Background/Objectives: Bone turnover markers (BTMs) can provide information on the bone growth of apparently healthy children and adolescents or useful results in the diagnosis and monitoring of the disease condition, comparing them with appropriate reference intervals (RIs). The aim of this study was to establish the RI for the BTM [specific bone alkaline phosphatase (BALP), carboxy-terminal cross-linked collagen type I telopeptide (CTX), N-terminal propeptide pro-collagen type I (PINP), osteocalcin (OC), resistant to acid tartrate phosphatase isoform 5b (TRAcP-5b)] on serum samples from children and adolescents. Method: 202 samples from children and adolescents (ages 1–18 years) (51.48% male), considered apparently healthy. The biomarker was analyzed on automatic immunometric equipment (TGSTA Technogenetics) and the IDS-iSYS automated system kits The RI of the studied parameters was calculated according to CLSI Guideline C28-A3 with stratification by age and sex. Evaluation of the distribution of values and the meaning of the biomarker concentrations were used to calculate general and specific RI for an age group. Results: BTM concentrations vary with pubertal growth. The pattern of change differs for each bone marker. General and age-specific RI were calculated: 1–14 years, 15–18 years for BALP and CTX; 1–13 years, 14–18 years for Oc and PINP and 1–12 years, 13–18 years for TRAcP. Discussion and Conclusions: Concentrations for biomarker studied vary with age and gender. The proof of concentrations with insignificant changes until puberty led to identification of two groups of RI relating to the covariables (age and sex) for each biomarker.

The purpose of the present study was to evaluate the concentrations of some bone turnover markers in preterm neonates with uncomplicated clinical course in the first month of life. Samples from 13 preterm neonates were collected at three different times: at birth (T0) from umbilical cord blood (UCB); and at 15 (T1) and 30 (T2) days of life from peripheral blood (PB). The concentrations of calcium (Ca), phosphate (P), total alkaline phosphatase (ALP), Collagen Type 1 Amino-terminal Propeptide (PINP), osteocalcin (OC), Collagen Type 1 Carboxyl-Terminal Telopeptide (CTX) and Leptin were assessed. A statistically significant difference for ALP concentration at birth versus T1 and T2 was found. An evident increase in the median concentrations of CTX, OC and PINP from T0 to T2 were observed. A significant difference was also found for Leptin concentration at T0 compared to T1. In preterm infants, in the absence of acute or chronic medical conditions and without risk factors for metabolic bone disease (MBD) of prematurity, there is a significant increase in bone turnover markers during the first month of life. The knowledge of the variations in these markers in the first weeks of life, integrated by the variations in the biochemical indicators of bone metabolism, could help in recognizing any conditions at risk of developing bone diseases.

Background and Objectives: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Blood cultures (BCs) remain the gold standard for diagnosing bloodstream infections, yet their positivity rate is limited and culture-negative sepsis remains poorly characterized. This study aimed to identify clinical and laboratory predictors of BC positivity in patients with suspected sepsis and to evaluate the prognostic implications of BC results on 28-, 90-, and 365-day survival. Materials and Methods: We retrospectively analyzed adult patients admitted to the Emergency Department of Policlinico di Bari (March 2023–December 2025) with sepsis or septic shock (Sepsis-3 criteria). After excluding contaminated cultures, 912 patients were included (602 culture-positive; 310 culture-negative) with a 1-year follow up. Predictors of BC positivity were assessed using logistic regression and ROC analysis; survival was evaluated with Kaplan–Meier curves and Cox models adjusted for age and Sequential Organ Failure Assessment (SOFA) score. We also evaluated time-to-positivity (TTP) for all blood culture isolates. Results: Culture-positive patients presented with greater initial severity, including higher rates of septic shock, elevated procalcitonin, CRP, lactate, and SOFA scores, and more frequent thrombocytopenia. Procalcitonin showed good discriminatory ability (AUC (area under the ROC curve) 0.785; cutoff 0.85 ng/mL; sensitivity 59.8%; specificity 83.8%). Key laboratory thresholds included a procalcitonin cutoff of 0.85 ng/mL, while CRP and platelet count did not show meaningful discriminatory cutoffs beyond their significant differences between culture-positive and culture-negative patients. Survival was consistently lower in culture-positive patients at 28 days (72.9% vs. 85.9%), 90 days (57.5% vs. 71.8%), and 365 days (44.3% vs. 61.2%). However, in adjusted Cox regression, BC positivity was not independently associated with 1-year mortality (HR 1.46; p = 0.092), whereas age and SOFA score remained significant predictors. Conclusions: Blood culture positivity identifies patients with greater initial severity, explaining their poorer unadjusted survival. However, culture positivity itself is not an independent predictor of long-term mortality, as age and organ dysfunction remain the main determinants of outcome. Procalcitonin showed solid discriminatory ability for true bacteremia.

Background: It is estimated that most patients with severe sepsis are admitted through the emergency department. Early identification and subsequent early appropriate therapy remain cornerstones of sepsis management. Early recognition of sepsis in the emergency department (ED) is crucial. The National Early Warning Score 2 (NEWS2) has shown limitations in prognostic accuracy. We aimed to develop and evaluate a prognostic model combining NEWS2 with triage data to predict 28- and 90-day mortality in adult patients with bacterial sepsis. Methods: We conducted a retrospective cohort study of 557 patients admitted to the ED with suspected bacterial infection between March 2017 and September 2019. Candidate predictors included triage variables (vital signs, comorbidities, blood gas data) and clinical scores (NEWS2, SOFA, qSOFA, APACHE2, and SIRS). Outcomes were 28- and 90-day mortality. Logit analysis was used to develop prognostic models, with assessment of discrimination and calibration. Results: Overall mortality was 24.6% at 28 days and 36.4% at 90 days. Models combining NEWS2, age, and lactates outperformed NEWS2 alone (28-day: 73.8% vs. 69%; 90-day: 71.6% vs. 67%). Including terminal status further improved accuracy. Finally, this paper proposes new criteria for the early identification of patients with sepsis in triage, with positive outcomes. Conclusions: Combining NEWS2 with age and lactates enhances prognostic accuracy at triage. This model may inform improved sepsis management.

Background/Objectives: Orthodontic treatment with a Rapid Maxillary Expander (RME) induces stress on the mid-palatal suture and involves the surrounding craniofacial sutures, leading to significant variations in bone turnover markers (BTMs). The aim of this study was to evaluate whether monitoring biomarkers of bone resorption and deposition in saliva could provide indications for assessing RME treatment effectiveness in pediatric patients. Materials and Methods: The study was conducted at the Dental Clinic of Foggia in collaboration with the Clinical Pathology Unit of the Policlinico-Bari from January 2023 to September 2025. Salivary samples were collected using cotton swabs (SALIVETTE^®, SARSTEDT, Nümbrecht-Elsenroth, Germany) from 47 patients (aged 9–13 years) presenting with Class I dental and skeletal relationships and transverse maxillary deficiency. Samples were collected at five time points: before RME application (t0), and 15 (t1), 30 (t2), 45 (t3), and 60 (t4) days after the start of expansion. For pairwise comparisons of concentrations at different time points the Wilcoxon signed-rank test was used. Analysis of Variance (ANOVA) and Ordinary Least Squares (OLS) multiple regression were used to analyze the relationships between different biomarker concentrations over time. Spearman correlation was used to assess relationships between BTM concentrations at the different time points. Results: The Wilcoxon test showed that the medians of the differences for P1NP measurements were statistically significant at all time points, except between t0 and t1. Differences in PTHrP concentrations were significant, except for the comparison of t2 and t3 relative to t4. No statistically significant differences were observed for TRAcP across any measurement times. ANOVA yielded a high F-value for P1NP (F = 3.6128; p = 0.0128), indicating significant variation, whereas the F-ratios for PTHrP (F = 1.3329; p = 0.2736) and TRAcP (F = 1.3915; p = 0.2534) were close to 1, suggesting non-significant variability. Spearman correlation indicated that P1NP showed the strongest relationships with temporal variables. Discussion and Conclusions: Rapid maxillary expansion results in a significant increase in P1NP levels, reflecting collagen deposition and the onset of bone formation. This preliminary study on saliva highlights how biochemical changes can support clinicians in monitoring and validating the effectiveness of treatment.

Background: Sepsis is a complex, heterogeneous syndrome involving dysregulated inflammatory, haematopoietic, and coagulation pathways that collectively drive organ dysfunction. Evaluating a multi-pathway biomarker panel may provide a more comprehensive characterization of clinical severity. Methods: This retrospective, single-centre study included 228 adult patients with suspected sepsis evaluated at emergency department admission and categorized by SOFA score into High Risk (HR, SOFA ≥ 13; n = 78), Severe Risk (SR, SOFA 10–12; n = 52), Moderate Risk (MR, SOFA 7–9; n = 58), and Low Risk (LR, SOFA 0–6; n = 40). We assessed procalcitonin (PCT), presepsin (P-SEP), C-reactive protein (CRP), white blood cell count (WBC), immature granulocyte (IG%), platelet count (PLT), immature platelet fractions (IPF%, IPF#), and D-dimer (DD). Results: Blood cultures were positive in 65.4% of patients. PLT count and DD demonstrated the highest discriminative performance for distinguishing combined HR + SR from MR + LR groups, with areas under the ROC curve (AUCs) of 0.902 and 0.894, respectively. Among inflammatory markers, PCT achieved the highest AUC (0.835), followed by P-SEP (0.793) and CRP (0.726). WBC showed limited discrimination (0.582); immature lineage markers showed higher numerical discrimination, with both IG% and relative IPF% achieving AUCs of 0.796. Conclusions: Relative IPF% increased in parallel with severe thrombocytopenia in higher-SOFA groups, a pattern compatible with compensatory thrombopoietic activity, whereas absolute IPF# declined in HR cases. These findings highlight distinct multi-organ biomarker profiles across severity states and support an integrated biomarker framework, a multi-pathway approach incorporating bone marrow kinetics and coagulation markers to refine early severity characterization in emergency settings.