Changes in and the relationships between alpha-klotho, oxidative stress, and systemic inflammation in cigarette smokers.

Background: Although smoking is known to accelerate aging, the mechanisms by which this occurs have not been fully clarified. Serum-soluble α-Klotho (sαKl), antiaging, anti-inflammatory, and developing resistance to oxidative stress properties are known. Aim: This study aimed to determine the relationship between cigarette smoking, sαKl (antiaging hormone), inflammation, and oxidative stress. Materials and Methods: Participants included in the study were divided into smoking and nonsmoking groups. sαKl, high-sensitivity C-reactive protein (hsCRP), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were assessed and compared in the study participants. Results: There were one hundred and forty-six study participants comprising 47 (32.2%) females and 99 (67.8%) males. There were 79 (54.1%) in the nonsmoking group and 67 (45.9%) in the smoking group. A significant difference was found between the groups in respect of TAS (P < 0.001), OSI (P = 0.017), sαKl (P = 0.013), and hsCRP (P = 0.024) values. A significant negative correlation was found between the sαKl values of the smoking group and the years of smoking (r = -0.271, P = 0.038) and pack-years (r = -0.299, P = 0.021). Among the smoking group, a lower median sαKl value of <3.84 pg/ml was significantly associated with years of smoking (P = 0.028) and pack-years (P = 0.012). Conclusions: This study found that sαKl, OSI, and hsCRP were elevated in those who smoke cigarette. Large prospective studies are needed to further elucidate this area of research.

The effects of smoking cessation on visceral adiposity index levels.

BACKGROUND: : Known to cause important metabolic disturbances, weight gain becomes a major health problem after smoking cessation. Visceral adiposity index (VAI) is becoming increasingly popular in the detection of cardiometabolic risks in several disorders and general population. Here, we aimed to investigate the effects of quitting smoking on VAI levels. MATERIALS AND METHODS: : Of 350 participants included into the cigarette cessation program, 70 (20%) completed the study and were enrolled into the analyses. VAI levels were calculated at the baseline and 3rd month after cigarette cessation. RESULTS: : Thirty-eight (54.3%) out of 70 participants were male. While the mean age was found as 42 ± 1.0 years, mean starting age of smoking was found to be 16.87 ± 0.45 years, and mean smoking time was 23.07 ± 1.18 years. While VAI levels were found higher in men at the baseline, VAI levels were found similar in both genders at the end of the study. Higher VAI levels were found in those smoking >20 cigarettes/day, compared to those smoking ≤20 cigarettes/day. Although weight, waist circumference, body mass index (BMI), and high-density lipoprotein cholesterol levels increased, VAI levels were found to decrease significantly at the 3rd month. In subgroup analyses, VAI levels were seen to decrease significantly only in men (P = 0.005). Furthermore, VAI levels were found to decrease (P < 0.001) in those with BMI ≥25 kg/m2, whereas no significant change was observed in those with BMI <25 kg/m2. CONCLUSIONS: Although body weight increases significantly after quitting smoking, VAI levels, an indicator of cardiovascular risks, decrease significantly, especially in men or obese patients.

Effects of smoking on thiol/disulfide homeostasis.

OBJECTIVE: Cigarette smoking is an important risk factor for many diseases. This study aimed to evaluate whether cigarette smoking is associated with changes in the thiol/disulfide homeostasis (TDH), a novel biomarker of systemic oxidative stress. PATIENTS AND METHODS: Eighty-four smokers and 86 non-smoking healthy volunteers were enrolled. Serum native thiol, disulfide and total thiol levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were analyzed using a new colorimetric method. Carbon monoxide (CO) levels were measured by a piCO smokerlyzer instrument. RESULTS: The native, total, and native/total thiol levels of smoking patients were significantly lower (p<0.001 for each), and disulfide, disulfide/native thiol, and disulfide/total thiol levels were significantly higher in smokers than the healthy controls (p<0.001 for each). The CO levels of all study participants were negatively correlated with native thiol (r= -0.627, p<0.001), total thiol (r= -0.569, p<0.001), native thiol/total thiol (r= -0.515, p<0.001), and positively correlated with disulfide (r=0.398, p<0.001), disulfide/native thiol (r=0.515, p<0.001) and disulfide/total thiol (r=0.515, p<0.001) levels. CONCLUSIONS: To our knowledge, this investigation is the first in the literature that investigated TDH in cigarette smokers. Our results show that cigarette smoking may lead to oxidative stress and TDH shifts through disulfide side compared to the healthy group. Further studies with larger sample size are needed to confirm our results for showing the changes in TDH to contribute to the clinical practice.

The effects of smoking on neutrophil/lymphocyte, platelet/ /lymphocyte ratios.

OBJECTIVE: The aim of this study was to compare the Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR) and Mean Platelet Volume to Platelet (MPV/Plt) ratio of smokers and non-smokers. METHODS: Two hundred smokers and two hundred non-smoking healthy volunteers were enrolled in this study. Sociodemographic data and hematologic parameters of all patients were recorded. NLR, PLR and MPV/Plt ratios were calculated. RESULTS: The mean age of the case group was 35.88 ± 10.56 and the mean age of the control group was 38.97 ± 10.56. 80 % (n = 160) of the smokers were male and 20 % (n = 40) were female. 27.5 % (n = 55) of the control group were male and 72.5 % (n = 145) were female. The smoker group had higher NLR and MPV/Plt ratio (p < 0.05). PLR was significantly higher for the non-smoker group (p < 0.05). CONCLUSION: As a result of our study, an increase in the NLR which is used as a systemic inflammatory marker, a decrease in the PLR and an increase in the MPV/Plt ratio which indicates thromboembolism risk were found for the smoker group (Tab. 3, Ref. 32).

Efficacy and Safety of ATG-Fresenius as an Induction Agent in Living-Donor Kidney Transplantation.

BACKGROUND: Induction therapy is mostly recommended for deceased-donor transplantation, whereas it has some controversies in live-donor transplantation. In this study, we described the outcomes of live-donor renal transplant recipients who received ATG-Fresenius (ATG-F) induction. METHODS: Live-donor transplantations in patients over 18 years old with ATG-F induction between 2009 and 2015 were included. All patients received quadruple immunosuppression, one of which was ATG-F induction. Biopsies after the artery anastomosis (zero hour) and protocol biopsies at the 6th month and at the 1st first year were obtained. Acute graft dysfunction was defined as a 20% to 25% increase in creatinine level from baseline. All acute rejection episodes were biopsy-confirmed. All episodes were initially treated with intravenous methyl prednisolone (MP) or ATG-F if resistant to MP. Four hundred twenty-two patients with live-donor transplantation were evaluated. The mean age was 40 ± 13 (18-73) years. The mean panel-reactive antibody levels were 42% ± 30% and 45% ± 30% for class I and II, respectively. RESULTS: The mean mismatch number for living unrelated donors (n = 112) was 4.6 ± 1.0. Acute rejection rate was 29.1% (123 patients) within the first year. The mean cumulative ATG-F doses for per patient and per kilogram were 344 ± 217 mg and 5.1 ± 2.7 mg, respectively. Patient survival rates were 98.3% and 96.7% for 12 months and 60 months, respectively. Death-censored graft survival rates were 97.6% and 92.1% for 12 months and 60 months, respectively. CONCLUSIONS: ATG-F induction provided excellent graft and patient survival rates without any significantly increased side effects. Increasing sensitized patient numbers, more unrelated donors, increasing re-transplantation numbers, and more desensitization protocols make ATG-F more favorable in an induction regimen.

Use of kidney donors with hepatitis B, hepatitis C, or brain tumor: a single-center experience.

INTRODUCTION: With the rapid increase in the number of patients on the waiting lists, the idea of using organs from donors who were previously classified as "marginal" has emerged. The aim of this study was to evaluate the clinical outcomes of the patients who received kidneys from donors with hepatitis B, hepatitis C, or brain tumors. PATIENTS AND METHOD: Between 2003 and 2010, 27 transplantations were performed from donors with hepatitis B, hepatitis C or brain tumors between 2003 and 2010. Demographic and clinical characteristics of donors and recipients were retrospectively collected from medical files. RESULTS: Fifteen patients received kidneys from donors with hepatitis B: 9 from deceased donors having a positive hepatitis B surface antigen (HBsAg) and six from living donors with positive HBsAg having negative results of qualitative hepatitis B DNA analysis. Two of the fifteen recipients were previously diagnosed with chronic active mild hepatitis B infection. The remaining 13, who were HBsAg (-)/anti-HBs(+) at the time of transplantation, underwent hepatitis B immune globulin and lamivudine therapy. Median follow up time was 40 ± 35 months. One patient developed decompensated liver disease owing to noncompliance to lamivudine therapy. Five patients who received grafts from anti-HCV(+) deceased donors were anti-HCV(+) at the time of transplantation with alanine aminotransferase (ALT) levels <40 U/L. All grafts remained functional at a median of 70 months. Seven subjects received grafts from deceased donors with brain tumors, none of whom had a history of a craniotomy or a ventriculoperitoneal shunt. All recipients had serious vascular access problems. No graft loss or de novo malignancies was observed among these patients after a median follow-up of 69 ± 26 months. CONCLUSION: With appropriate patient selection, the donated organ pool can be expanded by addition of donors with hepatitis or brain tumors.

What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis.

OBJECTIVE: Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implementation of The National Allocation System (NAS). PATIENTS AND METHODS: We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. RESULTS: Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P = .001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P = .000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P = .05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P > .05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P > .05). DISCUSSION: After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates.

Long-term outcomes of kidney transplants with multiple renal arteries: a retrospective study.

OBJECTIVE: The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. METHODS: Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. RESULTS: While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P < .05). CONCLUSION: Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases.

Spousal versus living unrelated renal transplantation: a retrospective analysis of allograft outcomes.

OBJECTIVE: To compare the outcomes of spousal and living unrelated donor (LUD) allografts. PATIENTS AND METHODS: The 378 ABO-compatible living and cadaveric kidney transplantations between February 2005 and August 2010 included 25 wife-to-husband (group 1), 15 husband-to-wife (group 2), and 20 LUD cases (group 3). Donor nephrectomy was performed by open surgery. Induction therapy with antithymocyte globulin or anti-interleukin-2 receptor antibody was followed by maintenance regimens using cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) and corticosteroids. We compared spousal donor and LUDs in terms of clinical characteristics as well as graft and patient survival rates. RESULTS: Fifty-six (93.3%) patients underwent induction therapy with either antithymocyte globulin (n = 30) or anti-interleukin-2 receptor antibody (n = 26). Maintenance immunosuppression was administered with Tac + MMF (n = 37; 61.6%) or CsA + MMF (n = 23; 38.4) with corticosteroids. Mean follow-up was 34 ± 16 months. There were four graft losses and five patient deaths. There were no significant differences between spousal and living unrelated transplants in terms of clinical characteristics or biopsy-proven acute rejection episodes. The Kaplan-Meier analysis showed 3-year patient survival rates of 94%, 100%, and 88% in group 1, group 2, and group 3, respectively (P > .05). Overall graft survival rates were 94%, 100%, and 77% in group 1, group 2, and group 3, respectively (P > .05). Graft and patient survival rates were similar at 3 years for wife-to-husband, husband-to-wife, or LUDs. CONCLUSION: In conclusion, family members should be encouraged as LUD or spousal donors, based on similar patient and graft survival rates.

Human serum paraoxonase (PON1) activity in acute organophosphorous insecticide poisoning.

Human serum paraoxonase (PON1) and perhaps other mammalian paraoxonases catalyzes the hydrolysis of certain organophosphorus (OP) insecticides and nerve gases and so may alter significantly an individual's susceptibility to the toxicity of these chemicals. Serum PON1 exhibits a substrate dependent polymorphism and this polymorphism shows great interethnic variability. This study focused on the investigation of PON1, arylesterase and cholinesterase activities in 28 acute OP insecticide poisoning cases. Insecticide analysis were performed by GC-NPD and activities of enzymes were measured by using spectrophotometer. The activity levels for salt stimulated PON1, basal PON1 and arylesterase were found as 78.83 (35.39-186.13), 39.97 (2.49-80.43) micromol/min/l and 126.26 (36.34-288.24) mmol/min/l respectively. On the other hand the activity levels for butyrylcholinesterase (BTC) and acetylcholinesterase (AchE) were found as 797.23 (106.3-3823)U/l and 4.65 (0.21-30.29)U/ml. There was a correlation between percent stimulation of PON1 and BTC activities (r=0.446, P<0.05), but this correlation was lower than in cases who exposed to OP insecticides chronically. As a conclusion, in chronic and acute OP exposure, both PON1 level and phenotype must be taken into consideration.

The evaluation of diagnostic accordance between plain radiography and bone scintigraphy for the assessment of sternum and rib fractures in the early period of blunt trauma.

OBJECTIVE: To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. DESIGN: Double-blind, prospective clinical study. METHODS: Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. RESULTS: Radiography displayed pathologies in 25 (73.5%), while scintigraphy suggested pathologies in 24 (70.5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52.6%), while scintigraphy suggested fracture in 14 (73.6%) patients with suspected sternal trauma. CONCLUSION: Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax or pneumothorax besides the osseous abnormality.