those of all eligible persons. The lists of beneficiaries which were used to build the list of contact persons were completed as necessary with information from other local listings; moreover, the investigated communities are small and live in reserves, which facilitated the identification and location of their members. Regarding the non-response and refusal to participate in the study, it is unlikely that these subjects have different levels of plasma DL-PCBs congeners or QUS parameter values, compared with participants; the recruitment of participants was made for a survey of general health and not specifically for the purpose of our study. Thirdly, the number of participants with QUS measurements was relatively small, limiting our capacity to observe an association between DLC concentrations determined by the reported gene assay and QUS parameters, especially considering that this measure is relatively imprecise compared to analytical chemistry based data. Fourthly, while we took a maximum number of potential confounding factors into account given the size of our sample, a residual confounding effect cannot be ruled out. The determinants of bone strength are multigenic and multifactorial and other factors  not measured in our study could have decreased the residual variance in multiple regression models. Lastly, two variables that are known to influence bone quality could not be thoroughly assessed. The assessment of dietary calcium intake considered only milk consumption. Physical activity was evaluated using the short form of the IPAQ , an instWe observed negative associations between SI values and plasma concentrations of two dioxin-like PCB congeners in women from this Aboriginal population. Our study does not allow causal inference and residual confounding may still be present. Therefore, we do not believe that dietary recommendations to reduce PCB exposure are warranted at this time. In multivariate models, associations were also noted with dietary and lifestyle factors, suggesting avenues to improve bone quality in this population, such as smoking cessation and increases in omega-3 PUFA intake and physical activity.p-dioxin; UV: ultra violet; 25OHD: 25-hydroxyvitamin D.AhR: aryl hydrocarbon receptor; AM: arithmetic mean; Apo B: Apolipoprotein B; BMD: bone mineral density; BMI: body mass index; DL-PCB: dioxin-like polychlorinated biphenyl; BUA: broadband ultrasound attenuation; CHUM: Centre Hospitalier de l’Université de Montréal; CHU de Québec: Centre Hospitalier Universitaire de Québec; 95% CI: 95% confidence interval; CSO: causes of secondary osteoporosis; CV: coefficient of variation; dB/MHz: decibels per microhertz; DLCs: dioxin-like compounds; DL-PCBs: dioxin-like polychlorinated biphenyls; DXA: dual-energy x-ray absorptiometry; GC-MS: gas chromatography–mass spectrometry; GM: geometric mean; g/L: grams per litre; HRT: hormone replacement therapy; ICP-MS: inductively coupled plasma mass spectrometry; INSPQ: Institut National de Santé Publique de Québec; MET: metabolic equivalent; m/s: metres per second; μg/L: micrograms per litre; μmol/L: micromoles per litre; mmol/L: millimoles per litre; nmol/L: nanomoles per litre; NR: not retained; LOD: limit of detection; OR: odds ratio; PUFA: polyunsaturated fatty acid; PA: physical activity; %: percentage; pg TCDD-EQ/L: picograms TCDD-equivalents per litre; QC: quality control; QUS: Quantitative UltraSonography; RR: relative risk; SOS: speed of sound; SRM: standard reference material; SI: Stiffness Index; TCDD: 2,3,7,8-tetrachlorodibenzo-The authors declare that they have no competing interests.ED, PA, SD and EN conceived the study design. ACP participated to data collection, performed the statistical analysis, interpreted the data, and drafted the manuscript. PA interpreted the data and helped draft the manuscript. All authors revised the manuscript critically. All authors approved the final version.Multivariate analysis: SOS (log) models (II).Click here for fileMultivariate analysis: BUA models (II).Click here for fileMultivariate analysis: SI (log) models (II).Click here for fileOther characteristics of participants.Click here for filePearson’s correlation coefficients between age, plasma concentrations of DLC and DL-PCBs, and QUS parameters in Cree women.Click here for file