Serum paraoxonase and arylesterase can be useful markers to predict neoadjuvant chemotherapy requirement in patients with breast cancer.

AIM: The aims of this study are to evaluate the serum levels of paraoxonase (PON) and arylesterase (ARE) in breast cancer (BC) patients; to determine their relationship with chemotherapy requirements in BC; and to find a cut-off value to assess subjects with a higher risk of BC. SUBJECTS AND METHODS: A total of 40 BC patients and 33 age-matched healthy women were included in this study. Beside other biochemical parameters, participants' serum PON and ARE levels were determined and analyzed. RESULTS: Serum PON and ARE levels were found decreased in sera of the patients (96.44 ± 21 and 159.75 ± 15.75 U/L, respectively)compared to controls (158.39 ± 23.04 and 239.33 ± 32.98 U/L, respectively) (P = 0.001 for both). Subgroup analysis of the BC patients revealed that both serum PON and ARE levels were lower in patients who needed neoadjuvant chemotherapy (NAC), compared to those who did not (P = 0.024 and 0.02, respectively). We determined a cut-off value of PON according to the receiver operating characteristic curve analysis as 131.2 U/L (sensitivity 97.5% and specificity 93.9%). CONCLUSION: BC patients have lower serum PON and ARE levels than healthy controls. Also, serum ARE levels (but not PON) were negatively correlated with body mass index in BC patients. Both serum PON and ARE levels were lower in patients who needed NAC than in patients who did not need such therapy.

Serum paraoxonase 1 activity in patients with iron deficiency anemia.

INTRODUCTION: In this study we aimed to detect paraoxonase 1 (PON-1) activity in iron deficiency anemia (IDA) and to compare it with healthy controls by observing the change after iron therapy. MATERIAL AND METHODS: In this study, 50 adult patients with IDA and 40 healthy subjects were enrolled. All patients were analyzed at the beginning and after treatment according to laboratory assessments. RESULTS: Mean paraoxonase and arylesterase activities in the iron deficiency anemia group were significantly lower than mean activities of the control group (102.4 ±19.2 U/l and 163.3 ±13.68 U/l, respectively and 157.3 ±26.4 U/l and 256.1 ±24.6 U/l, respectively; p = 0.0001 for both). Paraoxonase and arylesterase activities significantly increased after treatment for IDA (143.2 ±13.9 and 197.6 ±27.9 U/l, respectively, p = 0.0001). Mean activities after treatment with iron were significantly lower than mean activities in the control group (p = 0.002; p = 0.0001 respectively). CONCLUSIONS: Paraoxonase and arylesterase activities in patients with IDA significantly increased after treatment with iron therapy. In adults IDA may also be one of the factors associated with increased risk of atherosclerosis.

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer.

Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients' hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p = 0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with "obesity paradox" in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor.

Comparison of risk factors for cardiovascular disease in hemodialysis and peritoneal dialysis patients

OBJECTIVE:In this study, we aimed to compare the cardiovascular risk factors that might be associated with inflammation, atherosclerosis and metabolic syndrome between hemodialysis and peritoneal dialysis patients.METHODS:Fifty hemodialysis and 50 peritoneal dialysis patients who had been receiving dialysis therapy for at least one year were included in the study. Venous blood samples were taken after 12 hours of fasting, and serum glucose, triglyceride, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, fibrinogen and homocysteine levels were measured. The presence of atherosclerotic plaques in the carotid artery was evaluated by carotid Doppler ultrasound. These data were analyzed by Student’s t test, the chi-square test and the Mann-Whitney U test, as appropriate.RESULTS:No difference was found between the hemodialysis (n=50) and peritoneal dialysis (n=50) patient groups regarding mean age, gender distribution, body mass index or dialysis duration (p=0.269, 0.683, 0.426, and 0.052, respectively). LDL-cholesterol, fibrinogen and homocysteine levels were significantly higher in peritoneal dialysis patients (p=0.006, 0.001, and 0.002, respectively). In patients with diabetes mellitus (n=17) who were undergoing renal replacement therapy, LDL-cholesterol and fibrinogen levels were significantly higher than in patients without diabetes mellitus who were undergoing renal replacement therapy (p=0.001 and 0.004, respectively).CONCLUSION:In our study, cardiovascular risk factors (especially LDL-cholesterol) were more frequent in peritoneal dialysis patients than in hemodialysis patients.

Renal biopsy in the elderly: a single-center experience.

OBJECTIVE: Aging population has been increasing worldwide. So the number of elderly patients presenting with kidney disease has also been increasing. In this retrospective study, we assessed biopsy results of elderly patients and their clinical presentations. MATERIALS AND METHODS: Native renal biopsy results of 98 elderly patients (≥65 years) were analyzed. These 98 patients consisted of 56 males (57.1 %) and 42 females (42.9 %) with a mean age of 70.59 ± 5.31 years (65-88 years). RESULTS: The clinical presentations of our elderly patients were nephritic syndrome (n = 45), acute kidney injury (n = 35), nephrotic syndrome (n = 33), chronic kidney disease (n = 32) and combined nephritic and nephrotic syndrome (n = 14). In patients with nephritic syndrome, the most common diagnosis was crescentic GN (17.8 % type 3 and 13.3 % types 1 and 2). Crescentic GN was also the most frequent among patients with acute kidney injury (37.1 %), while membranous nephropathy was the major histopathological diagnosis in chronic kidney disease patients. In nephrotic syndrome, the most common histopathological diagnosis was AA amyloidosis. None of the patients had a major life-threatening complication. CONCLUSION: Biopsies in the elderly are as safe as in the general population. Renal biopsy should be performed to provide an accurate diagnosis and initiate specific treatment in elderly patients.

Utility of peripheral blood parameters in predicting breast cancer risk.

PURPOSE: We aimed to study the inflammatory parameters of complete blood count in breast cancer cases. MATERIALS AND METHODS: This retrospective study covered 178 breast cancer patients and 107 age and body mass index matched healthy women. Complete blood count parameters, neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) and MPV/platelet were analyzed. RESULTS: The leukocyte, neutrophil and neutrophil/ lymphocyte ratio were higher in the patient group (p values 0.001, 0.0001 and 0.0001, respectively) while haemoglobin and hematocrit were higher in the control group (p=0.0001 for both). Logistic regression analysis showed that elevated neutrophils and platelet distribution width (PDW) (OR: 0.627, 95%CI: 0.508-0.774, p=0.001 and OR: 1.191 95%CI: 1.057-1.342 p=0.003) were independent variables for predicting breast cancer. The cut- off value for the neutrophil/lymphocyte ratio was 2.56. CONCLUSIONS: According to our study results, neutrophil levels as part of complete blood count may be used as an independent predictor of breast cancer risk.

Duodenal biopsy for diagnosis of renal involvement in amyloidosis.

Amyloidosis results from extracellular deposition of a fibrillary protein in various organs, and renal biopsy is the best, but a complicated tool for diagnosis. Therefore, alternative biopsy sites have been proposed with varying degrees of sensitivity. We aimed to find the most appropriate biopsy site in patients with chronic kidney disease (CKD) in whom renal biopsy is contraindicated or unavailable. 42 patients (29 male; mean age 46 ± 16 y) with CKD in whom amyloidosis was suspected as the underlying etiology on clinical grounds, but renal biopsy was not available (Group I), and 36 patients (25 male; mean age 40 ± 16 y) with CKD in whom renal biopsy revealed AA-amyloidosis (Group II) were investigated. Upper and lower gastrointestinal tract (GIT) endoscopies were performed and multiple biopsies from gingiva, esophagus, antrum, duodenum and rectum were obtained. In Group I, no amyloidosis was detected in gingival and GIT biopsies among 13 patients. In the remaining 29 patients AA-amyloidosis was detected in various sites with the following frequencies: duodenum 100%, rectum 83%, antrum 79%, esophagus 44% and gingiva 29%. In Group II, frequency of amyloid deposition was 97% in duodenum, 76% each in antrum and rectum, 59% in esophagus and 32% in gingival mucosa. In conclusion, duodenal biopsy is sensitive for diagnosing amyloidosis in CKD patients, and highly correlates with renal amyloidosis.

Efficacy of immunosuppressive therapy in IgA nephropathy presenting with isolated hematuria.

The role of immunosuppressive therapy in the management of IgA nephropathy (IgAN) remains controversial. No consensus has yet emerged on the specific treatment of IgAN and this is mostly related to the lack of complete understanding of the multifactorial pathogenesis of the disease. Choice of appropriate therapeutic agents is further limited by the difficulty in identifying patients who would most likely benefit from therapy. Immunosuppressive therapy has not been recommended in patients with isolated hematuria and well preserved renal function because of their generally favourable prognosis and there are no clinical trials in this area. Considering that mild IgAN may be an early stage of the disease and can be reversed by immunosuppressive agents we have used prednisolone and azathioprine in patients with isolated hematuria in a prospective, randomized, controlled study since 1988. In this prospective study we have evaluated the effect of prednisolone with azathioprine on the clinical course of IgAN and its impact on histologic parameters and prevention of progression in patients with isolated hematuria. We studied 43 biopsy-proven IgAN patients (29 males and 14 females, aged between 13-63 years, mean age 28+/-6) with isolated hematuria and well-preserved renal function (Ccr 89.2+/-10.2 ml/min). The patients were assigned to two groups: 21 patients received prednisolone (40 mg/day) and azathioprine (100 mg/day) orally for four months (group A) and 22 patients received no specific treatment for IgAN and served as a control group (group B). In Group A prednisolone was reduced to 20 mg/day at the end of the second month, then slowly tapered over a two-month period and stopped. The median duration of follow-up was 60 months (range 12-120 months). At the end of the therapy hematuria disappeared in 17 patients. In three patients who did not respond to therapy, microscopic hematuria persisted. Of the 22 patients of group B, three had episodes of gross hematuria and proteinuria >500 mg/day. No significant changes in biochemical profile were observed in either group. Thirteen patients (eight from the treated, five from the untreated group) underwent a repeat biopsy after 12+/-6 months (range 10-25). An improvement of histopathological features was noted in Group A, while deterioration was noted in Group B. We conclude that early treatment with prednisolone and azathioprine appears to be beneficial in preventing the progression of immunologic renal injury and in improving histopathological features in IgAN patients with isolated hematuria.

Low-dose intravenous iron administration in chronic hemodialysis patients treated with recombinant human erythropoietin.

We conducted a prospective study to determine the effect of intravenous low-dose iron administration in chronic hemodialysis patients treated with recombinant human erythropoietin (rHuEPO). Sixteen hemodialysis patients (8 males and 8 females; mean age 63.1+/-9.8 years) on maintenance rHuEPO therapy were included in the study. Patients with <100 ng/ml of ferritin received 50 mg iron during every hemodialysis session. Patients with 100-200 ng/ml of ferritin were given 50 mg iron fortnightly. Iron was not supplemented in patients with ferritin levels >200 ng/ml. Mean hematocrit, serum iron levels and transferrin saturations were significantly higher at 6 and 12 months. There was a significant reduction in weekly rHuEPO doses between the start and the 6th and 12th months. Our study shows intravenous iron administration of 100 mg/month may be sufficient to achieve a satisfactory iron status in dialysis patients on maintenance rHuEPO therapy.