Neutron Skin Effects in Mirror Energy Differences: The Case of ^{23}Mg-^{23}Na

Energy differences between analogue states in the T=1/2 ^{23}Mg-^{23}Na mirror nuclei have been measured along the rotational yrast bands. This allows us to search for effects arising from isospin-symmetry-breaking interactions (ISB) and/or shape changes. Data are interpreted in the shell model framework following the method successfully applied to nuclei in the f_{7/2} shell. It is shown that the introduction of a schematic ISB interaction of the same type of that used in the f_{7/2} shell is needed to reproduce the data. An alternative novel description, applied here for the first time, relies on the use of an effective interaction deduced from a realistic charge-dependent chiral nucleon-nucleon potential. This analysis provides two important results: (i) The mirror energy differences give direct insight into the nuclear skin; (ii) the skin changes along the rotational bands are strongly correlated with the difference between the neutron and proton occupations of the s_{1/2} "halo" orbit.

Defining and Measuring a Standard Set of Patient-Relevant Outcomes in Coronary Artery Disease

Systematic outcome measurement enables to continuously improve treatment results and stimulates dissemination of best practices. For patients with coronary artery disease, no examples yet exist of standard sets of patient-relevant outcome measures that have already been fully implemented at a large scale in clinical care. The aim of this paper is twofold: (1) to share the standard set of outcome measures as developed by Meetbaar Beter, and (2) to show how the standard set is presented and published to support improvement of cardiac care. A step-wise approach was followed by an expert panel to construct a standard set of outcome measures. This resulted in a comprehensive set of relevant outcome measures, comprising 4 generic and 11 treatment-specific outcomes. Both short-term and long-term outcomes measures up to 5 years of follow-up were included. Relevant initial conditions were selected to enable case-mix adjustment. The standard set has been implemented in 21 hospitals across the Netherlands. The results and experiences have been used to fine-tune the set in 4 reporting cycles in 2012 to 2016, using an annual maintenance cycle. Currently about 83,000 percutaneous coronary interventions and 30,000 coronary artery bypass graftings are included in the dataset, covering the majority of all percutaneous coronary interventions and coronary artery bypass graftings in the Netherlands. In conclusion, Meetbaar Beter has defined and implemented a comprehensive set of patient-relevant outcome measures for coronary artery disease, and the variation of the results among the centers indicates that there are sufficient opportunities to further improve cardiac care in the Netherlands.

First Measurement of the g Factor in the Chiral Band: The Case of the ^{128}Cs Isomeric State

The g factor of the 56 ns half-life isomeric state in ^{128}Cs has been measured using the time-differential perturbed angular distribution method. This state is the bandhead of the positive-parity chiral rotational band, which emerges when an unpaired proton, an unpaired neutron hole, and an even-even core are coupled such that their angular momentum vectors are aplanar (chiral configuration). g-factor measurements can give important information on the relative orientation of the three angular momentum vectors. The measured g factor g=+0.59(1) shows that there is an important contribution of the core rotation in the total angular momentum of the isomeric state. Moreover, a quantitative theoretical analysis supports the conclusion that the three angular momentum vectors lie almost in one plane, which suggests that the chiral configuration in ^{128}Cs demonstrated in previous works by characteristic patterns of electromagnetic transitions appears only above some value of the total nuclear spin.

Ghrelin and NUCB2/Nesfatin-1 expression in unilateral testicular torsion-induced rats with and without N-acetylcysteine

Testicular torsion (TT) is a common urological problem in the field of pediatric surgery. The degree and duration of torsion determines the degree of testicular damage; however, its effects on the expression of octanoylated ghrelin and nucleobindin 2 (NUCB2) /nesfatin-1 synthetized from testicular tissue remain unclear. We explored the effects of experimentally induced unilateral TT on serum and contralateral testicular tissue ghrelin and NUCB2/nesfatin-1 levels, and determined whether N-acetyl cysteine (NAS) treatment had any effects on their expression. A total of 42 Wistar Albino strain rats were divided into 7 groups: Group (G) I control, GII sham, GIII 12-hour torsion, GIV 12-hour torsion + detorsion + 100 mg/kg NAS, GV 24-hour torsion, GVI 24-hour torsion + detorsion + 100 mg/kg NAS, and GVII 100 mg/kg NAS. Octanoylated ghrelin and NUCB2/nesfatin-1 concentrations were evaluated in serum using the ELISA method and in testicular tissue with immunohistochemical methods. Immunoreactivity of octanoylated ghrelin significantly increased in GI compared to GIII, GV, and GVI (p<0.05). NUCB2/nesfatin-1 immunoreactivity increased in GV and GVIII relative to GI (p<0.05). In the 12-hour torsion group, a significant decrease in octanoylated ghrelin levels with NAS treatment was observed; however, in the 24-hour torsion group, a significant decrease was not observed. In the 12-hour torsion + NAS treatment group, a significant change was not observed in NUCB2/nesfatin-1 expression. Following 24-hour torsion, an increase in NUCB2/nesfatin-1 levels was observed, and NAS treatment did not reverse this increase. It was determined that increases in the expression of octanoylated ghrelin and NUCB2/nesfatin-1, the latter of which was a result of TT, reflect damage in this tissue. Importantly, NAS treatment could prevent this damage. Thus, there may be a clinical application for the combined use of NAS and octanoylated ghrelin in preventing TT-related infertility.

The Unyvero P55 'sample-in, answer-out' pneumonia assay: A performance evaluation

Background

O’Neill’s recent Review on Antimicrobial Resistance expressed the view that by 2020 high-income countries should make it mandatory to support antimicrobial prescribing with rapid diagnostic evidence whenever possible.

Methods

Routine microbiology diagnosis of 95 respiratory specimens from patients with severe infection were compared with those generated by the Unyvero P55 test, which detects 20 pathogens and 19 antimicrobial resistance markers. Supplementary molecular testing for antimicrobial resistance genes, comprehensive culture methodology and 16S rRNA sequencing were performed.

Results

Unyvero P55 produced 85 valid results, 67% of which were concordant with those from the routine laboratory. Unyvero P55 identified more potential pathogens per specimen than routine culture (1.34 vs. 0.47 per specimen). Independent verification using 16S rRNA sequencing and culture (n = 10) corroborated 58% of additional detections compared to routine microbiology. Overall the average sensitivity for organism detection by Unyvero P55 was 88.8% and specificity was 94.9%. While Unyvero P55 detected more antimicrobial resistance markers than routine culture, some instances of phenotypic resistance were missed.

Conclusions

The Unyvero P55 is a rapid pathogen detection test for lower respiratory specimens, which identifies a larger number of pathogens than routine microbiology. The clinical significance of these additional organisms is yet to be determined. Further studies are required to determine the effect of the test in practise on antimicrobial prescribing and patient outcomes.

Multifaceted Quadruplet of Low-Lying Spin-Zero States in ^{66}Ni: Emergence of Shape Isomerism in Light Nuclei

A search for shape isomers in the ^{66}Ni nucleus was performed, following old suggestions of various mean-field models and recent ones, based on state-of-the-art Monte Carlo shell model (MCSM), all considering ^{66}Ni as the lightest nuclear system with shape isomerism. By employing the two-neutron transfer reaction induced by an ^{18}O beam on a ^{64}Ni target, at the sub-Coulomb barrier energy of 39 MeV, all three lowest-excited 0^{+} states in ^{66}Ni were populated and their γ decay was observed by γ-coincidence technique. The 0^{+} states lifetimes were assessed with the plunger method, yielding for the 0_{2}^{+}, 0_{3}^{+}, and 0_{4}^{+} decay to the 2_{1}^{+} state the B(E2) values of 4.3, 0.1, and 0.2 Weisskopf units (W.u.), respectively. MCSM calculations correctly predict the existence of all three excited 0^{+} states, pointing to the oblate, spherical, and prolate nature of the consecutive excitations. In addition, they account for the hindrance of the E2 decay from the prolate 0_{4}^{+} to the spherical 2_{1}^{+} state, although overestimating its value. This result makes ^{66}Ni a unique nuclear system, apart from ^{236,238}U, in which a retarded γ transition from a 0^{+} deformed state to a spherical configuration is observed, resembling a shape-isomerlike behavior.

Detection of metabolite changes in response to a varying visual stimulation paradigm using short-TE 1 H MRS at 7 T

The two-fold benefit of ¹ H magnetic resonance spectroscopy (MRS) at high B₀ fields - enhanced sensitivity and increased spectral dispersion - has been used previously to study dynamic changes in metabolite concentrations in the human brain in response to visual stimulation. In these studies, a strong visual on/off stimulus was combined with MRS data acquisition in a voxel location in the occipital cortex determined by an initial functional magnetic resonance imaging experiment. However, 1) to exclude the possibility of systemic effects (heartbeat, blood flow, etc.), which tend to be different for on/off conditions, a modified stimulation condition not affecting the target voxel needs to be employed, and 2) to assess important neurotransmitters of low concentration, in particular γ-aminobutyric acid (GABA), it may be advantageous to analyze steady-state, rather than dynamic, conditions. Thus, the aim of this study was to use short-TE ¹ H MRS methodology at 7 T to detect differences in steady-state metabolite levels in response to a varying stimulation paradigm in the human visual cortex. The two different stimulation conditions were termed voxel and control activation. Localized MR spectra were acquired using the SPECIAL (spin-echo full-intensity acquired localized) sequence. Data were analyzed using LCModel. Fifteen individual metabolites were reliably quantified. On comparison of steady-state concentrations for voxel versus control activation, a decrease in GABA of 0.05 mmol/L (5%) and an increase in lactate of 0.04 mmol/L (7%) were found to be the only significant effects. The observed reduction in GABA can be interpreted as reduced neuronal inhibition during voxel activation, whereas the increase in lactate hints at an intensification of anaerobic glycolysis. Differences from previous studies, notably the absence of any changes in glutamate, are attributed to the modified experimental conditions. This study demonstrates that the use of advanced ¹ H MRS methodology at 7 T allows the detection of subtle changes in metabolite concentrations involved in neuronal activation and inhibition.

Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with restless legs syndrome

OBJECTIVE

The aim of this study was to assess the predisposition for atherosclerosis in patients with RLS through serum sLOX-1 (serum Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1) measurements.

BACKGROUND

Recent epidemiological studies have suggested an association of RLS with certain chronic conditions such as diabetes mellitus (DM), obesity, hypertension (HT), and hyperlipidemia. LOX-1 is expressed in endothelial cells, macrophages, and in smooth muscle cells under the effect of proatherogenic conditions.

METHODS

This study was a prospective, cross-sectional, case-controlled. We measured the serum sLOX-1 levels in 37 restless legs syndrome patients and 38 controls.

RESULTS

Serum sLOX-1 level was significantly lower in the patient group. The two groups were similar in glucose, HbA1c, creatinine, LDL cholesterol, TG, HDL, total protein, albumin, AST, ALT, GGT, ALP, HGB, HCT, MCV, transferrin saturation rate (TSR), ferritin, CRP, TSH, FT4, FT3, B12, and folic acid levels. Also the two groups were similar with respect to age at menarche, number of previous births, number of abortions and/or curettage, total duration of breastfeeding, percentage of patients in menopause, and age at menopause.

CONCLUSION

Our results may suggest a lower atherosclerotic risk among RLS patients as compared to the general population (Tab. 3, Ref. 33).

1,138 women with adnexal mass: pathologic findings according to age

Purpose ofinvestigation: Influence of the patients' age are not well established to predict the malignancy potential of adnexal masses. This study was conducted to evaluate the impact of women's age on both histopathology and malignancy potential of adnexal masses.

MATERIALS AND METHODS

This is a retrospective chart review study. Patients who were operated for suspected adnexal masses were included in the study. Malignancy potentials of tumors were divided in benign and at least borderline in univariate and multivariate analyses. Univariate analyses and RR calculations were performed according to malignancy potential for age, serum cancer antigen-125 (CA-125) levels and menopause status.

RESULTS

A total of 1,138 women were included for this study; median age was 39 (16-92) years. Patients > 50 years had 5.920 times higher risk (95% CI 4.091-8.566; p = 0.0001) of having at least borderline tumor compared the younger group. The risk of at least borderline pathology was calculated as 3.723 (95% CI 2.595-5.342;p = 0.0001) in patients with CA 125 ≥ 35 IU/ml compared to the others. In multivariate analyses, only ≥ 35 IU/ml CA 125 level and > 50 years age groups were defined as independent variables for having at least borderline tumor. (OR: 4.456, 95% CI 2.982-6.659, p = 0.0001 and OR: 3.134, 95% CI 1.435-6.843, p = 0.004, respectively).

CONCLUSION

In this study; the age of > 50 years was detected as an independent factor for having at least borderline pathology for adnexal masses. The data from these results might be used as a differential diagnostic tool in a new combination for benign and malignant adnexal masses in future studies.

Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup

OBJECTIVES

To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands.

BACKGROUND

Controversy remains about the safety and efficacy of PPCI in off-site PCI centres.

METHODS

We retrospectively analysed clinical and procedural data as well as 6‑month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven.

RESULTS

PPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4 % VieCuri vs. 12.3 % Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9 %) patients in the VieCuri group and 9 (8.1 %) in the Catharina Hospital group had a major adverse cardiac event.

CONCLUSION

Performing PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.

Irisin immunostaining characteristics of breast and ovarian cancer cells

To determine expression pattern of irisin in tissues obtained from human ovarian cancer, breast cancer, and cervix cancer. Tissue samples obtained from subjects with breast cancer, ovarian cancer cervix cancer, simple endometrial hyperplasia, complex atypical endometrial hyperplasia. At least five sections from each subject were immunohistochemically stained with irisin antibody, and H-score method was used to evaluate irisin intensity. Tissues obtained from healthy breast tissues, proliferative phase endometrium adenomyosis and benign ovarian tumors were accepted as control. Irisin activity was not detected in control breast tissues significantly increased irisin staining was detected in invasive lobular, intraductal papillary, invasive ductal, invasive papillary, and mucinous carcinomas compared to control tissues. Also, significantly increased irisin immunoreactivity was detected in both ovarian endometriosis and mucinous carcinomas compared to benign tumors. However irisin staining was not observed at the papillary carcinoma of the ovary while sections obtained from simple and complex atypical endometrial hyperplasia, and cervix carcinoma demonstrated irisin immunoreactivity. Increased irisin immunoreactivity in tissues obtained from breast, ovary, cervix carcinomas, and endometrial hyperplasia suggest critical role of this peptide during carcinogenesis.

Predictors of unstable distal radius fractures: a systematic review and meta-analysis

The aim of this study was to perform a systematic review in order to identify predictors of secondary displacement in distal radius fractures. We performed a systematic review and identified all studies that reported secondary displacement following distal radius fractures. Where possible, we pooled the odds ratios of predictors. The initial search yielded 3178 studies of which 27 were included. Multiple studies found that age, shortening, volar comminution, loss of radial inclination, the presence of a volar hook, AO type 3 fractures (A3, B3, C3) and the Older classification were significant predictors of secondary displacement. Pooling revealed a significantly increased risk of secondary displacement in fractures with dorsal comminution, in women and in patients aged >60 years. An associated ulna fracture or intra-articular involvement does not result in an increased risk of secondary displacement. The overview provided in this study can help surgeons to inform patients of the chances of success of closed treatment regarding the radiological outcome and facilitate shared decision making.

LEVEL OF EVIDENCE

II.

Serum and follicular fluid irisin levels in poor and high responder women undergoing IVF/ICSI

OBJECTIVE

We examined the follicular fluid (FF) and serum levels of irisin in high and poor responders undergoing IVF/ICSI to test whether irisin has a role in the metabolic regulation of energy homeostasis in growing follicle.

PATIENTS AND METHODS

Twenty infertile women with PCOS and 20 poor responder participants undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol for IVF/ICSI treatment were allocated. Blood was obtained at the time of oocyte retrieval. The follicular fluid content of mature follicles was collected from both high and poor responder women. Irisin levels were measured by using EIA.

RESULTS

There was no significant difference between serum and FF-irisin levels in women with PCOS. (11.18 ± 5.14 µg/mL vs. 11.06 ± 4.93 µg/mL, p < 0.96). In contrast, serum levels of irisin in poor responders were significantly higher than in the FF-irisin levels (13.13 ± 4.27 µg/mL vs. 10.09 ± 4.14 µg/mL, p < 0.01). FF-irisin levels of PCOS subjects were positively and significantly correlated with serum levels of irisin (r: 0.81, p < 0.00). Serum irisin was positively associated with serum levels of total testosterone but was negatively associated with HOMA-IR in the overall patient population. FF-irisin levels were also noted to be negatively correlated with HOMA-IR. Although there is no correlation between serum irisin and AMH levels, FF irisin levels were negatively correlated with serum AMH levels in PCOS subjects. Contrary to PCOS group there were no significant correlation between serum and FF-irisin levels in poor responder group (r: 0.21; p < 0.35).

CONCLUSIONS

The present study is the first attempt to explore the role of irisin in oocyte development by measuring FF and serum levels of this molecules in patients with poor and high responders undergoing IVF/ICSI.

The early pregnancy volume measurements in predicting pregnancy outcome

OBJECTIVE

The authors' aim was to develop a logistic regression model based on the ultrasonographic parameters on maternities which are showing a healthy improvement process during the first trimester of pregnancy.

MATERIAL AND METHODS

Using 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS), and gestational sac (GS) diameters were recorded in 225 women with gestational age < 11 weeks. Simplified V = 0.523 x length x height x width formula was used for the volume calculations. The results which ended in abortion were not included in the study.

RESULTS

Linear regression analyses between yolk sac volume (YSV), YSV = 0.026 + 0.0018 x CRL (r²: 0.15; p < 0.001), gestational sac volume (GSV), GSV= -9.6 + 1.7 x CRL (r²: 0.52; p < 0.001), and embryo volume (EV), EV = -1.64 + 0.18 x CRL (r²: 0.4; p < 0.001), and CRL was made and a linear relationship was detected. The volume measurements showed a meaningful correlation with the week of pregnancy. The space in the GS (GS volume-embryo volume) increased as the age of pregnancy became older (r² = 0.46; p < 0.001).

DISCUSSION

The first volume value was made in the first trimester by transvaginal ultrasonography, which showed a correlation with the age of pregnancy.

Is there a correlation between the pineal gland calcification and migraine?

OBJECTIVE

The pineal gland calcifications have been associated with some diseases such as cerebral infarction, Alzheimer's disease and intracerebral hemorrhage while most cases are considered idiopathic and physiologic. However, there are limited data in the current literature about the association of pineal calcification and migraine. Our aim was to evaluate this association between migraine and pineal calcification by computed tomography of the brain.

PATIENTS AND METHODS

In our study, we assessed the computed tomography images of patients, who referred to the neurology outpatient clinic with the complaint of headache and were diagnosed with migraine without aura based according to 2004 criteria of the International Headache Society. 503 migraine patients and 500 control subjects without migraine diagnosis were included in this study.

RESULTS

When migraine and control groups were compared by pineal calcification, the rates were determined as 80, 6% and 55% in migraine and control group, respectively. The difference was statistically significant (p < 0.001). In addition, it was seen that pineal calcifications, detected in migraine patients, did not show age-related increase.

CONCLUSIONS

According to our data, we can point that pineal calcification may be associated with migraine.

Do patients with newly diagnosed type 2 diabetes have impaired physical fitness, and energy expenditures?

BACKGROUND

The disease-related components such as physical fitness and daily energy expenditure may change in each progressive period of type 2 diabetes. The purpose of this study was to compare the maximal aerobic capacity (VO2 max), muscle strength, trunk flexibility, total energy expenditure, daily physical activity, resting metabolic rate (RMR), body composition, and body fat distribution in newly diagnosed type 2 diabetic patients with those of healthy controls.

METHODS

Eighty patients (40 male, 40 female) with type 2 diabetes and 80 (40 male, 40 female) controls were included in this study. All participants completed the measurements.

RESULTS

It was determined that the VO2 max, muscle strength, daily number of steps, and total energy expenditure were lower, and the body fat percentage, and central obesity were higher in male and female type 2 diabetic patients, when compared with the controls. In addition, the lean body mass was decreased in male diabetic patients, compared with the controls. The fasting plasma glucose showed negative correlations with the maximal aerobic capacity, daily number of steps, and muscle strength in the patients in both genders. RMR and trunk flexibility values were not significantly different between the patients and the controls in either gender.

CONCLUSION

We suggest that using exercise intervention especially comprised of strength training and aerobic activities, including not only daily slow activities but also moderate to vigorous activities, as a lifestyle modification in newly diagnosed type 2 diabetic patients might be helpful for the development of earlier and more successful illness management strategies.

Plasma oxytocin levels are reduced in Slovak autistic boys

BACKGROUND

Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA.

METHODS

The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count.

RESULTS

While 130 patients (91 male, mean age: 49.9 ± 9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87 ± 0.80 vs 1.49 ± 0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %.

CONCLUSIONS

NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30).

Paraoxonase, oxidized low density lipoprotein, monocyte chemoattractant protein-1 and adhesion molecules are associated with macrovascular complications in patients with type 2 diabetes mellitus

AIM

The aim of this paper was to evaluate the association between blood glucose, oxidative stress, inflammation, endothelial dysfunction and paraoxonase activity as contributors to the accelerated atherosclerosis seen in type 2 diabetic patients.

METHODS

Plasma malondialdehyde (MDA), oxidized LDL (oxLDL), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cellular adhesion molecule-1 (VCAM-1) levels and paraoxonase-1 (PON1) activity were measured in sixty type 2 diabetic patients, 30 of whom had macrovascular complications, and 30 controls.

RESULTS

Diabetics with macrovascular complications had higher levels of MDA, oxLDL, MCP-1, ICAM-1, VCAM-1 than those without, and the difference was significant for all molecules except for ICAM-1. PON1 activity and ApoA1 levels of the controls were significantly higher than that of the patients, while PON1 activity and ApoA1 levels in the patients with macrovascular complications were significantly lower than that in patients without. Ambient plasma glucose concentration showed a significant positive association with plasma MDA, oxLDL, MCP-1, and VCAM, and a significant inverse association with PON1 and ApoA1 in diabetic patients. A significant positive correlation between oxLDL and MDA, a negative correlation between oxLDL and PON1; a significant inverse association between MDA and PON1; a positive correlation between MDA and MCP-1 and VCAM while a negative correlation between PON1 and MCP-1 and VCAM were detected in patients.

CONCLUSION

Hyperglycemia might play a significant role in generating increased oxidative stress, and decreased PON1 activity, resulting in elevated oxLDL, MCP-1 and VCAM levels. This might be one of the causal pathogenic factors initiating accelerated atherosclerosis in patients with type 2 diabetes mellitus. The implication of these findings are unclear and therefore further studies are required.

Administration of Gemcitabine for Metastatic Adenocarcinoma during Pregnancy: A Case Report and Review of the Literature

We present the case of a 38-year-old woman diagnosed with metastatic adenocarcinoma of the biliary tract in the 18th week of pregnancy. Chemotherapy based on cisplatin and gemcitabine was administered, reaching disease stabilization until late-preterm delivery at 35 + 0 weeks of gestation. The infant was healthy and showed no malformations. Her head circumference was small, yet no neurological and behavioral defects have been detected. Development was normal during 14 months of follow-up. We discuss the implications of metastatic cancer in pregnancy with focus on therapeutic options for metastatic adenocarcinoma of the biliary tract. In this context, available data for the active regimens in biliary tract cancers-platinum compounds and gemcitabine-are discussed. This report is the fourth in the literature detailing the application of gemcitabine during pregnancy and the first presenting longer term follow-up, complementing available evidence that gemcitabine-based regimens are feasible in this situation.