Recent outcomes of liver transplantation for Budd-Chiari syndrome: A study of the European Liver Transplant Registry (ELTR) and affiliated centers.

BACKGROUND AND AIMS: Management of Budd-Chiari syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplant (post-LT) outcomes in Europe. APPROACH AND RESULTS: Data from all patients who underwent transplantation from 1976 to 2020 was obtained from the European Liver Transplant Registry (ELTR). Patients < 16 years, with secondary BCS or HCC were excluded. Patient survival (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression analysis identified predictors of PS and GS after 2000. Supplemental data was requested from all ELTR-affiliated centers and received from 44. In all, 808 patients underwent transplantation between 2000 and 2020. One-, 5- and 10-year PS was 84%, 77%, and 68%, and GS was 79%, 70%, and 62%, respectively. Both significantly improved compared to outcomes before 2000 ( p < 0.001). Median follow-up was 50 months and retransplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplemental data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT, and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis (PVT) occurred in 9% and 7%, while recurrent BCS was rare (3%). CONCLUSIONS: LT for BCS results in excellent patient- and graft-survival. Older recipient or donor age and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.

Ultradiluted Homeopathic Medicines Cause Apoptosis in RPMI-8226 Multiple Myeloma Cells in vitro: a Pilot Study.

BACKGROUND: Multiple myeloma (MM) is the second most common type of cancer among hematological malignancies and is difficult to treat. Although controversial in nature, homeopathy's effects have been tested on a wide range of cancer cell types in vitro, as well as clinically. However, homeopathic medicines have yet to be tested in MM cells. In this preliminary study, we investigated the effects of Arsenicum album, Hecla lava, Carcinosinum and Carboneum sulphuratum 200C on a human MM cell line. METHODS: The RPMI-8226 MM cell line was cultured in vitro for up to 96 hours and treated with each of four homeopathic preparations. The spectrophotometric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, flow cytometric Annexin V-PE/7-actinomycin D (7-AAD) and propidium iodide (PI) staining were each used to examine cell viability, apoptosis and cell cycle, respectively. RESULTS: The MTT assay showed that all four homeopathic preparations reduced cell viability over time when compared to the control group cells, especially at 72 and 96 hours whereby only 50% of cells remained viable. Similarly, after 96 hours of treatment, the proportion of viable cells was significantly decreased and the proportion of early apoptotic (Annexin-V-PE +/7AAD-) cells was significantly increased for all four homeopathic preparations. Based on the PI-staining cell cycle data, cells treated with Hecla lava and Carboneum sulphuratum showed a statistically significant accumulation in the sub-G0/G1 phase of the cell cycle (p < 0.05). CONCLUSION: This is the first study to demonstrate that each of four homeopathic medicines causes apoptosis in a MM cell line. Further exploration of the potential of Arsenicum album, Hecla lava, Carcinosinum and Carboneum sulphuratum as a complementary therapeutic option in MM is warranted.

Development of a model to predict the risk of early graft failure after adult-to-adult living donor liver transplantation: An ELTR study.

Graft survival is a critical end point in adult-to-adult living donor liver transplantation (ALDLT), where graft procurement endangers the lives of healthy individuals. Therefore, ALDLT must be responsibly performed in the perspective of a positive harm-to-benefit ratio. This study aimed to develop a risk prediction model for early (3 months) graft failure (EGF) following ALDLT. Donor and recipient factors associated with EGF in ALDLT were studied using data from the European Liver Transplant Registry. An artificial neural network classification algorithm was trained on a set of 2073 ALDLTs, validated using cross-validation, tested on an independent random-split sample (n=518), and externally validated on United Network for Organ Sharing Standard Transplant Analysis and Research data. Model performance was assessed using the AUC, calibration plots, and decision curve analysis. Graft type, graft weight, level of hospitalization, and the severity of liver disease were associated with EGF. The model ( http://ldlt.shinyapps.io/eltr_app ) presented AUC values at cross-validation, in the independent test set, and at external validation of 0.69, 0.70, and 0.68, respectively. Model calibration was fair. The decision curve analysis indicated a positive net benefit of the model, with an estimated net reduction of 5-15 EGF per 100 ALDLTs. Estimated risks>40% and<5% had a specificity of 0.96 and sensitivity of 0.99 in predicting and excluding EGF, respectively. The model also stratified long-term graft survival ( p <0.001), which ranged from 87% in the low-risk group to 60% in the high-risk group. In conclusion, based on a panel of donor and recipient variables, an artificial neural network can contribute to decision-making in ALDLT by predicting EGF risk.

European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children.

BACKGROUND AND AIMS: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. APPROACH AND RESULTS: Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. CONCLUSIONS: Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.

Tramates trogii biomass in carboxymethylcellulose-lignin composite beads for adsorption and biodegradation of bisphenol A.

Tramates trogii biomass was immobilized in carboxymethyl cellulose-lignin composite beads via cross-linking with Fe(III) ions (i.e., Fe(III)-CMC@Lig(1-4)@FB). The composite beads formulations were used for the adsorption and degradation of bisphenol A (BPA) using the free fungal biomass as a control system. The maximum adsorption capacity of the free fungal biomass and Fe(III)-CMC@Lig-3@FB for BPA was found to be 57.8 and 95.6, mg/g, respectively. The degradation rates of BPA were found to be 87.8 and 89.6% for the free fungal biomass and Fe(III)CMC@Lig-3@FB for 72 h in a batch reactor, respectively. Adsorption of BPA on the free fungal biomass and Fe(III)CMC@Lig-3@FB fungal preparations described by the Langmuir and Temkin isotherm models, and the pseudo-second-order kinetic model. The values of Gibbs free energy of adsorption (ΔG°) were - 20.7 and - 25.8 kJ/mol at 298 K for BPA on the free fungal biomass and Fe(III)-CMC@Lig-3@FB beads, respectively. Moreover, the toxicities of the BPA and degradation products were evaluated with three different test organisms: (i) a freshwater micro-crustacean (Daphnia magna), (ii) a freshwater algae (Chlamydomonas reinhardti), and (iii) a Turkish winter wheat seed (Triticum aestivum L.). After treatment with the Fe(III)CMC@Lig-3@FB formulation, the degradation products had not any significant toxic effect compared to pure BPA. This work shows that the prepared composite bioactive system had a high potential for degradation of BPA from an aqueous medium without producing toxic end-products. Thus, it could be a good candidate for environmentally safe biological methods.

The method development for elimination of matrix interferences in seawater monitoring to determine elements by ICP-MS.

A simple, versatile, and economical method development with matrix elimination to determine the elements As, Ba, Cd, Co, Cr, Cu, Mn, Ni, Pb, V, and Zn in seawater by using the technique of inductively coupled plasma mass spectrometry is reported. Real seawater was used as a matrix for the standard adding calibration and other validation parameters. The samples were open digested at 80 °C with 2 mL HNO3 and 0.25 mL HF under the hood. A two-step digestion procedure was applied, and the volume was completed to 10 mL with deionized water. Chloride removal was accomplished by using this procedure. The concentrations of Ca and Mg ions were lessened by 15% and 20%, respectively. These results were verified with ion chromatography, SEM-EDS, and mass difference analyses. It was observed that there was a 40% loss in the average mass of particulate matter on the filter media after applying the two-step digestion procedure. Recovery and trueness values were in the range of 86 and 109%. The average precision amounts for elements were determined as RSD (%) in the range of 1.0% and 3.4%. The concentrations of elements determined in the 18 samples collected from the Konyaalti Beach located in Antalya were higher than the maximum allowable concentrations of the Directive 2013/39/EU.

Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation.

Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux-en-Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct-to-duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n = 20), and the groups showed no significant difference (P = 0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant (P = 0.6). The rate of bile leak was also similar in both groups (P = 0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.

When Does Fusing Two Rings Not Yield a Larger Ring? The Curious Case of BOPHY.

Structural and electronic features of ground and excited states of the bis(difluoroboron)-1,2-bis-(pyrrol-2-yl)methylene-hydrazine (BOPHY) fluorophore, a seemingly extended version of the popular 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY) fluorophore, are presented. Geometries of S0 and S1 electronic states are highly puckered, as confirmed by a combination of density functional theory (DFT), time-dependent (TD)-DFT, CASSCF-PT2, EOM-CCSD calculations and density functional theory-based molecular dynamics (DFT-MD). Packing effects are responsible for planarization in the solid state. Without the network of a solid matrix, planar conformation of BOPHY is an easily accessible transition state of inversion between two puckered conformations and hence solvated BOPHY is suggested to sample the conformational space between the two puckered geometries. The peculiar features of puckering as well as inversion via a planar TS are unaltered with a large range of lateral substitutions. Concentration-dependent electronic absorbance measurements were carried, which showed that the transformation of the low activation energy between the puckered and planar conformations is responsible for the broadening of the absorption spectrum. BOPHY, a four-ring system, is not an electronic extension of the three-ring BODIPY system since the excitation characteristics suggest BOPHY to behave as two electronically unlinked fragments despite the fact that the two subunits are covalently bonded.

C-Reactive Protein and Platelet-Lymphocyte Ratio as Potential Tumor Markers in Low-Alpha-Fetoprotein Hepatocellular Carcinoma.

The hepatocellular carcinoma (HCC) tumor marker alpha-fetoprotein (AFP) is only elevated in about half of the HCC patients, limiting its usefulness in following the effects of therapy or screening. New markers are needed. It has been previously noted that the inflammation markers C-reactive protein (CRP) and platelet-lymphocyte ratio (PLR) are prognostically important and may reflect HCC aggressiveness. We therefore examined these 2 markers in a low-AFP HCC cohort and found that for HCCs > 2 cm, both markers significantly rise with an increasing maximum tumor diameter (MTD). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index value for each marker, and their area-under-the-curve values for each MTD group. Patients were dichotomized into 2 groups based on the CRP and PLR from the receiver-operating characteristic curve analysis. In the logistic regression models of the 4 different MTD patient groups, CRP and PLR levels were statistically significant to estimate MTD in univariate logistic regression models of MTD groups > 2 cm. CRP and PLR were then combined, and the combination was statistically significant to estimate MTD groups of 3-, 4-, and 5-cm cutoffs. CRP and PLR thus have potential as tumor markers for low-AFP HCC patients, and possibly for screening.

Live donor liver transplantation for type 1 tyrosinemia: An analysis of 15 patients.

Type 1 tyrosinemia is a rare metabolic disorder of the tyrosine degradation pathway. Due to the rarity of the disease, the best evidence literature offers is limited to guidelines based on expert opinions and optimal treatment is still a debate. LT serves as a definitive treatment of the defective metabolic pathway in the liver along with other serious disease manifestations such as LF and HCC. Nitisinone is a relatively new agent that is currently recommended for the medical management of the disease. Its mechanism of action is well understood, and efficacy is well established when started presymptomatically. This study aims to evaluate outcomes of 15 patients with type 1 tyrosinemia who underwent LT in nitisinone era and discuss its effect on prevention of HCC. A LT database of 1037 patients was reviewed. Data from 15 patients with type 1 tyrosinemia were retrospectively analyzed. All the patients except one were treated with nitisinone prior to LT. Most common indications for LT were LF and suspicious nodules. Seven patients had HCC. Mortality rate was 20% (n = 3). Nitisinone treatment has opened new horizons in the management of type 1 tyrosinemia, but LT still remains the only option for the patients developing LF and in the event of HCC. Neonatal screening programs utilizing blood succinyl acetone as the marker should be encouraged especially in the countries, such as Turkey, with high prevalence of consanguineous marriages.

The efficiency of low-dose hepatitis B immunoglobulin plus nucleos(t)ide analogs in preventing posttransplant hepatitis B virus recurrence

Background/aim: In this study, the efficiency of using low-dose hepatitis B immunoglobulin (HBIG) plus antiviral treatment according to individual needs has been evaluated in posttransplant hepatitis B virus (HBV) patients. Materials and methods: We retrospectively evaluated 179 patients who were admitted between 2009 and 2014. Five thousand IU intravenous HBIG was given in the anhepatic phase, and 400 IU/day intramuscular (IM) HBIG was given in the posttransplant period. After HBsAg seroconversion, 400 IU IM HBIG was continued as prophylaxis every two weeks. Results: The average follow-up period was 26 (2­65) months. Seventy patients had hepatocellular carcinoma (HCC). The HBV recurrence was 4.5% in the first year, and 5.8% in the third year. The HBsAg became negative in 11 (2­63) days, and anti-HBs became positive in 9 (1­31) days. HBsAg positivity occurred in 6 patients during the follow-up period. Five of these patients were those who underwent transplantation due to HCC. In 5 of the HCC patients, in whom HBsAg became positive, tumor recurrence was observed after 0.3­9.9 months. HBsAg positivity was more frequently detected in patients with HCC (P = 0.009). Conclusion: The HBV recurrence should be evaluated as a predictor of the HCC recurrence in patients who were transplanted due to HCC.

Characteristics of Hepatocellular Carcinoma Aggressiveness Factors in Turkish Patients.

A large cohort of hepatocellular carcinoma (HCC) patients from several collaborating Turkish institutions were examined for the tumor parameters of maximum diameter (MTD), portal vein thrombosis (PVT), and α-fetoprotein (AFP) levels. A relationship was found between MTD and blood platelet levels. Patients with large ≥5 cm tumors who had normal platelet levels had significantly larger tumors, higher percent of PVT, and significantly lower blood total bilirubin and liver cirrhosis than similar ≥5 cm tumor patients having thrombocytopenia. A comparison of patients with and without PVT showed significantly larger tumors, greater multifocality, blood AFP, and C-reactive protein levels, and, interestingly, lower HDL levels in the patients with PVT. Fifty-eight percent of the total cohort had AFP levels ≤100 IU/mL (and 42.1% had values ≤20 IU/mL). These patients had significantly smaller tumors, less tumor multifocality and percent PVT, lower total bilirubin, and less cirrhosis. There was considerable geographic heterogeneity within Turkey in the patterns of HCC presentation, with areas of higher and lower hepatitis B virus, hepatitis D virus, cirrhosis, and tumor aggressiveness parameters. Turkish patients thus have distinct patterns of presentation, but the biological relationships between MTD and both platelets and bilirubin levels are similar to the relationships that have been reported in other ethnic patient groups.

NH3 as simple clathrate-hydrate catalyst: Experiment and theory.

The catalytic action of NH3 within the all-vapor approach for instant clathrate hydrate (CH) formation is studied using both FTIR spectroscopy and ab initio molecular dynamics simulations. A unique property of NH3, namely, the rapid abundant penetration and occupation of the water network, creates defects, particularly Bjerrum D-defects, in the hydrate frame that are generally stabilized by guest NH3 molecules in the cages. Furthermore, insertion of NH3 seriously disturbs the hydrate network where the guest NH3 molecules also make fluxional H-bonds with the host water molecules. These defects strongly facilitate a sub-second formation of the simple NH3 s-II gas hydrate at 160 K. FTIR spectra of aerosols of the NH3 s-II CH have been measured, and the displacement of both small and large cage NH3 guests by CO2 and tetrahydrofuran is examined.

The prognostic value of different node staging systems in patients with ≤15 lymph nodes following surgery for gastric adenocarcinoma.

AIM: Lymph node (LN) status is an important prognostic indicator in patients with gastric cancer (GC). Although American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) is the most widely used staging system, there is a challenge in predicting survival of patients when the number of total harvested LNs is ≤15. Our aim was to investigate the prognostic performances of seventh edition AJCC/UICC, lymph-node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) on the overall survival (OS) of GC patients with ≤15 examined LNs after gastric resection. MATERIAL AND METHOD: A total of 74 patients who underwent curative resection for gastric adenocarcinoma and had ≤15 LNs at the final histopathological examination were included in the study. The prognostic ability of three node staging models to predict OS was assessed using the area under the curve (AUC). RESULTS: Of the 74 patients, 15 (20.3%) had no LN metastasis whereas 59 (79.7%) had nodal involvement. The median OS was 26 months. When assessed as a continuous variable, LNR was the strongest staging system to stratify GC patients on the basis of LN status. LODDS had superiority on other node staging models when the number of LNs retrieved was modeled as categorical variable. CONCLUSIONS: LNR (continuous) and LODDS (categorical) were the strongest indicators of OS in GC when the number of LN harvested was ≤15. Therefore, they may be considered as an alternative nodal staging systems for GC.

Monitoring of metallic contaminants in energy drinks using ICP-MS.

In this study, an improved method was validated for the determination of some metallic contaminants (arsenic (As), chromium (Cr), cadmium (Cd), lead (Pb), iron (Fe), nickel (Ni), copper (Cu), Mn, and antimony (Sb)) in energy drinks using inductive coupled plasma mass spectrometry (ICP-MS). The validation procedure was applied for the evaluation of linearity, repeatability, recovery, limit of detection, and quantification. In addition, to verify the trueness of the method, it was participated in an interlaboratory proficiency test for heavy metals in soft drink organized by the LGC (Laboratory of the Government Chemist) Standard. Validated method was used to monitor for the determination of metallic contaminants in commercial energy drink samples. Concentrations of As, Cr, Cd, Pb, Fe, Ni, Cu, Mn, and Sb in the samples were found in the ranges of 0.76-6.73, 13.25-100.96, 0.16-2.11, 9.33-28.96, 334.77-937.12, 35.98-303.97, 23.67-60.48, 5.45-489.93, and 0.01-0.42 µg L-1, respectively. The results were compared with the provisional guideline or parametric values of the elements for drinking waters set by the WHO (World Health Organization) and EC (European Commission). As, Cd, Cu, and Sb did not exceed the WHO and EC provisional guideline or parametric values. However, the other elements (Cr, Pb, Fe, Ni, and Mn) were found to be higher than their relevant limits at various levels.

Live donor liver transplantation for a child presented with severe hepatopulmonary syndrome and nodular liver lesions due to Abernethy malformation.

A 15-year-old boy first presented with severe lung lesions and hypoxia and he was considered as a lung transplant candidate. Upon evaluation, hepatopulmonary syndrome, multiple nodular liver lesions, and Abernethy type 1b malformation were diagnosed. The patient underwent successful right lobe live donor liver transplantation, and all of the symptoms disappeared soon after the transplant. He is currently alive and well with excellent liver and lung functions 4 years after surgery.

Ischemia-modified albumin as a predictor of the severity of acute appendicitis.

BACKGROUND: The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. METHODS: Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. RESULTS: The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). CONCLUSIONS: The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA.

Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey.

The purpose of this study was to examine breast cancer prevention knowledge, beliefs, and information sources among people which are employed in healthcare system including nurses and hospital staff. A cross-sectional survey was conducted among hospital staff of the largest women health hospital in Turkey. Self-administered questionnaires were delivered to participants. A total of 200 hospital staff participated to the study with a response rate of 80.5 %. One-way ANOVA with post-hoc Tukey test was used for multiple comparisons. The results showed that the overall knowledge of hospital staff about breast cancer is inadequate. The mean total knowledge score of the participants was approximately 60 %. The overall mean score of the survey for all participants was 16.69 (SD, 3.12) out of 27. Significant difference was detected in mean total score among educational levels. Education and increasing awareness about the disease can be identified as the major determinants for improving the percentages of early diagnosis and decreasing the mortality rates. Hospital staff education should be the key target for increasing the awareness of whole population especially for developing countries.

Evaluation of heavy metal risk potential in Bogacayi River water (Antalya, Turkey).

This study analyzed 25 river water samples collected from the Bogacayi River in Antalya, Turkey, to evaluate the potential risk of pollution by heavy metals. Concentrations of As, Ba, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Se, Sr, and V were determined by inductively coupled plasma mass spectrometry (ICP-MS). The method was validated prior to analysis in terms of linearity, limit of detection (LOD), limit of quantification (LOQ), and recovery. In addition, a certified standard (SPS-SW2 surface water) was used to verify method trueness. Method validation data and results obtained from the certified material suggested that the method could be applied to determine elemental compositions of the samples. Although various concentrations of As, Ba, Cd, Cr, Cu, Mn, Ni, Pb, and Sr were found in the samples, no Hg, V, Co, and Se concentrations were found. The highest concentration of Pb, Cd, and As was found in the samples from the 22nd, 16th, and 5th sampling stations, respectively. Concentrations of the studied elements were aligned from high to low as Sr > Ba > Ni > Cr > Cu > Mn > Pb > As > Cd. To evaluate the risk potential of metallic pollution, the data were used to calculate the heavy metal pollution index (HPI). The HPI values were found to be in the range from 7.81 to 43.97 (mean 25.48). Samples from upstream seemed to show lower risk potentials (<15) than those from downstream (>30); however, all HPI values were lower than 100, which is the critical HPI value for drinking safety.

Comparison of TLR-2, TLR-4, and antimicrobial peptide levels in different lesions of acne vulgaris.

CONTEXT: Recent studies have shown that tolls like receptors (TLRs) and antimicrobial peptides (hBD-1, cathelicidin) play an important role in the pathogenesis of acne vulgaris (AV). OBJECTIVE: To evaluate and report the expression of TLR-2, TLR-4, hBD-1 and cathelicidin in different regions of skin in AV. PARTICIPANTS: This study was performed in 80 patients with AV and a control group of 20 healthy individuals. MATERIAL AND METHODS: Skin biopsies were performed from 20 papular, 20 pustular, 20 comedonal and 20 nodular lesions of patients and 20 healthy volunteers. Expression levels of TLR-2, TLR-4, hBD-1 and cathelicidin in four separate areas (epidermis, dermis, inflammation region and skin appendages) were evaluated by immunohistochemical method. Further, these parameters were compared between different skin lesions. RESULTS: A significant difference was found between the levels of staining of TLR-2, TLR-4 and hBD-1 from the epidermis, inflammation region, dermis and skin appendages (p < 0.05). Levels of cathelicidin were different in only the inflammation region (p < 0.05). The level of TLR-2 in the epidermis with nodules was lower than the papules and comedones (p < 0.05). Levels of TLR-2 in the inflammation and dermis of the cases with papules were significantly higher when compared to pustules (p < 0.05). The levels of staining of TLR-4 in the dermis with comedones were significantly lower compared to the cases with papules (p < 005). The level of hBD-1 in the epidermis region of comedones was significantly higher compared to nodules (p < 0.05). The expression of cathelicidin in the inflammation region of comedones was significantly low (p < 0.05). CONCLUSION: It is thought that TLR-2, TLR-4, hBD-1 and cathelicidin play an important role in the pathogenesis of AV and in the development of different acne types. We think that, better results could be obtained in treatment of AV with different treatment options targeted in regulation of TLR-2, TLR-4, hBD-1 and cathelicidin release.