Different responses of apoptotic, inflammatory and heat shock protein gene expression to a single bout of high-intensity interval exercise between physically active and inactive men.

High mechanical load of muscles may induce muscular apoptosis on the one hand and adaptation to exercise on the other. This study aimed to explore whether changes of circulatory levels of inflammation, apoptosis and heat shock proteins (HSPs) messenger RNA (mRNA) following single bout of high-intensity interval exercise (HIIE) differs between physically active (PA) and inactive (PI) men. Nine PA and 9 PI (peak oxygen consumption: 2.6 ± 0.4 vs. 2.0 ± 0.2 L·min-1) healthy men (age: 28.7 ± 6.3 vs. 30.2 ± 4.5 years and body mass index: 2.6 ± 2.1 vs. 23.3 ± 2.8 kg·m-2) performed HIIE, comprising 4 repeats of a Wingate test (load: 0.050 kg·kg-1 body weight). Blood samples were collected before exercise, 5 min after HIIE, and 24 h after HIIE for measuring mRNA of inflammation markers interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα), apoptosis markers including Bcl-2, Bax, and HSP27, HSP60, HSP70, HSP90 using quantitative real-time PCR analysis. Post-HIIE IL-6, TNFα and HSP60 were higher in the PI than the PA group 5 min after exercise (p = 0.003, effect size (ES) = 1.59; p = 0.007, ES = 1.59 and p = 0.027, ES = 1.10 respectively). HSP70 acutely increased only in the PA group (p = 0.024, ES = 1.20). The increase in Bcl-2 (p = 0.047, ES = 1.08) and Bax (p = 0.024, ES = 1.20) levels were higher in the PI group 5 min after HIIE. The present study indicated that the response of inflammatory, apoptosis and HSP gene expressions to HIIE in blood of healthy male volunteers strongly depends on their level of regular physical activity. Novelty: Blood IL-6 and HSP60 mRNA levels following high intensity exercise may indicate metabolic stress. Increased blood HSP70 mRNA in physically active men may show an alternative apoptosis suppression pathway.

Serum soluble Fas ligand levels and peripheral blood lymphocyte subsets in patients with drug-induced maculopapular rashes, dress, and viral exanthemas.

BACKGROUND: Fatty acid synthetase (Fas)/Fas ligand (FasL)-dependent apoptotic pathways have been reported as being involved in the pathogenesis of drug-induced maculopapular rashes. OBJECTIVE: We investigated serum soluble FasL (sFasL) levels and peripheral blood lymphocyte subtypes to discriminate maculopapular drug eruptions (MPDE) from viral exanthema (VE). PATIENTS/METHODS: Children with confirmed MPDE (group I), VE (group II), and drug rashes with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS) (group III) were included. Serum sFasL levels and peripheral blood lymphocyte subtypes were analyzed in groups I-III on admission, and repeated twice (only once for group IV - controls). RESULTS: There were no significant serum soluble FasL level differences among the groups for all the samples. In the initial samples, CD19+ cell numbers in group II were significantly higher than in group IV, and the CD4+/CD8+ ratio was higher than groups I and IV. In the second samples, CD4+ and CD19+ cell numbers were significantly higher in group II than group I. In the final samples, CD4+ cell numbers in group II were significantly higher than group I and group III. CD19+ cells numbers in group III were significantly lower than the other groups for all samples. CONCLUSION: Serum sFasL levels were not found to be useful in discriminating viral exanthemas from other drug rashes. The significant differences between MPDE, VE, and DRESS were high CD4+ and CD19+ cell-count numbers in VE but low B-cell numbers in DRESS. This might be important for discriminating VE from DRESS, and the low B-cell count in early symptoms might be a useful predictor of DRESS development.

Effect of Lipoic Acid on Serum Paraoxonase-1 and Paraoxonase-3 Protein Levels and Activities in Diabetic Rats.

The aim of the present study was to investigate the effect of streptozotocin-induced diabetes mellitus and lipoic acid treatment on serum paraoxonase-1 and paraoxonase-3 protein levels and paraoxonase, arylesterase and lactonase activities.36 rats were equally and randomly divided into 4 groups as control, lipoic acid, diabetes and diabetes+lipoic acid. To induce diabetes, a single dose of streptozotocin (40 mg/kg) was injected intraperitoneally to diabetes and diabetes+lipoic acid groups. Lipoic acid (10 mg/kg/day) was injected intraperitoneally for 14 days to lipoic acid and diabetes+lipoic acid groups. Serum PON1 and PON3 protein levels were measured by western blotting. Serum paraoxonase, arylesterase and lactonase activities were determined by the measuring initial rate of substrate (paraoxon, phenylacetate and dihydrocoumarin) hydrolysis.Streptozotocin-induced diabetes mellitus caused a significant decrease whereas lipoic acid treatment caused a significant increase in serum PON1 and PON3 protein levels and paraoxonase, arylesterase and lactonase activities. The increase percent of serum PON3 protein was higher than that of serum PON1 protein and the increase percent of serum lactonase activity was higher than that of serum paraoxonase and arylesterase activities in diabetes+lipoic acid group.We can report that, like PON1 protein, PON3 protein and actually its lactonase activity may also have a role as an antioxidant in diabetes mellitus and lipoic acid treatment may be useful for the prevention of the atherosclerotic complications of diabetes by increasing serum PON1 and PON3 protein levels and serum enzyme activities.

The effect of lipoic acid in the prevention of myocardial infarction in diabetic rats.

OBJECTIVES: We aimed to investigate the effect of lipoic acid in the prevention of myocardial infarction in diabetic rats. METHODS: Rats were divided into five groups as control, ISO, LA+ISO, STZ+ISO and STZ+LA+ISO. To induce diabetes, single dose of streptozotocin was injected to STZ+ISO and STZ+LA+ISO groups. Lipoic acid (10 mg/kg/day) was injected for 14 days to LA+ISO and STZ+LA+ISO groups. To induce myocardial infarction, isoproterenol was injected to ISO, LA+ISO, STZ+ISO and STZ+LA+ISO groups on the days 13 and 14 of lipoic acid treatment. Cardiac necrosis and leucocyte infiltration were investigated histopathologically. Serum malondialdehyde levels, paraoxonase and lactonase activities were measured spectrophotometrically. RESULTS: Isoproterenol caused a significant increase in cardiac necrosis, leucocyte infiltration and serum lipid peroxidation whereas a significant decrease in serum paraoxonase and lactonase activities. In myocardial infarcted non-diabetic rats, while lipoic acid caused a significant decrease in cardiac necrosis, leucocyte infiltration and serum lipid peroxidation and a significant increase in serum paraoxonase and lactonase activities, it did not change these histopathologic or biochemical parameters in myocardial infarcted diabetic rats. CONCLUSION: Lipoic acid, at the dose of 10 mg/kg, is effective to prevent myocardial infarction in non-diabetic rats but it is insufficient in diabetic rats (Tab. 1, Fig. 2, Ref. 35).

Aromatase inhibitors decrease radiation-induced lung fibrosis: Results of an experimental study.

PURPOSE: In experimental and clinical trials, tamoxifen (TAM) has been shown to increase radiation-induced lung fibrosis (RILF). Furthermore, aromatase inhibitors (AI) have been shown to be superior to TAM in the adjuvant setting and preclinical data suggest that letrozole (LET) sensitizes breast cancer cells to ionizing radiation in other studies. In this experimental study, we evaluated whether AI have any impact on the development of RILF in rats. MATERIALS AND METHODS: 60 female wistar- albino rats were divided into 6 groups: Control (group A), RT alone (group B), RT + TAM (group C), RT + anastrozole (ANA group D), RT + LET (group E), and RT + exemestane (EXE, group F). RT consisted of 30 Gy in 10 fractions to both lungs with an anterior field at 2 cm depth. Equivalent doses for 60 kg adult dose per day of TAM, ANA, LET, and EXE were calculated according to the mean weight of rats and orally administrated with a feeding tube. Percentage of lung with fibrosis was quantified with image analysis of histological sections of the lung. The mean score values were calculated for each group. the significance of the differences among groups were calculated using one way ANOVA test and Tukey HSD post-hoc test. RESULTS: Mean values of fibrosis were 1.7, 5.9, 6.7, 2.5, 2 and 2.2 for groups A, B, C, D, E, and F, respectively (p = 0.000). TAM increased RT-induced lung fibrosis but without statistical significance. Groups treated with RT + AI showed significantly less lung fibrosis than groups treated with RT alone or RT + TAM (p = 0.000). RT + AI groups showed nearly similar RT-induced lung fibrosis than control group. CONCLUSIONS: In this study, we found that AI decreased RT-induced lung fibrosis to the control group level suggesting protective effect.

GNB3 gene c.825C>T polymorphism and performance parameters in professional basketball players.

UNLABELLED: This study has been conducted to determine whether mean values of peak oxygen consumption (VO(2peak)), anaerobic test parameters and knee isokinetic test measurements are different among guanine nucleotide-binding protein, beta-3 (GNB3) genotype groups in a group of basketball players. METHODS: Seventy-two healthy male (mean age, 22.9 ± 5.3 years) basketball players from the first division of national league participated. We studied GNB3 gene c.825C>T (rs5443) polymorphism, then divided the subjects into three groups as CC (n = 21), CT (n = 35), and TT (n =1 6). Mean VO(2peak), Wingate anaerobic test results, and isokinetic knee muscle strength measurements were compared among the genotype groups. RESULTS: Mean VO(2peak) (60.1 ± 3.9; 56.7 ± 3.6; and 57.8 ± 3.3, respectively, p < 0.01), mean anaerobic minimum power (5.1 ± 0.4; 5.3 ± 0.5; and 4.4 v 0.5 W/kg, respectively, p < 0.001), mean anaerobic power drop (57.0 ± 6.2; 54.2 ± 6.9; and 62.9 ± 5.3%, respectively, p < 0.001) were significantly different among the study groups, CC, CT, and TT. Individuals with TT genotype exerted lower performance in terms of isokinetic knee muscle strength. CONCLUSION: The presence of 825T-allele may impair athletic performance and may serve as a genetic marker of low capacity for athletic performance in male basketball players.

Frequent oral ulceration during early disease may predict a severe disease course in males with Behçet's syndrome.

OBJECTIVES: The numbers and recurrence rates of mucocutaneous manifestations can be highly variable among patients with Behçet's syndrome (BS) but it is not known whether these differences influence the disease course at the long-term. METHODS: We evaluated the outcome of 30 patients that made up the placebo arm of a 6 months controlled trial of thalidomide and looked at the relation between the frequencies of mucocutaneous manifestations during the trial and the development of major organ involvement necessitating immunosuppressives during the post-trial period. RESULTS: Fifteen (50%) patients had received immunosuppresives for major organ involvement during the post-trial period. Patients receiving immunosuppressive treatment were significantly younger at the onset of BS compared to those who did not (24.5±5 vs. 29.7±3.8 SD years; p=0.003). The mean number of oral ulcers recorded throughout the trial was significantly higher among patients using immunosuppressives compared to those who did not (2.09±0.96 vs. 1.43±0.8; p=0.029). This significance disappeared when adjusted for age of onset of BS (p=0.16). ROC curve analysis showed that having 10 or more ulcers during 6 months has a sensitivity of 86.7% and a specificity of 53% for the subsequent necessity of immunosuppressive use. The same association was not true for genital ulcers, follicular lesions and erythema nodosum. CONCLUSIONS: These findings on a limited number of patients suggest that frequent occurrence of oral ulceration during the initial years of the disease may predict the development of major organ involvement in men with BS.

Effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block in patients undergoing lower abdominal surgery.

The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n = 45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n = 45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P < 0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.

Comparison between low flow sevoflurane anesthesia and total intravenous anesthesia during intermediate-duration surgery: effects on renal and hepatic toxicity.

BACKGROUND: Renal and hepatic dysfunction or injury might be involved by ether based anesthetic and intravenous anesthetic drug or surgical stress. The purpose of this study is to compare the effect of moderate duration low-flow sevoflurane versus total intravenous anesthesia on renal and hepatic functions. PATIENTS AND METHODS: Eighty (80) patients between the ages of 25-70 scheduled for elective lumbar disc herniotomy, with an expected operation time of 120-240 min, were enrolled in the study. Anesthesia was induced using remifentanil, propofol and atracurium. Patients were randomly divided into two groups. After intubation, Group S (n=40) received sevoflurane and Group T (n=40) received total intravenous anesthesia with propofol in oxygen and air with a fresh gas flow of 5 L min(?1). Ten minutes after induction the fresh gas flow was decreased to 1L min(?1) in both groups. Serum BUN, creatinine, ALT, AST, LDH and 24 hours excretion of glucose, protein, and creatinine in urine were measured preoperatively and the first three postoperative days. RESULTS: Serum BUN at 48 hours, creatinine at 24, 48. hours, and urine glucose at 24, and 48 hours were significantly higher from the preoperative values in Group S (p<0.05). However, serum BUN and creatinin, urine glucose were within the normal range. There were no significant differences in the renal and hepatic function tests between the groups. CONCLUSIONS: These results show that the renal and hepatic effect of moderate duration low-flow sevoflurane and total intravenous anesthesia is similar.

Differences in pain and fatigue perception among a group of rheumatoid arthritis patients in the United States and in Turkey who have similar disease activity and functional status.

OBJECTIVES: The concordance of patient reported outcomes in rheumatoid arthritis (RA) among different countries has not been studied in detail. We tried to determine the differences in pain and fatigue perception among a group of RA patients in the US and in Turkey who had similar disease activity and functional score in multidimensional health assessment questionnaire (MDHAQ FN). METHODS: One hundred and thirty seven RA patients from Turkey and 129 from the US were studied. An MDHAQ was obtained and a DAS28 was calculated for each patient. Pain and fatigue perception was compared between the two groups after adjusting for age, sex, MDHAQ FN and DAS 28. RESULTS: Turkish patients had less pain than their US counterparts when adjusted for MDHAQ FN, DAS 28, age and sex (3.56 (2.24) vs. 4.35 (2.23), p=0.005) whereas there was no difference in fatigue between the two groups (3.85 (2.44) vs. 4.25 (2.45), p=0.194). When the patients with a DAS28 score of above 5.1 and below 2.6 were compared in both groups, Turkish patients had again less pain albeit less in the high disease activity group. CONCLUSIONS: This study suggests that Turkish patients have less pain than the US patients when controlled for age, gender and MDHAQFN and DAS28 scores. This is at odds to the conventional wisdom that pain perception is increased among the non-Western cultures.

The impact of trastuzumab on radiation-induced pulmonary fibrosis: results of an experimental study.

There are no data regarding the late toxicity of trastuzumab (T) administration with radiotherapy (RT). In this experimental study, we aimed to asses if concurrent or sequential administration of T has any impact for the development of radiation-induced pulmonary fibrosis in rats. Fifty-four female Wistar-albino rats were divided into 6 groups. First group of rats (Group 1; concurrent T) had irradiation to whole thoracic region concurrently with T. Second group (Group 2: sequential T-RT) received thoracic irradiation, 1 week after T. Third group (Group 3: sequential RT-T) had thoracic irradiation first and they had T injection 1 week after RT. Fourth group (Group 4: T only) had only T application. Fifth group (Group 5: RT) had only RT. The last group (Group 6: sham) of rats were observed without any application. A single dose of 12 Gy was given to both lungs with an anterior field at 2 cm depth. T dose which was equivalent to 6 mg/kg adult dose was calculated for each rat, and injected by the tail vein. As an end point the extent of pulmonary fibrosis for each field was graded on a scale from 0 (normal lung or minimal fibrous thickening) to 4 (total fibrous obliteration of the field) at histopathological examination. The mean value of fibrosis scores were 1.44, 1.77, 1.75 and 1.62 for Group 1, 2, 3 and 5, respectively, without any statistically significant differences among them (P>0.05). The mean value of fibrosis scores for Group 4 and 6 were 0.25 and 0.33, respectively (P>0.05). When the mean value of fibrosis scores of the groups which had RT with or without T, compared with the observation and the T only groups, the difference was significant (P<0.05) (one-way ANOVA and Tukey HSD post hoc tests) As a conclusion: addition of T to thoracic irradiation either sequentially or concomitantly did not increase radiation-induced pulmonary fibrosis in rats.

Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.

BACKGROUND: We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients. METHODS: Forty early septic shock patients were included in the study and administered either the loading dose infusion of propofol (n = 20, group P) of 1 mg/kg over 15 minutes followed by a maintenance dose of 1 to 3 mg/kg per hour (n = 20, group P), or a loading dose of dexmedetomidine 1 microg/kg over 10 minutes followed by a maintenance of 0.2 to 2.5 microgg/kg per hour (n = 20, group D) (24-hour infusion). Indocyanine green (ICG) elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON; Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg of ICG was given through a cubital fossa vein as a bolus and immediately flushed with 10 mL of normal saline. We calculated ICG-PDR. Indocyanine green plasma disappearance rate measurements were obtained at baseline (before start of the propofol or dexmedetomidine infusion) and were repeated at the 24th hour. Biochemical and hemodynamic parameters and ICG-PDR were recorded before start of the study and at 24th hour. RESULTS: Biochemical and hemodynamic parameters did not differ significantly between the groups (P < .05). Baseline ICG-PDR levels of group P compared to group D were 24.7 +/- 14.4 vs 22.2 +/- 10.7, respectively, and after the study, ICG-PDR levels (26.5 +/- 13.7 vs 23.7 +/- 12.4) did not differ in groups (P > .05). When we examined ICG-PDR changes between groups before and after administration, there was no significant difference (P > .05). CONCLUSION: In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.

Synovial cysts of the lumbar facet joints: a retrospective magnetic resonance imaging study investigating their relation with degenerative spondylolisthesis.

Patients with synovial cysts of the facet joints were compared with patients with degenerative spondylolisthesis (DS), based on the magnetic resonance imaging (MRI) findings of their spondyloses. The lumbar MRI of 30 patients with DS (group 1) 24 patients with synovial cysts of the facet joints (group 2) were studied. All patients were evaluated in terms of facet joint arthritis, disc degeneration, facet joint effusion, and the thickness of the flaval ligament. 54.1% of the patients with synovial cysts had associated DS. The mean grade of disc degeneration (2.43+/-0.50 and 2.13+/-0.68 in groups 1 and 2, respectively) and the mean thickness of the flaval ligament (3.20+/-1.22 mm and 3.83+/-1.46 mm in groups 1 and 2, respectively) did not differ between the groups (p=0.093 and p=0.097). The mean grade of facet joint osteoarthritis (2.53+/-0.51 and 2.08+/-0.72 in groups 1 and 2, respectively) was significantly higher in group 1 (p=0.18). The co-existance of synovial effusion was significantly higher in cases with synovial cysts. (p=0.008). Synovial cysts are associated with DS and facet joint osteoarthritis. The presence of synovial effusion and the high degree of disc degeneration are prominent features in patients with synovial cysts. Although osteoarthritis and DS are highly concomitant with facet joint synovial cysts, both conditions do not invariably lead to a cyst formation.

The impact of treatment interruptions on locoregional control during postoperative breast irradiation.

PURPOSE: Patients treated in the years 1990-2003 with breast conserving surgery and postoperative adjuvant radiotherapy were retrospectively analyzed in order to determine the impact of radiotherapy interruptions on the treatment outcome. PATIENTS AND METHODS: 470 patients received breast irradiation with (60)Co or with 4MV photon linear accelerator (total dose 50 Gy, range 46-54). Four hundred and sixty-two (98%) patients had boost dose of 10-20 Gy to the tumor bed either with photon or electron irradiation. Irradiation of the lymphatic fields was carried out according to the number of involved nodes. Even one day of treatment break was accepted as treatment interruption. Unplanned treatment interruptions occurred in 423 (90%) patients. A total of 196 (41%) patients had no treatment breaks or had interruptions of 7 days or less and 274 (59%) patients had treatment interruptions longer than 7 days. Locoregional control (LC) and overall survival (OS) rates were estimated by Kaplan-Meier method. The groups were compared with log-rank x(2) and Pearson x(2) tests. RESULTS: For all patients 5-year LC and OS rates were 91% and 85%, and 10-year rates were 86% and 75%, respectively. LC rates for the group of patients without interruptions or with an interruption of less than a week were 95% for 5 years and 90% for 10 years. Five- and 10-year LC rates for the patients with interruptions of 8 days or more were 87% and 83%, respectively (p=0.02). CONCLUSION: This retrospective study shows that postoperative irradiation interruptions of more than a week negatively impact LC.

High plasma D-dimer level is associated with decreased survival in patients with lung cancer.

AIMS: An elevated plasma D-dimer level indicates the activation of coagulation and fibrinolysis. In the present study, we investigated the association of pre-treatment haemostatic parameters (D-dimer, fibrinogen and prothrombin fragment 1+2) with clinicopathological parameters and outcome in patients with lung cancer. MATERIALS AND METHODS: Plasma levels of D-dimer and other parameters were measured in 78 evaluable patients with lung cancer (60 non-small cell lung cancers, 18 small cell lung cancers). At diagnosis, 35 patients (44.9%) were locally advanced stage (IIIA/B) and 43 patients (55.1%) had metastatic disease (IV). Multivariate statistical analysis was carried out using Cox's proportional hazards model. The receiver operating characteristic curve was used to determine the cut-off values for D-dimer, fibrinogen and prothrombin fragment 1+2. RESULTS: The median survival for all patients was 264 days (95% confidence interval 200-328 days). A significant association between the plasma levels of D-dimer and the response to chemotherapy was observed (P=0.03). With the univariate analysis, tumour stage, pre-treatment plasma levels of D-dimer, fibrinogen, platelet count, lactate dehydrogenase concentration and Karnofsky performance status were predictive for survival. With the multivariate analysis (P< or =0.1), the plasma level of D-dimer (P<0.001), tumour stage (P=0.01) and Karnofsky performance status (P=0.02) were identified as independent predictive factors. The median survival times were 405 days (95% confidence interval 165-644 days) and 207 days (95% confidence interval 146-267 days, P<0.001), respectively, for patients with a low D-dimer level (< or =0.65 microg/ml) and a high D-dimer level (>0.65 microg/ml). CONCLUSIONS: Elevated plasma levels of D-dimer in patients with lung cancer are associated with decreased survival and a poor response to treatment. Pre-treatment for the D-dimer level may be useful in the prediction of survival and the response to treatment.

Vitamin E protects against the development of radiation-induced pulmonary fibrosis in rats.

AIMS: To investigate whether the application of vitamin E with or without pentoxifylline could modify the development of radiation-induced pulmonary fibrosis. MATERIALS AND METHODS: Wistar albino rats were supplemented with either vitamin E or pentoxifylline or with both vitamin E and pentoxifylline after a single dose of 14 Gy thoracic irradiation. Supplementation was started the day after irradiation and continued until the rats were sacrificed. As a quantitative end point, the extent of fibrosis was evaluated with a scale from 0 (normal lung) to 8 (total fibrous obliteration of the field) at pathological examination of the lung tissue. RESULTS: A significant reduction in fibrosis was obtained in the group of rats supplemented with vitamin E with or without pentoxifylline, when compared with the group that had irradiation only. CONCLUSION: This experimental study showed that vitamin E supplementation immediately after irradiation protected rats against radiation-induced pulmonary fibrosis. The combination with pentoxifylline was more effective, although pentoxifylline itself had limited efficacy, which was not statistically significant.

A cost analysis of Behcet's syndrome in Turkey.

OBJECTIVE: Behçet's syndrome (BS), a common chronic inflammatory disease in Turkey, results in considerable morbidity and increased mortality. We aimed to estimate its direct and indirect costs. METHODS: We studied 119 (78 male/41 female) patients with BS at our multidisciplinary BS out-patient clinic in Istanbul, between March and July 2005. The mean age and disease duration were 35 +/- 9 and 10 +/- 6 S.D. yrs. According to the primary clinical problem, patients were divided into: (i) ocular; (ii) vascular; (iii) neurological and (iv) mucocutaneous-joint disease subgroups. They were interviewed with a standardized questionnaire addressing: (a) direct costs such as medication, diagnostic tests, hospital visits, hospitalization fees and lodging and transportation expenses and (b) indirect costs such as lost workdays and wages. The costs were assessed retrospectively by assessing the expenses within a year of the survey and were expressed as US$ mean +/- S.D. RESULTS: The mean annual total cost per patient was US$ 3226 +/- 3488 (S.D.). The direct cost accounted for 68% of the total cost. Medication expenses made up 79% of the total direct cost. About 42% of the patients reported lost workdays that averaged 119 +/- 96 days S.D. Among the clinical subgroups mucocutaneous-joint involvement (US$ 1180 +/- 1053) had the lowest economic impact while the neurological disease (US$ 5005 +/- 2707) had the highest. CONCLUSION: In this first cost of illness study in BS, the neurological involvement had the highest annual cost. Direct costs were higher than the indirect costs. Drug costs were the major cost driver. BS causes considerable economic burden for the health care system in Turkey.

Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome.

BACKGROUND: The aim of this study was to evaluate the effects of metformin and acarbose on insulin resistance, hormone profiles and ovulation rates in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). METHODS: Thirty clomiphene citrate-resistant patients were selected randomly and divided into two groups. Group I was treated with 100 mg/day clomiphene citrate and 300 mg/day acarbose 100 mg/day orally, for 3 months. Group II was treated with clomiphene citrate 100 mg/day and metformin 1700 mg/day orally, for 3 months. Serum fasting insulin and glucose, FSH, LH, estradiol, progesterone, prolactin and total testosterone levels plus body mass index (BMI) were measured before and after treatment. Follicle growth was followed by transvaginal ultrasonography. RESULTS: LH:FSH ratio and total testosterone concentrations decreased (P<0.05) and ovulation rates increased in both groups. Reduction in weight and BMI was only significant in the acarbose group. CONCLUSIONS: Both treatment modalities were effective in the treatment of insulin resistance and improving ovulation rates. Increase in the number of eumenorrhoeic and normoinsulinaemic cases and decrease in the number of insulin-resistant cases were significant in both groups (P<0.05). Ovulation rate was greater in the metformin group in the second month of therapy (P<0.05). Acarbose was found to be a safe and effective agent that could be used in cases with clomiphene-resistant PCOS.