Nutritional state alters the association between free triiodothyronine levels and mortality in hemodialysis patients.

BACKGROUND: Serum free triiodothyronine (fT3) level is suggested to be a risk factor for mortality in unselected dialysis patients. We investigated the prognostic value of serum fT3 levels and also low-T3 syndrome on overall survival in a large cohort of hemodialysis (HD) patients with normal thyroid-stimulating hormone levels. METHODS: A total of 669 prevalent HD patients were enrolled in the study. Serum fT3 level was measured by enzyme immune assay in frozen sera samples at the time of enrollment. Overall mortality was assessed during 48 months of follow-up. RESULTS: Baseline fT3 was 1.47 ± 0.43 (0.01-2.98) pg/ml, and low-T3 syndrome was present in 71.7% of the cases. During a mean follow-up of 34 ± 16 months, 165 (24.7%) patients died. fT3 level was a strong predictor for mortality in crude and adjusted Cox models including albumin or high-sensitivity C-reactive protein (hs-CRP). Further adjustment for both albumin and hs-CRP made the impact of fT3 on mortality disappear. The presence of low-T3 syndrome was associated with mortality in only the unadjusted model. CONCLUSIONS: Low-T3 syndrome is a frequent finding among HD patients, but it does not predict outcome. However, serum fT3 level is a strong and inverse mortality predictor, in part explained by its underlying association with nutritional state and inflammation.

Retrospective analysis of seven patients with adult-onset langerhans cell histiocytosis syndromes: A single center experience.

Langerhans cell histiocytosis syndromes have been described as encompassing a range of disorders, such as eosinophilic granuloma, Letterer-Siwe syndrome and Hand-Schüller-Christian disease. These disorders have been mainly diagnosed at early ages of life and are relatively rare entities in adult age groups. In this study, we aimed to retrospectively evaluate the patients with Langerhans cell histiocytosis followed-up in our hospital. Seven patients were treated between 1995 and 2005. Median age of patients was 27.5 (18-40) years. Main complaints were classified as bone pain in multiple sites (100%), polydipsia (28%), lung infiltration (14%), oral mucosal infiltration (14%), and cranial nerve infiltration (14%). Two patients were diagnosed as Hand-Schüller-Christian disease, and the others were accepted as eosinophilic granuloma. There was no bone marrow or any other organ infiltration except lung infiltration in one patient. Bone infiltration was the prominent sign in all patients with a minimum of one to maximum of seven different sites. All patients were alive during the follow-up period. All patients were treated with radiotherapy except one patient treated with chemotherapy regimen started with vincristine plus dexamethasone and continued with cladribine. Three of seven patients were treated with combined modality, one patient with only chemotherapy and the others with only radiotherapy. There was no grade 3-4 hematological or systemic side effects of treatment. Relapses were detected in only two patients as new bone infiltrations which responded completely to radiotherapy. Langerhans cell histiocytosis syndromes have a relatively benign course in adult patients and can be treated with either radiotherapy or chemo-radiotherapy successfully.

Hypericium perforatum extract (St. John's Wort) and hypericin induce apoptosis in leukemic HL-60 cells by effecting h-TERT activity.

Hypericin is the main active component of Hypericium perforatum (St. John's Wort). Hypericin has been proven to have antitumoral effect in in vitro condition against solid tumors by deteriorating the mitochondrial functions. It has also anti-leukemic effect in in vitro conditions. However, there has not been any comparative study with hypericin and extract obtained from Hypericium perforatum L. In this study, it has been aimed to investigate the potential cytotoxic role of the extract obtained from Hypericium perforatum grown in Ege region on leukemic cell line, to compare the cytotoxic effects of both extract and hypericin in HL-60 cells, and to clarify the underlying mechanism(s) of this cytotoxicity. Hypericium perforatum extract was used in dilutions as 1/1000, 1/5000, 1/10.000, 1/50.000 and the IC50 value was found to be as 1/10.000 dilution. Hypericin was found to have cytotoxicity in HL-60 cells in time and dose dependent manner between the doses of 1nM to 100 µM with IC50 dose of 0.5 µM. Hypericin with the dose of 0.5 µM had similar cytotoxicity pattern with the cytotoxicity curve obtained with 1/10000 diluted extract. Apoptosis as an underlying mechanism of this cytoxocity was shown in HL-60 cells after incubation with IC50 dose of hypericin which was more remarkable at 48th hours by using acridine orange/ethidium bromide dye method. Total RNA was isolated concomittantly and h-TERT mRNA expression was analyzed at Light Cycler Real-time online polymerase chain reaction and it was found that the mRNA expression was meaningfully decreased at 48th hour of incubation of cells with hypericin. According to results of this study, we have shown that hypericin, as main cytotoxic compound of Hypericium perforatum L, induces apoptosis in HL-60 cells via effecting h-TERT mRNA expression.

Retrospective analysis of results of short-term low dose interferon-α-2b combined with PUVA in the treatment of early stage mycosis fungoides.

Early-stage mycosis fungoides (MF) can be treated with different regimens such as oral photo-chemotherapy (Psoralen and UVA-PUVA). There have been some studies showing the effectiveness of combination of interferon (IFN) with PUVA. In this study, we aimed to evaluate retrospectively the patients with early-stage MF treated with IFN + PUVA. Six patients with the diagnosis of early stage (Ia-IIa) MF between June 2003 and May 2005 were enrolled in this study. IFN combined with PUVA was started and followed by IFN maintenance in complete response (CR) patients. Patients achieving CR were followed up at monthly intervals until relapse. Interferon-α-2b was administered at a dose of 3 MU 3 times a week and PUVA was applied 3 times a week. There were 4 female and 2 male patients, aged 32-75 years (mean 54.3 years). Four patients were at stage Ia, one patient at Ib and one patient at stage IIa according to TNM staging. Four of 6 patients (66%) achieved CR and 2 of 6 (33%) achieved partial response (PR). No grade 3-4 side effects due to IFN were detected, and no progression was observed during the treatment. All patients have been under treatment as planned. Low dose of IFN-α-2b plus PUVA was found to be successful in achieving excellent clinical responses in patients with early-stage MF. This treatment modality was very well tolerated.

Relation between serum estradiol levels and mortality in postmenopausal female hemodialysis patients.

BACKGROUND: Recently, low serum estradiol levels have been associated with increased cardiovascular risk and mortality in non-uremic patient populations. We investigated the predictive value of serum estradiol levels for mortality in female hemodialysis patients. METHODS: One hundred and forty-seven prevalent female hemodialysis patients were included in March 2005 and followed up for 32 ± 16 months. Serum estradiol levels were determined by ELISA at baseline and studied in relation to cardiovascular and overall mortality. RESULTS: Mean serum estradiol level was 28.6 ± 15.4 pg/ml (5.7-81.3). Patients in the higher estradiol tertile were likely to be more often diabetic and to have more cardiovascular diseases and higher body mass index (BMI). Serum estradiol was inversely correlated with age and urea reduction rate and positively correlated with postdialysis body weight, BMI and hs-CRP levels. During the follow-up period, 52 (35.6 %) patients died. Patients who died were older, had shorter dialysis vintage, were more likely to have a history of diabetes and cardiovascular disease, and lower serum creatinine, albumin, hemoglobin, and higher hs-CRP levels than those who survived. In Cox regression analysis, estradiol levels, in a bimodal (U-shaped) distribution, along with diabetes, low serum albumin and high hs-CRP levels, were predictors for overall mortality. CONCLUSIONS: A U-shaped association between serum estradiol levels and cardiovascular and overall mortality was found in postmenopausal hemodialysis patients.