Fibrinogen: Structure, abnormalities and laboratory assays.

Fibrinogen is the primary precursor protein for the fibrin clot, which is the final target of blood clotting. It is also an acute phase reactant that can vary under physiologic and inflammatory conditions. Disorders in fibrinogen concentration and/or function have been variably linked to the risk of bleeding and/or thrombosis. Fibrinogen assays are commonly used in the management of bleeding as well as the treatment of thrombosis. This chapter examines the structure of fibrinogen, its role in hemostasis as well as in bleeding abnormalities and measurement thereof with respect to clinical management.

The effect of Annona muricata (Graviola) on the prevention of brain damage due to ionizing radiation in rats.

In this study, it was aimed to evaluate the effect of ethanol extract of Annona Muricata (AM) leaves in the prevention of brain damage caused by ionizing radiation (IR). This study was conducted in the Experimental Animal Research Unit of a university with 28 adults female Wistar Albino rats. The experimental groups were as follows: Control group (n = 8), AM group (n = 6), IR group (n = 8), AM + IR group (n = 6). In the IR group, astrocyte hypertrophy, microglial reaction and inflammatory reaction levels were significantly higher than the control and AM groups (P < 0.001). Edema was significantly higher in the IR group compared to the control group (P=0.001). The MDA of the IR group was significantly higher compared to the control group and AM group (P=0.031, P=0.006, respectively). The MDA of the AM + IR group was significantly higher than the AM group (P=0.039). Our findings show that histomorphology and oxidant damage caused by IR can be ameliorated using AM, as demonstrated by the comparison of the controls to AM + IR recipients, which showed similar histomorphology and oxidant damage levels.

The relationship between metabolic syndrome criteria and pentraxin-3 levels in children.

OBJECTIVES: While the positive correlation was shown in a few studies which investigated the relationship between obesity and pentraxin-3 (PTX-3) levels, different findings were obtained in other studies. We aimed to determine PTX-3 levels in obese and healthy children, and their relationship with Metabolic Syndrome (MetS) criteria. METHODS: 105 children and adolescents were considered as the study population. Participants were divided into three groups; obese and MetS (OM+), obese and non-MetS (OM-) and the control group. Fasting glucose, blood lipids and PTX-3 levels were measured. Ultrasonography was performed to detect hepatic steatosis. MetS and hepatic steatosis were investigated by dividing the patients into two groups according to PTX-3 levels. RESULTS: The study population consisted of 37 patients with OM+; 35 patients with OM- and 33 healthy children. OM+ patients had higher fasting insulin (p<0.001), homeostatic model assessment for insulin resistance (p<0.001), triglyceride (p<0.001) and lower high-density lipoprotein (p=0.001). The PTX-3 level was higher in the OM+ group compared to both OM- group and the control group (p=0.002). When two groups were generated according to PTX-3 level, a higher frequency of MetS was detected in the high PTX 3 group than in all three major MetS diagnostic criteria groups. Moreover, there was more hepatic steatosis in the high PTX-3 group independent from obesity and MetS. CONCLUSIONS: Higher PTX-3 levels were present in children and adolescent obese patients with MetS.

Effect of different retreatment files using different kinematics on the release of inflammatory mediators in root canal retreatment of single-rooted teeth: a randomized clinical trial.

OBJECTIVES: This randomized clinical trial aimed to evaluate the effect of two rotaries (ProTaper Universal Retreatment (PTUR)), D-Race (DR) + XP-Endo Finisher R (XPFR) and one reciprocating (Reciproc Blue (RB) retreatment techniques on the release of neuropeptides (Substance P, calcitonin gene-related peptide (CGRP)), and cytokines (IL-6 and IL-10) in periapical fluid in root canal retreatment of single-rooted teeth. MATERIALS AND METHODS: In this randomized clinical trial (ClinicalTrials.gov ID: NCT05039502), seventy-five patients scheduled for retreatment were randomly divided into 3 groups according to the file system used to remove root canal filling materials (n = 25): PTUR, RB, and DR + XPFR. After reshaping and disinfection of the root canals, periapical fluid samples were taken, and the levels of Substance P, CGRP, IL-6, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed using the Kruskal-Wallis and chi-square tests. The level of significance was set as p = 0. 05. RESULTS: All the allocated participants received the intervention and were analyzed. There was no statistically significant difference among groups in terms of gender, age, tooth localization, and the distribution of analgesic use after treatment (p values 0.799, 0.095, 0.637, 1.000, respectively). No statistically significant difference was found in terms of the levels of Substance P, CGRP, and IL-10 among groups (p > .05), except IL-6. CONCLUSIONS: PTUR, RB, and DR + XPFR files have comparable results in the expression of inflammatory mediators. CLINICAL RELEVANCE: Retreatment files powered with rotary or reciprocating motion produced similar neuropeptide and cytokine levels in patients.

Undefilled blood tube containing EDTA: Is it an inappropriate sample for HbA1c assay?

Introduction: Blood samples having inappropriate volume are a substantial part of preanalytical errors. Inadequate sample volume for glycated haemoglobin (HbA1c) test may be a common problem of patients with diabetes mellitus having vascular changes. In this study, we compared HbA1c concentrations of underfilled and appropriately filled blood collection tubes. Materials and methods: To compare HbA1c concentrations, blood samples were collected into 2 mL tubes containing K3-EDTA from 109 subjects. Two blood samples (underfilled and appropriately filled) were drawn from a patient by the same personnel and materials. HbA1c measurements were assayed on a Cobas 6000 analyser module c 501 (Roche Diagnostics, Mannheim, Germany). The HbA1c% results were compared by t-test and Wilcoxon's signed-rank statistical methods (SPSS Inc., Chicago, USA). Bias analysis was performed using Microsoft Excel 4.0. Results: Underfilled samples were classified three groups (group 1, N = 44; group 2, N = 36; and group 3, N = 29) according to the filling ratio of the samples; 0.5 mL and below (< 25%), 0.5-1.0 mL (25-50%), and 1.0-2.0 mL (> 50%), respectively. When we compared underfilled tubes with pairing filled tubes, there was a statistically significant difference only with tubes filled less than 25% (P = 0.030). Furthermore, we have done bias analysis between paired tubes according to the diagnostic cut-off value of 6.5%. The bias was more prominent in up to 50% underfilled blood tubes (1.1%), when HbA1c concentrations were below the diagnostic cut-off of 6.5%. Conclusions: We suggest that the blood tubes with EDTA for HbA1c measurement should be filled with at least 50% to avoid clinical variations.

Cyclophilin A and D Levels in Acute Coronary Syndrome and Their Relationship with Cardiovascular Risk Factors.

OBJECTIVE: Our objective was to evaluate cyclophilin levels in patients with acute coronary syndrome (ACS) and their association with the clinical characteristics of these patients. METHODS: We enrolled 150 patients with ACS (n=75 ST-elevation myocardial infarction [STEMI], n = 75 non-ST-elevation myocardial infarction [NSTEMI]). For comparison, 25 healthy volunteers were included in the study. Levels of cyclophilin A, cyclophilin D, and C-reactive protein (CRP) were measured in both the acute myocardial infarction (AMI) groups and the healthy group. We examined the effects of cardiovascular risk factors, including diabetes mellitus, hypertension, dyslipidemia, age, gender, and smoking on these parameters. RESULTS: Cyclophilin A levels were significantly lower in the STEMI group, while cyclophilin D and CRP levels were significantly higher in all AMI groups (P < 0.05). A negative correlation existed between cyclophilin A and troponin T and CK-MB (respectively r = -0.287, P < 0.001; r = -0.231, P = 0.005). However, there was no correlation between cyclophilin D and the cardiac markers. A positive correlation was observed between cyclophilin D and CRP (r = 0.219, P = 0.004). Cyclophilin A was associated with hypertension, whereas cyclophilin D was associated with the female gender and dyslipidemia (P < 0.05). CONCLUSION: Our findings suggest that a decrease in cyclophilin A indicates a more severe disease in STEMI and an increase in cyclophilin D in both STEMI and NSTEMI may be valuable markers. Therefore, further detailed studies are warranted to monitor their changes and interactions in ACS patients.

Comparison of Fibrinogen Concentrations Determined by the Clauss Method with Prothrombin-Derived Measurements on an Automated Coagulometer.

BACKGROUND: This research aims to compare fibrinogen results, obtained from the Clauss and PT-derived method on the Cobas t511 analyzer, in patients with specific categories of disease. A second aim was to determine the reference range for these 2 methods. METHODS: We retrospectively compared fibrinogen concentrations of 914 patients obtained by the Clauss and PT-derived methods on the Cobas t511 coagulation analyzer from the laboratory information system. Fibrinogen data was segregated into a healthy outpatient population and those populations with possible fibrinogen abnormalities including pregnancy, chronic illness, liver disease, heart and vascular diseases, and clinical suspicion of COVID-19. All data were analyzed using Passing-Bablok regression and Bland-Altman analysis. Reference ranges were determined from fibrinogen results of the healthy outpatient population who presented for a clinic check-up. RESULTS: All fibrinogen results were grouped and compared according to fibrinogen values (low, normal, and high), international normalized ratio (INR) values (<1.2, 1.2-2.0, and >2.0), and diagnosis. There were statistically significant positive correlations in all groups (P < 0.05), except for low fibrinogen values (P = 0.96). Results with INR value <1.2 had the highest correlation between 2 methods. CONCLUSION: The PT-derived method can be used alone in the Cobas t511 analyzer, especially in patients with an INR <1.2. Reported new reference ranges of the PT-derived method could help to determine and compare the clinical significance of fibrinogen methods. Further studies must be focused on the conditions in which PT-derived fibrinogen results should be directed to the Clauss test.

Efficacy of Annona muricata (graviola) in experimental spinal cord injury: biochemical and histopathological analysis.

BACKGROUND: Annona muricata (AM) (graviola) is a plant that grows in tropical regions and is thought to be good for many diseases by local people. Unfortunately, there is no acceptable medical treatment for spinal cord injury (SCI) yet. In our study, we investigated the neuropeotective effects of AM leaf extract on SCI in an experimental rat model. METHODS: A total of 40 Wistar albino rats were randomly divided into five equal groups (n=8). Group 1 was the control group in which only laminectomy was performed. Trauma was induced in four groups after laminectomy. Group 2 (untreated trauma group) was given no medication. In Group 3, a single intraperitoneal dose of methylprednisolone (30 mg/kg) was administered after trauma. The rats in Groups 4 received a low dose (100 mg/kg) of AM leaf extracts by oral gavage one week before trauma while the rats in Group 5 received a high-dose (300 mg/kg) of these extracts by oral gavage one week before trauma. All rats, including the control group, were sacrificed 24 h after the trauma was created. RESULTS: Tissue samples taken to evaluate the neuroprotective effect were examined biochemically and histopathologically. Inflam-matory findings in the trauma group were significantly better in both groups treated with AM. There was no difference between the groups in terms of clinical motor examination and inclined plane test results. CONCLUSION: Our histopathological and biochemical results showed that AM is an agent with neuroprotective effects in trau-matic SCI.

The change pattern in serum G protein-coupled estrogen receptor-1 (GPER1) levels during pregnancy with and without gestational diabetes mellitus.

OBJECTIVES: The purpose of this study was to evaluate serum G protein-coupled estrogen receptor-1 (GPER1) levels in non-pregnant and pregnant with and without gestational diabetes mellitus (GDM). METHODS: The study comprised 40 pregnant women with (n=20) and without GDM (n=20) and 20 healthy non-pregnant women. Data as maternal age, gestational age, and body mass index (BMI) of participants were recorded and serum samples were collected. Serum GPER1 levels were measured by enzyme-linked immunosorbent assays. RESULTS: Serum GPER1 level was significantly higher in GDM (p=0.03) and non-pregnant women (p=0.005) than those of normal pregnancy. There was no significant correlation between the serum GPER1 levels age (r=0.18, p=0.34), gestational age (r=-0.22, p=0.47), and BMI (r=0.004, p=0.975). CONCLUSIONS: Our results suggest that changes in serum GPER1 levels in pregnancy and GDM may be associated with estrogen. More detailed studies should be conducted to monitor the changes and their interactions in serum sex hormones and serum GPER1 levels during GDM.

GPER-1 and sex-hormone levels in patients with otosclerosis.

OBJECTIVE: Otosclerosis is a widespread disease but the etiopathogenesis is still not fully understood. Hormonal factors especially estrogens are accused in recent years. The study aimed to evaluate the levels of G-protein associated membrane estrogen receptor-1 (GPER-1) and sex-hormones in patients with otosclerosis. SUBJECT AND METHODS: The study included 60 people (30 otosclerosis patients, 30 control group). Serum sex-hormone (estradiol, progesterone, prolactin and total testosterone) and GPER-1 levels were measured in otosclerosis patients and compared with the normal population. For the otosclerosis group, air conduction and bone conduction thresholds and air-bone gaps were viewed from audiograms and the relationships between hearing and GPER-1 or sex-hormone levels were also investigated. RESULTS: Sex-hormone levels were not different between the groups. GPER-1 level was significantly lower in the otosclerosis group [3.1353 (0.76-8.21) ng/mL] than the control group [5.4773 (0.96-20.31) ng/mL] (p =0.017). Differential diagnosis with ROC analysis for the GPER-1 level was also significant (p=0.017). GPER-1 level was significantly lower for the females than the males in the otosclerosis group (p=0.043). Serum estradiol, progesterone, and prolactin levels were significantly higher (p=0.02, p =0.029 and p=0.019 respectively) and the GPER-1 level was significantly lower (p= 0.04) in the female patients compared to the female controls. There was no statistically significant relationship between GPER-1 or sex-hormone levels and hearing parameters. CONCLUSION: GPER-1 level was lower in the otosclerosis patients compared to healthy volunteers and also lower in females than males in the patient group. Female sex-hormone levels were higher and GPER-1 level was lower in the female patient group than the female control group. Neither GPER-1 nor sex-hormone levels were not predictive of hearing levels. These findings indicate that sex-hormones especially estrogen and GPER-1 might have a potential role in the etiopathogenesis of otosclerosis. This is the first study in the literature that investigates the GPER-1 values in otosclerosis.

Neuroprotective effects of quercetin on cerebral vasospasm following experimental subarachnoid haemorrhage in rats

Background/aim: We examined the protective effects of the natural flavonoid, quercetin, against cerebral vasospasm in an experimental rat subarachnoid haemorrhage (SAH) model. Materials and methods: Thirty-eight albino Wistar rats were divided into five groups as follows: group 1 (G1, n=8), no experimental intervention; group 2 (G2, n=8), subarachnoid physiological saline; group 3 (G3, n=8), SAH; group 4 (G4, n=7) SAH and low-dose (10 mg/kg) quercetin treatment; group 5 (G5, n=7), SAH and high-dose (50 mg/kg) quercetin treatment. Subarachnoid haemorrhage was induced by injection of 0.15 cc of autologous blood taken from the tail artery into the cisterna magna from the craniocervical junction and basilar arteries and blood samples were taken for biochemical and histopathological analyses. Results: Malondialdehyde (MDA) levels were significantly higher in G2 and G3 than in G1 (P < 0.05). Significant decreases in MDA were observed in G4 and G5 compared with G2 (P < 0.05, G4­G2; P < 0.05, G5­G2). There were no significant differences between G2 and G3 or among G1, G4, and G5. No statistically significant differences were found in total antioxidant capacity between the groups (P > 0.05). There were no significant differences in basilar artery (BA) wall thickness between G3 and G4 or between G3 and G5, but G4 and G5 showed greater luminal diameters than G3 (P < 0.05). There were no significant differences in BA thickness or luminal diameter between G4 and G5. Conclusion: Our results suggested that quercetin may be beneficial in SAH therapy by preventing vasospasm.

Folate-receptor 1 level in periodontal disease: a pilot study.

BACKGROUND: The purpose of this study was to investigate gingival crevicular fluid (GCF) and serum folate-receptor 1 (FOLR1) levels in subjects with different periodontal status. METHODS: The study consists of three groups: Healthy group (n = 15), gingivitis group (n = 15) and chronic periodontitis group (n = 15). Clinical periodontal parameters including probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI) and bleeding on probing (BOP) were assessed. GCF and serum samples were collected from each patient and were analyzed FOLR1 levels by enzyme-linked immunosorbent assay. RESULTS: The values of FOLR1 in GCF were higher in gingivitis and periodontitis groups than among patient in control group (p < 0.016). Serum FOLR1 levels showed no significant difference between the groups. A significant correlation was observed between FOLR1 levels of GCF and BOP (p < 0.05). CONCLUSIONS: Our preliminary data suggest that FOLR1 is not useful in monitoring the periodontal disease. Further studies are necessary to clarify the role, regulation and function of folate and it's receptors in the pathogenesis of periodontal disease.

Flavonoids protect colon against radiation induced colitis.

Radiation induced colitis is one the most common clinical issue for patients receiving radiotherapy. For this reason, we aimed to investigate the effect of antioxidant-effective flavonoids hesperidin and quercetin on the intestinal damage induced by radiation in this study. TNF-alpha, interleukin-10 (IL-10), heat shock protein 70 (HSP 70) and caspase 3, 8, 9 markers of apoptotic pathways were measured in the colon tissues of irradiated acute intestinal damage by enzyme-linked immunosorbent assay (ELISA). Irradiation of rats caused a significance increase of TNF-alpha, caspase 3/8/9 and decrease of IL-10 concentrations. Hesperidin and quercetin treatment resulted in decreased levels of TNF-alpha and increased levels of IL-10. Quercetin significantly decreased caspase 3/8/9 levels. Hesperidin produced a decreased of caspase 3/8/9 levels compared with irradiation group but this was statistically not significant. Only significant alteration of HSP 70 were seen in hesperidin treated rats. Further studies are needed to elucidate the mechanism by which flavonoids induced signaling provides protection against apoptosis and inflammation.

Sclerostin and bone metabolism markers in hyperthyroidism before treatment and interrelations between them.

Sclerostin, which is a glycoprotein produced by osteocytes, reduces the formation of bones by inhibiting the Wnt signal pathway. Thyroid hormones are related with Wnt signal pathway and it has been reported that increased thyroid hormones in hyperthyroidism fasten epiphysis maturation in childhood, and increase the risk of bone fractures by stimulating the bone loss in adults. The aim of this study was to examine the sclerostin serum levels, the relation between sclerostin and thyroid hormones as well as the biochemical markers of the bone metabolism in patients with hyperthyroidism (including multinodular goiter and Graves' disease), whose treatments have not started yet. No difference was found in the serum sclerostin levels between the hyperthyroidism group (n=24) and the control group (n=24) (p=0.452). The serum osteocalcin levels and 24-hour urinary phosphorus excretion were found to be higher in the hyperthyroid group than in the control group (p<0.001, p=0.009). A positive correlation was determined between the sclerostin and bone alkaline phosphatase levels (p<0.001); a negative correlation between the osteocalcin and thyroid stimulating hormone (TSH) (p<0.05); a positive correlation between the osteocalcin and thyroid hormones (FT3,FT4) (p<0.001); and a positive correlation between the deoxypyridinoline and hydroxyproline (p<0.001). No correlation was determined between sclerostin and TSH,FT3,FT4 (p>0.05). Therefore, we consider that a long-term study that covers the pre-post treatment stages of hyperthyroidism, including both the destruction and construction of the skeleton would be more enlightening. Moreover, the assessment of the synthesis of sclerostin in the bone tissue and in the serum level might show differences.

Evaluation of Serum Fetuin-A and Osteoprotegerin Levels in Patients with Psoriasis.

Psoriasis patients are determined to have a high ratio of coronary artery calcification. Fetuin-A and osteoprotegerin are systemic calcification inhibitors and related to vascular calcification and cardiovascular mortality. In this study we investigated the relationship between fetuin-A and osteoprotegerin levels in psoriasis patients. The study included 40 healthy volunteers and 40 psoriasis patients. Venous blood were collected from healthy volunteers and psoriasis patients in order to search the fetuin-A and osteoprotegerin levels. Disease severity were grouped as mild, moderate and severe according to psoriasis area and severity index (PASI). The relationship between fetuin-A and osteoprotegerin levels and clinical features as sex, PASI and presence of psoriatic arthritis were analyzed. Fetuin-A levels in psoriasis patients were statistically lower than the control group (p < 0.001). In serum osteoprotegerin levels, no statistically significant difference was found in two groups (p > 0.05). Serum fetuin-A and osteoprotegerin level differences were not statistically significant between patients with psoriatic arthritis history and those without. When we grouped patients in respect of their sexes fetuin-A and osteoprotegerin levels of males and females were not significantly different (p > 0.05). No correlation was detected between the ages and PASI scores and the fetuin-A and osteoprotegerin levels of patients. As a result fetuin-A levels in psoriasis patients are found to be low but not related to disease severity. In the light of our results we concluded that fetuin-A may have a role in psoriasis pathogenesis and may contribute to the calcification process developed in psoriasis.

Effect of Non-Surgical Periodontal Treatment on Gingival Crevicular Fluid and Serum Endocan, Vascular Endothelial Growth Factor-A, and Tumor Necrosis Factor-Alpha Levels.

BACKGROUND: Periodontitis is a chronic inflammatory disease that occurs due to the interaction between pathogenic microorganisms and host defenses. Endocan is a proteoglycan secreted by endothelial cells under the control of inflammatory cytokines. Aims of the study are to determine serum and gingival crevicular fluid (GCF) endocan levels in the pathogenesis of periodontal diseases, supported with vascular endothelial growth factor (VEGF-A) and tumor necrosis factor (TNF)-alpha levels. This study additionally aims to evaluate correlation between GCF endocan levels, VEGF-A, and TNF-α levels with periodontal probing depth (PD). METHODS: The study consists of two groups: group 1 (n = 20), healthy individuals; group 2 (n = 20), individuals with generalized chronic periodontitis (CP). Clinical measurements were recorded; GCF and serum samples were obtained from each participant before and 6 weeks after therapy. Levels of biomarkers were measured by enzyme-linked immunosorbent assay. Intergroup comparisons of biochemical and clinical parameters were analyzed by Kruskal-Wallis/Bonferroni-adjusted Mann-Whitney U test using statistical software. RESULTS: Serum and GCF endocan, VEGF-A, and TNF-α levels were significantly higher in patients with CP than in healthy individuals (P <0.001) and decreased after treatment (P <0.03). A significant correlation was observed between GCF TNF-α and PD (4 mm ≤ PD ≤5 mm and PD ≥6 mm). A significant relationship was found among GCF endocan and TNF-α, VEGF-A, CAL, and GI for all groups (P <0.05). CONCLUSIONS: Endocan and TNF-α levels, both in GCF and serum, increased from health to periodontitis and decreased with non-surgical periodontal treatment. Within the limits of the study, endocan may be considered as a potential inflammatory marker for periodontal disease.

Visfatin levels in gingival crevicular fluid and serum before and after non-surgical treatment for periodontal diseases.

The purpose of this study was to evaluate visfatin levels at different stages of periodontal disease and in healthy tissues. In addition, the effect of non-surgical periodontal therapy on visfatin levels in gingival crevicular fluid and serum was investigated. Forty-five patients were divided into three groups based on clinical and radiographical findings. Group 1 comprised periodontally healthy individuals (n = 15); group 2 comprised patients with gingivitis (n = 15); and group 3 was composed of patients with generalized chronic periodontitis (n = 15). Gingival crevicular fluid and serum samples were collected before treatment and at 1, 3, and 6 months after treatment. Visfatin levels were measured by enzyme-linked immunosorbent assays. Gingival crevicular fluid and serum visfatin levels were higher in patients with chronic periodontitis than those with gingivitis or healthy controls (P < 0.016). In addition, visfatin levels were higher in the gingivitis group than in healthy controls (P < 0.016). Non-surgical periodontal treatment resulted in a significant reduction in gingival crevicular fluid and serum visfatin levels. Furthermore, visfatin levels increased with inflammation and decreased following periodontal treatment. Our findings suggest that visfatin is an inflammatory biomarker of periodontal disease.(J Oral Sci 58, 491-499, 2016).

Effect of continuous positive airway pressure (CPAP) therapy on IL-23 in patients with obstructive sleep apnea.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated episodes of apnea and hypopnea during sleep. Continuous positive airway pressure (CPAP) is the most effective method for treating OSAS and alleviating the patients' symptoms. The aim of this study was to assess the effect of 3-month CPAP therapy on serum levels of IL-23 in patients with OSAS. Twenty-three patients with newly diagnosed moderate-to-severe OSAS who had not yet started nasal CPAP treatment were prospectively enrolled. All of the subjects underwent simple spirometry and an overnight sleep study. Twenty-seven healthy individuals without OSAS were also recruited as the control group. Serum IL-23 and C-reactive protein (CRP) levels were measured before and after 3 months of CPAP therapy. There was no significant difference between moderate and severe OSAS patients in IL-23 and CRP, but both parameters were significantly higher than control group. The CPAP treatment produced a significant decrease in the levels of the inflammatory mediators CRP and IL-23 in patients. Changes in IL-23 were positively correlated with changes in AHI and in CRP. In conclusion, based on these results, serum IL-23 levels reflect OSAS-related systemic inflammation and are a useful marker for improvement in OSAS following CPAP therapy.

The effects of tadalafil and pentoxifylline on apoptosis and nitric oxide synthase in liver ischemia/reperfusion injury.

The aim of this study was to investigate the effects of tadalafil (TDF) and pentoxifylline (PTX) on hepatic apoptosis and the expressions of endothelial and inducible nitric oxide synthases (eNOS and iNOS) after liver ischemia/reperfusion (IR). Forty Wistar albino rats were randomly divided into five groups (n=8) as follows: sham group; IR group with ischemia/reperfusion alone; low-dose and high-dose TDF groups received 2.5 mg/kg and 10 mg/kg TDF, respectively; and PTX group received 40 mg/kg PTX. Blood was collected for the analysis of serum alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, malondialdehyde (MDA), and total antioxidant capacity (TAC). MDA and TAC also were measured in liver tissue. Histopathological examination was performed to assess the severity of hepatic injury. Apoptosis was evaluated using the apoptosis protease-activating factor 1 (APAF-1) antibody; the expressions of eNOS and iNOS were also assessed by immunohistochemistry in all groups. Serum alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, MDA, and TAC, tissue MDA and TAC levels, hepatic injury, and score for extent and for intensity of eNOS, iNOS, and apoptosis protease-activating factor 1 were significantly different in TDF and PTX groups compared to the IR group. High dose-TDF and PTX have the best protective effect on IR-induced liver tissue damage. This study showed that TDF and PTX supplementation may be helpful in preventing free oxygen radical damage, lipid peroxidation, hepatocyte necrosis, and apoptosis in liver IR injury and minimizing liver damage.