Can serum progranulin level be used as a prognostic biomarker in non-small cell lung cancer?

Progranulin has been considered to be a poor prognostic biomarker for some types of malignancies. However, the clinical significance of serum progranulin level and the prognostic value are still not explored in advanced stages of lung cancer.  The current study investigates the prognostic significance of progranulin serum levels in advanced-stage non-small cell lung cancer (NSCLC) patients. This study involved 94 subjects (70 advanced-stage NSCLC patients and 24 healthy controls). Serum progranulin level was measured by enzyme-linked immunosorbent assay (ELISA) and was correlated with patient outcome. The association between circulating progranulin level and clinicopathological parameters was detected. Serum progranulin cut-off level predicting six-month survival was determined. Serum progranulin level was found significantly elevated in NSCLC patients than in the control group (p<0.001). We did not determine a significant difference between stage IIIB and stage IV NSCLC patients for serum progranulin levels (p=0.166). When we evaluated the laboratory parameters, only serum LDH level was found significantly correlated with serum progranulin level (p=0.043), also bone and liver metastasis showed a significant correlation with progranulin level (p=0.008 and p = 0.024, respectively). The cut-off level of serum progranulin in predicting six months of survival was determined as 16.03 ng/ml (AUC = 0.973, 95%Cl: 0.903-0.997, p<0.001) with 97.06% sensitivity and 88.89% specificity. Overall survival was determined shorter in patients with progranulin level ≥16 ng/ml than those with <16 ng/ml (p<0.001). Also, in the multivariate analysis using the Cox regression model serum progranulin level was found as an independent prognostic factor for NSCLC (p=0.001). Serum progranulin level may be a useful biomarker for predicting poor survival in advanced-stage NSCLC patients.

Echocardiographic evaluation from a different perspective in asthmatic patients.

Introduction: It is known that there is a complex interaction between asthma and cardiovascular physiology. Some investigations on echocardiography and electrocardiography (ECG) in asthmatic patients have revealed many findings such as pulmonary hypertension (PHT) and arrhythmia. In this study, we aimed to perform tissue Doppler imaging (TDIE) and conventional echocardiographic (CEI) assessment with many indexes of arrhythmia on electrocardiography (ECG) in asthmatic patients. Materials and Methods: A total of 89 patients, 63 females (70.8%) and 26 males (29.2%), were included in this study. Patients were divided into three groups, and then each group was separated in two groups as mild-moderate and severe asthma. Result: There was no difference among groups with respect to age, sex and anthropometric data. There was no difference between the groups with respect to indexes of arrhythmia on ECG (p> 0.05). Mitral annular plane systolic excursion (MAPSE), tricuspid annular alane systolic excursion (TAPSE) and both ventricular diastolic velocities on CEI were similar between the groups, except for left ventricular A wave velocity which was higher in severe asthmatic patients (p<0.05). Investigation of time intervals of both ventricular diastolic filling velocities (e' and a') at the mitral lateral, septal and tricuspid lateral annulus revealed significant difference at Pa'm-3 and Pa's-3 intervals based on TDEI (p<0.05). Only maximal volume of the LA was higher in severe asthmatic patients (p<0.05). However, there was no significant difference between LA-VpreA and LA-Vmin (p<0.05). Conclusions: Based on these results, it can be suggested that LA mechanical functions and intra-atrial LA electromechanical durations were impaired in severe asthmatic patients.

Optimal Cut-Off Points of 4-meter Gait Speed to Discriminate Functional Exercise Capacity and Health Status in Older patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Gait speed, a vital sign of health and functional capacity, is commonly used to measure mobility. Although studies have assessed gait speed in older adults and individuals with chronic obstructive pulmonary disease (COPD) separately, few have evaluated gait speed in older adults with COPD. Therefore, the primary objective of our study was to determine the threshold point for the 4-meter gait speed test (4MGS) to better discriminate between functional exercise capacity and health status in older patients with COPD. The second objective was to determine possible predictors of gait speed. METHODS: In this cross-sectional study, we assessed participants' pulmonary function, dyspnea, health status (COPD Assessment Test [CAT]), gait speed (4MGS), functional exercise capacity (6-minute walk test [6MWT]), and physical activity. RESULTS: Forty-five older patients with COPD participated in this study. The predicted 6MWT and CAT scores were independent and significant determinants of the 4MGS score, explaining 54% of the variance (p<0.001). We identified gait speeds of 0.96 m/s and 1.04 m/s as thresholds to predict abnormal functional exercise capacity (sensitivity 85% and specificity 56%) and impaired health status (sensitivity 90% and specificity 69%), respectively (p<0.05). CONCLUSION: Our findings demonstrated that gait speed can discriminate between abnormal functional exercise capacity and impaired health status in older patients with COPD. Moreover, functional exercise capacity and health status are predictors of gait speed.

Gait speed predictors and gait-speed cut-off score to discriminate asthma control status and physical activity in patients with asthma.

INTRODUCTION: As a "vital sign" of health and functional capacity, gait speed is commonly used. However, there is insufficient evidence for possible determinants of gait speed in patients with asthma. The primary objective of the present study was to determine predictors of gait speed in patients with asthma. The second objective was to determine the cut-off point for the 4-minute Gait Speed (4MGS) to better discriminate asthma control status and physical activity in asthma. MATERIAL AND METHODS: Fifty-seven patients with asthma were included in this cross-sectional study. Demographic and clinic characteristics, pulmonary function, asthma control status (ACT, Asthma Control Test), dyspnea, gait speed (4MGS), physical activity [International Physical Activity Questionnaire-Short Form (IPAQ-SF)] and activities of daily living were evaluated. Stepwise multiple linear regression analysis was used to investigate the possible predictors of gait speed. Receiver operating characteristic (ROC) curve analysis was used to determine whether usual gait speed had a discriminative value. RESULTS: The stepwise multiple regression analysis revealed that the ACT score and the IPAQ-SF score were significant and independent predictors of the 4MGS in patients with asthma explaining 40% of the variance in 4MGS (p < 0.001). The ROC curve showed a cut-off point of 1.06 m/s for the 4MGS for poorly controlled asthma and physical inactivity (p < 0.05). CONCLUSIONS: Our findings indicate that asthma control status and physical activity can be independent predictors of gait speed in patients with asthma. In addition, gait speed may be discriminative to determine poorly controlled asthma and physical inactivity in patients with asthma.

Intra- and Inter-Rater Reproducibility of the Face-to-Face and Tele-Assessment of Timed-up and Go and 5-Times Sit-to-Stand Tests in Patients with Chronic Obstructive Pulmonary Disease.

Timed-Up and Go (TUG) and 5-Times Sit-to-Stand (5STS) are frequently used in clinical practice for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the intra- and inter-rater reproducibility of the TUG and 5STS as both face-to-face and tele-assessment tests in patients with COPD. Forty-four patients with diagnosed COPD were included. Evaluations were carried out face-to-face and tele-assessment (synchronized and asynchronized). Inter-reliability between face-to-face and tele-assessment was excellent for TUG (ICC = 0.977) and 5STS (ICC = 0.970). Inter-reliability between two tele-raters was also excellent for TUG (ICC = 0.995) with the SEM = 0.04, SEM95% = 0.08, and SDC95% = 0.10 s, and 5STS (ICC = 0.990) with the SEM = 0.06, SEM95% = 0.12, and SDC95% = 0.18 s. Intra-rater reliability of the tele-assessment (synchronized) was excellent for TUG (ICC = 0.976) and 5STS (ICC = 0.964). The SEM, SEM95%, and SDC95% values were computed as 0.08, 0.16, and 0.22 s for TUG, and 0.11, 0.22, and 0.31 s for 5STS, respectively. The TUG and 5STS tests are reproducible tele-assessment measures in patients with COPD with excellent intra- and inter-rater reproducibility. The authors recommend these tests as practical assessment tools in patients with COPD at home for tele-health interventions. The reported SEM, SEM95%, and SDC95% values can be used as a minimum change that needs to be observed to be confident that the observed change is real and not, potentially, a product of measurement error.

Choroidal vascularity index in obstructive sleep apnea syndrome.

BACKGROUND: There is growing evidence supporting an association between obstructive sleep apnea syndrome (OSAS) and systemic vascular disorders. However, the data on choroidal microvasculature are limited. In recent years, choroidal thickness (CT) and choroidal vascularity index (CVI) have been of considerable interest as objective markers of choroidal vascularity. We hypothesized that the imbalance of vascular regulation in OSAS may adversely affect the CT and CVI and may help to assess the vascular risk in these patients. PURPOSE: This study aimed to evaluate the choroidal morphology in patients with OSAS. MATERIALS AND METHODS: Patients with moderate OSAS were included to this study. The subfoveal, nasal, and temporal CT were calculated. The choroidal area (CA) was binarized to the luminal area (LA) and stromal area (SA) using ImageJ software. The CVI was calculated as the proportion of the LA to the total CA. RESULTS: Of 40 eyes of 40 patients, the mean subfoveal CT was significantly decreased in the OSAS group in comparison to the controls (p = 0.032). The mean CA, LA, and SA were decreased in the OSAS group compared with the controls, but the differences did not reach a statistical significance (p = 0.132, p = 0.104, and p = 0.184, respectively). The CVI was not significantly changed in patients with OSAS (p = 1.000). CONCLUSION: Unlike CT, there were no significant differences in choroidal structural parameters and CVI in patients with OSAS.

The use of new oral anticoagulants in geriatric patients: A survey study for physicians.

INTRODUCTION: The use of new oral anticoagulants (NOACs) for the treatment of thromboembolic diseases is becoming more widespread. The present study brings together the opinions and daily routine clinical practices of physicians regarding the use of NOACs in the geriatric age group for the treatment of venous thromboembolic diseases. MATERIALS AND METHODS: The study accessed 274 physicians (197 attending, 70 resident and seven primary care physicians) with various specialties and academic positions through face-to-face interviews or e-mails, and asked them to complete a questionnaire form prepared for NOAC use on a voluntary basis between 1 May and 31 December 2019. RESULT: It was found that physicians preferred NOACs mostly for patients contraindicated for the regular use of low-molecular-weight heparins and warfarin (n: 264, 96%), and with an unbalanced INR level (n: 230, 87%). The use of NOACs was found to be higher in the geriatric age group than other anticoagulants due to the easy dose adjustment, the extended monitoring intervals and the low risk of bleeding. Among the physicians, neither the specialty nor a higher number of occupational working years affected the preference for NOACs or other anticoagulants. CONCLUSIONS: Our study has demonstrated that physicians consider NOACs to be a good treatment option in terms of efficacy and reliability for the treatment of thromboembolic diseases in the geriatric age group, who may have treatment compliance difficulties. It was found also that they plan treatment considering the benefit-to-harm ratio and the bleeding-ischemic event balance.

Cognitive and motor performances in dual task in patients with chronic obstructive pulmonary disease: a comparative study.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) may display a motor and/or cognitive disadvantage during dual tasking. However, studies investigating dual task are quite limited in patients with COPD. AIMS: To compare cognitive and motor performances (i.e., muscle force production and functional balance/mobility together with a cognitive task) in dual task between patients with COPD and healthy controls. METHODS: Thirty-five clinically stable patients with COPD and 27 age- and sex-matched healthy controls participated in this cross-sectional controlled study. The muscle force production (knee extension muscle strength assessed with an isokinetic strength dynamometer) and functional balance/mobility (Timed Up and Go (TUG) test) were performed with and without a cognitive task. Dual-task interference (DTI) was assessed. Additionally, the rate of correct responses per second (RCR) was calculated to evaluate cognitive performance. RESULTS: The decrease in RCRmuscle force production values was greater in the COPD group compared with the control group (p = 0.045). Similarly, the cognitive DTI in muscle force production test was higher in the control group than in the COPD group (p < 0.001). There was no significant difference in other outcome measures between the two groups (p > 0.05). CONCLUSION: The study results indicate that in individuals with COPD, cognitive performance deteriorations are more pronounced than motor performance defects during dual tasking. Further studies are needed to investigate the effects of dual task taking into account this disadvantage in patients with COPD rather than focusing solely on motor performance.

Short-term effect of particular matter and sulfur dioxide exposure on asthma and/or chronic obstructive pulmonary disease hospital admissions in Center of Anatolia.

We investigated the associations between the daily variations of coarse particulate matter (PM10) and/or sulfur dioxide (SO2) and hospital admissions for asthma and/or chronic obstructive pulmonary disease (COPD) diseases in Kirsehir, Center of Anatolia of Turkey. We analyzed the poison generalized linear model (GLM) to analyze the association between ambient air pollutants such as PM10 and SO2 and asthma and/or COPD admissions. We investigated single-lag days and multi-lag days for the risk increase in asthma, COPD, asthma, and/or COPD hospital admissions PM10, SO2, and PM10 with SO2 per 10 µg/m3. In single-lag day model a 10 µg/m3 increase in the current day (lag 0) concentrations of PM10 and SO2 corresponded to increase of 1.027 (95% CI:1.022-1.033) and 1.069 (95% CI:1.062, 1.077) for asthma. A 10 µg/m3 increase in the current day (lag 0) concentrations of PM10 and SO2 corresponded to increase of 1.029 (95% CI:1.022-1.035) and 1.065 (95% CI:1.056, 1.075) for COPD. A 10 µg/m3 increase in the current day (lag 0) concentrations of PM10 and SO2 corresponded to increase of 1.028 (95% CI:1.024-1.032) and 1.068 (95% CI:1.062, 1.074) for asthma and/or COPD. It was found that some lag structures were related with PM10 and SO2. Significant lags were detected in some lag structures from the previous first day until the previous eighth day (lag 1 to lag 7) in the asthma, COPD, and asthma and/or COPD hospital admissions in the model created with PM10 with SO2 both in the single-lag day model and in the multi-lag day model. Our study that used GLM in time series analysis showed that PM10 and/or SO2 short-term exposure in single-lag day and multi-lag day models was related with increased asthma, COPD, and asthma and/or COPD hospital admissions in the city between 2016 and 2019 until the previous-eighth day.

Pulmonary lymphangioleiomyomatosis: a rare case.

Lymphangioleiomyomatosis is an uncommon lung disease primarily affecting women of childbearing age. It is characterized by the progressive proliferation and infiltration of smooth muscle-like cells, which lead to cystic destruction of the lung parenchyma; obstruction of airways, blood vessels, and lymphatics; and loss of pulmonary function. We present the case of a 46-year-old female patient with chest pain, cough, sputum, and dyspnea on exertion for three weeks. Minimal pneumothorax was noted, and the patient was referred to our center for further investigation and treatment. High-resolution computed tomography revealed numerous bilateral thin-walled air cysts and interstitial thickening affecting the central and peripheral part of the upper zone of the lung. We performed an open-lung biopsy to confirm lymphangioleiomyomatosis. Our aim is to discuss the pathogenesis and other lesions noted in the differential diagnosis of this rare disease.

The role of CD14 gene promoter polymorphism in tuberculosis susceptibility.

BACKGROUND: CD14 is expressed principally by cells of monocyte/macrophage lineage and plays a pivotal role in the innate immunity to intracellular infections. Recent research findings have revealed an association between the CD14 gene promoter polymorphism and several major infectious diseases. OBJECTIVE: The aim of the present study was to investigate the association between the CD14-159C/T polymorphism and tuberculosis in a Turkish population. METHODS: For this purpose, 88 consecutive patients with tuberculosis (63 pulmonary, 25 extrapulmonary) and 116 control subjects were enrolled into a prospective study. We determined CD14-159 genotypes by polymerase chain reaction - restriction fragment length polymorphism analysis and also measured serum concentrations of soluble CD14 (sCD14) by using a quantitative sandwich enzyme immunoassay technique. RESULTS: There was no significant difference in terms of genotype distribution between patients with tuberculosis (CC 18.2%, CT 48.9%, TT 33.0%) and controls (CC 12.9%, CT 50.9%, TT 36.2%) or between patients with pulmonary and extrapulmonary tuberculosis. Serum levels of sCD14 were significantly increased in patients with active tuberculosis compared to those with inactive tuberculosis and healthy controls (p<0.001). However, levels of sCD14 were not associated with any genotypes of CD14-159. CONCLUSION: The genotyping findings of the present study do not support a role for the CD14-159C/T polymorphism in the development of tuberculosis, at least in the geographical region of central Anatolia. Significantly elevated serum sCD14 levels in patients with active disease reflect the importance of the mononuclear phagocytic system activation in tuberculosis.

A sarcoidosis patient with hand involvement and large pulmonary lymph nodes: results of 1-year treatment with methotrexate.

Sarcoidosis infrequently involves the phalanges and the adjacent soft tissue. The management of bone lesions is not clear. We present herein the results of methotrexate therapy applied for 1 year in a sarcoidosis patient with hand involvement and large hilar lymphadenopathies.

Disseminated tuberculosis with lymphatic, splenic and scrotal abscesses: a case report.

INTRODUCTION: Disseminated tuberculosis can involve several organs and clinically present with a potpourri of signs and symptoms. Early diagnosis and timely initiation of proper treatment are of great importance in preventing the later complications of the disease. CASE PRESENTATION: We report a case with disseminated tuberculosis who exhibited a wide spectrum of extrapulmonary involvement. The present case had lung and lymph node tuberculosis with abscess formation and remained undiagnosed for two years. Thereafter, multiple splenic abscesses developed that necessitated splenectomy, and at the final stage, he presented with scrotal abscesses. CONCLUSION: This paper highlights the diverse clinical appearances of disseminated tuberculosis and the significant importance of early diagnosis and treatment.

Correlation of plasma transforming growth factor beta 1 with asthma control test.

Assessment of asthma with a control test is suggested as a relevant approach for recent years. Ideally, an asthma control test should apply not only to clinical manifestations but also to laboratory markers of inflammation as well. Until now, this could not be performed because of the lack of a confirmed marker which indicates inflammation. A fibrotic mediator TGF-beta 1 has been reported as a key mediator of remodeling in asthma. The aim of this study is to evaluate plasma TGF-beta 1 level in stable asthmatic sufferers and to investigate its correlation with the asthma control test. Stable asthmatic sufferers and healthy controls were recruited for this study. After obtaining demographic information, skin prick and asthma control tests were performed. Blood samples were collected for plasma TGF-beta 1 level. Any contributing factors that may affect plasma TGF-beta 1 level were excluded from both groups. Thirty-five atopic, 35 nonatopic asthmatic sufferers and 15 healthy control subjects were included for this study. The mean age was 38 +/- 10 (years) and 61% were female. When the asthmatic group compared with the control group, plasma TGF-beta 1 level was significantly higher in the asthmatic group (41.7 +/- 12.6 ng/mL versus 27.6 +/- 13 ng/mL) (p < 0.05) whereas it was similar among the atopic and nonatopic groups (41.8 +/- 14.2 ng/mL versus 41.6 +/- 11 ng/mL) (p > 0.05). Spearman Correlation Analysis results pointed positive correlation between uncontrolled asthma and plasma TGF-beta 1 level. This study shows that plasma TGF-beta 1 level may be a systemic marker of asthma control.

Helicobacter pylori in bronchiectasis: a polymerase chain reaction assay in bronchoalveolar lavage fluid and bronchiectatic lung tissue.

BACKGROUND: A number of studies have implicated an association between H. pylori and diverse extra-gastroduodenal pathologies. Chronic inflammation and increased immune response have been observed in bronchiectasis, likely gastroduodenal inflammatory diseases. H. pylori has been found in the trachea-bronchial aspirates of mechanically ventilated patients. Furthermore, the seroprevalence of H. pylori was found to be significantly higher in patients with bronchiectasis than in the control group. The present study was performed to investigate the possible role of H. pylori in the pathogenesis of bronchiectasis. METHODS: Prospectively, bronchoalveolar lavage fluid (BALF) was obtained from patients with bronchiectasis (n=26) and control (n=20). BALF was subjected to polymerase chain reaction (PCR) to determine the presence of H. pylori and serum IgG against H. pylori was determined with micro-ELISA kit. In addition, PCR was performed to determine H. pylori in surgically removed lung tissues from patients with bronchiectasis (n=97). RESULTS: H. pylori DNA was not detected in the BALF or in lung tissue samples. In addition, anti-H. pylori IgG level in patients with bronchiectasis did not show statistically significant difference from that of the control. CONCLUSIONS: Our study provided evidence that there might be no direct association between H. pylori and bronchiectasis; however, the indirect role of soluble products of H. pylori could not be excluded.