Targeting PI3K/AKT/mTOR and MAPK Signaling Pathways in Gastric Cancer

Gastric cancer (GC) is the fourth leading cause of death worldwide, with more than 1 million cases diagnosed every year. Helicobacter pylori represents the main risk factor, being responsible for 78% of the cases. Increased amounts of salt, pickled food, red meat, alcohol, smoked food, and refined sugars negatively affect the stomach wall, contributing to GC development. Several gene mutations, including PIK3CA, TP53, ARID1A, CDH1, Ras, Raf, and ERBB3 are encountered in GC pathogenesis, leading to phosphatidylinositol 3-kinase (PI3K) protein kinase B (AKT)/mammalian target of rapamycin (mTOR)-PI3K/AKT/mTOR-and mitogen-activated protein kinase (MAPK) signaling pathway activation and promoting tumoral activity. Helicobacter pylori, growth factors, cytokines, hormones, and oxidative stress also activate both pathways, enhancing GC development. In clinical trials, promising results have come from monoclonal antibodies such as trastuzumab and ramucirumab. Dual inhibitors targeting the PI3K/AKT/mTOR and MAPK signaling pathways were used in vitro studies, also with promising results. The main aim of this review is to present GC incidence and risk factors and the dysregulations of the two protein kinase complexes together with their specific inhibitors.

Red Blood Cells' Area Deformation as the Origin of the Photoplethysmography Signal

The origin of the photoplethysmography (PPG) signal is a debatable topic, despite plausible models being addressed. One concern revolves around the correlation between the mechanical waveform's pulsatile nature and the associated biomechanism. The interface between these domains requires a clear mathematical or physical model that can explain physiological behavior. Describing the correct origin of the recorded optical waveform not only benefits the development of the next generation of biosensors but also defines novel health markers. In this study, the assumption of a pulsatile nature is based on the mechanism of blood microcirculation. At this level, two interconnected phenomena occur: variation in blood flow velocity through the capillary network and red blood cell (RBC) shape deformation. The latter effect was qualitatively investigated in synthetic capillaries to assess the experimental data needed for PPG model development. Erythrocytes passed through 10 µm and 6 µm microchannel widths with imposed velocities between 50 µm/s and 2000 µm/s, according to real scenarios. As a result, the length and area deformation of RBCs followed a logarithmic law function of the achieved traveling speeds. Applying radiometric expertise on top, mechanical-optical insights are obtained regarding PPG's pulsatile nature. The mathematical equations derived from experimental data correlate microcirculation physiologic with waveform behavior at a high confidence level. The transfer function between the biomechanics and the optical signal is primarily influenced by the vasomotor state, capillary network orientation, concentration, and deformation performance of erythrocytes.

Reliability of cardiac computed tomography examination in cardiac pathology - a case series and literature review

Due to the technological progress in the last decade, the medical practice of cardiology relies more and more on the information provided by cardiac computed tomography. Current guidelines propose coronary computed angiography as a first-line anatomic investigation in patients with low and intermediate probability of coronary atherosclerosis. At the same time, anatomical information is obtained about the rest of the cardiac structures and about cardiac function. The present work aimed to present the contribution of cardiac computed tomography in the morphological and functional characterization of patients with complex cardiac pathology. Three cases are presented in which the information provided by cardiac computed tomography contributed significantly to the diagnosis. The cases were cardiac pathologies such as ventricular apical aneurysm, aortic prosthetic thrombosis, and a cardiac malformation with transposition of great arteries. In addition to highlighting the role of cardiac computed tomography in diagnosing cardiac pathology, a brief review of cardiac computed tomography indications, inclusion criteria, patient safety, basic techniques, and the main protocols and types of post-processing used in practice is provided. This article provides an overview of the applications of cardiac computed tomography, highlighting its role within clinical practice, particularly in the characterization of complex cardiac pathologies.

Oral Arginine Supplementation in Healthy Individuals Performing Regular Resistance Training

Resistance exercise training is well documented as having cardiovascular benefits, but paradoxically, it seems to increase arterial stiffness, favoring the development of high blood pressure. The present study investigates the potential effects of oral supplementation with arginine in healthy individuals performing exercise resistance training. We studied 70 non-smoking male subjects between the ages of 30 and 45 with normal or mildly increased blood pressure on ambulatory monitoring (for 24 h) and normal blood samples and echocardiography, who performed regular resistance exercise training for at least five years with a minimum of three workouts per week. They were divided into two groups in a random manner: 35 males were placed in the arginine group (AG) that followed a 6-month supplementation of their regular diets with 5 g of oral arginine powder taken before their exercise workout, and the control (non-arginine) group (NAG) consisted of 35 males. All subjects underwent body composition analysis, 24 h blood pressure monitoring and pulse wave analysis at enrollment and at six months. After six months of supplementation, blood pressure values did not change in the NAG, while in the AG, we found a decrease of 5.6 mmHg (p < 0.05) in mean systolic blood pressure and a decrease of 4.5 mmHg (p < 0.05) in diastolic values. There was also a 0.62% increase in muscle mass in the AG vs. the NAG (p < 0.05), while the body fat decreased by 1% (p < 0.05 in AG vs. NAG). Overall, the AG gained twice the amount of muscle mass and lost twice as much body fat as the NAG. No effects on the mean weighted average heart rate were recorded in the subjects. The results suggest that oral supplementation with arginine can improve blood pressure and body composition, potentially counteracting the stress induced by resistance exercise training. Supplementation with arginine can be a suitable adjuvant for these health benefits in individuals undertaking regular resistance training.

Cardiovascular Disease in Primary Sjögren's Syndrome: Raising Clinicians' Awareness

In the ever evolving landscape of systemic immune mediated diseases, an increased awareness regarding the associated cardiovascular system impairment has been noted in recent years. Even though primary Sjögren’s Syndrome (pSS) is one of the most frequent autoimmune diseases affecting middle-aged individuals, the cardiovascular profile of this specific population is far less studied, at least compared to other autoimmune diseases. Traditional cardiovascular risk factors and disease specific risk factors are inextricably intertwined in this particular case. Therefore, the cardiovascular risk profile in pSS is a multifaceted issue, sometimes difficult to assess. Furthermore, in the era of multimodality imaging, the diagnosis of subclinical myocardial and vascular damage is possible, with recent data pointing that the prevalence of such involvement is higher in pSS than in the general population. Nevertheless, when approaching patients with pSS in terms of cardiovascular diseases, clinicians are often faced with the difficult task of translating data from the literature into their everyday practice. The present review aims to synthesize the existing evidence on pSS associated cardiovascular changes in a clinically relevant manner.

Burnout and Online Medical Education: Romanian Students in Lockdown and Their Residency Choices

The primary aim of the study was to investigate the prevalence of burnout in Romanian medical students during the COVID-19 pandemic using the Maslach Burnout Inventory-General Survey for Students (MBI-GS(S)). The presence of burnout was assessed based on Exhaustion (EX), Cynicism (CY) and Professional Efficacy (PE) subscales. The secondary aim of the study was to identify the presence of intentional shift in medical specialty compared to their initial pursued choice within the population investigated. Data was collected online at the end of 2020 and beginning of 2021 through a licensed, customized MBI-GS(S) questionnaire from a sample of 126 Romanian medical students at the two leading medical schools in the country, Iasi (N = 56) and Cluj Napoca (N = 70). Descriptive statistics and bivariate correlations were also applied to describe the data set (age and gender of participants) and the relationship between variables (EX, CY, PE). Subsequently, the MBI-GS(S) group report revealed that 36.5% of the medical students in the sample (46) experienced burnout, with problematic results both in Exhaustion and Cynicism. Exhaustion and Cynicism, which contribute to burnout, showed high scores compared to the average scale (EX = 3.5/2.4; CY = 2.8/1.8), while the Professional Efficacy score was relatively high (PE = 3.8/4.4), showing a protective effect and burnout reduction. One of the main conclusions is that the consequences of burnout in medical students plays a significant role in shaping the future healthcare practitioners’ perception of the medical profession and of patients’ wellbeing. Exhaustion and Cynicism are mainly associated with depersonalization and disconnection from the patient. Another conclusion of the study is that about one third of the respondents (30% Cluj students and 37.5% Iasi students) considered changing residency options. The pandemic has also revealed the limitations of and challenges facing current medical education, and that further research is required to assess the trends in prevalence of burnout in medical students.

P832 ESCAPE Stroke: first results

Objective

"ESCAPE Stroke" (Enhancement, Segmentation and Characterization of Atheroma PlaquE for Stroke Prevention) is a multidisciplinary project that aims to develop a new software tool to obtain maximum information about carotid atherosclerosis, through the (semi)automatic analysis of the morphological characteristics of the carotid plaque. We present the first results for evaluating this software.

Methods

For the morphological analysis of the characteristics of the atheroma plaques, a database of 117 carotid ultrasound images was used. The extracted morphological features refer to the degree of echogenicity, texture and the surface of the atheroma plaque.

Regarding to echogenicity of the atheroma plaques, the implemented software algorithm divides the plaques into four classes as follows:

• Anechogenic A type, the echogenic areas representing less than 25% of the plaque. The 117 plaques subjected to computerized analysis were classified as: 54 Type E plaques, 57 Type E / 2 plaques, 6 Type A / 2 plaques and no Type A plaques

• A / 2 type: predominantly anechogenic, anechogenic areas accounting for more than 50% of the plaque but less than 75%;

• Type E / 2: predominantly echogenic, echogenic areas accounting for more than 50% of the plaque but less than 75%;

• Type E: echogenic, an-echogenic areas representing less than 25% of the plaque; (Figure 1)

On the subject of texture of atheroma plaques, the implemented software algorithm studies the homogeneity. In order to quantify the degree of homogeneity of the atheroma plaques, from the Spatial Gray Level Dependency Matrix, a number of functions have been calculated that have become the homogeneity-classification parameters. The 117 plaques were divided into three different classes (Figure 1) as follows:

• 28 plaques type 1, with uniform consistency regardless of their echogenicity;

• 51 plaques type 2, with an average non-uniform consistency, the distribution of gray levels in the atheroma plaque varies but does not go through the entire interval from hypo-echogenic zones to hyper-echogenic zones;

• 38 plaques type 3, with high non-uniform consistency, with hypo-echogenic and hyper-echogenic zones.

With regard to the surface of the atheroma plaques, it is defined as smooth and regular, slightly irregular or ulcerated (Figure 1). Using different contour parameters, the 117 atheroma plaques subjected to computerized analysis were classified as follows:

• 48 plaques with smooth and regular surface;

• 55 plaques with slightly irregular surface;

• 14 plaques with ulcerative surface; The overall agreement between software analysis and "eyeball" assessment made by 2 independent physicians was 69% for echogenicity, 58% for homogeneity and 74% for plaque surface evaluation.

Conclusion

Our automatic/semiautomatic method for plaque characterization could add important information in atheroma plaque assessment and further research is needed in order to confirm its value.

Abstract P832 Figure1

P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)

Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events.

The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score .

We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model.

A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%.

The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p &lt; 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p&lt; 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%.

In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.

1100 When multimodality imaging is needed to understand the etiology of diffuse negative t waves

Introduction

We present the case of a 50 year old woman, active smoker, hypercholesterolemic, nondiabetic, with normal body mass index, referred to our cardiology department for atypical chest pain and ECG changes (diffuse negative T waves in V1-V6, DII, DIII) (Panel A), also present on a resting ECG recorded 4 years previously.

Purpose

To highlight the fact that even though the most frequent cause of negative T waves remains coronary artery disease (CAD), the cause could be related to other more rare medical conditions.

Methods

After clinical examination and ECG, 2D echocardiography was performed. It revealed a normal sized left ventricle (LV) with perserved global and regional function, normal global longitudinal strain, nondilated atria and no significant valvular disease. The subcostal view suggested a hypertrophied right ventricle (RV) free wall (10 mm thickness, with apparent homogeneous echogenicity) (Panel B, arrow), with normal longitudinal function and no regional wall motion abnormalities.

Cardiac magnetic resonance (CMR) was performed for a better tissue characterization. The CMR examination found normal cardiac cavities, normal wall thickness of both ventricles (RV free wall of 3 mm), no late gadolinium enhancement, but described a large amount of fat with concentric disposition, maximum thickness of 9 mm anterior of RV, 3 mm posterior of LV (Panel C).

Since this was not fully explaining the ECG changes and the patient presented with a low-intermediate pretest probability for CAD, an angio-CT coronary scan was performed and showed a calcium score of 7 AU, no significant coronary atherosclerosis, and a hypoplastic circumflex artery (Panel D, arrow). A total volume of 149 ml. of pericardial fat was measured (Panel E).

Stress echocardiography was performed with maximal workload achieved (145 bpm, 85% predicted, 100 W); no chest pain was reported, no regional wall motion abnormalities were seen and there was normal contractile reserve.

Results

Using multimodality imaging a differential diagnosis was followed, which included: arrhythmogenic cardiomyopathy (negative T waves, apparent changes of RV free wall on echo, but no family history of sudden cardiac death), CAD (atypical angina, cardiovascular risk factors, negative T waves), and pericarditis (but negative inflammatory markers, no pericardial fluid). The final hypothesis is that the ECG changes are related to the abnormal pericardial adipose tissue deposit, which acts similar to pericarditis.

Conclusions

The present case report is, to our knowledge, the first to describe an association between large pericardial fat deposit and ECG changes, when other causes were excluded. Even if the current findings are benign, the patient should be followed closely, and risk factors should be thoroughly controlled, as several studies have shown that pericardial fat is associated with poorer cardiovascular prognosis

Abstract 1100 Figure. Multimodality imaging in our patient

An adult case with onset of celiac disease during chronic hepatitis C antiviral treatment

We present the case of young women who developed celiac disease during the treatment for chronic hepatitis C. Celiac disease is now considered to be an immune disorder that is triggered by an environmental agent in genetically predisposed persons. Many studies have shown that the total prevalence of gluten sensitive-enteropathy has increased over last decades, and advances in serological screening leads to the idea that there are more celiac disease cases that are asymptomatic and undiagnosed. Actually, pegylated interferonum (IFN) in combination with ribavirine provides the most effective treatment for patient with chronic hepatitis C. However, interferon and ribavirin therapy are associated with induction or exacerbation of preexistent autoimmune disorders.

Are systemic inflammatory profiles different in patients with COPD and metabolic syndrome as compared to those with COPD alone?

BACKGROUND

Metabolic Syndrome (MS) is frequent in patients with COPD, almost 50% of patients with COPD had one or more components of metabolic syndrome (MS). Moreover, it was demonstrated that BMI might be one of the determinants of COPD phenotype. Chronic comorbid diseases affect health outcomes in COPD, in fact, patients with COPD mainly die of non-respiratory disorders such as cardiovascular disease. Inflammation plays a key role in COPD and MS but we do not know the real inflammatory profile of these patients. A better understanding of the origin and consequences of systemic and local inflammation, and of potential therapies, will most likely lead to better care of patients with COPD.

METHODS

We compared 64 consecutive, consenting smoker patients with COPD and MS (mean age: 62.7 +/- 0.7 years) with this serum inflammatory profile (hsCRP: 1.9 +/- 0.01 mg/dL, TNF-alpha: 6,4 +/- 0.1 pg/mL, adiponectin: 4.7 +/- 0.01 mg/L) versus 69 COPD smoker patients matched for age (mean age 61.4 +/- 0.4 years) with following serum inflammatory cytokine (CRP: 0.9 +/- 0.01 mg/dL, TNF-alpha: 3.9 pg/mL +/- 0.01, adiponectin: 9.3 +/- 0.01 mg/L). COPD and MS was diagnosed according to the GOLD criteria respectively IFD 2005 criteria. Data were expressed as mean +/- SE (standard error). Comparisons of parameters among the two groups were made by Student unpaired t test. The level of statistical significance was set as p < 0.05.

RESULTS

Serum TNF-alpha and high-sensitivity CRP levels in patients with COPD and MS were significantly higher (p < 0.05) than those of COPD alone. Plasma adiponectin levels in patients with COPD were significantly higher (p < 0.05) than in subjects with COPD and MS.

CONCLUSIONS

Patients with COPD and MS have a more exacerbated systemic inflammatory profile and a significantly reduced specific adipose response represented by adiponectin than patients with COPD alone. These results help us to better understand the inflammatory pattern in patients with COPD with metabolic disorders and permit us to sustain the regulatory role of adiponectin in metabolism balance. It is possible that this association between COPD and MS with a specific inflammatory pattern (high serum levels of CRP and TNF-a but with low plasma levels of adiponectin) to explain the high rate of death adjudicated as due to cardiovascular causes.

The metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease and obesity are major causes of morbidity and mortality worldwide and, according to current data, the global burden of these conditions will increase further. Obesity plays a major role in the development of the metabolic syndrome and has been identified as an important risk factor for chronic diseases such as type 2 diabetes mellitus and cardiovascular disease. Adiposity is associated with insulin resistance even over relatively normal ranges of body fatness. There is strong evidence that altered adipose tissue function plays a crucial role in the pathogenesis of obesity-related insulin resistance and type 2 diabetes, as has recently been reviewed. Obesity is linked to respiratory diseases such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome and accumulating evidence suggests an association between obesity and asthma. A potential link between obesity and COPD is also increasingly recognized although little data is known about the mechanisms underlying this association. The inflammatory and metabolic profile differs between obese with COPD and normo or underweight with COPD in part due to dysfunction of adipose tissue.

Complicated sigmoid diverticulitis

In medical practice, the colonic diverticulitis diagnosis is easy, based especially on a barium enema and an inferior digestive endoscopy, but the diverticulitis complications, especially metastatic infections, raise serious positive and differential diagnosis problems. We present the case of a 51 year old male who comes with hepatomegaly and multiple hepatic formations, in deteriorating clinical condition, context suggestive of secondary metastasis, but after investigation it was demonstrated they were of infectious nature, from a sigmoidian diverticulitic abscess. In this case, the hepatic biopsy was appropriate and it represented an important moment in the management of the patient.

Vibroarthrography--a possible functional non-invasive method for early detection damaged cartilage joint

The vibroacoustic signals emitted by the diarthrodial articulation during a normal movement differentiates a healthy case from a pathologic one, due to alteration in forms and contact surfaces. The differences are shown by a various dynamics of the vibroacoustic spectra. Parametric representation of the acquired signals, filtering and clinical interpretation of those allow classification and fast recognition of a normal/pathologic status of the investigated articulation by the physician. Our method of acquiring the sound and vibration signals is effectuated completely non-invasive, with a set of translators using Pulse - sounds and vibrations analyzers (a matrix of prepolarised microphones with measurement domain in infrasound scale and piezoelectric acceleration transducers). A comparative study of vibroacoustic and thermal spectra, with early alterations revealed by knee nuclear magnetic resonance, correlates vibroacoustic and thermic spectra alterations with morphological ones, by determining certain limits between normal and pathological morphofunctional patterns. This prospective comparative study will help us evaluate the method in terms of sensibility, specificity, negative and positive predictive value, indices that assure the diagnostic power to the method.

Relationship between serum gamma-glutamyl transferase and pulse pressure in apparently healthy middle-aged subjects

Higher values of pulse pressure (PP)--the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP)--are associated with an increased cardiovascular risk; SBP and DBP values are correlated with serum levels of gamma-glutamyl transferase (GGT), both in drinkers and non-drinkers subjects. Moreover, some studies showed that high levels of serum GGT might be related with an increased cardiovascular risk. However, few studies analyzed the relationship between GGT and PP. In 72 subjects (18 male; 54 women), middle-aged (mean age: 36.63 yrs; limits: 24-54 yrs), apparently healthy, we performed the measurements of: weight, height (from which we calculated the body mass index [BMI]), SBP, DBP, PP, standard biochemical workup, including GGT (UI/l).

RESULTS

PP values are correlated with SBP (r=0.74, p<0.001), but not with DBP (r=0.15, p=NS) values. GGT is significantly correlated with SBP (r=0.28, p=0.01), DBP (r=0.29, p=0.01), and BMI (r=0.41, p<0.001). Mean values of PP are significantly higher in those with a GGT>20 than those with GGT<20 (48.69 vs. 43.85 mmHg, p<0.05); similarly, mean values of SBP (131.66 vs. 116.81 mmHg, p=0.0004) and DBP (82.59 vs. 73.52 mmHg, p=0.0008) are higher in the group with GGT>20. We observed an ascending trend of the mean value of GGT in the different groups of PP; therefore, mean value of GGT was 19.21, 22.65, 23.18 in the PP<40, PP=40-60, respectively PP>60 groups. However, the correlation between PP and GGT was not significant, both in univariate analysis (r=0.14, p=NS) and after adjusting for SBP, DBP, BMI (r=0.12, p=NS). When we analyzed subgroups, the relationship between GGT and PP was more evident in women and in subjects with increased values of BMI.

CONCLUSIONS

GGT values are significantly correlated with SBP and DBP, but not with PP, in middle-aged, apparently healthy subjects; even though the highest values of GGT are associated with an increased PP value, further studies would be necessary in order to explain this link.

Hypertension in obese patients: a dysmetabolic hypertension with a possible adipocyte dysfunction mechanism

Large longitudinal studies showed the epidemiological link between obesity and hypertension. During last years, multiple possible mechanisms involved in this association were identified. Adipose tissue has an important role in the genesis of hypertension in obese patients through several pathways: insulin resistance, leptin, renin-angiotensin-aldosteron system and mediators of inflammation (TNF-alpha, IL-6). Adipocyte may be the major player in the development of insulin resistance and hypertension, elements of the metabolic syndrome, responsible for the cardiovascular complications.

Pulse pressure and inflammatory markers in apparently healthy premenopausal women

Several epidemiological studies showed that pulse pressure (PP), as a marker of large arterial stiffness, is an independent predictor of cardiovascular risk. A high pulse pressure may induce lesions of the vessel walls and of the endothelium of the large arteries. Now, inflammation represents one of the most extensively studied pathways involved in the pathogenesis of cardiovascular disease. The aim of the present study was to evaluate if usual markers of systemic inflammation were correlated with pulse pressure. In fifty-four apparently healthy premenopausal women, without any known disease, we performed anthropometrical and blood chemistry measurements, together with the standard measurements of blood pressure. Mean values of fibrinogen are significantly more elevated in PP > 50 mmHg group than in PP < 50 mmHg group (364.79 +/- 71.07 vs. 329.31 +/- 57.81, P < 0.05). Fibrinogen was also significantly correlated with PP (r = 0.27, P < 0.05). However, after controlling for age the correlation between PP and fibrinogen was not significant (r = 0.18, P = NS). ESR was significantly correlated with PP (r = 0.31, P < 0.05) and systolic blood pressure (SBP) (r = 0.32, P < 0.05) but not with diastolic blood pressure (DBP). After controlling for age the correlation between PP and erythrocyte sedimentation rate (ESR) was not significant (r = 0.20, P = NS), but after controlling for body mass index (BMI) this correlation became significant (r = 0.28, P < 0.05). White blood cell (WBC) was not correlated with age, SBP, DBP, PP, age and BMI and the mean values of WBC were increased in the PP > 50 mmHg group, but not significantly (6637.93 +/- 1615.19 vs. 6416.67 +/- 1427.57, P = NS). In our study we found that ERS and fibrinogen values are related to pulse pressure values. Otherwise, blood pressure values, including pulse pressure, were correlated with the age of the subjects and the correlation between pulse pressure and inflammatory markers (ESR and fibrinogen) was not significant after controlling for age. After controlling for BMI, the correlation between ESR and PP remains significant.