Audiological evaluation of the cochlear nerve with brainstem evoked response audiometry in patients with COVID-19.

PURPOSE: In this clinical study, it was aimed to prospectively evaluate the cochlear nerve with brainstem evoked response audiometry (BERA) in terms of audiological ailments in patients with COVID-19. Although the relationship of COVID-19 with tinnitus and hearing loss has been investigated since the day this infectious respiratory disease emerged, its relationship with BERA has not been fully demonstrated from a neurological perspective. METHODS: It was carried out on a group of patients who had COVID-19 in the last 6 months between February and August 2021 in Diyarbakir Gazi Yasargil Training and Research Hospital. Patients between the ages of 18-50, who applied to the otorhinolaryngology and neurology clinic and had COVID-19 in the last 6 months, were selected. The COVID-19 group of our study consisted of 30 patients, 18 males and 12 females, who had had COVID-19 disease in the last 6 months, and 30 healthy individuals, 16 males and 14 females, as the control group. RESULTS: In patients with COVID-19, the evaluation of the destruction of the cochlear nerve with BERA showed that there was a statistically significant prolongation in I-III and I-V interpeaks at 70, 80 and 90 db nhl. CONCLUSIONS: Statistically significant prolongation of especially I-III and I-V Interpeaks in BERA showed that COVID-19 has the potential to cause neuropathy. We believe that the BERA test should be considered in the neurological evaluation of cochlear nerve damage in patients with COVID-19 as a differential diagnosis.

Spreading depolarization: A phenomenon in the brain.

In 1944, the physiologist Leão while studying epilepsy in the rabbit noticed a sudden temporary cessation of electrocorticographic (ECoG) activity accompanied with a large negative slow potential change recorded by extracellular electrodes, that is later known as spreading depolarizations (SDs). The depression of the brain electrical activity was slowly propagating through the cerebral cortex. The mechanism of propagation is still controversial. SDs and seizures are following each other interchangeably, yet the puzzle needs more investigation to be clarified. SDs have an obvious effect on blood-brain barrier integrity mainly through transcellular and paracellular routs, but not much known about that especially following traumatic brain injury (TBI). The cortical spreading depolarization (CSD) and the depression of brain activity have been recognized following a variety of neurological diseases and brain injuries. CSD has been studied in animal models and recently in humans, and it has been recognized and described as a massive neuronal depolarization accompanied with high level of disturbances in transmembrane ion gradients and significant changes in cerebral blood flow (1-3). Although there is a considerable amount of literatures on SD have been done since 1944, but the biophysical mechanism of SD, the long term effect on the brain structures and functions, and it is role in different disorders are still incompletely understood.Here, we summarize the history of spreading depolarization and the most accepted hypothesis for mechanism of initiation and propagation of that phenomenon. Most importantly, we present the most updated research on the relationship and interaction between spreading depolarization and traumatic brain injuries, seizure, blood-brain barrier, neurovascular coupling, and other neurological conditions. Learning more about the spreading depolarization will increase our understanding about that phenomenon and may explain its association with different clinical presentations.

Surgical management of sporadic hemangioblastomas located in the posterior fossa of brain.

PURPOSE: Hemangioblastomas (HBs) are highly vascular tumors, constituting 2%-3% of central nervous system (CNS) tumors. Surgery is a treatment option for HBs. The purpose of this study was to evaluate the demographic, clinical, and radiological findings of patients with HBs who were operated on via microsurgical technique at our clinic and to determine the findings specific to HBs and evaluate their pathological findings and confirmation. METHODS: We evaluated age, gender, initial complaints and duration of 100 patients (50 female and 50 male patients), presence of cranial nerve deficits, magnetic resonance imaging, data (localization, presence of hydrocephalus, tumor size, enhancement pattern, and cystic and solid component features), resection rates, pathological findings (grade, Ki-67 ratio, and staining results), recurrence, special conditions of patients, and the final status of patients in this study. RESULTS: Mean age was 39.08 ± 14.77 years and 66.7% of the patients presented with cerebellar findings. Five of the cases were located in the brainstem, five were located in the cerebellopontine angle, and two were in the cerebellar cortex. In all patients, gross total resection was performed using arteriovenous malformation repair. CONCLUSIONS: Surgical intervention of small and cystic tumors can be performed safely with en bloc resection along with preoperative detailed imaging, improved microsurgical techniques, and an extensive understanding of anatomical and vascular structures. On the contrary, patients with a brainstem invasion and solid structure present surgical difficulties due to arteriovenous malformation-like vascularizations; therefore, gross total resection is the optimal treatment in HBs.

Histopathological changes in the choroid plexus after traumatic brain injury in the rats: a histologic and immunohistochemical study.

BACKGROUND: Traumatic brain injury (TBI) is in part associated with the disruption of the blood-brain barrier. In this study, we analysed the histopathological changes in E-cadherin and vascular endothelial growth factor (VEGF) expression after TBI in rats. MATERIALS AND METHODS: The rats were divided into two groups as the control and the trauma groups. Sprague-Dawley rats were subjected to TBI with a weight-drop device using 300 g/1 m weight-height impact. After 5 days of TBI, blood samples were taken under ketamine hydroxide anaesthesia and biochemical analyses were performed. The control and trauma groups were compared in terms of biochemical values. RESULTS: There was no change in glutathione (GSH) levels and blood-brain barier permeability. However, malondialdehyde (MDA) and myeloperoxidase (MPO) activity levels increased in the trauma group. In the histopathological examination, choroid plexus in the lateral ventricle, near the pia mater membrane, was removed. In the traumatic group, some of epithelial cells were hyperplasic. Some of them were peeled off the apical surface and had local degeneration. CONCLUSIONS: In addition, we observed congestion in capillary vessels and mononuclear cell infiltration around the vessels. After TBI, the increase in VEGF levels, vascular permeability, and interaction with VEGF receptors in endothelial cells lead to oedema of the vessel wall. On the other hand, E-cadherin expression decreased in the tight-junction structures between epithelial cells and basal membrane, resulting in an increase in cerebrospinal fluid in the intervillous area.

Effects of nicotine administration in rats on MMP2 and VEGF levels in periodontal membrane.

BACKGROUND: Nicotine is associated with increased incidence of periodontal disease and poor response to therapy. This article aimed at identifying the expression of matrix metalloproteinases 2 (MMPs2) and vascular endothelial growth factor (VEGF) proteins on extracellular matrix, fibrous distribution and angiogenetic development in periodontitis caused by nicotine effects on periodontal membrane. MATERIALS AND METHODS: In this experimental study, rats were divided into nicotine and control groups. While the rats in the nicotine group (n = 6) were administered 2 mg/kg nicotine sulphate for 28 days, the animals in the control group (n = 6) were only administered 1.5 mL physiologic saline solution subcutaneously for 28 days. RESULTS: Histological sections were prepared and immunohistochemically stained for MMP2 and VEGF. The sections stained with Trichrome-Masson were observed under light microscope. VEGF and MMP2 immunoreactivity of periodontal gingiva and dentin was assessed by immunohistochemical staining. CONCLUSIONS: Nicotine reduces MMP production, disrupts collagen synthesis and causes periodontitis. We observed that nicotine increases periodontitis by disrupting periodontal membrane and prevents tooth to anchor in dental alveoli by disrupting epithelial structure.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

PURPOSE: To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. METHODS: Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. RESULTS: Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). CONCLUSION: Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Polyomavirus BK replication in de novo kidney transplant patients receiving tacrolimus or cyclosporine: a prospective, randomized, multicenter study.

Polyomavirus BK (BKV)-associated nephropathy causes premature kidney transplant (KT) failure. BKV viruria and viremia are biomarkers of disease progression, but associated risk factors are controversial. A total of 682 KT patients receiving basiliximab, mycophenolic acid (MPA), corticosteroids were randomized 1:1 to cyclosporine (CsA) or tacrolimus (Tac). Risk factors were analyzed in 629 (92.2%) patients having at least 2 BKV measurements until month 12 posttransplant. Univariate analysis associated CsA-MPA with lower rates of viremia than Tac-MPA at month 6 (10.6% vs. 16.3%, p = 0.048) and 12 (4.8% vs. 12.1%, p = 0.004) and lower plasma BKV loads at month 12 (3.9 vs. 5.1 log(10) copies/mL; p = 0.028). In multivariate models, CsA-MPA remained associated with less viremia than Tac-MPA at month 6 (OR 0.60; 95% CI 0.36-0.99) and month 12 (OR 0.33; 95% CI 0.16-0.68). Viremia at month 6 was also independently associated with higher steroid exposure until month 3 (OR 1.19 per 1 g), and with male gender (OR 2.49) and recipient age (OR 1.14 per 10 years) at month 12. The data suggest a dynamic risk factor evolution of BKV viremia consisting of higher corticosteroids until month 3, Tac-MPA compared to CsA-MPA at month 6 and Tac-MPA, older age, male gender at month 12 posttransplant.

Do ureteral catheterisation procedures affect sexual functions? A controlled prospective study.

The use of ureteral stents is a common procedure in urology practice. We investigated whether the use of double-J stent had an effect on sexual functions or not. One hundred and seventy-seven cases were included in the study. Unilateral double-J stent was placed during ureteral stone treatment in one hundred and eight of these cases. Sixty-nine cases were included as the control group. 'International Index of Erectile Function' (IIEF) and 'Female Sexual Function Index' (FSFI) questionaries were assessed before and 4 weeks after the intervention in all patients. When total IIEF and subdomains of IIEF scores of men and total FSFI and subdomains of FSFI scores of women whom double-J stent was placed were evaluated before and after the procedure, there was statistically significant reduction in patient's scores. In the control group, any statistically significant alteration in patient's score was not observed in men and women. Sexual functions are negatively affected in both women and men whom ureteral stents are placed. To reduce these problems specific to urinary system owing to stents, new treatment strategies and new studies that lead to improvements in the material and design of stents are required.

Role of mandibular anatomical structures in sexual dimorphism in Turkish population: a radiomorphometric CBCT study.

Sex determination is one of the primary concerns of forensic science. The cranial bones, pelvis, and mandible have been used for determining the sex of specimens. Because the mandible is robust and sexually dimorphic, studies have evaluated its metric and morphological traits. This study was designed as a retrospective study involving cone beam computed tomography (CBCT) images to assess sexual dimorphism of the mandible in the Turkish population. Total sample group consisted of 176 bimaxillary CBCT scans (71 males and 102 females; ages 19-67 years). Sixteen mandibular parameters were measured using two different software programmes. Measurements were recorded in various planes of three-dimensional (3D) reconstructions of the scans. All parameters aside from SIMaCD were found to be statistically significant. The highest diagnostic accuracy rate was associated with IMaF, and the overall accuracy rate of the fourteen parameters was found to be 80%.

Concomitant trastuzumab with thoracic radiotherapy: a morphological and functional study.

BACKGROUND: The purpose of this study is to elucidate if there is an additive or supra-additive toxic effects of radiotherapy (RT) and trastuzumab (T) on vascular structures when used concomitantly. METHODS: Female Wistar albino rats were treated with either 8 or 15 Gy of thoracic RT. T was applied i.p. with a dose of 6 mg/kg 2 h before RT. Four rats in each arm were killed at 6th h, 21st and 70th days after irradiation and thoracic aorta of each animal was dissected for electron microscopy. In addition, functional studies for evaluating the relaxation and contraction were carried out 21 days after RT. RESULTS: Only 15-Gy RT dose groups showed significant difference in terms of functional deterioration as more contraction than the others (P < 0.05) without any difference between RT and RT + T. However, T produced additional deficit in relaxation when added to RT, which was considered near significant (P: 0.0502). Electron microscopy showed endothelial and subendotelial damage signs in 15-Gy dose groups. T + 15-Gy arm showed more pronounced endothelial cell damage than 15-Gy RT-only arm, 70 days after RT. CONCLUSION: T and high-dose RT may lead to vascular damage that seems at least additive.

A review of Morgagni and Bochdalek hernias in adults.

The incidence of Bochdalek and Morgagni hernias among adults is very rare. The purpose of this study was to determine retrospectively the prevalence and characteristics of adult Bochdalek and Morgagni hernias in a decade. Consequently, we demonstrated 12 patients with Bochdalek and 8 patients with Morgagni hernias. We presented plain radiography, operation images, and computed tomography findings of an adult patient with symptoms due to Bochdalek and Morgagni hernias. In surgical repair, the Morgagni hernia is best approached via laparotomy, and the Bochdalek hernia can be treated through thoracotomy or laparotomy.

Comparison of Molecular Markers and Classical Histopathological Diagnostic Methods in Grade II and III Glial Tumors and Their Prognostic Outcomes.

AIM: To demonstrate the changes in Grade II and III glial tumors after WHO 2016 Brain Tumors Classification. MATERIAL AND METHODS: The previous diagnoses and postoperative treatment of the 83 patients were recorded. We used real-time PCR (mutation assay) for the analysis of IDH1 and IDH2, while we used FISH test to determine 1p/19q codeletion. The integrated diagnosis was compared with classical histopathological diagnoses. RESULTS: We studied 13 oligodendendrogliomas, 41 astrocytomas and 29 oligoastrocytomas patients with classical histopathological diagnosis group. IDH mutation was detected in 51 of the patients after genetic analysis, whereas 1p/19q codeletion was detected in 20 patients. We found that grade II IDH-mut astrocytoma patients had significantly better survival outcomes compared to grade III IDH-mut astrocytoma patients. CONCLUSION: Grade II and III gliomas are separated into more homogeneous diagnostic groups for survival after molecular marker analyses. Compared to histopathological diagnosis, the WHO 2016 glioma classification with molecular markers provides new perspectives in patient prognosis and treatment. However, due to the costs of using molecular markers, the extent to which it can be used remains questionable.

Comparison of local rosmarinic acid and topical dexpanthenol applications on wound healing in a rat experimental wound model.

BACKGROUND: The aim of the study was to compare the effects of rosmarinic acid and dexpanthenol in a rat experimental wound model. MATERIALS AND METHODS: Twenty-four Wistar albino rats weighing 200-250 g were randomly divided into three groups. After 2-cm full-thickness skin defects were created, the wounds were washed with sterile 0.9% NaCl solution. After washing, the control group was left untreated, the second group received 5% dexpanthenol cream, and the third group received 10% rosmarinic acid cream. Before excision, the skin was evaluated macroscopically by measuring the reduction in wound size; after excision, histological examination (epithelisation, inflammation, fibrosis, granulation) was performed. RESULTS: Macroscopic comparison of the wound sizes showed that group 3 showed a statistically significant difference in wound size reduction compared to the other two groups. Histopathological examination showed that there was no statistically significant difference between the groups. We found that the rosmarinic acid group had greater wound size reduction than the other two groups. However, epithelialisation was detected in fewer cases. CONCLUSIONS: We believe that rosmarinic acid can be used as a topical cream for wound healing, as it leads to significant reduction in wound size, resulting in fewer scars.

Role of echocardiography in the evaluation of atrial function and diseases.

This article describes four essential components (hemodynamic, bioelectrical, hormonal and metabolic) of atrial function. And then discusses the traditional and more recent echocardiographic measures that have been employed to evaluate atrial function. Conventional parameters include the study of the various phases of atrial activity using atrial volume measurements, the peak A wave velocity, its velocity time integral (VTI), fraction of atrial contribution and atrial ejection force. Newer parameters for atrial function assessment include Doppler tissue imaging (DTI) including segmental atrial contractility using color Doppler tissue imaging (CDTI) and estimates of atrial strain and strain rate. Furthermore, the authors relate various particular types of atrial function in physiological and in selected pathological conditions.

Relationship between radiographic features and bone mineral density in elderly men.

Lumbar disc degeneration is characterised radiologically by the presence of osteophytes, endplate sclerosis, and disc space narrowing. Our study was designed to assess anterior lumbar osteophytes, disc space narrowing, end plate sclerosis, and bone mineral density (BMD) in the lumbar vertebrae and femoral neck of elderly men. A total of 1000 men, aged between 71 and 90 years, were invited to participate in the study. BMD was assessed at the spine and femoral neck using dual energy X-ray absorptiometry (DXA). We examined the relationship with the degree of lumbar spinal and femoral neck deformity by using the Z-score. Lateral and anterioposterior spinal radiographs were evaluated for features of lumbar disc degeneration. The observers consisted of a consultant physical therapist, a radiologist, and anatomists who together studied the series of radiographs. Anterior lumbar osteophytes (grade 0-3), end-plate sclerosis, and disc space narrowing (grade 0-2) were evaluated. The Pearson correlation test was used to determine the association between radiographic features, the lumbar mineral density (LBMD), and femoral neck mineral density (FNBMD). In all, 90.6% of lumbar vertebral levels showed evidence of anterior osteophytes, 87.5% showed evidence of end plate sclerosis, and 68.2% of disc space narrowing. Additionally, there was a strong negative correlation in terms of age at the femoral neck, though not at the spine. On the other hand, there was a significant correlation between osteophyte grade and end plate sclerosis at the spine. In our study, the radiographic features of lumbar disc degeneration, anterior osteophytes, and end plate sclerosis were associated with an increase in BMD at the spine.

Bochdalek hernia with concomitant partial situs inversus in an adult.

We report the case of 44-year-old woman with a left-sided Bochdalek hernia (BH) with concomitant partial situs inversus. The patient was presented from the outpatient clinic with lower chest discomfort. She had suffered from abdominal pain for one year, with no history of trauma, previous surgery, or extreme physical exertion. Chest radiograph revealed a large left-sided BH. The patient underwent thoracotomy. Intestinal organs, containing bowel, small intestine, caecum, and appendix were seen in the left hemithorax. Because of the failure to reduce the intestinal organs into the peritoneal cavity, laparotomy was performed. The right side of the abdominal cavity was empty. In conclusion, partial situs inversus was diagnosed. The diaphragmatic defect was repaired with non-absorbable sutures via laparotomy, and with a prolene mesh via thoracotomy. Bochdalek hernia with partial situs inversus is a rare clinical entity with none reported in medical literature.

Splenic artery angiography: clinical classification of origin and branching variations of splenic artery by multi-detector computed tomography angiography method.

BACKGROUND: The splenic artery (SA) variations are rarely reported in the literature. Knowledge of the range of the SA and other arterial anomalies and their specific frequencies is very important ever for every visceral surgeon as well as for treatment of gastrointestinal bleeding, organ transplantation, transarterial chemoembolisation of neoplasm, infusion therapy, therapeutic arterial ligation, iatrogenic injuries. At the literature, there are more studies on the coeliac trunk, superior mesenteric artery and hepatic artery variations, but studies on the SA variations are uncommon. The studies on the SA variations are mostly in the form of case reports, but there are not many studies with large population on this issue. The purpose of this study was to evaluate the SA alone and to determine the variations determined separately from the other arteries. Accurate awareness of all the possible anatomic variations is crucial in the upper abdomen surgery. MATERIALS AND METHODS: Seven hundred fifty patients undergoing multi-detector computed tomography angiography between 2015 and 2017 were retrospectively evaluated for the SA variations. We created a new classification system to determine anatomic variations of the SA. RESULTS: Twenty-three different types were identified related to anatomic variations in the origin and branching pattern of the SA. While 596 (79.47%) patients had standard SA anatomy, 154 (20.53%) patients had variant SA anatomy. CONCLUSIONS: The SA has quite different variation types and the practical context of the issue is of primary importance in surgery, gastroenterology, oncology and radiology. Liver and pancreas transplantation, splenectomy, embolisation of tumours of the abdominal organs, as well as other numerous diagnostic and therapeutic procedures, require detailed anatomical knowledge.

Investigation of antioxidant effects of rosmarinic acid on liver, lung and kidney in rats: a biochemical and histopathological study.

BACKGROUND: The aim of the study was to investigate the protective effects of rosmarinic acid in rats exposed to hepatic ischaemia/reperfusion (I/R) injury. MATERIALS AND METHODS: Thirty-two rats were randomly classified into four groups of 8 rats each: laparotomy without medication, rosmarinic acid (dose of 50 mg/kg via oral gavage) followed by laparotomy, laparotomy followed by hepatic I/R, and hepatic I/R with rosmarinic acid. Serum aspartate aminotransferase, alanine aminotransferase, and malondialdehyde levels and total oxidant activity and total antioxidant capacity levels of the liver, lung, and kidney were assessed. The histopathologic assessment was also performed. RESULTS: Rosmarinic acid significantly reduced liver function test parameters and decreased oxidative stress and abnormal histopathologic findings in the liver. The oxidative stress in the lung significantly increased in the I/R group but significantly decreased in the I/R + rosmarinic acid group due to the addition of rosmarinic acid. Rosmarinic acid led to no reduction in oxidative stress in kidney following hepatic I/R injury. There were no statistically significant differences among the groups regarding histopathologic changes in kidney and lung sections. CONCLUSIONS: Rosmarinic acid has antioxidant properties and is an effective hepatoprotective agent. However, although rosmarinic acid provides useful effects in the lung by increasing antioxidant capacity and reducing oxidative stress after I/R injury, it does not ameliorate histopathologic changes. These findings suggest that rosmarinic acid is likely to provide favourable outcomes in the treatment of hepatic I/R injury.

Calvarial bone defects in ovariectomised rats treated with mesenchymal stem cells and demineralised freeze-dried bone allografts.

BACKGROUND: The aim of the study was to investigate the ability of a combination of bone marrow mesenchymal stem cells (BM-MSCs) with and without demineralised freeze-dried bone allografts (DFDBAs) to induce bone regeneration in calvarial defects in ovariectomised rats. MATERIALS AND METHODS: Critical size defects were filled with a combination of DFDBAs and BM-MSCs or BM-MSCs alone. Eight weeks after calvarial surgery, the rats were sacrificed. The samples were analysed histologically and immunohistochemically. RESULTS: No difference was observed in vascularisation between groups C1 (animals with cranial defect only, control group) and O1 (animals with cranial defect only, ovariectomy group). Intramembranous ossification was observed at a limited level in groups C2 (animals with cranial defect with MSCs, control group) and O2 (animals with cranial defect with MSCs, ovariectomy group) compared to C1 and O1. In group C3 (animals with DFDBAs with MSCs, control group), the fibrous structures of the matrix became compact as a result of a bone graft having been placed in the cavity, but in group O3 (animals with DFDBAs with MSCs, ovariectomy group), the fibrous tissue was poorly distributed between the bone grafts for the most parts. CONCLUSIONS: We conclude that the insertion of BM-MSCs enhances bone healing; however, the DFDBA/BM-MSC combination has little effect on overcoming impaired bone formation in ovariectomised rats.

Serum apolipoprotein C-III in high-density lipoprotein: a key diabetogenic risk factor in Turks.

AIMS: We studied determinants of serum apolipoprotein C-III (apoC-III) and whether levels of apoC-III or its fractions predict metabolic syndrome (MetS), Type 2 diabetes and coronary heart disease (CHD). METHODS: The predictive value of apoC-III, measured by immunoturbimetric immunoassay in 802 tracked individuals of a Turkish general population in determining cardiometabolic risk was assessed over 4.4 +/- 1.2 years' follow-up. Patients with MetS, Type 2 diabetes and CHD at baseline were excluded. RESULTS: Total apoC-III, as well as both fractions, was significantly, linearly and inversely related to smoking status, positively to alcohol usage and to levels of complement C3. Mid and high tertiles of total or non-high density lipoprotein (HDL) apoC-III predicted significantly and independently incident MetS; they predicted CHD with risk ratios of 1.6 [95% confidence intervals (CI) 1.02-2.5], for 1 sd increment, after adjustments that included HDL cholesterol and body mass index (BMI). The highest tertile of HDL apoC-III was a major independent predictor of new-onset diabetes with a 2.5-fold risk ratio for 1 sd increment (95% CI 1.5-4.0) in combined sexes, after adjustment for waist circumference, HDL cholesterol and other confounders and was a better predictor than waist girth. CONCLUSIONS: Serum total apoC-III or its fractions are linearly and inversely associated with smoking, positively with alcohol usage and serum complement C3. The presumably dysfunctional HDL apoC-III is a stronger predictor of Type 2 diabetes than waist girth in Turks. Non-HDL apoC-III predicts strongly the development of MetS as well as incident CHD, independent of HDL cholesterol, BMI and non-lipid factors. The atherogenicity of apoC-III and dysfunctionality of HDL apoC-III carry huge public health implications in Turks.