The Effect of Peritoneal Prednisolone Lavage in Bacterial Peritonitis: An Experimental Study.

OBJECTIVE: This study investigated and compared the effects of antibiotic and steroid lavage on survival and cytokine levels in an experimental abdominal sepsis model. BACKGROUND: In abdominal sepsis, abdominal lavage with saline or antibiotic solutions is a well-documented intervention known to have positive impact on survival; however, the effects of steroid lavage in abdominal sepsis have not yet been investigated. MATERIALS AND METHODS: Ninety-six Wistar rats were divided into 4 groups (n = 24). Abdominal sepsis was induced by cecal ligation and puncture. Six hours after laparotomy, the authors performed a relaparatomy followed by cecal resection and an abdominal lavage. Abdominal lavage was performed using saline in group 1, equal volumes of cefazolin sodium in group 2, low-dose methylprednisolone (1 mg/kg) in group 3, and high-dose methylprednisolone (2 mg/kg) in group 4. After division of 2 subgroups from each of the 4 groups, the first of the rats (n = 12) were euthanized 6 hours later for evaluation of cytokines (ie, interleukin [IL] 1ß, 2, 4, 10, and tumor necrosis factor alpha [TNF-α]), and the others were followed for 30 days for analysis of mortality rates. RESULTS: The mortality rate of the rats in group 2 was significantly higher than group 4, which had no mortality (P = 0.032). Although insignificant, the lowest mean value of IL-1ß, IL-2, and TNF-α were in group 1, and the highest was in group 2. The lowest IL-4 level was in group 3, and the highest level was in group 2 (P = 0.41). Interleukin-10 levels were significantly lower in group 4 and higher in group 2 (P = 0.014). CONCLUSION: The authors state that peritoneal lavage with prednisolone improved survival rates with increasing doses in abdominal sepsis.

The Distribution of Apolipoprotein E Gene Polymorphism and Apolipoprotein E Levels among Coronary Artery Patients Compared to Controls.

OBJECTIVE: Coronary artery disease (CAD) is a multifactorial disease that is caused by various genetics and environmental factors. Genetically, predisposition is an important component for CAD. The candidate apolipoprotein E (apoE) gene is the most studied one. ApoE is composed of e2, e3, e4 alleles and E2/2, E2/3, E2/4, E3/3, E3/4, E4/4 genotypes. In this study, the relationship between CAD and apoE polymorphism and apoE level has been studied in Tokat region. MATERIALS AND METHODS: The study population is composed of 100 CAD patients diagnosed by coronary angiography and 100 control patients of whom fifty have normal coronary angiography and fifty did not have any CAD symptoms. The serum lipid and apoE levels and apoE genotypes of all participants have been measured, and the relationship between these parameters has been evaluated. RESULTS: Apolipoprotein E, total cholesterol, HDL cholesterol and LDL cholesterol levels were statistically low at CAD patients than control patients (p=0.0004, p=0.0005, p=0.0107, p=0.0052 respectively). There was not any significant difference between triglyceride levels (p=0.0848). Waist circumferences were significantly high at CAD patients (p=0.0012). Allele frequencies were as e2 (7.25%), e3 (83.5%), e4 (9.25%) and genotype distributions were as E2/2 (0.5%), E2/3 (13%), E2/4 (0.5%), E3/3 (68.5%), E3/4 (16.5%), E4/4 (1%). The distribution of alleles and genotypes were not significantly different (p>0.05). ApoE levels were higher at e2 allele carriers than e3 and e4 allele carriers (p<0.05). However, there was no significant difference between e3 and e4 allele carriers. CONCLUSION: In conclusion, the distribution of apoE genotype and allele at our region is similar to the general of Turkey. The low apoE levels in CAD patients may show the influence of apoE on CAD by local and systemic mechanisms.

Increased melatonin levels in aqueous humor of patients with proliferative retinopathy in type 2 diabetes mellitus.

AIM: To report the association between melatonin levels in aqueous humor and serum, and diabetic retinopathy (DR) grade in type 2 diabetic patients. METHODS: Aqueous humor and plasma samples from 26 patients with DR (in nonproliferative and proliferative stages) and 14 control subjects were collected during cataract surgery after 6 p.m. Melatonin concentrations were determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Melatonin levels were significantly higher in the aqueous humor of patients with proliferative diabetic retinopathy (PDR) [18.57±2.67 pg/mL (range 15.20-23.06) vs 13.63±2.71 pg/mL (range 10.20-20.20), P=0.0001], but not in those with nonproliferative retinopathy (NPDR) [13.79±2.56 pg/mL (range 9.80-20.10) vs 13.63±2.71 pg/mL (range 10.20-20.20), P=0.961] compared to controls. There was decrement in the plasma melatonin level of patients with PDR, but no significant differences between the plasma melatonin levels of the study groups [5.37±1.74 pg/mL (range 2.85-8.65) vs 6.11±1.90 pg/mL (range 3.13-9.41), P=0.293], or between control and DR groups [NPDR 6.11±1.90 pg/mL (range 3.13-9.41) vs control 6.15±1.91 pg/mL (range 2.18-9.86); PDR (5.37±1.74 pg/mL (range 2.85-8.65) vs control 6.15±1.91 pg/mL (range 2.18-9.86), P=0.808, P=0.264]. CONCLUSION: Elevated melatonin levels in aqueous humor in PDR may indicate the level to be associated with DR severity.

Caffeic acid phenethyl ester as a remedial agent for reproductive functions and oxidative stress-based pathologies of gonads.

In recent years, the studies on the roles of caffeic acid phenethyl ester (CAPE) in several disease models and cell cultures are tremendously growing. It is such a great molecule that was used by ancient times to ameliorate some diseases and nowadays, it is used by modern medicine to test the effectiveness. In this mini-review article, the protection capability of CAPE, as a liposoluble antioxidant and a potent nuclear factor kappa B inhibitor, on oxidative and non-oxidative ovary, and testis damages has been summarized. In view of our laboratory findings/experience and those reported in the hitherto literature, we suggest that CAPE possesses protective effects for pathologies of the reproductive organs induced by untoward effects of harmful molecules such as free oxygen radicals, pesticides, methotrexate, and MK-801 (dizocilpine).

Is rosuvastatin protective against on noise-induced oxidative stress in rat serum?

Noise, one of the main components of modern society, has become an important environmental problem. Noise is not only an irritating sound, but also a stress factor leading to serious health problems. In this study, we have investigated possible effects of rosuvastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor, thought to have an antioxidant effect, on noise-induced oxidative stress in the serum of rat models. Thirty-two male Wistar albino rats were used. In order to ease their adaptation, 2 weeks before the experiment, the rats were divided into four groups (with eight rats per each group): Noise exposure plus rosuvastatin usage, only noise exposure, only rosuvastatin usage and control. After the data had been collected, oxidant (Malondialdehyde, nitric oxide [NO], protein carbonyl [PC]) and antioxidant (superoxide dismutase [SOD], glutathione peroxidase [GSH-PX], catalase [CAT]) parameters were analyzed in the serum. Results indicated that SOD values were found to be significantly lower, while PC values in serum were remarkably higher in the group that was exposed to only noise. GSH-Px values in serum dramatically increased in the group on which only rosuvastatin was used. During noise exposure, the use of rosuvastatin caused significantly increased CAT values, whereas it resulted in reduced PC and NO values in serum. In conclusion, our data show that noise exposure leads to oxidative stress in rat serum; however, rosuvastatin therapy decreases the oxidative stress caused by noise exposure.

Role of first trimester total testosterone in prediction of subsequent gestational diabetes mellitus.

AIM: To assess the role of first trimester maternal testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels in prediction of development of gestational diabetes mellitus (GDM). METHODS: Four hundred and fifty pregnant women were included in this prospective cohort study. All pregnant women with a singleton pregnancy who were not diabetic, had no family history of diabetes, had no history of previous GDM, were of white race and non-smokers were enrolled. Total testosterone and DHEA-S were measured at 11-14 weeks of gestation. The patients were called for routine pregnancy visits and followed accordingly. Forty-two patients did not come to their visits and were excluded. During gestational weeks 24-28, the remaining 408 patients were screened for GDM. The total testosterone and DHEA-S levels were compared between patients with and without GDM. Regression and receiver-operator curve analysis were performed. RESULTS: GDM developed in 22 women (5.7%). Compared with women without GDM, first trimester total testosterone levels were higher among women in whom GDM subsequently developed. The DHEA-S level did not differ. Age, total testosterone and body mass index were found to be independent predictors of GDM development. A total testosterone value of 0.45 ng/mL was found to predict development of GDM with a sensitivity of 63.6% and a specificity of 62.7%. CONCLUSION: First trimester total testosterone has a low testing power for GDM screening with low sensitivity and specificity values and cannot be used as a marker alone. It may have a role in combination with other markers.

Possible effects of rosuvastatin on noise-induced oxidative stress in rat brain.

The problem of noise has recently gained more attention as it has become an integral part of our daily lives. However, its influence has yet to be fully elucidated. Other than being an unpleasant stimulus, noise may cause health disorders through annoyance and stress, including oxidative stress. Rosuvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, may possess antioxidant properties. Based on rat models, our project investigates the effect of rosuvastatin on noise-induced oxidative stress in the brain tissue. Thirty-two male Wistar albino rats were used. The rats were divided into four groups: Noise exposure plus rosuvastatin usage, only noise exposure, only rosuvastatin usage, and control. After the data had been collected, oxidant and antioxidant parameters were analyzed in the cerebral cortex, brain stem, and cerebellum. Results indicated that superoxide dismutase values were significantly decreased in the cerebral cortex, while malondialdehyde values in the brainstem and cerebellum were significantly increased in the group with only noise exposure. Superoxide dismutase values in the brainstem were significantly increased, but nitric oxide values in the cerebellum and brainstem and malondialdehyde values in the cerebellum and cerebral cortex were significantly decreased in the group where only rosuvastatin was used. During noise exposure, the use of rosuvastatin caused significantly increased superoxide dismutase values in the cerebral cortex and brainstem, but significantly reduced malondialdehyde values in the brain stem. Consequently, our data show that brain tissue was affected by oxidative stress due to continued exposure to noise. This noise-induced stress decreases with rosuvastatin therapy.

VKORC1 C1173T and VKORC1 G-1639A gene polymorphisms in Turkish Behçet's patients with ocular and non-ocular involvement.

BACKGROUND: Behçet's disease (BD) is a multisystemic vasculitis with unknown etiology. Vitamin K epoxide reductase complex subunit 1 (VKORC1) is the key enzyme in the formation of active vitamin K that is a cofactor of various coagulation factors. Polymorphisms of the VKORC1 may affect the levels of active forms of vitamin K-dependent coagulation proteins and the tendency to thrombosis. The current study aimed to evaluate the role of VKORC1 gene polymorphisms in ocular and non-ocular Behçet's disease. METHODS: VKORC1 C1173T (rs 9934438) and G-1639A (rs 9923231) gene polymorphisms were evaluated by real-time polymerase chain reaction-based DNA analysis. The frequency of alleles and distribution of genotypes were assessed by the chi-squared test. Genotype distribution and Hardy-Weinberg equilibrium were tested with the χ(2) test for quality of fit. RESULTS: The distribution of GG, GA and AA and CC, CT, TT genotypes and the frequency of G,A and C,T alleles were not found to be different between patients and controls (p = 0.5651; p = 0.335 respectively), as well as patients with or without eye involvement (p = 0.9267; p = 0.384 respectively). CONCLUSION: VKORC1 polymorphisms seem not to be related with the thrombotic state of systemic and ocular Behçet's disease.

The reference intervals of thyroid stimulating hormone in healthy individuals with normal levels of serum free thyroxine and without sonographic pathologies.

INTRODUCTION: The aim of the present study was to investigate the reference intervals for thyroid stimulating hormone (TSH) in healthy individuals with normal levels of serum free thyroxine (fT4) and without sonographic pathologies, and determine the effects of age, gender, and residence on the TSH reference intervals. SUBJECTS AND METHODS: This research was a population-based study conducted in 70 regions. The random sampling method was used to select the 1095 subjects of the study among inhabitants aged 18 and above. Patients who had a previous history of thyroid disease and had been taking medication were excluded from the study as this may have affected their fT4 or TSH levels. In addition, subjects who had serum fT4 without a reference range and abnormal ultrasonography findings were also excluded. A total of 408 subjects were used for establishing the reference intervals for TSH. RESULTS: The data for TSH in the study group were not normally distributed according to the Kolmogorov-Smirnov index. The geometric mean was 1.62 mIU/L, the median was 1.40 mIU/L, and the 95% reference intervals were 0.38-4.22 mIU/L. The median TSH level was higher in females compared to males (p < 0.05). In the female subjects 2.5th percentile of TSH was lower and 97.5th percentile was higher than those of males. The reference intervals of TSH were of lower values in subjects over 50 years old (p < 0.001). DISCUSSION: Studies suggest that determination of the TSH reference intervals may differ due to environmental influences or due to age, gender, and race. It is suggested that the lower limit of normal TSH for the adult Turkish population would be 0.38 mIU/L and the upper limit similar to the traditional value of 4.2 mIU/L. If each clinician uses their population-specific reference interval for TSH, thyroid function abnormalities can be accurately estimated.

Evaluation of oxidative status with exhaled breath 8-isoprostane levels in patients with hyperthyroidism.

INTRODUCTION: Studies conducted so far on the effect of hyperthyroidism on oxidative stress (OS) have employed blood and urine samples. Exhaled Breath Condensate (EBC) is a non-invasive technique used to take sample from lungs to determine many biological indications. The aim of the present study was determine the possibility of using 8- isoprostane levels in EBC as an indicator of OS in hyperthyroid patients. METHODS: The present study was performed on 42 patients with hyperthyroidism and 42 healthy control subjects. Hyperthyroid patients included patients with newly diagnosed Graves' disease, toxic multinodular goiter and toxic adenoma. Exhaled breath condensates were collected from patients in each group using a condensing device. 8- isoprostane levels as an indicator of OS in EBC were detected via immunoassay method. RESULTS: Hyperthyroid patients and control groups had 8-isoprostane levels of 6.08±6.31 and 1.56±0.88 pg/ml, respectively. The difference between patient and control groups was statistically significant (p<0.001). Of the hyperthyroid patients, eleven had Graves', 21 multinodular goiter, and 10 toxic adenoma diagnosis. There were no significant differences among patients of different diagnoses for 8-isoprostane levels (p=0.541). No significant correlations were found between 8-isoprostane and free thyroxine (fT4) or thyroid stimulating hormone (TSH) levels. CONCLUSION: In the present study, 8-isoprostane levels in EBC of hyperthyroid patients were found to be significantly higher than that in healthy control group. This study is important in that it is the first to evaluate the effects on respiratory system of elevated OS of hyperthyroidism in EBC.

Thyroid dysfunctions and sonographic characteristics in northern Turkey: a population-based study.

BACKGROUND AND OBJECTIVES: In this study, it was aimed to investigate thyroid functions, sonographic characteristics of thyroid gland, relation of thyroid functions, and cardiovascular risk factors in adult population living in northern Turkey. DESIGN AND SETTINGS: The study was conducted in 70 areas (12 urban and 58 rural) in the province of Tokat in northern Turkey from 2005 to 2006. PATIENTS AND METHODS: The study included about 530000 inhabitants of 18 years and older. Demographic characteristics and thyroid sonographic findings were noted for each subject, and blood samples were collected for measuring serum lipids and thyroid function tests. RESULTS: A total of 1095 subjects (541 males, 554 females) were included, and their mean age (SD) was 41.4 (17) years. Mean thyrotropin (TSH) and free T4 levels (SD) were 1.5 (1.6) micro IU/mL and 1.2 (0.1) ng/dL, respectively, in males, and 2.2 (6.6) micro IU/mL and 1.2 (0.3) ng/dL, respectively, in females (P < .05). According to mean TSH levels, the prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was detected as 1.6%, 0.5%, 2.7%, and 4.9%, respectively. Nodular goiter, multi-nodular goiter, and thyroid heterogeneity were determined as 13.8, 32.1, and 15.6%, respectively. The correlation between cardiovascular risk factors and serum TSH levels was not statistically significant (P > .05). The age was independently and significantly associated with serum TSH levels (P < .0001). CONCLUSION: In terms of high prevalence of thyroid dysfunction and nodular goiter, thyroid diseases must be concluded as a public health problem, and accurate and effective strategies must be identified.

Relationship between maternal thyroid hormones and the biochemical markers of the first trimester aneuploidy screening.

PURPOSE: The role of thyroid function in biochemical markers of first trimester screening has not been assessed. The aim of the present study was to investigate if there were any relation between maternal thyroid hormones and free-beta subunit of human chorionic gonadotropin (fß-hCG) and pregnancy-associated plasma protein A (PAPP-A) levels as the biochemical markers of the combined first trimester aneuploidy screening. METHODS: 375 pregnant women between 11 and 14 weeks of gestation who were offered routine first trimester prenatal aneuploidy screening and whose thyroid hormone levels (Thyroid stimulating hormone (TSH), free and total thyroxine, free and total triiodothyronine, anti thyroid peroxidase antibody) were measured were assessed. Correlation of free-ß-hCG and PAPP-A with maternal thyroid hormones was analyzed. RESULTS: There was no statistically significant correlation between maternal TSH, free and total thyroxine, free and total triiodothyronine, anti-thyroid peroxidase antibodies and free-ß-hCG and PAPP-A as biochemical markers of first trimester aneuploidy screening. CONCLUSION: Maternal thyroid function does not seem to affect secretion of fß-hCG and PAPP-A.

The frequency of antibodies against cyclic citrullinated peptides and rheumatoid factor in healthy population: a field study of rheumatoid arthritis from northern Turkey.

Rheumatoid arthritis (RA) is a chronic, systemic and an autoimmune disease characterized by inflammation of the synovial membrane that affects approximately 1 % of the total world population. Rheumatoid factor (RF) is a widely used auto antibody in diagnosis of the RA and found positive in 50-80 % of the patients but with a lower specificity. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) is the latest serological marker with a specificity around 98 %. This field survey was conducted in different regions to investigate the frequency of RF and anti-CCP and also frequency of RA in a northern province of Turkey. This study was conducted in 70 local areas (12 urban and 58 rural) in the province of Tokat, which is located in northern Turkey. The population of Tokat was reported to be 828,000 at the last census and about 530,000 individuals aged > 18 years old. The study population of 941 subjects (462 male and 479 female; urban 501 and rural 440) was selected by random sampling method among 530,000 individuals. Of the 941 healthy controls assigned to the study, 479 of them were female (51 %) and 462 of them were males (49 %), and median age of all participants was 41 ± 17. Twenty-six subjects were RF positive (2.8 %), and 9 patients were anti-CCP positive (1 %). The presence of both RF and anti-CCP antibodies has also been shown in two patients (0.2 %). In conclusion, we demonstrated that the frequency of RA was 0.53 %, RF presence was 2.8 %, and anti-CCP presence was 1 % in total 941 healthy subjects enrolled into study.

Cysteinyl leukotrienes in exhaled breath condensate of smoking asthmatics.

BACKGROUND: Cysteinyl leukotrienes (CysLTs) are among important inflammatory mediators in asthma pathogenesis. In this study, we aimed to determine leukotriene D4 (LTD4) and leukotriene E4 (LTE4) levels in exhaled breath condensate (EBC) in asthmatics and to evaluate the effect of smoking upon CysLTs levels and to speculate the importance of adding leukotriene receptor antagonists in smoking asthmatics. METHODS: A total of 88 participants were included in the study. Of them, 59 were asthmatics; 30 of the 59 asthmatics were smokers (Group I) and the others were non-smokers (Group II). As a control group (Group III), 29 healthy non-smokers were enrolled. EBC samples were collected (EcoScreen, Jaeger, Hoechberg, Germany) and pulmonary function tests (PFTs) were performed in each case, and an asthma control questionnaire (ACQ) was completed by the asthmatics. LTD4 and LTE4 levels in EBC samples were analyzed by using ELISA. RESULTS: LTD4 levels were found to be higher in Group I than other groups and similar in Group II and Group III. LTE4 levels were lower in Group III than other groups and similar in Group I and Group II. PFTs were different between Group I and Group III and there was a significant negative correlation between LTE4 levels and forced expiratory volume in one second and forced vital capacity ratio in Group I. CONCLUSIONS: LTD4, but not LTE4, concentrations in EBC were higher in asthmatic smokers than asthmatic nonsmokers. LTE4 concentrations in EBC were higher in asthmatics than healthy non-smokers. In smoking asthmatics usage of agents that block the effects of LTD4 can be beneficial; however, new clinical studies are required.

Predictive value of the vitamin K epoxide reductase complex subunit 1 G-1639A and C1173T single nucleotide polymorphisms in retinal vein occlusion.

BACKGROUND: To determine if vitamin K epoxide reductase complex subunit 1 gene polymorphisms have an effect on the risk of having a retinal vein occlusion. DESIGN: Case-control study. PARTICIPANTS: The study population consisted of 68 patients who were newly diagnosed with retinal vein occlusion and 66 sex-matched controls. METHODS: Genomic DNA was extracted from peripheral leukocytes from ethylenediamine tetra-acetic acid-anticoagulated blood. Genotyping of the vitamin K epoxide reductase complex subunit 1 G-1639A (rs 9923231) and C1173T (rs 9934438) single nucleotide polymorphisms was performed using real-time polymerase chain reaction and commercially available kits. MAIN OUTCOME MEASURES: A full ophthalmological evaluation was performed in each subject, and all subjects were screened for hypertension, hypercholesterolaemia and diabetes. The genotypes of the vitamin K epoxide reductase complex subunit 1 single nucleotide polymorphisms were determined. RESULTS: The vitamin K epoxide reductase complex subunit 1 GG and CC genotypes were more frequent (41% vs. 21%; P = 0.021), and the combined GA/AA and CT/CC genotypes were less frequent in patients with retinal vein occlusion than in control subjects. After adjusting for hypertension, age, plasma fibrinogen levels and prevalence of diabetes and hypercholesterolaemia, the GG and CC genotypes were found to be an independent predictor of retinal vein occlusion (B = 2.28; odds ratio = 9.79; P = 0.003; 95% confidence interval: 2.22-43.24). CONCLUSION: It was found that subjects with the vitamin K epoxide reductase complex subunit 1 GG and CC genotypes had a higher risk of retinal vein occlusion.

A preliminary retrospective study about the relationship between ductus venosus Doppler indices, nuchal translucency (NT) and biochemical markers in the first and second trimester screening tests.

In our study, we tried to assess the relation between ductus venosus Doppler indices [pulsatility index (PI), resistance index (RI) and S/D] and first-trimester screening markers (MoM of serum pregnancy-associated plasma protein A, pappalysin 1 (PAPP-A), MoM of serum free ß-human chorionic gonadotrophin (ß-hCG), and nuchal translucency (NT) and second trimester screening markers (MoM of serum α-fetoprotein, MoM of serum total ß-hCG and MoM of serum estriol). We analyzed the data of 121 singleton pregnancies. Roche cobas e 601ECLIA (electrochemiluminescence immunoassay) was used to measure MoM of serum PAPP-A and Roche cobas e 602 ECLIA (electrochemiluminescence immunoassay) was used to measure MoM of serum free ß-hCG in the first trimester. Beckman Coulter Access 2 Immunoassay was used to measure MoM of serum α-fetoprotein, MoM of serum total ß-hCG and MoM of serum estriol in the second trimester. The first author performed all ultrasound screenings and ductus venosus Doppler studies. What we found new in our study is presented as following; MoM of serum α-fetoprotein had a negative correlation with RI of ductus venosus Doppler, MoM of serum estriol had a negative correlation with RI of ductus venosus Doppler and MoM of serum estriol had a negative correlation with S/D of ductus venosus doppler. The results of our study suggest that ductus venosus Doppler can be used to increase the effectiveness of the second trimester screening test.

Procalcitonin: Is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation?

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AeCOPD) are important causes of morbidity and mortality. In this study, we analyzed procalcitonin (PCT) levels in AeCOPD and stable period of COPD in order to evaluate usage of PCT in the prediction of the severity of AeCOPD, and its value on the planing of noninvasive positive pressure ventilation (NPPV). MATERIALS AND METHODS: In this cross sectional study (2009-2010) 118 COPD patients were enrolled, 68 of them (58%) were in acute exacerbations (case group). The others had stabile COPD and they were defined as control group. RESULTS: In case group the mean levels of PCT (0.19 ± 0.02) C-Reactive Protein (44.7 ± 5.92), erythrocyte sedimentation rate (28.4 ± 2.65), white blood cell (9.4 ± 0.43) and %neutrophils (69.9 ± 1.22) were significantly higher than controls (P = 0.0001). There was no difference between PCT levels based on stages of COPD. There were significiant differences in mean PCT levels according to type and severity of AeCOPD. Mean PCT level in hospitalized patients receiving NPPV was 0.36 ng/ml, while it was 0.15 ng/ml for those treated without NPPV (P = 0.0001). PCT cut-off value for NPPV indication was determined to be 0.10 ng/ml. CONCLUSIONS: PCT levels were found to be higher in AeCOPD patients than in stable COPD patients, as expected. Also mean PCT levels increased especially in cases with severe AeCOPD and those receiving NPPV among them. In the present study, we determined a cut off value of PCT as 0.10 ng/ml as a predictor of necessity of NPPV in AeCOPD.

Angiotensin-converting enzyme DD polymorphism is associated with poor coronary collateral circulation in patients with coronary artery disease.

OBJECTIVES: Although association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported by many studies, the relation between ACE I/D polymorphism and coronary collateral circulation (CCC) has not been studied yet. The aim of the present study was to investigate a possible relationship between ACE I/D polymorphism and CCC. METHODS: Patients who were subjected to coronary angiography in the 2006 to 2009 period and had at least a completely occluded major artery were included in this study. To classify collateral circulation, we used the Rentrop classification. Patients were classified as having poor CCC (Rentrop grades 0 to 1) or good CCC (Rentrop grades 2 to 3). Gene polymorphism was detected through the detailed melting curve analysis of polymerase chain reaction products after amplification using real-time polymerase chain reaction method and LightCycler 1.5 apparatus. RESULTS: We prospectively studied 113 patients who had at least 1 totally occluded major epicardial coronary artery. Forty-seven patients had poor CCC and 67 patients had good CCC. There were no differences among groups in age, sex, risk factors, lipid profile, uses of cardiovascular drugs, and number of diseased vessels. Plasma ACE levels were significantly higher in poor CCC group (P < 0.001). The frequency of DD polymorphism was higher in the poor CCC group (P < 0.001). In allele frequency, we found that the frequency of the D allele was higher in poor CCC group than in the good CCC group (95% confidence interval [CI], 2.16-7.38; P < 0.001). Multiple regression analysis with CCC development as the dependent variable revealed that the presence of total occlusion of the left circumflex artery (95% CI, 1.29-6.6; P = 0.001), ACE DD genotype (95% CI, 2.55-12.79; P = 0.001), presence of diabetes (95% CI, 1.03-3.16; P = 0.005), and pulse pressure (95% CI, 1.04-1.56; P = 0.045) were independent determinants of poor coronary collateral development. CONCLUSIONS: This study showed that ACE DD polymorphism is associated with poor CCC. Poor collateral circulation in patients carrying the D allele may be associated with endothelial dysfunction and elevated blood ACE levels in these patients.

Cardiotrophin-1 plasma levels are increased in patients with diastolic heart failure.

BACKGROUND: Cardiotrophin-1 (CT-1) is a member of the interleukin (IL-6) family of cytokines and is increased in various cardiovascular diseases, including chronic heart failure. The aim of the study was to determine if plasma CT-1 is associated with diastolic heart failure (DHF) and to investigate the relationship between CT-1 and echocardiographic parameters. MATERIAL/METHODS: Fifty-seven consecutive patients (mean age 57 ± 8 years, 24 males) diagnosed with DHF in our clinic and 33 controls (mean age 55 ± 7 years, 12 males) were included in the study. All study participants underwent echocardiographic evaluation and blood samples were obtained. RESULTS: CT-1 and NT-proBNP values were significantly higher in DHF subjects than in controls (11.30 [8.09-16.51] vs. 17.5 [8.95-28.74] fmol/mL, P=0.017 and 64 [27.5-95] vs. 82 [55.5-241] pg/mL, P=0.009, respectively). The mitral peak velocity of early diastolic filling (E), mean ratio of E to early diastolic mitral annular velocity (E/Em), and the pulmonary capillary wedge pressure (PCWP) estimated from E/Em measurements were all significantly higher in the patient group (62.27 ± 14.69 vs. 75.67 ± 18.85 cm/sec, 6.40 ± 1.48 vs. 10.30 ± 3.48, and 10 [9-11] vs. 14[12-16] mmHg, P ≤ 0.001 for all). Lateral and septal Em were significantly lower in the patient group (10.69 ± 1.87 vs. 8.69 ± 2.00 cm/sec and 8.91 ± 1.22 vs. 6.65 ± 1.58 cm/sec, P<0.001 for both). CT-1 positively correlated with NT-proBNP (P=0.001, r=0.349), mean E/Em (P=0.003, r=0.307), and estimated mean PCWP (P=0.001, r=0.308). CONCLUSIONS: CT-1 is elevated in patients with DHF and is associated with NT-proBNP and estimated left ventricular filling pressures.

Oxidative stress levels in exhaled breath condensate associated with COPD and smoking.

BACKGROUND: COPD is characterized by chronic air-flow limitation. Smoking is the most important factor in the pathogenesis of COPD. Smoking is associated with increased oxidative stress in the lungs. In this study our aim was to evaluate the differences in the burden of oxidative stress in patients with COPD, smokers, and non-smokers by measuring hydrogen peroxide (H(2)O(2)), malondialdehyde (MDA), and 8-isoprostane levels in the exhaled breath condensate (EBC) samples. METHODS: Eighty subjects were included in the study. Group I (no. = 25) had COPD, Group II (no. = 26) was smokers, and Group III (no. = 29) was nonsmokers. The severity of the COPD and dyspnea was assessed according to the results of pulmonary function tests (PFTs) and Medical Research Council (MRC) scale. RESULTS: The mean age of the subjects was 58 ± 8.9 years. While 8-isoprostane and H(2)O(2) levels were significantly higher in subjects with COPD (44.8 ± 40.2 pg/mL and 1.9 ± 0.8 µmol/L) and smokers (41.3 ± 26 pg/mL and 1.7 ± 0.7 µmol/L) than non-smokers (15.8 ± 6.9 pg/mL and 0.8 ± 0.4 µmol/L), levels were similar between smokers and COPD subjects. MDA levels were similar between the 3 groups (P = .31). There was no correlation between 8-isoprostane and H(2)O(2) levels and PFT parameters. There was a significant positive correlation between dyspnea grade on the MRC scale and 8-isoprostane levels (r = 0.805, P < .001). CONCLUSIONS: Even if respiratory function tests are within normal limits, oxidant burden in lungs of smokers is equivalent to that in COPD patients. 8-isoprostane could be useful in assessing symptom severity and health status of COPD patients.