Follistatin as a Potential Biomarker for Identifying Metabolically Healthy and Unhealthy Obesity: A Cross-Sectional Study.

Metabolically healthy obesity (MHO) refers to obese individuals with a favorable metabolic profile, without severe metabolic abnormalities. This study aimed to investigate the potential of follistatin, a regulator of metabolic balance, as a biomarker to distinguish between metabolically healthy and unhealthy obesity. This cross-sectional study included 30 metabolically healthy and 32 metabolically unhealthy individuals with obesity. Blood samples were collected to measure the follistatin levels using an enzyme-linked immunosorbent assay (ELISA). While follistatin did not significantly differentiate between metabolically healthy (median 41.84 [IQR, 37.68 to 80.09]) and unhealthy (median 42.44 [IQR, 39.54 to 82.55]) individuals with obesity (p = 0.642), other biochemical markers, such as HDL cholesterol, triglycerides, C-peptide, and AST, showed significant differences between the two groups. Insulin was the most significant predictor of follistatin levels, with a coefficient of 0.903, followed by C-peptide, which exerted a negative influence at -0.624. Quantile regression analysis revealed nuanced associations between the follistatin levels and metabolic parameters in different quantiles. Although follistatin may not serve as a biomarker for identifying MHO and metabolically unhealthy obesity, understanding the underlying mechanisms that contribute to metabolic dysfunction could provide personalized strategies for managing obesity and preventing associated complications.

Bacteria Found in Brasswind Instruments: Analyses Using Culture-Dependent Method and Culture-Independent 16 S rRNA Amplicon Sequencing Method.

BACKGROUND: In wind instrument performance, there is a constant contact between the player and the instrument, during which microorganisms in the mouth flora of the player are transferred into the instrument. The inner surface of the brass instruments provides the perfect environment for microorganisms to grow. As a result, players repeatedly interact with these micro-organisms during playing. In previous studies, different kinds of microorganisms were detected in brass instruments, some of which can carry serious health hazards. PURPOSE: Revealing the common bacterial populations of brasswind instruments will be helpful in raising awareness among musicians and establishing their habits of cleaning/disinfecting their instruments. METHODS: In this study, samples from 4 different areas of 14 brass instruments were collected and analyzed using culture-dependent and -independent (16 S rRNA amplicon sequencing) approaches. The bacterial loads in different parts of the instruments were compared. RESULTS: The amount and variety of bacteria detected in the sampled instruments were unexpectedly large. While some of the found bacteria are harmless, others, such as Chryseobacterium and Elizabethkingia, may occasionally cause serious infections, especially in people with suppressed immune systems. Likewise, the Mycobacterium group includes a type that causes tuberculosis, and the Streptococcus group also shows pathogenic characteristics. The mouthpiece and leadpipe of the instruments had a much larger microbial load compared to the tuning and valve slides. CONCLUSION: According to the findings, brass instruments may harbor a wide variety of bacteria, some of which are potentially hazardous for the musicians' health, especially if their immune systems are compromised. These risks can be minimized by regularly cleaning and disinfecting the instrument, especially the mouthpiece and leadpipe, which are the areas harboring most of the microorganisms.

A comparative study of art therapy in cancer patients receiving chemotherapy and improvement in quality of life by watercolor painting.

BACKGROUND: There is limited data on the role of art therapy used in cancer patients. We wanted to test the effect of painting art therapy provided by a dedicated professional painting artist on quality of life and anxiety and depression levels in patients having chemotherapy. METHODS: Cancer patients having chemotherapy in the day unit of a medical oncology department of a university hospital were offered to take part in a painting art therapy program (PATP). This program consisted of a professional painting artist facilitating and helping patients to perform painting during their chemotherapy sessions while they were in the day unit, as well as supplying them painting material for home practice. The changes in quality of life domains of EORTC-QLQ-C30 questionnaire and in Hospital Anxiety and Depression Scores (HADS) were assessed before and after the PATP. These results were contrasted with a reference group of cancer patients on chemotherapy but not taking part in the PATP. In order to adjust for multiple comparisons of quality of life parameters between patient groups, we utilized the Bonferroni correction. RESULTS: A total of 48 patients, of which 26 patients did and 22 did not have prior exposure to PATP, were enrolled in the PATP. A control group of 24 patients who did not have any PATP activity during the study period also took part in the study. With PATP, there was significant improvement in global quality of life (F=7.87, P=0.001), and depression scores (F=7.80, P=0.001). CONCLUSIONS: To our knowledge, this is the largest comparative PATP experience in cancer patients on chemotherapy and show that PATP is feasible in the clinics. Our results confirm that art therapy in the form of painting improves quality of life and depression in cancer patients having chemotherapy. This effect was more pronounced in patients without any previous experience of PATP.

Serum concentrations of Cyclophilin A in patients with Nonalcoholic Fatty Liver Disease.

AIM: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and its incidence is rising worldwide. Cyclophilin A (CyPA) is a protein, which is secreted under the presence of oxidative stress and hyperglycemia, and it plays role in proinflammatory signal reduction. In this study we investigated serum levels of CyPA in patients with biopsy proven NAFLD and examined their association with clinical and histological phenotypes. METHODS: In this study, we identified serum levels of CyPA in patients with NAFLD (n=52) and healthy controls without evidence of any liver disease (n=44). The levels of CyPA were measured by enzyme-linked immunosorbent assay and were compared between two study groups. Furthermore, serum levels of CyPA were assessed in relation to the clinical characteristics of the study participants. RESULTS: Serum levels of CyPA were significantly higher in patients with NAFLD (3,8±2,6 µg/ml, P=0.03) compared to healthy controls (2,8±1,8 µg/ml). Moreover, concentrations of CyPA were 2,8±1,8, 3,4±2,3, and 4,2±2,9 µg/ml in control group, non-diabetic and diabetic NAFLD patients, respectively. The difference between the groups was statistically significant (P=0.04). There was significant correlation between the serum concentrations of CyPA and glucose levels (P=0.01), but there was no significant correlation with other clinical and histologic parameters. CONCLUSIONS: Our data suggest that CyPA levels are elevated in patients with NAFLD, especially in patients with diabetes. (Acta gastroenterol. belg., 2017, 80, 3-7).

Massive Upper Gastrointestinal Bleeding Caused by Diffuse Large B-Cell Lymphoma.

Massive upper gastrointestinal bleeding is a life-threatening emergency which needs urgent intervention. Hematological malignancies are very rare causes of this type of bleeding and they usually originate from duodenum. In this case we present a gastric diffuse large B-cell lymphoma (DLBCL) causing massive upper gastrointestinal system bleeding. A 77-year-old male patient was admitted to emergency clinic with hematemesis and hematochezia. In physical examination patient was pale and sweaty; his vitals were unstable with a heart rate of 110 per minute and a blood pressure of 90/50 mmHg. His hemoglobin level was found 7.5 g/dL and he was transfused with one unit of packed red blood cells. After his vitals were normalized, gastroscopy was performed showing mosaic pattern in corpus and antrum mucosa and multiple ulcers in various sizes, largest being approximately 2 cm in diameter, higher than mucosa covered with exude mostly on corpus and large curvature. Biopsy results were reported as DLBCL. Gastric mucosa is involved in most of the DLBCL cases. Although not listed as a common cause of massive gastrointestinal bleeding DLBCL can cause life-threatening situations mostly because of its malignant nature.

Prone versus supine position during surgery for supracondylar humeral fractures.

PURPOSE: To compare the supine versus prone position in closed reduction and percutaneous pinning for supracondylar humeral fractures in children in terms of patient characteristics and outcome. METHODS: Records of 25 girls and 31 boys aged 4 to 9 (mean, 6.7) years who underwent closed reduction and percutaneous pinning in the prone (n=27) or supine (n=29) position each by one experienced surgeon for supracondylar extension type-3 humeral fractures were reviewed. RESULTS: The prone and supine groups were comparable in terms of patient characteristics and outcome, except that anaesthesia duration was shorter in surgery performed in the supine position (46.7 vs. 37.2 minutes, p<0.001). CONCLUSION: In surgery for supracondylar humeral fractures in children, patient position affected only the duration of anaesthesia.

NEUROPATHY ASSOCIATED WITH HYPERTRIGLYCERIDEMIA IN PATIENTS WITH METABOLIC SYNDROME.

CONTEXT: With more studies investigating effects of high serum lipid levels, new findings are emerging regarding the damage these biomolecules may cause. AIM: In this study we aimed to find a relation between neuropathy and hypertriglyceridemia in patients with metabolic syndrome (MS). MATERIAL AND METHODS: One hundred and twenty subjects (Ninety subjects with metabolic syndrome and 30 healthy controls) were included in the study. Subjects with MS were divided into three groups. HbA1C levels of the subjects were < 5.7% in group A, ≥ 5.7% - < 6.5% in group B, and ≥ 6.5% - < 8.0% in group C. Pin-Prick test and Semmes- Weinstein Monofilament were used for neurological examination. Electromyography was performed to patients with neuropathy to support the diagnosis. RESULTS: Neuropathy prevalence was found to be higher in the subjects with metabolic syndrome compared to control group. (9.9 %; 16.65 %; 23.31 % vs. 3.3%; in group A, group B, group C vs. healthy control group respectively) (p=0.003 for group A, p=0.0002 for group B, p=0.0002 for group C). There was an association between triglyceride levels and neuropathy in group C. CONCLUSION: Patients with MS may have more neuropathy risk than we estimate.

The expression of miR-181a-5p and miR-371b-5p in chondrosarcoma.

OBJECTIVE: Chondrosarcomas are malignant tumors of chondrocytes that affect bones and joints, and it represents the third most common type of primary bone tumors. Chondrosarcoma is difficult to treat because it is relatively resistant to both chemotherapy and radiation. Thus, surgery remains the best available treatment. It is important to find new diagnostic markers and improve treatment options. BACKGROUND: miRNAs are small non-coding transcripts (19-25 nucleotides) that regulate gene expression via targeting complementary sequences within messenger RNAs (mRNAs). miRNAs have been shown to be involved in regulation of many biochemical pathways. Dysregulated expression of many miRNAs has also been associated with multiple human diseases, such as cancer. PATIENTS AND METHODS: 18 surgical chondrosarcoma specimens were obtained from patients. RNA extractions were performed from decalcified paraffin embedded tissues. The aim of this study was to investigate the expression levels of miR-181a and miR-371b in patients with chondrosarcoma by using RT-PCR and to evaluate the relationship between these miRNAs and chondrosarcoma. RESULTS: miR-181a was found to be upregulated in chondrosarcoma specimens whereas no significant alteration was found for miR-371b expression. CONCLUSIONS: It has been proposed that miRNA expression studies might be used as diagnostic, prognostic marker in cancer. miRNA expression data produced in our study may contribute future chondrosarcoma diagnosis and therapy.

Line of abiraterone acetate in castration-resistant metastatic prostate cancer--Does it matter? report of a multi-institutional experience.

OBJECTIVE: We present our data comparing retrospectively the efficacy of abiraterone and cabazitaxel in patients who progress after docetaxel treatment. PATIENTS AND METHODS: The study included 56 patients diagnosed with hormone-refractory metastatic prostate cancer who were previously treated with abiraterone therapy at four oncology centers in Turkey. RESULTS: With abiraterone, the patients had a median progression-free survival (PFS) of 5.9 months (95% confidence interval (CI) for hazard ratio (HR) (4.4-7.4)) and an overall survival of 13.4 months (95% CI for HR (5.5-21.3)). When we compared the disease-free survival (DFS) of reference patients treated with cabazitaxel as a second-line treatment with those receiving second-line abiraterone therapy, there was no significant difference. (PFS = 5.9 months with cabazitaxel vs. 6.7 months with abiraterone, P = 0.213). CONCLUSION: This study has shown that in our experience abiraterone acetate is an effective agent in metastatic castration-resistant prostate cancer (mCRPC) regardless of the line of treatment.

Effects of hormonotherapy administered after concurrent radiotherapy and Trastuzumab on pulmonary fibrosis.

AIM: This study was to investigate whether the use of hormonotherapy after concurrent radiotherapy (RT) and trastuzumab (T) has a contribution to the development of radiation fibrosis in the lungs. MATERIALS AND METHODS: Seventy Wistar Albino rats were divided into seven groups as follows: Group C: control, Group RT: RT only; Group T: trastuzumab only; Group RT+T+Tam: tamoxifen following concurrent RT and trastuzumab; Group RT+T+Le: letrozole following concurrent RT and trastuzumab; Group RT+T+An: anastrazole following concurrent RT and trastuzumab; Group RT+T+Exe: exemestane following concurrent RT and trastuzumab. Trastuzumab was prepared at an equivalent dose of 6 mg/kg. RT was administered 2 hours after T to the thoracic region at a dose of 12 Gy. Hormonotherapy was initiated one week after RT and administered by oral gavage once daily for 6 months. At the end of 24 weeks, the rats were sacrificed after being sedated with anesthesia. Both lungs were removed en bloc and blocked in paraffin. The level of fibrosis in each cross-section was assessed with the help of a scale. RESULTS: Significant differences were observed between the groups in terms of pulmonary fibrosis scoring. Statistically significant differences were observed when the radiotherapy group was compared to the C, T, T+RT+An, T+RT+Le and T+RT+Exe groups (p<0.05). Significant differences were found between the T+RT+Tam group and the C, T, T+RT+An, T+RT+Le and T+RT+Exe groups (p<0.05). CONCLUSIONS: This study showed that the sequential administration of aromatase inhibitors following concurrent thoracic irradiation and T decreases radiation-induced pulmonary fibrosis. However, tamoxifen was found to have an opposite effect.

Value of diffusion-weighted MRI in the differentiation of benign and malign breast lesions.

INTRODUCTION: Our purpose was to determine whether diffusion-weighted MR imaging (DWI) could be used in differentiation of benign and malign breast lesions. MATERIALS AND METHODS: 41 women patients were included in the study. 45 lesions were diagnosed by biopsy; 25 (55.5%) of these lesions were malignant and 20 (44.5%) were benign. The apparent diffusion coefficient (ADC) values of these lesions were prospectively compared with their histopathological results. RESULTS: Differentiation of the malignant and benign masses revealed that the threshold value of the ADC was 1.0 x 10(-3) mm(2)/s, its sensitivity was demonstrated as 95%, specificity as 100%, positive predictive as 100%, negative predictive as 94% and accuracy rate as 97%. CONCLUSIONS: DWI improves diagnostic accuracy of the conventional breast MRI. ADC measurements may be useful for differentiation of the malign and benign masses.

Diagnosis of small-bowel disease: comparison of magnetic resonance enteroclysis and conventional enteroclysis.

In this prospective study, 32 patients with symptoms suggestive of small-bowel disease underwent conventional enteroclysis and magnetic resonance (MR) enteroclysis. Image quality, luminal distension, wall thickening, homogeneity of luminal opacification, the presence of artefacts and extraluminal changes were assessed. Small-bowel pathologies were subsequently proved surgically and by follow-up examinations in 19 (59.4%) of the patients. Abnormal findings were detected by MR enteroclysis in 11 of these 19 patients (57.9%). Normal findings on MR enteroclysis were found in eight of the 19 patients (42.1%) whereas conventional enteroclysis detected abnormal findings in these patients. Abdominal lesions outside the small bowel, comprised renal cysts, cholelithiasis, ovarian cysts and horseshoe kidney, and were detected by MR enteroclysis in two, one, four and one, respectively, of these normal patients but not by conventional enteroclysis. Excluding lesions outside of the small bowel, a higher rate of false-negative results and the missing of superficial lesions occurred with MR enteroclysis. It is, therefore, suggested that MR enteroclysis should not be used as a primary way of evaluating small-bowel disease and its use should be restricted to follow-up examinations of known disease.

Evaluation of cochlear nerve size by magnetic resonance imaging in elderly patients with sensorineural hearing loss.

PURPOSE: We aimed to determine any differences, if present, between the cross-sectional area of the cochlear nerve (CN) of elderly patients with sensorineural hearing loss (SNHL) and of young patients with normal hearing. MATERIALS AND METHODS: The study group included ten patients with age-related SNHL. Fourteen volunteer individuals with normal hearing were recruited as the control group. T1-weighted, T2-weighted and parasagittal three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) reconstruction images of all cases were evaluated. Images were examined for any abnormality of CN. The data obtained for each ear with clinical, radiological and audiometric examinations were evaluated. RESULTS: The mean CN cross-sectional area was measured as 0.0252 cm(2) in the control group, whereas that in the SNHL group was 0.0232 cm(2). Although speech discrimination scores showed significant differences, no statistically significant difference was observed for the CN cross-sectional area (p=0.0616). Likewise, there was no difference in CN calibre between male and female patients. CONCLUSIONS: The 3DFT-CISS sequence yields superior results in CN imaging. Acquired SNHL may not present with significant changes in CN size on magnetic resonance imaging (MRI).

Complete remission of psoriasis following bevacizumab therapy for colon cancer.

Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF), which is used to treat several cancers. Currently, experience with anti-VEGF treatment for psoriasis is limited, and no published reports on this use exist. We describe a patient with metastatic colon cancer and psoriasis who experienced complete remission of psoriasis during treatment with bevacizumab and combination chemotherapy without any other treatment for psoriasis. These data suggest that bevacizumab may be a promising therapeutic agent for the treatment of psoriasis.

MRI screening of dysbaric osteonecrosis in hyperbaric-chamber inside attendants.

Inside attendants are medical staff who accompany patients during hyperbaric oxygen treatments. Dysbaric osteonecrosis (DON) is a well-known consequence of hyperbaric exposure. The aim of this study was to evaluate DON in inside attendants using magnetic resonance imaging (MRI). The bilateral shoulder, hip and knee joints of 12 inside attendants (four men, eight women; mean age 29 years; age range 22 - 36 years) were investigated. The mean +/- SD duration of employment as an inside attendant was 3.8 +/- 3.0 years (range 1 - 9 years) and the mean +/- SD number of hyperbaric exposures was 198 +/- 267 (median 96; range 30 - 950). None of the inside attendants had a history of decompression sickness. The MRIs of the attendants did not reveal bone lesions consistent with DON. This study failed to find an increased risk for DON in inside attendants. Additional multicentre epidemiological studies are warranted to investigate the occupational safety of inside attendants.

Split-cord malformation and accompanying anomalies.

OBJECTIVE: To present the magnetic resonance imaging (MRI) appearances of spinal split-cord malformation (SCM) and to investigate the various types of congenital spinal disorders associated with SCM. MATERIALS AND METHODS: MR examinations of 23 patients with SCM were carried out in our hospital between June 2002 and May 2007 and retrospectively analysed. RESULTS: Nineteen (82.6%) patients were diagnosed as type I SCM, while four (17.4%) were diagnosed as type II SCM. The most commonly involved site of SCM was the dorsolumbar area (47.8%) while cervical involvement was the least common (4.3%). No accompanying congenital spinal disorders were detected in four patients (17.4%). In 19 patients (82.6%), congenital spinal disorders accompanying SCM were detected, the most common of which was a low-lying cord, found in 14 patients (60.9%). Other anomalies included hydromyelia in seven patients (30.4%), lipoma in six (26%), meningomyelocele in four (17.4%), thick filum in three (13%) and dermoid cyst in three (13%). CONCLUSION: In preoperative planning for SCM, its characteristics and those of the accompanying anomalies should be determined. MRI is a valuable tool for making such determinations.

Relationship between tuberculous otomastoiditis and tuberculous meningitis.

OBJECTIVE: The aim of this study was to determine the correlation between tuberculous meningitis and tuberculous otomastoiditis. MATERIALS AND METHODS: Meningeal involvement sites were investigated by magnetic resonance imaging in 32 patients (21 males, 11 females) who had previously been diagnosed with tuberculous meningitis. Clinical and laboratory findings and responses to anti-tuberculous treatment were evaluated, and the presence of concomitant tuberculous otomastoiditis was also investigated. RESULTS: The meningeal involvement site was unilateral (in the sylvian fissure and the perimesencephalic cistern) in 28 patients (87.5 per cent), and bilateral and widespread in four patients (12.5 per cent). Tuberculous otomastoiditis was found in 11 of the patients with tuberculous meningitis (34.3 per cent). Otomastoiditis was on the same side as the meningeal involvement in nine of these 11 patients. Bilateral otomastoiditis with meningeal involvement was observed in two patients. CONCLUSIONS: Tuberculous meningitis is frequently accompanied by otomastoiditis, although the exact causal relationship between the two conditions is unclear. Since meningitis is a serious clinical condition, concomitant otomastoiditis generally remains unrecognised. Tuberculosis should be considered in the differential diagnosis of patients with otitis or otomastoiditis who do not respond to antibiotic therapy.