Donor-recipient killer immunoglobulin like receptor (KIR) genotype matching has a protective effect on chronic graft versus host disease and relapse incidence following HLA-identical sibling hematopoietic stem cell transplantation.

Impact of donor-recipient killer immunoglobulin-like receptor (KIR) gene-gene matching on transplant outcomes is still inconclusive. Recent data suggest that killer cell immunoglobulin-like receptor (KIR) regulated natural killer cell (NK cell) activity may contribute to graft versus leukemia (GvL) effects and graft versus host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This case-control study aims to evaluate the effects of both aKIR and iKIR donor-recipient genotype matching on the outcomes of T cell replete HLA-identical sibling allo-HSCTs in a homogenous young patient population with myeloid leukemias. Five transplant outcomes including relapse rate (RR), disease-free survival (DFS), overall survival (OS), cumulative incidences of acute GvHD (aGvHD), and chronic GvHD (cGvHD) are investigated. Out of 96 HLA-identical sibling donor-recipient pairs, 34 were matched for activating KIR (aKIR), 38 for inhibitory KIR (iKIR), and 20 for both aKIR and iKIR. Fourty-four pairs were mismatched for both iKIR and aKIR. In univariate analysis, aKIR-matching resulted with a decrease in relapse rate (RR) (hazard ratio [HR]: 0.4; p = 0.04) and an increase in disease-free survival (DFS) (HR: 0.5; p = 0.03). In addition, cGvHD ocurred less frequently in the aKIR-matched (odds ratio [OR]: 0.4; p = 0.04) or iKIR-matched (OR: 0.3; p = 0.009) cohorts. Matching for both aKIR and iKIR was also associated with a decrease in cGvHD incidence (OR: 0.3; p = 0.02). iKIR-matching had no effects on RR, OS, or DFS. Analysis of donor haplotype effects showed haplotype-BB to have a tendency towards reduced relapse rate (HR: 0.4; p = 0.08) and better OS (HR: 0.4; p = 0.04); haplotype-Bx to increase the incidence of cGvHD (OR: 4.1; p = 0.03). In multivariate analysis, DFS advantage remained significant for aKIR-matching (HR: 0.5; p = 0.04); cGvHD incidence was reduced in the presence of iKIR-match (OR: 0.3; p = 0.02) and increased in the presence of haplotype-AB and -BB donors (OR: 7.9; p = 0.02; OR: 5.1; p = 0.03, respectively). In an attempt to investigate the pathogenesis underlying KIR-matching, we searched for residual NK/T cells on day 0 peripheral blood samples of six additional recipients and noted the presence of CD3+ (7.0-91.4 × 106/L) and CD56+57+ (0.8-12.7 × 106/L) cells. In conclusion, conditioning regimen surviving recipient NK/T cells potentially influenced by KIR-matching may contribute to GvL/GvH reactions.

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence?

OBJECTIVE: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women. METHODS: Forty-two women with stress UI or mixed UI who met the inclusion criteria from a group of 541 women with stress UI or mixed UI, were included in the study. The study group was compared with a control group of 20 healthy women without UI who matched to the study group's demographic data and met the inclusion criteria. Demographic data as well as duration of symptoms and vitamin B12 levels were analyzed and compared. RESULTS: The mean ages of the study and the control groups were 50.04 ± 4.6 and 49.02 ± 5.1 years, respectively. Vitamin B12 level was 300.95 ± 142.9 pg/mL in the study group, whereas in the control group it was 598.98 ± 120.3 pg/mL (P < 0.001). In the study group, 66.6% of the patients with stress UI had vitamin B12 levels less than 300 pg/mL. When the duration of symptoms and vitamin B12 levels were compared, women with vitamin B12 levels less than 200 pg/mL had symptoms for a longer duration (P < 0.01). CONCLUSION: One of the main etiologic factors for stress UI is a defect in pelvic floor support. Vitamin B12 is lower in women with stress UI. Analysis of vitamin B12 levels should also be considered in the evaluation of women with stress UI.

The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes.

AIMS AND OBJECTIVES: To determine the prevalence of urinary incontinence and fecal incontinence among older people residing in nursing homes in Istanbul. BACKGROUND: Urinary incontinence (UI) is a multifactorial condition associated with age-related changes and disorders of the genitourinary system and systemic problems affecting normal micturition. The impact of UI and fecal incontinence (FI) on older people living in nursing homes is more significant than those living in the community. DESIGN: Cross-sectional study. METHODS: This study was performed with 1110 older people who were 60 years and older residing in five government rest homes on the European side of Istanbul in Turkey. An interview was conducted with the residents that had sufficient cognitive function and agreed to participate. Demographic findings and complaints about incontinence were analyzed using a special questionnaire. RESULTS: The total number of older people who participated was 694; 56.5% females and 43.5% males; 43.4% of females and 20.9% of males. Urge incontinence was common in both groups. FI was more common among females (14%, males 6%) and the mean duration of symptoms was longer. The related factors for UI among older females revealed that history of an episiotomy, frequency, urgency, fecal incontinence and functional incapacity among males; whereas history of stroke and pulmonary disorders were independent variables that increased the incidence of frequency, recurrent urinary tract infections and fecal incontinence. The related factors for fecal incontinence among older females included history of stroke and functional status. Diabetes mellitus requiring medical treatment, frequency, functional incapacity and urinary incontinence were significant related factors for fecal incontinence among males. CONCLUSIONS: According to similar studies, the urinary and fecal incontinence rates in nursing home residents were lower compared to the other countries. Incontinence was more common among females according to males. Understanding related factors of incontinence are important for providing care and counseling in nursing homes. RELEVANCE TO CLINICAL PRACTICE: Nurses can provide appropriate information and support at each step in the protecting, screening, diagnosis and treatment process so that elders' incontinence is minimized.

Retraction: Mesenchymal Stem Cells: Are They Suitable for Systemic Injection? An In Vitro Study.

This article is being retracted because another article was published using the same data, but under a different title, in Microvascular Research.

Aortic stiffness in diabetes mellitus--association with glutamine and heat shock protein 70 expression: a pilot study based on an experimental rodent model.

BACKGROUND: Diabetes mellitus (DM) alters arterial wall compliance and causes aortic stiffness, which is a predictor of vascular mortality. Heat shock proteins (HSPs) are involved in the protection of cells under stress. We evaluated aortic stiffness in DM and the effects of glutamine (which induces HSP 70) on HSP 70 levels in experimental DM. MATERIALS AND METHODS: Male Sprague-Dawley rats (n = 30) were divided into three groups: Control (Group 1), DM (Group 2) and glutamine-treated DM (Group 3). DM was induced using streptozocin injection. Group 3 rats received two doses of glutamine during the fourth week. Blood and infrarenal aortic tissue samples were obtained for analysis at the end of the fourth week. RESULTS: Compared with Group 1, serum HSP 70 levels were significantly increased in Groups 2 and 3. Aortic HSP 70 was increased in DM. There was a significant difference in aortic HSP 70 with glutamine injection (Group 1 versus Group 3). DM also interfered with the elastin content of the aorta. There was a significant correlation between the serum glucose and serum and aortic HSP 70 levels and between serum and aortic HSP 70 levels; as well as between severity of DM and aortic elastin levels. CONCLUSIONS: DM causes aortic stiffness and this may contribute to the increase in mortality and morbidity associated with DM. The expression of HSP 70 may become a therapeutic target.

Vascular effects of estrogen and progestins and risk of coronary artery disease: importance of timing of estrogen treatment.

The effects of estrogen and progestins on the vascular wall have drawn major medical attention, and significant controversy over various studies has been developed. Several experimental and observational studies have shown cardioprotective effects; however, prospective randomized trials showed an increase in cardiovascular events in postmenopausal women on estrogen/ medroxyprogesterone acetate treatment. The most significant parameter for cardiovascular benefit of estrogen seems to be the interval since the onset of menopause. In the early postmenopausal years, estrogen has beneficial effects on the vascular wall by inhibition of atherosclerosis progression, whereas in the late postmenopause, adverse effects like upregulation of the plaque inflammatory processes and plaque instability may develop. The effects of progestins on the cardiovascular system are not as clear and may differ according to the choice of progestins that is used. The aim of this review is to summarize the effects of estrogen and progestins on the vascular wall and their clinical implications.

Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey.

The objective of this study was to evaluate urinary incontinence (UI) and its effect on the quality of life (QoL) of older people dwelling in residential homes in Turkey. A cross-sectional study was applied in residential homes. A total of 1110 people older than 60 years residing in five selected residential homes were studied. An interview was conducted with the residents who had sufficient cognitive function and agreed to participate. The QoL and the mental and the functional state of the residents were analyzed using the King's Health Questionnaire (KHQ), Mini Mental State Examination (MMSE), and the Rankin Scale, respectively: Of the total pool, 694 residents were included in the study of which 56.48% (n=392) were female and 43.52% (n=302) were male. UI was present in 170 women and 63 men. Pad usage was more common in women (88%) than that in men (29.1%). The QoL subdimensions showed that women had higher scores than men. Urge UI (UUI) had more impact on the QoL than that on functional, mixed or stress incontinence. We concluded that UI negatively affects the QoL of older people living in residential homes. In particular, women and patients suffering from UUI are more severely affected.

Effects of atorvastatin on vascular intimal hyperplasia: an experimental rodent model.

INTRODUCTION: Vascular intimal hyperplasia is associated with increased mortality and morbidity. The authors investigated the effects of atorvastatin on vascular intimal hyperplasia. MATERIALS AND METHODS: Rats were divided into 4 groups. Groups 1, 2, and 3 had experimental aortic injury and received intraperitoneal injection of atorvastatin, solvent, or 0.9% NaCl, respectively. Group 4 was a nonintervention (laparotomy only) control group. Animals were sacrificed after 3 weeks. Blood samples and injured aortic segment were analyzed. RESULTS: Atorvastatin administration significantly lowered total and low-density lipoprotein cholesterol levels (P = .012 and P = .001, respectively), intima-media ratio (P = .002), and intimal smooth muscle cell accumulation (P < .05) in group 1. Luminal narrowing in animals in group 1 was significantly lower than that in animals in groups 2 and 3, but was higher than in animals in group 4 (P = .009). CONCLUSIONS: Atorvastatin suppresses intimal hyerplasia and aids in intimal regeneration by lowering blood lipids and intimal smooth muscle cell accumulation.

Efficacy of remote ischaemic preconditioning for spinal cord protection against ischaemic injury: association with heat shock protein expression.

INTRODUCTION: We aimed to determine the efficacy of remote ischaemic preconditioning in the hind limb of rats for ischaemic damage of the spinal cord through neurological and histological investigation and examination of heat shock proteins (HSP). MATERIAL AND METHODS: Thirty male Sprague-Dawley rats were divided into three groups as Group 1 (control group, n=10), Group 2 (ischaemia control group, n=10), and Group 3 (remote ischaemia preconditioning group, n=10). The right lower limb of the rats in the study group was compressed with a tourniquet for three cycles of ten-minute ischaemia followed by ten-minute reperfusion. After a period of 8 hours, the peritoneal cavity was accessed through a midline vertical incision. The abdominal aorta was clamped between the origin of the renal arteries and the iliac arteries for 45 minutes and spinal cord ischaemia was induced. The same procedure of abdominal aorta clamping was performed in the control group without creating leg ischaemia. The rats were evaluated for neurological parameters at 24 and 48 hours. At the end of this time period, all rats were sacrificed and the spinal cords were stained for determination of HSP and histopathological classification. For immunohistochemical evaluation, the samples were analyzed according to the degree of staining with HSP70 rabbit antibody. RESULTS: After completing the neurological examinations and histological evaluations, we determined the spinal cords of the animals in the sham group to be completely normal. The post-operative neurological examination scores of Group 3 at 24 and 48 hours were significantly higher than scores measured in the other two groups. There were seven rats with HSP expression and this was detected in animals pretreated with remote ischaemic preconditioning. There were also two rats in Group 2 with HSP expression. CONCLUSION: Our results show that production of transient remote ischaemia preconditioning in the lower extremities reduces damage in the spinal cord secondary to ischaemia probably by the increase of HSP.

Connective tissue alterations in women with pelvic organ prolapse and urinary incontinence.

BACKGROUND: Alterations in collagen synthesis and metabolism have previously been reported in patients with pelvic organ prolapse (POP) and/or urodynamic stress incontinence (USI). Since urinary incontinence does not always associate with POP, the objective of this study was to examine connective tissues from patients with USI plus POP, and patients with prolapse only. METHODS: Biopsies from the uterosacral ligaments were obtained during the operation from POP patients (n =28), and from continent women (control group, n =12) who underwent surgery for other benign reasons. POP patients were classified following urodynamic tests and symptom questionnaire with respect to the presence (n =14) or absence (n =14) of USI. N-terminal propeptides of collagen (PINP and PIIINP), TGF-beta and leptin were measured in plasma. Hydroxyproline and glycosaminoglycan (GAGs) concentrations and total hexosaminidase activity were measured in tissue samples. Histological sections were prepared using Masson's trichrome technique, and digitised solutions were used for imaging provided by Soft Imaging System GmBh. Statistical evaluations were made by the Kruskal-Wallis test. RESULTS: A significant decrease in hydroxyproline content was found in USI+POP women in comparison to controls (p<0.05). In contrast, histopathological examination revealed an increased density of collagen in USI+POP patients. Hexosaminidase activity was decreased in both groups with POP, but no change in the amount of GAGs was observed. Markers of collagen synthesis (PINP, PIIINP), and factors related to the collagen synthesis (TGF-beta, leptin) remained unaltered. CONCLUSION: Our biochemical and morphological findings suggest a different organisation of collagen fibres in tissues of patients with USI+POP, when compared with both the controls and the POP patients.

Transient gestational diabetes insipidus diagnosed in successive pregnancies: review of pathophysiology, diagnosis, treatment, and management of delivery.

Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-D: -arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.