IGFBP-4: A promising biomarker for lung cancer.

Background: Insulin-like growth factor binding protein-4 (IGFBP-4), a member of the insulin-like growth factor (IGF) family, transports, and regulates the activity of IGFs. The pregnancy-associated plasma protein-A (PAPP-A) has proteolytic activity towards IGFBP-4, and both proteins have been associated with a variety of cancers, including lung cancer. Thus, we aimed to evaluate the use of IGFBP-4 and PAPP-A as potential biomarkers for lung cancer. Methods: Eighty-three volunteers, including 60 patients with lung cancer and 23 healthy individuals, were included in this study. The patients with lung cancer were selected based on their treatment status, histological subgroup, and stage of the disease. Enzyme-linked immunosorbent assays were used to assess the serum levels of IGFBP-4 and PAPPA, whereas the IGF-1 levels were measured using a chemiluminescent immunometric assay. Results: The serum IGFBP-4 levels in all patient groups, regardless of the treatment status and histological differences, were significantly higher than those in the control group (p<0.005). However, the serum PAPP-A levels in the untreated patient group were found to be higher than those in the control group, but this difference was not statistically significant (p=0.086). Conclusions: The serum PAPP-A and IGFBP-4 levels are elevated in lung cancer. However, IGFBP-4 may have better potential than PAPP-A as a lung cancer biomarker.

Short-term positive airway pressure therapy response in obstructive sleep apnea patients: impact of treatment on the quality of life.

INTRODUCTION: We aimed to assess the compliance of obstructive sleep apnea (OSA) patients of whom we planned positive airway pressure (PAP) therapy by using "Calgary Sleep Apnea Quality of Life Index (SAQLI)","Epworth Sleepiness Score (ESS)","OSAS Symptoms Questionnaire (OSQ)" and, to investigate the early effects of treatment on the quality of life. PATIENTS AND METHODS: A total of 30 adult (male/female: 23/7) OSA patients who applied to Sleep Research Laboratory at the University Hospital, complaining of symptoms related to sleep and polysomnographically verified as OSAS with PAP therapy indications were included to the study. Their written consent were obtained. RESULTS: Characteristics of the patients, OSAS symptoms, ESS and SAQLI sores were recorded. After a month, on the second visit, ESS, SAQLI and OSAS symptoms questionnaire had been repeated. All the patients have routinely used PAP devices for a period of a month. PAP therapy provided significant improvements in excessive daytime sleepiness, symptoms questionnaire and SAQLI scores (p< 0.001). There was a significant correlation between apnea hypopnea index (AHI) score and the improvements in emotional functioning (r = -0.374, p= 0.045). CONCLUSION: We concluded that the OSA patients can have remarkable benefits from PAP therapy during the early treatment period. This study increased the awareness of the patients about their illness and their perceived benefits related to PAP treatment. Emotional functioning improved prominantly as the disease's severity increased.

Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis.

BACKGROUND: Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. REPORT: A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. CONCLUSIONS: Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.

Obstructive sleep apnea syndrome and anthropometric obesity indexes.

BACKGROUND: The purpose of this study is to investigate whether the general body adiposity or regional adiposity was a risk factor in the evolution of obstructive sleep apnea syndrome (OSAS) by examining the relationships between the anthropometric obesity indexes such as waist (WC) and neck circumference index (NC), body mass index (BMI), and OSAS in Turkish adult population, and to access the possible differences by gender. METHODS: The data related to polysomnographic, demographic, and anthropometric indexes of the 499 subjects were examined retrospectively. The patients whose apnea-hypopnea index was ≥5 were determined as OSAS group. RESULTS: The avarage BMI, WC, and NC of the OSAS group (n = 431) were statistically higher than the control group (p < 0.001). According to logistic regression analysis, BMI, WC, and NC enlargement were observed as significant risk factors for OSAS development. Risk coefficients were determined 5.53 for NC, 4.48 for WC, and 2.22 for BMI. Cutoff point values for anthropometric obesity indexes as OSAS determiner were recorded as below: BMI for male >27.77 kg/m(2) and female >28.93 kg/m(2), NC index for male >40 cm and female >36 cm, and WC index for male >105 cm and female >101 cm. CONCLUSIONS: BMI, WC, and NC enlargement were determined as significant risk factors for OSAS development. This was an initial study to determine the cutoff points of which increase the OSAS risk in BMI, WC, and NC index in Turkish adult population.