Serum YKL-40 level is correlated with apnea hypopnea index in patients with obstructive sleep apnea sindrome

OBJECTIVE

Obstructive sleep apnea syndrome (OSAS) has been associated with elevated biochemical markers of inflammation. Although the exact mechanism is unknown, both sleep deprivation and hypoxemia are believed to be important causative factors. YKL-40, also known as chitinase-like protein, has been shown to be related to various inflammatory conditions including atherosclerosis, diabetes, cancer, and asthma. The present study aimed to evaluate the relationship between YKL-40 levels and the Apnea Hypopnea Index (AHI) in patients with obstructive sleep apnea syndrome.

PATIENTS AND METHODS

The study was conducted at the Sleep Unit of the Namik Kemal University Research Center. From January 2013 to December 2013, 120 patients diagnosed with OSAS by polysomnography and 40 subjects without OSAS were recruited. Patients in both groups were matched by age, sex, and body mass index (BMI). They were further divided into groups of mild, moderate and severe OSAS based on their AHI value. Serum YKL-40 concentrations were measured by the enzyme-linked immunosorbent assay (ELISA).

RESULTS

OSAS patients showed significantly elevated YKL-40 levels compared to the control group; 102,05 (23.14) pg/ml in the control group vs. 144.81 (65.53) pg/ml in the OSAS group. A Spearman correlation analysis showed that serum YKL-40 levels were significantly and positively correlated with AHI (r = 0.434, p < 0.001) and oxygen desaturation index (r = 0.374, p < 0.001).

CONCLUSIONS

The study demonstrated that high serum YKL-40 levels correlated with the severity of OSAS and might serve as a nonspecific biomarker for prediction and progression of the disease.

Comparison of colorectal neoplastic polyps and adenocarcinoma with regard to NLR and PLR

OBJECTIVE

Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps.

PATIENTS AND METHODS

A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio.

RESULTS

A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut-off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer.

CONCLUSIONS

NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor.

Protein carbonyl levels in the aqueous humour and serum of patients with pseudoexfoliation syndrome

PURPOSE

Protein oxidation is an oxidative stress marker and the oxidation of proteins is analysed by measuring the carbonyl groups. Protein oxidation can have a role in the physiopathology of pseudoexfoliation (PEX) syndrome. The aim of this study was to investigate the protein oxidation in the aqueous humour and serum of cataract patients with and without PEX.

METHODS

A multicenter study was carried out. Aqueous humour and serum samples were collected from patients who underwent routine cataract surgery. Patients were divided into PEX (n=29) and control (n=27) groups. Patients had no elevated intraocular pressure or glaucoma. Spectrophotometer was used to measure protein carbonyl (PC) levels in the samples.

RESULTS

Mean PC concentration in the PEX aqueous (2.18+/-1.51 nmol/l) and serum (119.62+/-13.2 nmol/l) samples was significantly higher than that measured in the control aqueous (1.31+/-0.47 nmol/l) and serum (105.85+/-11.76 nmol/l) samples, respectively (P< 0.001).

CONCLUSION

The increased PC levels in the aqueous humour and serum of PEX patients suggest that protein oxidation may play a role in the physiopathology of PEX.

Neurotoxicity with single dose intrathecal midazolam administration

BACKGROUND AND OBJECTIVE

The aim of study was to investigate the electron microscopic changes in the medulla of the spinal cord that occur with intrathecal midazolam administration.

METHODS

Twenty-eight albino rabbits of New Zealand type were randomized into two groups. Following anaesthesia, 16 rabbits were given 300 microg of midazolam (Group M) and 12 rabbits were given 0.3 mL of normal saline solution (Group C) intrathecally. Eight rabbits from Group M (Group M1) and 6 rabbits from Group C (Group C1) were sacrificed 24 h after the anaesthesia and 8 rabbits from Group M (Group M2) and 6 rabbits from Group C (Group C2) were sacrificed 6 days after the anaesthesia. The lumbosacral portion was removed by laminectomy and thin sections were examined microscopically.

RESULTS

Severe separation in myelin lamella of the large axons, honeycomb appearance, slight separation in myelin lamella of small to moderately large axons, degenerate vacuoles in the cytoplasm and nuclear membrane irregularity were observed in neurons of Groups M1 and M2. Myelin lamella and nuclear membranes were found to be regular, vacuoles and oedema were observed in the neurons in the Groups C1 and C2.

CONCLUSION

Midazolam administered at single dose by the intrathecal route may have neurotoxic effects on the neurons and myelinated axons at 24 h and 6 days following administration.

Effects of whole-body hypoxic preconditioning on hypoxia/reoxygenation-induced intestinal injury in newborn rats

PURPOSE

The precise cause of necrotizing enterocolitis (NEC) is elusive. Ischemia and reperfusion injury of the intestine has been considered to be a major contributing factor for NEC. Ischemic preconditioning is defined as one or more brief periods of ischemia with intermittent reperfusion that protects tissues against a sustained period of subsequent ischemia. Contribution of preconditioning to hypoxia/reoxygenation-induced intestinal injury in newborn rats has not been evaluated previously.

METHODS

The study was carried out on 1-day-old Wistar albino rat pups. Whole-body hypoxia and reoxygenation (H/R) was achieved by 10 min hypoxia using 95 % N (2) + 5 % CO (2) followed by 10 min reoxygenation with 100 % oxygen. Whole body hypoxic preconditioning (HP) cycles were performed with 3 min hypoxia and 5 min reoxygenation. Thirty-three pups were randomly allocated into 4 groups. Group 1 served as untreated controls. The pups in group 2 were subjected to H/R only. In groups 3 and 4, 1 cycle and 3 cycles of HP were performed prior to H/R, respectively. Animals were killed at the end of the protocols. Intestine specimens were obtained to determine the histological changes, as well as to measure the tissue malondialdehyde (MDA) and nitric oxide (NO) levels, and xanthine oxidase (XO) and myeloperoxidase (MPO) activities.

RESULTS

The microscopic lesions in H/R rat pups were virtually the same as those seen in neonatal NEC, with severe destruction of villi and crypts, in some cases extending to the muscularis. In both HP groups, the lesions were found to be milder. H/R resulted in a marked elevation in MDA and NO levels, and XO and MPO activities compared to the untreated controls. Both 1 cycle and 3 cycles of HP prior to H/R resulted in an obvious decrease in all biochemical parameters. Differences of the biochemical results between both HP groups were not statistically significant.

CONCLUSION

This study revealed that whole-body hypoxic preconditioning is beneficial for hypoxia/reoxygenation-induced intestinal injury in newborn rats.

Vitamin E protects against acetone-induced oxidative stress in rat red blood cells

Acetone may induce oxidative stress leading to disturbance of the biochemical and physiological functions of red blood cells (RBCs) thereby affecting membrane integrity. Vitamin E (vit E) is believed to function as an antioxidant in vivo protecting membranes from lipid peroxidation. The aim of the present study was the evaluation of possible protective effects of vit E treatment against acetone-induced oxidative stress in rat RBCs. Thirty healthy male Wistar albino rats, weighing 200-230 g and averaging 12 weeks old were randomly allotted into one of three experimental groups: Control (A), acetone-treated (B) and acetone + vit E-treated groups (C), each containing ten animals. Group A received only drinking water. Acetone, 5% (v/v), was given with drinking water to B and C groups. In addition, C group received vit E dose of 200 mg/kg/day i.m. The experiment continued for 10 days. At the end of the 10th day, the blood samples were obtained for biochemical and morphological investigation. Acetone treatment resulted in RBC membrane destruction and hemolysis, increased thiobarbituric acid reactive substance (TBARS) levels in plasma and RBC, and decreased RBC vit E levels. Vit E treatment decreased elevated TBARS levels in plasma and RBC and also increased reduced RBC vit E levels, and prevented RBC membrane destruction and hemolysis. In conclusion, vit E treatment appears to be beneficial in preventing acetone-induced oxidative RBC damage, and therefore, it can improve RBC rheology.

Oxidant-antioxidant enzymes and lipid peroxidation in generalized vitiligo

Vitiligo is a common pigmentary disorder of the skin with selective destruction of melanocytes. The pathogenetic mechanisms in vitiligo have not been completely clarified. The aim of our investigation was to evaluate the oxidative stress in the pathogenesis of generalized vitiligo. Twenty-seven patients with generalized vitiligo and 24 phototype-, age-, and sex-matched healthy controls were included in this study. We analysed serum levels of malondialdehyde (MDA), nitric oxide (NO), and serum activities of superoxide dismutase (SOD) and xanthine oxidase (XO) in the patients with vitiligo and in the controls. We found significantly higher levels of MDA and XO activity (P < 0.001 and P < 0.05, respectively), and a significantly lower level of serum SOD activity (P < 0.05) in patients with vitiligo compared with the controls. However, the increase in the level of serum NO was insignificant (P > 0.05). These results suggest that lipid peroxidation of cellular membrane of melanocytes by free radicals may have a significant role in the pathogenesis of generalized vitiligo.

Comparison of Early Postoperative Enteral Nutrients versus Chow on Colonic Anastomotic Healing in Normal Animals

We aimed to clarify the effects of different enteral nutrients (normal chow, complete balanced nutrition, elemental nutrition enriched with glutamine, immune-enhancing diet and fiber) on colonic anastomotic healing in the stress-free metabolic state. The study was carried out with 50 male Balb-C mice in five groups of 10 animals each. After transverse colon anastomosis, animals were fed with early enteral nutrients using normal chow (group 1), Ensure((R)) (group 2), Alitraq((R)) (group 3), Impact((R)) (group 4), and Benefiber Resource((R)) orange juice drink (group 5) for 7 days. There were no significant differences among the groups in bursting pressure (p > 0.05). There was no statistical difference in terms of hydroxyproline level among groups 1-3. The hydroxyproline levels of groups 4 and 5 were statistically higher than that of the control group (p < 0.05 for both comparisons). Under normal conditions without stress, we could not demonstrate the superior effects of early enteral feeding with specialized enteral preparations over normal diets on colonic anastomoses when the bursting pressures were compared.

Decomposition: to what extent? The case of Turkish

It has been proposed that in agglutinative languages, lexical access of morphologically complex words must involve decomposition rather than full listing (Frauenfelder & Schreuder, 1992; Hankamer, 1989). We tested this proposal in Turkish using a simple lexical decision task. Results show that multimorphemic words that consist of frequent affixes are processed as fast as monomorphemic words. This finding suggests that in languages with rich morphology, not all multimorphemic words are accessed in a decomposed form. To the extent that morphemes are in frequent use, they may induce whole-word rather than decompositional lexical access.

Equine glanders in Turkey

In the course of an epidemiological study of glanders on a number of Turkish islands in the Sea of Marmara, 1128 horses were examined by using the intracutaneous mallein test. Thirty-five (3-1 per cent) developed an increase in rectal temperature and a swelling at the point of injection. Ten of these horses were killed and glanders was confirmed in five cases by the presence of lesions and by the immunohistological demonstration of the causative agent, Burkholderia mallei. Clinical and pathological findings indicated that in all cases the infection was restricted to the mucous membrane of the nasal cavity with its parasinus, the nostrils and the upper lips. It was confirmed that equine glanders is endemic in Turkey.

Effect of moderate alcohol intake on lipid peroxidation in plasma, erythrocyte and leukocyte and on some antioxidant enzymes

Plasma, erythrocyte and leukocyte lipid peroxidation, erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and plasma gamma-glutamyl transferase (GGT) levels were investigated in 36 healthy non-drinkers aged between 18-55 years (mean 38.7) and 72 alcohol drinkers aged between 20-48 years (mean 35.3) in order to determine the oxidative effect of alcohol. Erythrocyte lipid peroxidation of the drinkers (measured in terms of MDA) was found to be significantly (P < 0.05) reduced compared to that of controls. However, when Tukey-HSD and F test with ANOVA were performed, that significance disappears in those who consume less than 140 g of alcohol per day and persists in those who consume more than 140 g of alcohol per day (P < 0.05). Plasma GGT level was significantly increased compared to that of controls (P < 0.001). Also, there was a significant (P = 0.01) correlation between serum GGT level and the amount of alcohol. There were no significant differences between all the other parameters of both groups. Reduced lipid peroxidation of erythrocytes without any accompanying increase in the activities of antioxidant enzymes shows that another mechanism might be responsible for this finding. This mechanism was thought to be an alteration in lipid composition of erythrocyte membranes.

Thoracic epidural anaesthesia and analgesia with bupivacaine for transsternal thymectomy for myasthenia gravis

The present study describes the management of a myasthenic patient undergoing transsternal thymectomy for whom thoracic epidural anaesthesia using 15 mL of bupivacaine 0.5% combined with isoflurane 0.4% and nitrous oxide in oxygen 50% provided good intra-operative relaxation followed by an uneventful recovery and eliminated the need for other post-operative analgesics.

Vascular injuries and amputation following limb fractures

Sixty-seven cases treated for peripheral vascular injuries associated with fractures between the years of 1977 and 1988 in the Department of Thoracic and Cardiovascular Surgery of the Dicle University, Faculty of Medicine, were reviewed retrospectively. The cause of injury was blunt trauma in 37 cases (55%) and penetrating wounds in the others, 29 gunshot injuries and one case with a stab wound. The maintenance of vessel continuity was aimed at in all patients. The ratio of limb amputation was 13% in patients operated upon within the first 8 hours after the injury. The same ratio was 39% in cases where the surgical intervention was delayed beyond 8 hours.

Aminophylline reversal of flunitrazepam sedation

Seventeen otherwise healthy patients were given either intravenous physiologic saline, 5 ml, or aminophylline, 2 mg/kg, randomly 30 min after they were given intravenous flunitrazepam in doses adequate to produce sleep and sedation during spinal anesthesia for anorectal surgery. In the control group, mean sedation scores were 1.8 +/- 0.3 and 1.0 +/- 0.4 15 and 45 min after injection of placebo. Fifteen and 45 min after the injection of aminophylline the mean scores of sedation were 0.4 +/- 0.2 and 0.2 +/- 0.2, respectively. Even though the patients in both groups appeared to be equally alert and responsive after 75 min, Trieger tests revealed that psychomotor function was still significantly impaired in the control group 90 min after the injection of placebo. The amnesic effects of flunitrazepam were not affected by aminophylline. Aminophylline may be used to reverse the sedative and psychomotor effects of flunitrazepam.

Epidural morphine for postoperative pain relief in anorectal surgery

Postoperative analgesia and side effects of a single dose of 20 ml of 2% epidural prilocaine followed immediately by either morphine (3 mg in 3 ml saline) or saline (3 ml) were studied in 79 patients scheduled for anorectal surgery. Pain relief was evaluated by a linear scale for 24 hr and by an assessment of the requirement for parenteral analgesics. Of the patients given epidural morphine, 25% did not require analgesics, whereas all patients given prilocaine alone asked for additional analgesia. Remaining patients given morphine were pain-free for a mean duration of 7.6 +/- 5.1 hr (SD). Only 9% of patients given morphine required a maximum of three analgesic parenteral injections in 24 hr. Urinary retention was the most prominent side effect observed in patients given epidural morphine. No early or delayed respiratory depression was noted in our patients.