Comparison of the effects of exenatide and insulin glargine on right and left ventricular myocardial deformation as shown by 2D-speckle-tracking echocardiograms.

Background: Exenatide is a glucagon-like peptide-1 (GLP-1) analogs. The effects of GLP-1 analogs on myocardial function are controversial. Aims: The purpose of this study is to compare the effects of exenatide and insulin glargine on subclinical right and left ventricular dysfunction. Methods and Material: In this study, 27 patients with type 2 diabetes were randomized into exenatide and insulin glargine treatment groups. The patients were monitored for six months by conventional echocardiography (ECHO) and 2D-speckle-tracking echocardiography (2D-STE) to evaluate right and left ventricular functions. Results: ECHO parameters did not change significantly pre- and post-treatment, except for the tricuspid annular plane systolic excursion (TAPSE) values. Post-treatment TAPSE values significantly increased in both groups compared to pre-treatment values. In the insulin group, values for 2D-STE parameters of the left ventricular global longitudinal strain (LVGLS) based on apical long-axis (ALA) images increased significantly (p: 0.047) compared to pre-treatment values; however, apical 4-chamber (A4C), apical 2-chamber (A2C), LVGLS, and right ventricular global longitudinal strain (RVGLS) values did not change. In the exenatide group, LVGLS based on A4C values improved (p: 0.048), while ALA, A2C, and LVGLS values did not change. Moreover, the RVGLS values improved significantly after exenatide treatment (p: 0.002). Based on 2D-STE parameters the two treatments did not differ statistically in either pre- or post-treatment periods. Conclusions: Glp-1 treatment can improve left ventricular regional and right ventricular global subclinical dysfunction. Therefore, early GLP-1 treatment may be recommended in diabetic patients with a high risk of cardiac dysfunction.

CUSHING'S SYNDROME DUE TO PRIMARY BILATERAL MACRONODULAR ADRENAL HYPERPLASIA AND METACHRONOUS PHEOCHROMOCYTOMA.

Introduction: Primary bilateral macronodular adrenal hyperplasia (PBMAH) is one of the uncommon causes of endogenous Cushing's syndrome (CS).Pheochromocytoma (PCC) is another adrenal tumor which is derived from neural crest arising in the adrenal medulla. Here we are reporting a case with recurrent overt CS due to PBMAH, 2 years after unilateral adrenalectomy, concomitant with recently developed PCC. Case Presentation: A 43-year-old woman was admitted to our clinic with a 30 kg weight gain, proximal muscle weakness, menstrual irregularity, easy bruising and excessive hair growth on face and body.The lab results were compatible with a diagnosis of solely ACTH-independent CS. Screening showed bilateral macronodular lesions and she underwent right adrenalectomy. Postoperatively, she had lost weight and her well-being had improved; 2 years later, she developed CS and paroxysmal hypertension. The left adrenal gland was laparoscopically removed. Histopatologically, the lesion was reported as a typical PCC and macronodular-micronodular hyperplasia of the adrenal tissue surrounding that lesion. Conclusions: Pheochromocytoma with synchronous ACTH-independent CS originating from the same adrenal gland is very rare. To the best of our knowledge,our case is the first one describing the coexistence of overt ACTH-independent CS due to PBMAH and metachronous PCC.The importance of detailed re-evaluation of patients with recurrent ACTH-independent CS is highlighted here.

How does pregnancy affect the patients with pituitary adenomas: a study on 113 pregnancies from Turkey.

OBJECTIVE: Data regarding pregnancies in relation to pituitary tumors are limited. The effects of pregnancy on pituitary adenomas and the effects of adenoma itself (hormonal activity, mass effects and pituitary insufficiency) and/or treatment on the ongoing gestation and developing fetus were evaluated. METHODS: The study was a retrospective study. A questionnaire involving questions regarding medical history before index gestation, history of related pregnancy, result of index gestation and postpartum follow-up of the patients was filled by the investigator in one of the eight Referral Endocrinology Centers from Turkey. RESULTS: One hundred and thirteen (83 prolactinoma, 21 acromegaly, 8 NFPA and 1 plurihormonal pituitary adenoma) pregnancies of 87 (60 prolactinoma, 19 acromegaly, 7 NFPA and 1 plurihormonal pituitary adenoma) patients were reviewed. The clinically important pregnancy-related tumor growth of pituitary adenomas was found to be low in previously treated adenomas. Prolactinomas were more likely to increase in size during pregnancy especially if effective prior treatment was lacking. The risk of hypopituitarism is also minimal due to pituitary adenomas during pregnancy. The results of pregnancies did not differ in patients who were on medical treatment or not for prolactinomas and acromegaly during gestation. Neural tube defect and microcephaly associated with maternal cabergoline use; Down syndrome and corpus callosum agenesis associated with maternal bromocriptine use; unilateral congenital cataract, craniosynostosis and microcephaly associated with maternal acromegaly were detected for the first time. CONCLUSION: Medical treatment can be safely done stopped in patients with prolactinoma and acromegaly when pregnancy is confirmed and reinstituted when necessary. Prospective studies may help to determine the effects of medical treatment during gestation on the mother and fetus.

Correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic factors and preoperative tumor markers in patients with early-stage and locally advanced breast cancer.

PURPOSE: To evaluate the correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic variables and preoperative CA 15-3 and CEA levels in patients with early-stage and locally advanced breast cancer. METHODS: Preoperative serum concentrations of CA 15- 3 and CEA were measured in 123 patients undergoing surgical treatment for stage I-III breast cancer and the association between these markers and clinical and biological variables were evaluated. RESULTS: With cut-off values of 45 U/ml (CA 15-3) and 2.5 ng/ml (CEA), the sensitivity for CA 15-3 and CEA was 10% and 24% and their mean values were 23 U/ml and 2.32 ng/ml, respectively. A significant correlation between preoperative levels of CA 15-3 and CEA was noticed (p=0.023). Preoperative CA 15-3 levels were significantly higher in patients with tumors > 5 cm (p<0.0001), with positive axillary lymph nodes (p=0.04), with increasing nodal burden (p= 0.025) and in patients with stage III disease (p=0.003). Tumor size >5 cm (p=0.002), increasing axillary nodal burden (p=0.02) and stage III disease (p<0.0001) were also significantly correlated with CEA values above the cut-off level. There were no correlations between CA 15-3 and CEA levels and other variables including c-erbB2 expression, age, grade, hormone receptor status, and lymphovascular invasion. CONCLUSION: Preoperative CA 15-3 and CEA levels are significantly correlated with tumor size, axillary nodal status and stage in patients with non-metastatic breast carcinoma. No correlation between preoperative values of CA15-3/CEA and c-erbB2 status, lymphovascular invasion and other prognostic factors was detected.

Prevalence and risk factors for gall bladder polyps.

OBJECTIVE: Polyps of gallbladder are tumour-like lesions of this organ. Little has been known about factors associated with the occurrence of gallbladder polyps. We aimed to examine prevalence and factors associated with gallbladder polyps in our region. DESIGN: Prospective clinical study. SETTING: Kocaeli University Teaching Hospital. SUBJECTS: Four hundred and thirty two patients were enrolled to the study. INTERVENTIONS: Subjects were screened for the presence of any pathological condition for gallbladder by upper abdominal ultrasonography completed a questionnaire, and underwent a physical examination and blood chemistry tests. RESULTS: Family history of gastrointestinal disease, gallbladder disease and any neoplastic disease and abnormality in HDL-cholesterol levels had most consistent association at univariate analysis. Multivariate logistic regression analysis showed that family history of any gastrointestinal disease and abnormalities of HDL-cholesterol levels were significant. CONCLUSIONS: Our findings suggest the formation of gallbladder polyps is associated with fat metabolism. Other unknown factors may also influence the formation of this lesion. Relationship between gallbladder polyps and family history of some diseases suggests us to perform some genetic studies.

Synthesis and biological evaluation of some new amide moiety bearing quinoxaline derivatives as antimicrobial agents.

In this study, we aimed to synthesize some new quinoxaline derivatives bearing amide moiety and to evaluate their antimicrobial activity. A set of 16 novel compounds of N-[2,3-bis(4-methoxy/methylphenyl)quinoxalin-6-yl]-substituted benzamide derivatives were synthesized by reacting 2,3-bis(4-methoxyphenyl)-6-aminoquinoxaline or 2,3-bis(4-methylphenyl)-6-aminoquinoxaline with benzoyl chloride derivatives in tetrahydrofuran and investigated for their antimicrobial activity. The structures of the obtained final compounds were confirmed by spectral data (IR, (1)H-NMR, (13)C-NMR and MS). The antimicrobial activity of the compounds were determined by using the microbroth dilution method. Antimicrobial activity results revealed that synthesized compounds exhibited remarkable activity against Candida krusei (ATCC 6258) and Candida parapsilosis (ATCC 22019).

Risk of nosocomial infections and effects of total cholesterol, HDL cholesterol in surgical patients.

BACKGROUND AND AIMS: Changes of lipoprotein pattern in plasma occur in many acute infections. The aim of this study was to analyse the role of total cholesterol and HDL cholesterol in postsurgical patients with nosocomial infection. METHODS: Four hundred and eighteen patients admitted to our department and operated on for various diseases are included in this prospective study. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and HDL-cholesterol (HDL-C) levels were measured. RESULTS: In our study, the most frequent infection was surgical site infection. There was an increased association between low HDL-C level and nosocomial infections such as surgical site and pulmonary infections. HDL levels may be used as predictive parameter for surgical nosocomial infections. CONCLUSIONS: HDL-C levels seem to be one of the risk factors for postoperative nosocomial infection. Although total cholesterol level was not significantly increased, it may be also associated with the infection risk. Screening of lipoprotein pattern in patients undergoing operation may be useful for ascertaining of risk for nosocomial infection.

Protective effect of vitamin E on gastric mucosal injury in rats with biliary obstruction.

Patients with liver disease display increased susceptibility to gastric mucosal damage. A role of free radicals has been suggested in the development of gastric mucosal damage in normal subjects. The effects of antioxidant vitamin E treatment on the liver and stomach in cirrhotic rats were examined. Fifty rats were divided into three groups. Cirrhosis was induced by bile duct ligation in 40 of 50 rats. Controls underwent a sham operation. Gastric mucosal lesions were produced by intragastric administration of 1 mL of 95% ethanol in all three groups. Twenty bile duct-ligated rats were injected intramuscularly with vitamin E (100 mg/kg/day). Liver and stomach histology, and stomach malondialdehyde and glutathione levels were determined. Portal hypertension was measured. Macroscopic and microscopic gastric mucosal injury were significantly greater in the control and common bile duct-ligated groups than in the vitamin E-pretreated group (P<0.05). The tissue malondialdehyde and glutathione levels were significantly decreased in the vitamin E-administrated group compared with the common bile duct-ligated group (P<0.001). Vitamin E administration may be cytoprotective for both the liver and gastric mucosa in bile duct-ligated rats.

The effects of prostaglandin E2 indomethacin & Ginkgo biloba extract on resistance to experimental sepsis.

We investigated the effect of 16,16-dimethyl prostaglandin E2 indomethacin and Ginkgo biloba extract on the survival in two experimental sepsis models in rats due to administration of 1 x 10(7) cfu and 1 x 10(9) cfu Escherichia coli. Animals in each model were then randomly divided (10/group) into four groups, administered saline, indomethacin, G. biloba extract and prostaglandin E2 respectively. When compared, there was no significant difference in the survival period between the two sepsis models (P > 0.05). The best survival rate was observed in the PGE2-administered animals in the first major model (P < 0.05). Indomethacin appeared not to decrease the mortality rates. There was no significant difference in PGE2 levels between two sepsis models (P > 0.05). Our results suggest that elevated prostaglandin E2 levels following major trauma are not responsible for the postinjury increased susceptibility to infectious complications. Our observations should also discourage aggressive use of cyclo-oxygenase inhibitors for protection against infectious complications after major trauma.

Effects of vitamin E on neutrophil phagocytosis during experimental obstructive jaundice.

BACKGROUNDS/AIMS: Depression of non-specific immunity is one of the systemic complications of biliary obstruction. Vitamin E, which decreases during prolonged obstructive jaundice, may be beneficial to diseased function of neutrophils. In this study we want to investigate changes in neutrophil phagocytosis and the effect that vitamin E supplementation has on this function METHODOLOGY: Rats were divided into 5 groups as follows: the control group and 4 other groups that underwent double ligation and division of the common bile duct. Two of these 4 groups (Group 3 and 5) received vitamin E during the experiment. Alkaline phosphatase, aspartate aminotransferase, bilirubin serum levels, white blood cell count and neutrophil phagocytosis index were determined for group 2 and 3 at the end of the 15 days and for group 1, 4 and 5 at the end of the 21 days. RESULTS: There was a significant increase in white blood cell counts and biochemical parameters in group 2, 3, 4, and 5 (P < 0.05). Neutrophil phagocytosis index significantly increased 15 days after bile duct ligation (P < 0.001) (Group 2) and significantly decreased 21 days after bile duct ligation (P < 0.001) (Group 4). Neutrophil phagocytosis index in vitamin E pretreated groups were significantly decreased at the end of the 15 days (P < 0.001) (Group 3) and increased at the end of the 21 days (P < 0.001) (Group 5). CONCLUSIONS: Finally, If vitamin E is administered for further days and weeks of prolonged jaundiced, neutrophil phagocytosis index improves.

Comparison of five detection methods for Helicobacter pylori.

OBJECTIVE: To evaluate which diagnostic test is preferable for the diagnosis of Helicobacter pylori in patients with gastroduodenal disease. STUDY DESIGN: H pylori infection was diagnosed prospectively in 101 patients. Diagnosis of H pylori was made by tests based on five different principles: (1) culture, (2) direct histologic demonstration, (3) imprint cytology, (4) brushing cytology, and (5) gram staining of H pylori. Efficacy of each test was compared. RESULTS: All the tests were reliable for diagnosing H pylori infection; 73.3% of patients showed concordance in at least two tests. All the tests were positive in > 50% of patients. Significant concordance between brushing and imprint cytology was also determined. These two tests have almost similar specificity when compared to other tests. CONCLUSION: When patients undergo upper endoscopy, we recommend taking biopsy specimens for culture and histology. H pylori can be assessed equally well with all the tests, but imprint and brushing cytology have the advantage of rapid response, specificity, much lower cost and reproducibility.

Imprint cytology in the diagnosis of Helicobacter pylori. Does imprinting damage the biopsy specimen?

OBJECTIVE: To investigate the efficacy of imprint cytology in the diagnosis of Helicobacter pylori infection and whether it damages the biopsy specimen for subsequent histologic examination. STUDY DESIGN: Two antral biopsies were taken from 76 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. Imprint cytology was made from the first specimen. This specimen was fixed in 10% formalin and sent for histopathologic examination. The second specimen was directly fixed in 10% formalin for routine histopathologic examination without being used for an imprint. The imprint smears were examined by cytopathologists. The biopsy specimens were examined by pathologists who did not know which specimens were used for the imprints. RESULTS: H pylori was seen in smears from 55 (72%) patients and in both biopsy specimens from the same patients. The pathologists could not recognize the biopsy specimens from which the imprints were made. Concordance between imprint cytology and histopathology was 100%. CONCLUSION: Imprint cytology is a suitable test for H pylori diagnosis, and imprints do not adversely affect the quality of the biopsy specimen.

The protective effect of vitamin E on gastric mucosal injury in rats with cirrhosis of the liver.

OBJECTIVE: To evaluate the functional and morphologic features of stomach in liver cirrhosis model and the cytoprotective effects of Vitamin E. METHODS: Experimental cirrhosis was induced in rats by subcutaneous administration of 0.4 ml CCl4 (diluted 1:4 with olive oil) per kilogram of body weight twice a week for 12 weeks. Rats were divided into three groups. Group 1 was control. Group 2 consisted cirrhotic rats induced by CCl4 and Group 3 cirrhotic rats treated with Vitamin E (intramuscularly 100 mg/kg per day during study). At the end of 12 weeks, gastric mucosal injury was produced by instillation of absolute alcohol via an orogastric tube. After 3 hours, each animal was sacrificed. The stomachs were macroscopically, microscopically and biochemically analyzed. RESULTS: Macroscopic and microscopic area of gastric mucosal injury were significantly larger in cirrhotic rats (P < 0.05). Gastric mucosal injury was more serious in cirrhotic rats as compared with Group 1. With vitamin E treatment, tissue Malondialdehyde (MDA) and glutathione [GSH (X)] levels were significantly lower in group 3 as compared with group 2 (P < 0.001). CONCLUSION: Gastric mucosa in cirrhotic rats has distinctive histological and functional abnormalities. These abnormalities can be reversed by Vitamin E or other antioxidants.

The role of L-arginine and neutrophils on incisional wound healing.

Although arginine plays an important role in many aspects of inflammation and wound healing, the mechanism is not clear. We aimed to evaluate the effect of L-arginine administration on wound healing and neutrophil activity and on the interaction of these effects. Sixteen rats were divided into two groups: control group and L-arginine group. L-arginine was given intraperitoneally. The rats underwent incisional wounding and were killed on the 7th day of wounding. Blood neutrophil counts, neutrophil adhesivity index, tensile strengths and hydroxyproline level of skin were determined, histopathological and electron microscopical evaluation of healing was performed. Wound scores in the control group were significantly lower (p < 0.05). Hydroxyproline and collagen levels of skin were significantly increased in the L-arginine group (p < 0.05). Blood neutrophil counts and neutrophil adhesivity index in the L-arginine group were significantly increased (p < 0.05), as were the inflammatory cells in the skin. L-arginine may be used during the first phase of healing to induce inflammation in high risk patients.

Experimental cirrhosis of the liver and cytoprotective effects of alpha tocopherol.

OBJECTIVE: To investigate whether alpha tocopherol (alpha-T) treatment influences liver cirrhosis induced by carbon tetrachloride (CCl4) in the rat. DESIGN: Laboratory experiment. SETTING: Teaching hospital, Turkey. SUBJECTS: Fifty rats were divided into three groups. Group I consisted of ten controls; Group II: twenty CCl4 induced cirrhotic rats and Group III: twenty cirrhotic rats treated with Vitamin E. INTERVENTIONS: Experimental cirrhosis was induced in rats by subcutaneous administration of 0.4 ml CCl4 (diluted 1:4 with olive oil) per kilogram body weight twice a week for 12 weeks. MAIN OUTCOME MEASURES: Histopathologically evaluation of liver, liver malondialdehyde and glutathione peroxidase levels and aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT) and gamma-glutamyltranspeptidase (GGT) levels. RESULTS: Histopathologic evaluation of liver samples demonstrated cirrhotic changes in CCl4 treated groups. The enzyme levels in Group II were significantly increased (p < 0.05) but it was insignificantly lower in the alpha tocopherol treated group III. In Group II, statistically significant increase in liver malondialdehyde levels was determined (p < 0.001). CONCLUSION: Our results demonstrate that alpha-T administration may protect liver against CCl4 induced cirrhosis.

Cytoprotective effects of alpha tocopherol against liver injury induced by extrahepatic biliary obstruction.

There are several important aetiologies of extrahepatic biliary obstruction (EBO). If EBO is surgically reconstructed in the critical time period, liver damage can be halted or reversed. In this golden period, lipid peroxidations significantly intensify liver defects. We hypothesised that alpha tocopherol (alpha-T) could protect the liver from the damage caused by response to EBO. In standard conditions, albino rats of Wistar strain were divided into two groups. All rats underwent double ligations and divisions of common bile ducts (CBD). One of these groups received alpha-T (CBDL-alpha-T). The other CBDL animals received intramuscular injections of normal saline (CBDL-NS). Serum samples were taken for biochemical analyses by light microscopy. The data showed a decrease in plasma bilirubin and liver enzyme levels in CBDL-alpha-T group, when compared with CBDL-NS (p < 0.05). Morphologic analyses showed better results for CBD-alpha-T. Serum levels of Malonyldialdehyd (MDA) in the CBDL-alpha-T group was 9.2 +/- 3.4 nmol/g compared to that in CBDL-NS, 12.3 +/- 4.4 nmol/g (p < 0.05). In conclusion, a dramatic protective effect of alpha-T on functional and structural features of the liver in rats with EBO was demonstrated. The data suggest that EBO may cause liver damage by stimulation of lipid peroxidation and that alpha-T may slow down liver damage in this setting.

Effect of hypothyroidism in the thyroidectomized rats on immunophenotypic characteristics and differentiation capacity of adipose tissue derived stem cells.

INTRODUCTION: Thyroid hormones influence multiple physiological functions, like growth, differentiation, protein synthesis and metabolic rate. The hypothyroid state is a complex hormonal dysfunction rather than a single hormonal defect. The relation between hypothyroidism after thyroidectomy and stem cells is not clear. AIM: This study was designed to investigate the effect of thyroidectomy on the proliferation, telomerase enzyme activities, immunophenotypic properties and differentiation potentials of adipose tissue-derived (AT-) stem cells (SCs). MATERIALS AND METHODS: AT-SCs after 60 and 120 days of thyroidectomized (Tx) rats were compared to normal rats by flow cytometry and immunocytochemistry analyses, and their telomerase activities were estimated. RESULTS: The telomerase activity was found to be positive for AT-SCs of Tx rats of both 60 and 120 days used in this study, but a decrease was noticed in the cells with the long-term exposure to hypothyroidism. This might indicate the decrease in the regenerative ability of the AT-SCs after 120 days of Tx compared to cells after 60 days of Tx. Both cell lines were induced to differentiate into adipogenic, osteogenic and neurogenic cell lineages, but osteogenic marker expression was not detected in the undifferentiated AT-SCs of the Tx rats. Osteogenic differentiation was also failed in stem cells derived from Tx rats, shown by Alizarin red S staining and alkaline phosphates enzyme assays. DISCUSSION: These results suggest that hypothyroidism affected SCs, altered stem cell characteristics, like telomerase activity and loss of in vitro bone formation, but not adipogenic or neurogenic differentiation ability. CONCLUSIONS: Hypothyroidism after Tx affects the osteogenic differentiation capacity of stem cells, which might be one of the factors of bone loss due to postnatal hypothyroidism.

Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database.

Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.

Lipoprotein(a) concentrations in patients with type 2 diabetes mellitus without cardiovascular disease: relationship to metabolic parameters and diabetic complications.

BACKGROUND AND AIM: Diabetes mellitus is associated with a 3-4 times greater risk of coronary artery disease. One of the major risk factors in diabetics is their abnormal plasma lipid and lipoprotein levels, and a high serum concentration of lipoprotein(a) [Lp(a)] is an acknowledged risk factor for atherosclerosis. The aim of this study was to evaluate serum Lp(a) levels in type 2 diabetic (T2DM) patients without cardiovascular disease, and assess the relationship between these levels and microvascular complications. METHODS AND RESULTS: The study involved 86 T2DM patients without cardiovascular disease and 44 healthy control subjects. There were no statistically significant differences between the two groups in terms of mean age, body mass index, total cholesterol, low density lipoprotein-cholesterol or Lp(a) levels. There was a positive correlation between Lp(a) levels and diabetic proliferative retinopathy. Microalbuminuria and serum Lp(a) concentrations were significantly higher in the T2DM patients with proliferative retinopathy, who also had a longer duration of diabetes. CONCLUSIONS: Diabetes does not increase serum Lp(a) concentrations. T2DM patients with high Lp(a) levels may be at high risk of retinopathy.

Effects of rhG-CSF on neutrophil functions and survival in sepsis induced diabetic rats.

Diabetic patients are more prone to infection and evidence for an immunologic defect superimposed upon the metabolic abnormalities of diabetes is convincing. Neutrophils play a critical role in the host defense mechanism against various bacterial infections, and it is suggested that impaired neutrophil functions cause susceptibility to infections in diabetic patients. To explore the possibility that Granulocyte colony-stimulating factor (G-CSF) may be useful to prevent the morbidity and mortality caused by infections in diabetics. We studied the effect of G-CSF against septicemia in diabetic rats. Forty eight rats were divided into seven equal groups. The IInd, IVth-VIth groups were made diabetic by single intraperitoneal injection of streptozotocin. Fourth, VIth and VIIth groups were made septicemic by cecal ligation and perforation at the end of the second week of streptozotocin injection. G-CSF was subcutaneously injected into IIIrd, Vth and VIth groups. White blood cell count, neutrophil counts and function were determined. Rats in all groups were also observed for seven days for survival. White blood cells, neutrophil and lymphocyte counts and the neutrophil phagocytosis index decreased but neutrophil adherence rate was not different in diabetic group II (p<0.05). All these variables were significantly diminished in diabetes and sepsis-induced group IV (p<0.05). G-CSF injections improved all variables except neutrophil adherence. Cumulative survival ratio was better in G-CSF-injected group VI than in ceftriaxon-administrated group VII (p<0.05). In conclusion, G-CSF increased neutrophil counts, developed neutrophil functions and improved survival. These results suggest that G-CSF may be useful as a drug to prevent bacterial infection in diabetic patients.