A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate

OBJECTIVES

To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer.

MATERIALS AND METHODS

The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values.

RESULTS

PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations.

CONCLUSION

PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Investigation of cardiovascular risk parameters in adolescents with metabolic syndrome

BACKGROUND

Metabolic syndrome leading to type 2 diabetes mellitus and cardiovascular diseases is a chronic multifactorial syndrome, associated with low-grade inflammation status. In our study, we aimed at assessing the serum levels of follistatin (FST), pregnancy-associated plasma protein-A (PAPP-A), and platelet/endothelial cell adhesion molecule-1 (PECAM-1) in adolescent patients with metabolic syndrome.

METHODS

This study was performed in 43 (19 males, 24 females) metabolic syndrome adolescents and 37 lean controls matched for age and sex. The serum levels of FST, PECAM-1, and PAPP-A were measured by using ELISA method.

RESULTS

Serum FST and PAPP-A levels in metabolic syndrome were significantly higher than those of controls (p < 0.005 and p < 0.05). However, there was no difference in serum PECAM-1 levels between metabolic syndrome and control groups (p = 0.927). There was a significant positive correlation between serum FST and triglyceride (r = 0.252; p < 0.05), and PAPP-A and weight, (r = 0.252; p < 0.05) in metabolic syndrome groups. Follistatin was determined statistically significant in both univariate (p = 0,008) and multivariate (p = 0,011) logistic regression analysis.

CONCLUSIONS

Our findings indicated a significant relationship between FST and PAPP-A levels and metabolic syndrome. These findings offer the possibility of using these markers in diagnosis of metabolic syndrome in adolescents as the prevention of the future complications.

The Levels of Phoenixin-14 and Phoenixin-20 in Patients with Type 2 Diabetes Mellitus

BACKGROUND

New pathogenesis-related early detection markers are needed to prevent Type 2 Diabetes Mellitus (T2DM).

OBJECTIVE

We aimed to determine phoenixin (PNX)-14 and PNX-20 levels in T2DM patients and investigate their relationship with diabetes.

METHODS

36 T2DM patients and 36 healthy controls were included in the study, and PNX-14 and PNX-20 levels in blood samples taken from the groups were measured by ELISA method.

RESULTS

Patients' serum PNX-14 and PNX-20 levels were statistically significantly lower than in controls (p <0.001). A negative correlation was detected between PNX-14 and BMI, fasting blood sugar, HbA1c%, and HOMA-IR. A negative correlation was found between PNX-20 and BMI, fasting insulin and glucose, HbA1c%, and HO-MA-IR. A positive correlation was noticed between PNX-14 and PNX-20 levels. In ROC analyses, PNX-14 and PNX-20 performed almost equally in predicting T2DM. In predicting T2DM, the area under the ROC curve for PNX-14 was 0.874 (cutoff value 413.4 ng/L, sensitivity 89 %, specificity 72%), and for PNX-20 was 0.858 (cutoff value 228.7 ng/L, sensitivity 80 %, specificity 83 %).

CONCLUSION

This study shows that serum PNX measurement may have a high level of evidence in predicting T2DM. PNX, related to pathogenesis, may be useful in diagnosing T2DM and other information to support clinical decision-making.

Association between COVID-19 and increased incidence of overactive bladder symptoms in female patients: A retrospective analysis

INTRODUCTION AND OBJECTIVES

To investigate female patients' post-COVID-19 voiding symptoms and to research how they relate to overactive bladder (OAB).

PATIENTS

One hundred and forty patients aged 20-50 years who were hospitalised and discharged due to COVID-19 at Kartal Dr. Lütfi Kırdar City Hospital between 2021 and 2022 and 50 patients with a history of COVID-19 among two hundred female patients who presented to the urology outpatient clinic with symptoms related to OAB were retrospectively analysed. Bladder diary, overactive bladder symptom score (OABSS), uroflowmetry values and time of onset of symptoms of symptomatic patients were recorded for all patients. Disease-free individuals for control purposes were not included in the study.

RESULTS

It was observed that 38% of 140 hospitalized patients had a symptomatic change related to OAB, and there was a significant difference in voiding diary, OABSS, and uroflowmetry Qmax values between symptomatic and non-symptomatic patients after COVID-19. (p:0.001) There was a significant difference between the pre-COVID-19 (estimated) and post-COVID-19 (current) voiding diary and OABSS values of all symptomatic patients (with and without a history of hospitalization). (p:0.001) When these two groups were compared with each other, there was a significant difference between the post-COVID-19 voiding diary, OABSS values, and the meantime to the onset of symptoms in inpatients and outpatients (p:0.001) CONCLUSION: COVID-19 may be associated with urgency/urge incontinence and overactive bladder in female patients.

The investigation of levels of endothelial cell-specific molecule, progranuline, clusterin, and human epididymis protein 4 in the differential diagnosis of malignant pleural effusions

BACKGROUND

Progranulin (PGRN), endothelial cell-specific molecule-1, clusterin (CLU), and human epididymis protein 4 (HE-4) are novel proteins reported to have diagnostic and prognostic potential in lung cancer. Here, we aimed to identify the markers with high sensitivity and specificity in distinguishing malignant pleural fluids from other pleural fluids.

METHODS

This prospective, descriptive study was conducted at a medical faculty hospital between 2016 and 2019. The study population consisted of 90 patients <18 years of age with pleural effusion (PE). Levels of pleural fluids of PGRN, endothelial cell-specific molecule-1, CLU, and HE-4 were measured with enzyme-linked immunosorbent assay kits under the manufacturer's manual.

RESULTS

Of 90 patients, 54 were men, and 36 were women (mean age 65 ± 16 years). Of pleural fluids investigated, 23 (25%) and 67 (74%) were transudates and exudates, respectively. Of exudates, while 27 (40%) and 19 (28%) were parapneumonic PE and tuberculous PE, respectively, 20 (29%) were malignant pleural effusion (MPE). Levels of all biomarkers in exudate fluids were found significantly higher than those of transudate fluids. CLU, HE-4, and PGRN levels in MPE were also found significantly higher than benign fluids (P < .05). Cutoff values were achieved by receiver operating characteristics analysis for CLU, HE-4, and PGRN to distinguish between malignant and benign groups. For diagnosis of MPE, the sensitivity and specificity values were found as 0.66 and 0.67 for a cutoff value of CLU of 18.29 mg/L (P = .00), as 0.76 and 0.76 for a cutoff value of HE-4 of 9.33 mg/L (P = .00), and as 0.66 and 0.67 for a cutoff value of PGRN of 105.91 mg/L (P = .001).

CONCLUSION

HE-4 having high sensitivity and specificity can be a potential diagnostic marker in distinguishing between malignant and benign effusions, and these findings can constitute a basis for future research.

Some miRNA expressions and their targets in ischemic stroke

Ischemic stroke (IS) is a global health challenge leading to life-long disabilities or the deaths of patients. IS is a complex disease where genetic and environmental factors are both concerned with the pathophysiology of the condition. Here, we aimed to investigate various microRNA (miRNA) expressions and their targets in IS. A rapid and accurate diagnosis of acute IS is important to perform appropriate treatment. Therefore, there is a need for a more rapid and simple tool to carry out an acute diagnosis of IS. miRNAs are small RNA molecules serving as precious biomarkers due to their easy detection and stability in blood samples. The present systematic review aimed to summarize previous studies investigating several miRNA expressions and their targets in IS.

Investigation of serum phoenixin levels in patients with hypertension

OBJECTIVE:

Hypertension is a major modifiable risk factor for cardiovascular disease and premature death worldwide. Phoenixin is a newly identified neuropeptide with multiple bioactivity. However, there was no published data about phoenixin levels in hypertension. The aim of this study was to evaluate the relationship between phoenixin and hypertension.

METHODS:

This study was performed in 36 patients with hypertension and 36 healthy controls. Serum phoenixin-14 and phoenixin-20 levels were determined by Enzyme-Linked ImmunoSorbent Assay method.

RESULTS:

Serum phoenixin-14 and phoenixin-20 values were significantly lower in hypertension patients compared with the control group (p<0.001). The levels of phoenixin-14 were negatively correlated with weight (r=-0.376; p<0.005), body mass index (r=-0.407; p<0.001), systolic blood pressure (r=-0.586; p<0.001), and diastolic blood pressure (r=-0.319; p<0.01). There was a negative correlation between serum phoenixin-20 and weight (r=-0.378; p<0.005), body mass index (r=-0.383; p<0.005), systolic blood pressure (r=-0.551; p<0.001), and diastolic blood pressure (r=-0.306; p<0.01). We used receiver operating characteristic curve analyses to compare the diagnosis value of Phoenixin-14 and Phoenixin-20 levels in hypertensive patients. We found that Phoenixin-14 value is an area under the curve of 0.87 (cutoff value 404.7 ng/L, sensitivity 92%, specificity 72%) and Phoenixin-20 value is an area under the curve of 0.83 (cutoff value 209.9 ng/L, sensitivity 86%, specificity 75%). Phoenixin-14 did nearly show equally compared to phoenixin-20 in predicting hypertension.

CONCLUSION:

Serum phoenixin-14 and phoenixin-20 may be related to the pathogenesis of hypertension. Our findings indicated that serum phoenixin-14 and phoenixin-20 may serve as a novel biomarker for the diagnosis of hypertension.

Investigation of serum vitamin D and ischaemia-modified albumin levels in infertile Turkish men

Our aim was to explore the existence of a possible relationship of sperm motility with serum 25-hydroxyvitamin D3 (25-OH VD) levels and with ischaemia-modified albumin (IMA) levels in infertile Turkish men. A total of 30 men with nonobstructive azoospermia (no spermatozoa in ejaculate), 30 men with oligospermia (total progressive motile sperm count (TPMSC) <15 × 10⁶ /ml) and 33 fertile men with normospermia (with at least one child, as the control group) were enrolled in the study. The mean 25-OH VD levels for groups 1, 2 and 3 were 9.31 ± 6.46, 19.71 ± 12.80 and 30.52 ± 12.49 respectively (p < .05). There was a statistically significant difference in serum IMA levels among the groups (479.32 ± 307.56 vs. 296.37 ± 127.27 vs. 150.04 ± 81.05, respectively; p < .05). A positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels were determined. Infertile men had lower serum 25-OH VD and higher IMA levels than fertile men, with a positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels. Vitamin D supplementation may increase the sperm motility.

P1797 Left atrial mechanics in patients with stoke: Implications for emprical anticoagulation

Purpose

Detection of atrial fibrillation (AF) after stroke impacts patient management. However, detection of AF is difficult due to its paroxsysmal nature. We sought to test the hypothesis that echocardiographic quantification left atrial (LA) mechanics in patients with stoke can be an imaging biomarker to predict AF.

Methods

We enrolled prospectively and consecutively 131 patients in normal sinus rhythm with a new diagnosis of ischemic stroke. All patients underwent 48-hour Holter monitorization, transthoracic echocardiography with saline injection in addition to routine work-up of stroke evaluation. Two-dimensional and Doppler studies, together with most up-to-date LA quantification tools were performed including 3-dimensional LA phasic volumes (maxiumum and minimum LA Volume index - LAVImax, LAVImin) and LA strain quantification (average strain from apical 4- and 2-chamber during reservoir (Ss) and contraction (Sa) phases). Patients were followed-up and underwent second 48-hour Holter monitorization 6-12 months later if no etiologic cause was found. Any AF episode lasting &gt;30 seconds was considered significant parosysmal AF.

Results

In 49 patients, causes other than AF were identified (Noncryptogenic). In 43 patients no discernable cause was found (NoAF Cryptogenic). Paroxysmal AF episodes lasting longer than 30 sec were documented in 27 patients at first 48-hour Holter and in 12 patients during follow-up (9.2 ± 3.1 months) either by second 48-hour Holter monitorization or clinically (AF cryptogenic). LAVImax and LAVImin were significantly increased, Ss and Sa were significantly reduced in patients with AF as compared to No AF and Noncryptogenic groups (Table). LA volumes and strain measures predicted AF development independently of CHA2DS2-VASc score. Better discrimination between No AF and AF groups was obtained after second Holter monitorization that enabled detection of more cases with paroxysmal AF (Figure).

Conclusions

Our findings underscore the value of echocardiographic assessment of LA function as a marker of AF development and for selection of patients who could benefit from empiric anticoagulation.

Noncryptogenic AF cryptogenic No AF cryptogenic 3D LAVI max (ml/m&sup2;) 30.1 ± 9,4 38.1 ± 12.7 28.9 ± 9.2 3D LAVI min (ml/m&sup2;) 13.9 ± 7.5 20.7 ± 10.7 13.4 ± 5.3 3D LA EF (%) 55.5 ± 9.4 50.0 ± 10.5 53.8 ± 10.0 Ss (%) 17.4 ± 8.5 12.7 ± 5.3 17.5 ± 8.5 Sa (%) 12.7 ± 6.3 9.0 ± 5.0 12.8 ± 6.3 CHA2DS2-VASc 4.0 ± 1.6 5.0 ± 1.6 3.9 ± 1.5

Abstract P1797 Figure.

The relationship between plasma microRNAs and serum trace elements levels in primary hyperlipidemia

OBJECTIVES

The aim of the study was to investigate the relationship between plasma microRNA expression levels, which are associated with lipid metabolism and serum trace element levels in patients with primary hyperlipidemia.

METHODS

This study was performed on 46 (21M / 25F) primary hyperlipidemia patients aged 25-65 years and 37 (18 M/19 F) healthy people aged 25-65 years.

RESULTS

The following miRNAs were upregulated: miR-33a-5p, miR-370-5p, miR-378a-3p, miR-27a-3p, miR-27a-5p and miR-335-5p. Additionally, the levels of Co (p < 0.001), Ni (p < 0.01), Cd (p < 0.001) were significantly higher and the level of Cr (p < 0.01), Fe (p < 0.05), Mn (p < 0.01), Se (p < 0.001) and Mo (p < 0.001) was significantly lower in the primary hyperlipidemic patients compared to the healthy people . Also, miR-33a-5p was negatively correlated with serum Cr levels in patients with primary hyperlipidemia (r = -0.376, p < 0.05).

CONCLUSIONS

Our study demonstrates that miR-33a-5p and Cr element may regulate abnormal lipid homeostasis. Also, miR-370, miR-378, miR-27-a and miR-335 might aid in the identification of new therapies to treat patients with primary hyperlipidemia (Tab. 3, Ref. 36).

Can YKL-40 be an Inflammatory Biomarker in Vitamin D Deficiency?

Vitamin D deficiency is associated with several non-homeostatic conditions and/or diseases like inflammation, atherosclerosis, cardiovascular disease and mortality. YKL-40 is a glycoprotein, secreted by macrophages, neutrophils and different cell types and it is also associated with inflammation and pathological tissue remodeling. In this study, we aimed to evaluate relationship between the proinflammatory biomarkers YKL-40 and hs-CRP levels and vitamin D deficiency. Our study group includes 45 subjects with vitamin D deficiency (Group 1) (20 M, 25 F; mean age 37.72 ± 7.70 years) and 40 age and sex-matched healthy subjects with normal serum levels of vitamin D (Group 2) (19 M, 21 F; mean age 39.26 ± 7.41 years). Plasma 25 (OH) vitamin D levels were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Plasma YKL-40 analysis was performed by ELISA. Serum hs-CRP levels were measured by nephelometric method. Plasma vitamin D levels below 20 ng/mL were accepted as vitamin D deficiency. Although we could not find any significant differences by means of serum hs-CRP levels between Group 1 and Group 2 (2.21 (0.27-11.70); 1.79 (0.16-9.85) mg/L, p = 0.247), plasma YKL-40 levels were significantly higher in group 1 than group2 (70.47 (17.84-198.50); 47.14 (4.80-135.48) ng/mL, p = 0.047). In literature, vitamin D deficiency is associated with inflammation. In our study, we found similar hs-CRP levels between groups and higher YKL-40 levels in group 1. Vitamin D deficiency may be related to high YKL-40 levels in terms of causing chronic inflammation.

Serum levels of soluble urokinase plasminogen activator receptor as a new inflammatory marker in adolescent obesity

Background & objectives:

Obesity is known for low-grade inflammatory state with enhanced production of inflammatory mediators in children and adolescents. Soluble urokinase plasminogen activator receptor (suPAR) can be generated as a pro-inflammatory marker. This study was conducted to evaluate the role of suPAR, and its association with leptin, adiponectin, interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP) and fibrinogen in adolescent obesity.

Methods:

A total of 98 participants, 55 obese individuals and 43 healthy controls, aged between 10 and 17 yr, were included in the study. Serum suPAR, IL-6, leptin and adiponectin were measured using ELISA method.

Results:

Serum suPAR, IL-6, fibrinogen, hsCRP and leptin levels in obese individuals were significantly higher than those of controls (P<0.05 & P<0.001). Serum adiponectin levels in obese individuals were significantly lower than those of controls (P<0.01).

Interpretation & conclusions:

Our findings showed that suPAR, IL-6, fibrinogen, hsCRP and leptin were significantly higher in the obese individuals than those of controls. suPAR may be a good novel biomarker for systemic subclinical inflammation and immune activation linked to adolescent obesity.

Enhanced serum levels of matrix Gla protein and bone morphogenetic protein in acute coronary syndrome patients

BACKGROUND

Vascular calcification has been found to be associated with increased risk of cardiovascular (CV) morbidity and mortality. Various bone-associated proteins have been suggested to be related with this process. In this study, we aimed to evaluate whether serum levels of bone morphogenic protein-4 (BMP-4) and matrix Gla protein (MGP) differed in patients who were found to have normal epicardial coronary arteries or a culprit lesion in the coronary angiography leading to acute coronary syndrome (ACS).

METHODS

Patients admitted to emergency department with the diagnosis of ACS who underwent primary percutaneous coronary intervention (PCI) between October 2015 and April 2016 were consecutively recruited as the patient group. Age and gender-matched subjects who underwent coronary angiography following non-invasive ischemia assessment made the control group.

RESULTS

A total of 90 subjects (63.00±14.02 years, 70% male) were included in this study. MGP (<0.001) and BMP-4 (<0.001) levels were significantly elevated when compared to subjects with normal coronary arteries. Fasting blood glucose (P=.024), HDL-cholesterol (P=.002), C-reactive protein (CRP) (P=.001) levels, and left ventricular ejection fraction (LVEF) (P=.021) were significantly correlated with serum MGP levels. HDL-cholesterol (P=.001) and CRP (P=.030) levels were also significantly correlated with serum BMP-4 levels. In the model including HDL-cholesterol, CRP, MGP, and BMP-4 levels, only MGP (odds ratio[OR]: 1.018, P=.019) and BMP-4 (OR: 1.313, P=.023) were found to be independently associated with ACS.

CONCLUSION

This study shows that serum BMP-4 and MGP are independently associated with ACS occurrence when adjusted for other CV risk factors. These biomarkers may have a diagnostic potential in ACS patients.

The Association Between Serum Vaspin and Omentin-1 Levels in Obese Children with Metabolic Syndrome

BACKGROUND AND AIM

Excess visceral fat accumulation results in altered release of adipokines. The aim of this study was to examine the relationship between new adipokines (omentin-1 and vaspin), insulin resistance, and serum inflammatory markers in obese subjects with metabolic syndrome (MS).

PATIENTS AND METHODS

The study included a total of 121 obese children (79 females and 42 males, aged 12-17 years old). The obese subjects were divided into two groups based on the presence or absence of MS criteria (MS group and non-MS group). Serum omentin-1, vaspin, and high-sensitivity C-reactive protein (CRP) were measured in addition to the other glucose metabolism parameters.

RESULTS

MS was diagnosed in 45 obese children and 76 children did not meet the MS criteria. Serum omentin-1 (289.5 ± 51.9 ng/mL vs. 268.2 ± 60 ng/mL, P = 0.03) levels were significantly lower in the MS group compared to the non-MS group. Serum vaspin levels (1058.3 ± 118 pg/mL vs. 1178.6 ± 158 pg/mL, P = 0.02) were higher in the MS group than the non-MS group. CRP levels correlated well with both the adipokines (r = -0.236, P = 0.04 for omentin-1 and r = 0.296, P = 0.008 for vaspin), although these adipokines did not show statistically significant correlations with fasting glucose-insulin levels, homeostasis model assessment of insulin resistance, and 2 hr postload glucose level.

CONCLUSIONS

Higher vaspin and lower omentin-1 levels were determined in obese MS children compared to non-MS children and these adipokines were significantly correlated with high CRP values. These data support the view that adipokines in MS children contribute to increased inflammation markers before abnormal glucose metabolism.

Serum total oxidant/anti-oxidant status, ischemia-modified albumin and oxidized-low density lipoprotein levels in patients with vitamin D deficiency

OBJECTIVE

Oxidative damage may be responsible for the pathogenesis and complications of many diseases. Vitamin D deficiency has been suggested as a potential mediator of various extra-skeletal pathologies. However, there are limited data on anti-oxidant properties of vitamin D.

MATERIALS AND METHODS

Forty-one subjects with vitamin D deficiency and 30 healthy controls were enrolled into the study. The levels of total anti-oxidant status (TAS), total oxidant status (TOS), ischemia-modified albumin (IMA), oxidized-low density lipoprotein (ox-LDL), high-sensitivity C-reactive protein (hs-CRP) and fibrinogen were measured in both groups. The measurements were repeated in 17 patients after the replacement of vitamin D.

RESULTS

Serum IMA and TOS levels were significantly higher (p < 0.001 and p = 0.035, respectively), while TAS levels were significantly lower in patients, compared to controls (p < 0.001). Additionally, fibrinogen was significantly higher in patients than controls (p = 0.003), while ox-LDL and hs-CRP levels were similar between two groups. After the replacement of vitamin D, TAS level significantly increased (p = 0.037), and TOS and fibrinogen levels significantly decreased (p = 0.043 and p = 0.010, respectively). Vitamin D levels were negatively correlated with IMA and fibrinogen levels (r = -0.500, p < 0.001 and r = -0.391, p = 0.002, respectively), although positively correlated with TAS levels (r = 0.430, p < 0.001). No correlation was found between vitamin D levels, and the TOS, ox-LDL and hs-CRP levels.

CONCLUSIONS

In this study, while serum IMA, TOS and fibrinogen levels were increased, TAS levels were seen to be decreased in patients with vitamin D deficiency. These results suggest that oxidative/anti-oxidative balance shifts in favours of oxidative status in vitamin D deficiency.

Enhanced S100A9 and S100A12 expression in acute coronary syndrome

AIMS

In this study, we aimed to investigate whether serum S100A8, S100A9 and S100A12 levels were markers of acute coronary syndrome (ACS).

MATERIALS & METHODS

Patients who underwent coronary angiography and/or percutaneous coronary interventions between June 2015-October 2015 were consecutively recruited in this study and categorized three groups each containing 30 patients (normal coronary arteries, stable coronary artery disease, and acute coronary syndrome). Baseline characteristics, including co- morbidities and medications, were recorded and serum S100A8, S100A9, S100A12, and C- reactive protein levels were measured besides routine laboratory tests.

RESULTS

A total of 90 patients (63.00 [56.00-73.00] years, 62.89% male) have been included. None of the groups differed from each other regarding baseline characteristics (p > 0.05). S100A9 levels were elevated in ACS when compared with the normal coronary arteries (p = 0.033) and S100A12 levels were found to be elevated in ACS when compared with both patients with normal coronary arteries and stable coronary artery disease (p = 0.001). S100A12 was identified as an independent associate of ACS (p = 0.002).

CONCLUSION

These results suggest that S100A12 may serve as a marker of coronary plaque instability, and may have a therapeutic implication in ACS treatment.

Investigation of the inflammatory biomarkers of metabolic syndrome in adolescents

BACKGROUND

Metabolic syndrome (MetS) is a chronic and multifactorial syndrome characterized by a low-grade chronic inflammation, and a major risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In our study, we aimed to investigate the serum levels of high sensitive C-reactive protein (hs-CRP), haptoglobin (Hp), α2-macroglobulin (α2-MG), platelet factor-4 (PF-4), fetuin-A, serum amyloid P (SAP) and α1-acid glycoprotein (AGP) in an adolescent population with MetS.

METHODS

This study was performed in 43 (18 males, 25 females) MetS adolescents between the ages of 13 and 17 years (14.70±1.15) and 43 lean controls were matched for age and sex. The serum levels of Hp, α2-MG, PF-4, fetuin-A, SAP and AGP were measured by using a multi-ELISA technique.

RESULTS

Serum Hp, fetuin-A (p<0.01) and PF-4, hs-CRP, SAP, AGP (p<0.001) values of the MetS subjects were significantly higher than those of the controls. No difference was found in serum α2-MG levels between the MetS and control groups (p=0.184).

CONCLUSIONS

This finding suggests the possibility of using these markers in diagnosis of MetS in adolescents to prevent future complications.

The investigation of circulating microRNAs associated with lipid metabolism in childhood obesity

BACKGROUND

Childhood obesity is an increasing health challenge related to increased risk of chronic diseases. microRNAs (miRNAs) are noncoding short RNA molecules regulating multiple biological processes linked to obesity.

OBJECTIVES

We aimed at evaluating the association between circulating miRNA levels and lipid metabolism in obese and non-obese children and adolescents.

METHODS

By constituting study group, 45 obese children and adolescents were recruited. To perform comparisons with study group, 41 lean controls were matched for age and sex. Using real-time quantitative PCR analysis, circulating miRNAs were evaluated in both groups.

RESULTS

Circulating miR-335 (P < 0.001), miR-143 (P = 0.001) and miR-758 (P = 0.006) in obese children were significantly lower than those of controls. However, circulating miR-27 (P = 0.032), miR-378 (P < 0.001) and miR-370 (P = 0.045) in obese children were significantly higher, compared with those of controls. In addition, circulating miR-33 in obese children was higher than those of controls, but no significant difference was present (P = 0.687).

CONCLUSION

Our findings showed that a significant association is present between circulating miR-370, miR-33, miR-378, miR-27, miR-335, miR-143 and miR-758 values, and childhood obesity. Low levels of miR-335, miR-143 and miR-758, and high levels of miR-27, miR-378, miR-33 and miR-370 may have been responsible for elevated triglycerides and low-density lipoprotein (LDL-C) levels, and low level of high-density lipoprotein (HDL-C) in obese subjects. Therefore, miRNAs may be a good novel biomarker for childhood obesity.

Evaluation of oxidant/anti-oxidants status in patients with mild acute -pancreatitis

BACKGROUND AND AIM

Acute pancreatitis (AP), an inflammatory disorder of the pancreas, is associated with significant morbidity and mortality. The pathogenesis of AP has been suggested to -involve high oxidative stress (OS), combined with inadequate antioxidant status. We aimed to investigate the levels of serum total anti-oxidant status (TAS), total oxidant status (TOS) and ischemia-modified albumin (IMA) in patients with mild AP2016.

METHODS

Thirty subjects with mild AP and 29 healthy controls were enrolled into the study. The levels of TAS, TOS and IMA, C-reactive protein (CRP), high sensitivity CRP (hs-CRP) and fibrinogen were measured in both groups.

RESULTS

TAS levels were significantly lower (p = 0.037), while IMA levels were significantly higher (p < 0.001) in patients, compared to controls. TOS levels were similar between two groups. Fibrinogen, CRP and hs-CRP levels were significantly higher in patients than those of controls (p < 0.001 for all parameters). IMA levels were positively correlated with amylase and lipase levels (r = 0.448, p = 0.001 and r = 0.469, p < 0.001, respectively). There was a negative correlation between TAS levels, and amylase and lipase levels (r = -0.277, p = 0.035 and r = -0.278, p = 0.034, respectively).

CONCLUSION

OS is reported to be associated with the inflammatory process and the severity of AP. In our study, among OS parameters, an increase in IMA levels and a decrease in TAS levels were observed in mild AP patients.

Role of oxidative stress and serum lipid levels in stable chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) has been associated with increased oxidative stress or reduced antioxidant resources. The main goal of this study was to evaluate the levels of serum ischemia-modified albumin (IMA), oxidized low-density lipoprotein (ox-LDL), total oxidant status (TOS), and total antioxidant status in patients with stable COPD, compared with a control group.

METHODS

This study was performed on 51 patients with stable COPD (42 men and 9 women; mean age 56.92 ± 3.0 years) and 45 healthy control participants (32 men and 13 women; 54.8 ± 3.8 years). The levels of serum lipids, IMA, total antioxidant status, TOS, and ox-LDL were measured in all participants.

RESULTS

The levels of serum IMA, ox-LDL, and TOS were significantly higher in patients with COPD than those in control individuals. There was no difference between the levels of serum total antioxidant status, triglycerides, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) of patients with COPD and those of control individuals. Serum high-density lipoprotein cholesterol levels were significantly lower in patients with COPD than in control individuals.

CONCLUSION

Our study indicated that serum IMA, ox-LDL, and TOS may be increased as a result of chronic hypoxia, inflammation, and oxidative stress in patients with severe and very severe stable COPD. Our findings also revealed that IMA is higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stages II, III, and IV, while TOS and ox-LDL are higher in patients with Global Initiative for Chronic Obstructive Lung Disease Stage IV. Measurements of serum IMA, TOS, and ox-LDL levels may be useful markers in the evaluation of stable COPD.

Assesment of oxidative status and its association with thyroid autoantibodies in patients with euthyroid autoimmune thyroiditis

Oxidative stress results from either overproduction of free radicals or insufficiency of several anti-oxidant defense systems. It leads to oxidation of main cellular macromolecules and a resultant molecular dysfunction. Thyroid hormones regulate oxidative metabolism and, thus, play a role in free radical production. Studies evaluating oxidative stress in patients with hypothyroidism and hyperthyroidism have been encountered in recent years; however, oxidative status in patients with euthyroid autoimmune thyroiditis (AIT) was not investigated previously. Thirty-five subjects with euthyroid AIT and 35 healthy controls were enrolled in the study. Serum oxidative status was determined by the measurement of total anti-oxidant status (TAS), total oxidant status (TOS), ischemia-modified albumin (IMA), and oxidized-low density lipoprotein (ox-LDL) levels. Serum TAS levels were significantly lower (p<0.001), while serum TOS levels and IMA levels were significantly higher (p<0.001 and p=0.020, respectively) in patients compared to controls. In both groups, ox-LDL levels were similar (p=0.608). Serum TAS levels were negatively correlated with anti-thyroid peroxidase and anti-thyroglobulin (anti-TG) levels (rho=-0.415, p=0.001 and rho=-0.484, p<0.001, respectively). Serum TOS was positively correlated with anti-TG levels (rho=0.547, p<0.001). Further, TAS was positively correlated with free T4 levels (r=0.279, p=0.043). No correlation was observed between thyrotropin, free T3 levels, and TOS and TAS levels. These results suggest that oxidants are increased, and anti-oxidants are decreased in patients with euthyroid AIT, and oxidative/anti-oxidative balance is shifted to the oxidative side. Increased oxidative stress might have a role in thyroid autoimmunity.

Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

BACKGROUND

It is not well established if and to what extent mild to moderate cognitive impairment predicts mortality and risk of nursing home admission after hip fracture.

OBJECTIVE

To investigate prospectively whether and to what extent mild to moderate cognitive impairment, contributes to mortality and admission to nursing home in the first year after acute hip fracture.

METHODS

We enrolled 173 patients with acute hip fracture age 65 and older who reached a Mini-Mental State Examination (MMSE) score of at least 15 during acute care after hip fracture repair. An MMSE score of 15 to 24 (median) was classified as mild to moderate cognitive impairment. Primary outcomes were mortality in all and admission to nursing home among seniors who lived at home prior to their hip fracture. Follow-up was 12 months with clinical visits at baseline, 6, and 12 months, plus monthly phone calls. We used Cox proportional hazards models controlling for age, sex, body mass index, baseline number of comorbidities and 25-hydroxyvitamin D status, and severe incident infections to assess the risk of mortality and nursing home admission. Because the study population was enrolled in a factorial design clinical trial testing high dose vitamin D and/or an exercise home program, all analyses also controlled for these treatment strategies.

RESULTS

Of 173 acute hip fracture patients enrolled, 79% were women, 77% were admitted from home, and 80% were vitamin D deficient (<20ng/ml). Mean age was 84 years. 54% had mild to moderate cognitive impairment. Over the 12-month follow-up, 20 patients died (27% of 173) and 47 (35% of 134) were newly admitted to a nursing home. Mild to moderate cognitive impairment was associated with a more than 5-fold increased risk of mortality (HR=5.77; 95% CI: 1.55-21.55) and a more than 7-fold increased risk of nursing home admission (HR=7.37; 95% CI: 1.75-30.95). Additional independent risk factors of mortality were male gender (HR=3.55; 95% CI: 1.26-9.97), low BMI (HR=7.25; 95% CI: 1.61-33.74), and baseline 25-hydroxyvitamin D level (per 1ng/ml: HR=0.93; 95% CI: 0.87-0.998; p=0.04).

CONCLUSIONS

Mild to moderate cognitive impairment in patients with acute hip fracture is associated with a high risk of mortality and nursing home admission during the first year after hip fracture. Female gender, a greater BMI and a higher 25-hydroxyvitamin D status may protect against mortality after hip fracture independent of cognitive function.

Severe vitamin D deficiency in Swiss hip fracture patients

BACKGROUND

Most clinical guidelines for the prevention of hip fractures recommend 800 IU vitamin D per day. This dose shifted serum 25-hydroxyvitamin D levels (25(OH)D) in previous studies to between 60 and 100 nmol/l.

AIM

To measure 25(OH)D levels and prevalence of vitamin D supplementation in individuals age 65+ with acute hip fracture.

METHODS

222 consecutive hip fracture patients were investigated over a 12 month period. Mean age of patients was 86 years and 77% were women.

RESULTS

Mean serum 25(OH)D levels were low among hip fracture patients admitted from home (34.6 nmol/l), from assisted living (27.7 nmol/l), and from nursing homes (24 nmol/l). Severe vitamin D deficiency below 30 nmol/l was present in 60%, 80% were below 50 nmol/l, and less than 4% reached desirable levels of at least 75 nmol/l. Consistently, only 10% of hip fracture patients had any vitamin D supplementation on admission to acute care with significantly higher 25(OH)D levels among individuals supplemented with 800-880 IU/day (63.5 nmol/l). Controlling for age and gender, vitamin D supplementation, type of dwelling, and season were independently and significantly associated with 25(OH)D levels.

CONCLUSION

These data provide evidence that current guidelines for the prevention of hip fractures need further effort to be translated into clinical practice.

Sudden cortical hearing loss for speech: a case report

A 35-yr-old male patient experienced a sudden loss of speech understanding due to a bilateral cerebrovascular disease. A detailed summary of audiological and neurological findings was presented. Findings indicated that the presence of Pa waves of the Middle Latency Response (MLR) may be a positive prognosis for improvement in hearing thresholds and speech understanding.

Internal carotid artery occlusion in a patient with malignant peritoneal mesothelioma: is it a sign of malignancy-related thrombosis?

To our knowledge, the occlusion of arteries and platelet hyperaggregation have not been reported in patients with malignant mesothelioma. However, venous thromboembolism, especially in the pulmonary vasculature in association with thrombocytosis and hyperfibrinogenemia, are commonly noticed in this disorder. Furthermore, we detected enhanced platelet aggregation in a case of malignant peritoneal mesothelioma with internal carotid artery occlusion in whom there were postsplenectomy thrombocytosis and hyperfibrinogenemia. The possible mechanisms of ICA occlusion in this patient, including the role of MPM and postsplenectomy state, thrombocytosis, platelet functional changes, and other factors were investigated and discussed.

Transcranial Doppler ultrasound criteria for hemodynamically significant internal carotid artery stenosis based on residual lumen diameter calculated from en bloc endarterectomy specimens

BACKGROUND AND PURPOSE

Transcranial Doppler (TCD) is often used in conjunction with carotid duplex ultrasonography (CDUS) to evaluate the hemodynamic significance of internal carotid artery (ICA) stenosis. We examined the sensitivity and specificity of TCD criteria for detection of a hemodynamically significant stenosis (residual lumen diameter < 1.5 mm) at the origin of the ICA.

METHODS

We selected patients who underwent carotid end-arterectomy (CEA) and had preoperative TCD data available. Eighty-one patients underwent transorbital evaluation, 49 of whom also had transtemporal TCD performed. The endarterectomy specimens were removed en bloc and sectioned, and the minimal residual lumen diameter calculated by computer analysis.

RESULTS

For the transorbital approach, the strongest indicators of a residual lumen diameter < 1.5 mm were reversed flow in the ipsilateral ophthalmic artery and a > 50% peak systolic velocity difference between the carotid siphons (distal ICAs) in patients with unilateral ICA origin stenosis. They were 100% specific and 31% and 26% sensitive, respectively. For the transtemporal approach in patients with a unilateral stenosis, a > 35% difference in ipsilateral middle cerebral artery (MCA) peak systolic velocity relative to the contralateral MCA or a > 50% difference in contralateral anterior cerebral artery (ACA) peak systolic velocity relative to the ipsilateral ACA were 100% specific for identifying a residual lumen diameter of < 1.5 mm. Sensitivities were 32% and 43%, respectively. Irrespective of contralateral stenosis, a > 35% difference in ipsilateral MCA peak systolic velocity relative to the ipsilateral posterior cerebral artery had a 100% specificity and a 23% sensitivity for detecting a < 1.5 mm minimal residual lumen diameter.

CONCLUSIONS

Although the TCD sensitivity for detecting a hemodynamically significant stenosis is relatively low, it can be highly specific (up to 100%). We conclude that TCD enhances the specificity of highly sensitive CDUS criteria for detecting a hemodynamically significant ICA stenosis.

Carotid Doppler ultrasound criteria for internal carotid artery stenosis based on residual lumen diameter calculated from en bloc carotid endarterectomy specimens

BACKGROUND AND PURPOSE

Carotid duplex ultrasound is widely used to screen patients for carotid endarterectomy and if combined with MR angiography and transcranial Doppler may be an alternative to conventional angiography in the preoperative assessment. We have examined the correlation between Doppler velocities and the residual lumen diameters of internal carotid arteries from surgical pathological specimens to establish Doppler criteria for residual lumen diameter independent of percent stenosis.

METHODS

Ninety-one patients who underwent 99 carotid endarterectomies for internal carotid artery stenosis within 6 months of their carotid duplex ultrasound evaluation were studied. The endarterectomy specimens were removed en bloc, and the minimal residual lumen diameter was calculated by computer analysis. The sensitivity and specificity of the Doppler criteria for determining high-grade stenosis were calculated and receiver-operator curves generated.

RESULTS

Peak systolic velocity (PSV), end-diastolic velocity (EDV),and carotid index (peak internal carotid artery velocity/ common carotid artery velocity) correlated with the residual lumen diameter. PSV > 440 cm/s, EDV > 155 cm/s, or carotid index > 10 indicated a residual lumen diameter of < or = 1.5 mm (specificity of 100% and sensitivity of 58%, 63%, and 30%, respectively). When these criteria were combined, the sensitivity increased to 72%. A PSV > 200 cm/s combined with either an EDV > 140 cm/s or a carotid index > 4.5 has a sensitivity of 96% and a specificity of 61%.

CONCLUSIONS

Doppler criteria can be both specific and sensitive for detecting a significant stenosis, defined as a < or = 1.5 mm residual lumen diameter. By adjustment of the velocity criteria, it can be 100% specific or a highly sensitive test (96%).

Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging

PURPOSE

To evaluate acute stroke with conventional, multisection diffusion-weighted (DW), and hemodynamically weighted (HW) magnetic resonance (MR) imaging.

MATERIALS AND METHODS

The three MR imaging techniques were performed in 11 patients within 10 hours of the onset of acute hemiparesis. The volume of DW and HW abnormalities were compared with infarct volumes depicted at initial and/or follow-up MR or computed tomography (CT).

RESULTS

Findings at DW and HW imaging were abnormal in nine of the 11 patients, despite normal findings at initial CT and/or MR. In all nine patients, infarcts were depicted at follow-up CT or MR. The DW abnormality was generally smaller and the HW abnormality was generally larger than the infarct volume determined at subsequent imaging. In the two patients with normal findings at DW and HW imaging, symptoms resolved completely within 1-48 hours.

CONCLUSION

Different aspects of hyperacute cerebral ischemia are depicted at DW and HW imaging before infarction is depicted at conventional MR or CT. These techniques may improve stroke diagnosis and may contribute to advances in treatment.

Parinaud syndrome due to solitary pineal metastasis

Parinaud syndrome due to metastatic lesion of the pineal gland has been reported rarely in the literature. We present a case of Parinaud syndrome with solitary pineal metastasis of an oat cell carcinoma.