PI3K Signaling in Dendritic Cells Aggravates DSS-Induced Colitis.

Aberrant innate immune responses to the gut microbiota are causally involved in the pathogenesis of inflammatory bowel diseases (IBD). The exact triggers and main signaling pathways activating innate immune cells and how they modulate adaptive immunity in IBD is still not completely understood. Here, we report that the PI3K/PTEN signaling pathway in dendritic cells enhances IL-6 production in a model of DSS-induced colitis. This results in exacerbated Th1 cell responses and increased mortality in DC-specific PTEN knockout (PTENΔDC) animals. Depletion of the gut microbiota using antibiotics as well as blocking IL-6R signaling rescued mortality in PTENΔDC mice, whereas adoptive transfer of Flt3L-derived PTEN-/- DCs into WT recipients exacerbated DSS-induced colitis and increased mortality. Taken together, we show that the PI3K signaling pathway in dendritic cells contributes to disease pathology by promoting IL-6 mediated Th1 responses.

Epicardial adipose tissue volume predicts long term major adverse cardiovascular events in patients with Type 2 diabetes.

OBJECTIVE: Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot that plays an important role in coronary atherosclerosis. In this study, our aim was to investigate the relationship between long-term major adverse cardiovascular events (MACEs) and EAT volume detected by coronary computed tomography angiography (CCTA) in patients with Type 2 diabetes mellitus (T2-DM) without previous coronary events. METHODS: A total of 127 patients with diabetes who underwent CCTA between 2012 and 2014 were enrolled retrospectively. The study population was divided into 2 groups according to whether they experienced or did not experience MACE, which was defined as cardiac death, non-fatal myocardial infarction or unstable angina requiring hospitalization, coronary revascularizations (percutaneous coronary intervention or coronary artery bypass grafting surgery), heart failure, peripheral arterial disease, or ischemic stroke. In both groups, EAT volumes were measured by CCTA. RESULTS: During 60±7 months follow-up period, 22 participants experienced MACEs. Data were evaluated with univariate and multivariate analyses and receiver operating characteristic (ROC) analysis. Age, male sex, coronary artery disease, hemoglobin A1c, glucose, creatinine, C- reactive protein, and cholesterol levels were found to be associated with MACE. EAT volume (odds ratio [OR]: 1.027; 95% confidence interval [CI]: 1.010‒1.044, p=0.002) and low-density lipoprotein (OR: 1.015; 95% CI: 1.000‒1.030, p=0.050) were found to be independent predictors for MACE. ROC analysis indicated that EAT volumes >123.2 mL had a 72.7% sensitivity and a 77.1% specificity for predicting long-term MACE in patients with T2-DM (area under the curve: 0.820; 95% CI: 0.733-0.908). CONCLUSION: EAT volume is an independent predictor of long-term MACE in patients with T2-DM without previous coronary events. EAT volume may be used additionally in risk stratification for MACE besides the well-known vascular risk factors in patients with T2-DM.

Systemic immune-inflammation index predicts mortality in infective endocarditis.

OBJECTIVES: The aim of our study was to evaluate the usefulness of systemic immune-inflammation index (SII) at admission in predicting in-hospital mortality in patients with infective endocarditis. METHODS: 133 definite IE patients (≥18 years) according to modified Duke criteria, treated in our tertiary care hospital between December 2009 and May 2019, were retrospectively analysed. Symptoms, comorbidities, predisposing valvular diseases, prosthetic valve, device, history of injectable drug use, blood culture results, echocardiography findings, and complications were collected. We calculated the SII as follows: SII = platelet count × neutrophil count/lymphocyte count at admission. RESULTS: The median age of the patients was 56 (40-66) years. Prosthetic valve disease was the most frequent predisposing valve lesion. Staphylococcus species were the most common microorganisms. The most frequent complication was in-hospital mortality (22%) followed by renal failure. Older population, syncope, increased inflammatory markers, high systolic pulmonary artery pressure (PAPs), heart failure, renal failure, and septic shock were associated with high mortality. However age, syncope, hypocalcemia, not going to surgery, and SII were independent predictors of in-hospital mortality. According to receiver operating characteristic curve analysis, the optimal SII cut-off value for predicting mortality was 2314 (area under the curve 0.641; P = 0.019). CONCLUSION: We demonstrated that high SII levels are independently associated with in-hospital mortality. The SII may be a promising prognostic predictor for patients with infective endocarditis.

Effect of lung resection on electrocardiography.

BACKGROUND: Post-operative changes in electrocardiography (ECG) after lung surgery have been investigated in prior researches. We have limited data about benign physiologic changes in ECG after lung surgery, specifically after lung resection. The aim of our study was to investigate relationship in between lung resection with minimally invasive robotic or video-assisted thoracoscopic surgery (VATS) and its effect on ECG after lung resection. METHODS: After exclusion criteria had been applied, a total of 133 patients were enrolled in the present study. Operational information such as amount of resected segment and side of resection was recorded. Lung resections were divided into two groups. One group included surgeries with lung resections <3 segments and other group included surgeries with segmentectomy ≥3 segments. Pre-operative and postoperative (in between 2nd and 3rd months) ECG data of the patients were compared. The location of resected segments as left-sided and right-sided resections were noted to compare the ECG changes for sub-analysis. RESULTS: Among 133 patients, 101 patients were male (75.9%). There was no significant difference between parameters including ventricular rate, P wave, QRS wave and T wave axis in degrees, PR, QRS, QT and QTc durations, Tpe interval, ratio of Tpe interval to QT and QTc interval and fQRSTa. There was significant difference between before and after resection in terms of degree of QRS axis (before resection =37.3 ± 52.7 vs. after resection = 26.2 ± 55.7, P = .026). Sub-analysis regarding to amount of resected segments, there was no significant difference identified in terms of QRS axis in degrees between before and after resection for patients who underwent lung resection <3 segments (p = .885). However, there was significant difference in QRS axis in degrees for patients who underwent lung resection ≥3 segments (before resection = 47.3 ± 57.5 vs. after resection = 23.7 ± 66.2, P = .010). There was significant rightward axial change after left-sided lung resections (before resection =32.0 ± 52.4 vs. after resection = 49.4 ± 47.1, P = .005) and leftward axial change after right-sided lung resection (before resection = 41.7 ± 53.0 vs. after resection = 7.1 ± 55.2, P < .001). CONCLUSION: Understanding and recognition of possible ECG changes are crucial during post-operative follow-up of the patients who underwent lung resection. These changes might be benign changes, which are related to anatomical and geometrical changes within thoracic cavity.

The prognostic value of fQRSTa in patients with aortic stenosis undergoing surgical aortic valve replacement.

BACKGROUND: Surgical aortic valve replacement (sAVR) is the ultimate therapy for severe aortic stenosis (AS) in suitable patients. Prognostic factors of sAVR are great interest in recent studies. Frontal QRS-T angle (fQRSTa) is a novel marker of ventricular repolarization abnormalities. In this study, we aimed to investigate the prognostic value of fQRSTa in patients with severe symptomatic AS undergoing sAVR. METHODS: A total of 372 patients with severe degenerative AS who underwent successful sAVR were included in this retrospective study. Then, patients were divided into two groups: patients with narrow fQRSTa (≤90°) as group 1 and wide fQRSTa (>90°) as group 2. Perioperative and postoperative clinical evaluation and time of death were recorded from all subjects. RESULTS: The incidence of total mortality was higher in patients with wider fQRSTa (13.8% [15]; 4.9% [9], P = .013) compared to patients with narrow fQRSTa. In multivariate logistic regression analysis, advanced age (odds ratio [OR] = 1.054; 95% confidence interval [CI] = 1.004-1.106; P = .034), dyspnea (OR = 7.687; 95% CI = 2.296-25.729; P = .001), lower efection fraction (OR = 0.924; 95% CI = 0.884-0.966; P = .001), in-hospital duration (OR = 1.051; 95% CI = 1.016-1.088; P = .004) and wider fQRSTa (OR = 4.029; 95% CI = 1.383-11.740; P = .011) were found to be independent predictors of mortality. Additionally, a Kaplan-Meier survival analysis also revealed that long-term survival was found to be significantly decreased in patients with wider fQRSTa (log-rank P = .014). CONCLUSION: fQRSTa was related with poor prognosis in patients with AS undergoing sAVR. fQRSTa was also an independent predictor of mortality in this population.

Congenital Gingival Granular Cell Tumor: A Case Report.

The congenital gingival granular cell tumor (CGCT), also as known as congenital epulis, is an unusual benign oral mucosal lesion in newborns. A two-day-old female patient was admitted to the Department of Pediatric Dentistry at Gulhane Medical Academy, Ankara, Turkey with her family, and an intraoral examination showed a CGCT located in the buccal region of the maxillary right first primary molar. In this report, we present a case of CGCT in a newborn.