TCF7L2 (rs7903146) But Not CDKAL1 (rs7754840) Gene Polymorphisms Increase the Risk of New-Onset Diabetes After Kidney Transplant.

OBJECTIVES: Incidence of new-onset diabetes after transplant negatively affects graft and patient survival. Obesity, impaired fasting glucose before transplant, and a history of diabetes in first-degree relatives are well-defined risk factors. TCF7L2 and CDKAL1 gene polymorphisms have been implicated in the pathogenesis. We investigated the effect of single gene polymorp-hisms of TCF7L2 (rs7903146) and CDKAL1 (rs7754840) on new-onset diabetes in renal transplant recipients. MATERIALS AND METHODS: We evaluated 239 renal transplant recipients. TCF7L2 and CDKAL1 gene polymorphisms were assessed by polymerase chain reaction. RESULTS: Mean patient age was 43 ± 13 years. There were 148 male patients (61.9%), and 91 were female (38.1%). New-onset diabetes was detected in 55 patients (23%). In 20 cases (36%), the glycemic disorder was transient; 61% of patients required insulin therapy. In terms of CDKAL1, 108 patients had the wild-type allele, 112 had a single-allele mutation, and 19 had a 2-allele mutation (45.2%, 46.9%, and 7.9%, respectively). In terms of TCF7L2, 163 of the patients had the wild-type allele, 49 had a single-allele mutation, and 27 had a 2-allele mutation (68%, 20%, and 11%, respectively). New-onset diabetes-related factors were age at transplant, body mass index after transplant (calculated as weight in kilograms divided by height in meters squared), tacrolimus, mycophenolate, and TCF7L2 polymorphism but not CDKAL1 polymorphism. After multiple regression analysis, the effect of TCF7L2 polymorphism persisted. A single allelic change resulted in a risk factor 1.4 times higher for new-onset diabetes after transplant (P = .043; 95% CI, 1.142-1.874) and a double allelic change was 2.7 times higher (P < .01; 95% CI, 1.310-4.073) Conclusions: TCF7L2 (rs7903146) gene polymorphism is an independent risk factor for new-onset diabetes in Turkish renal transplant patients. This study is the first in Turkey to show the distribution and effect of these genes in kidney transplant patients.

Comparison of the clinical and radiological outcomes of arthroscopic transosseous and transosseous-equivalent double-row rotator cuff repair techniques.

OBJECTIVE: This study compared the clinical and radiological results of the arthroscopic transosseous (ATO) and transosseous-equivalent (TOE) double-row rotator cuff repair techniques. METHODS: Prospective data collected from patients treated with ATO (32 women and 7 men, mean age: 57.03±6.39 years) and TOE (36 women and 8 men; mean age: 57.86±7.81 years) techniques were retrospectively evaluated. The visual analog scale score, Constant score, and Oxford shoulder score were used to assess the clinical results. Anchor pullout on standard anteroposterior shoulder radiographs and rotator cuff re-tear on magnetic resonance images were examined at the final follow-up to evaluate the radiological results. Rotator cuff re-tears were graded as per the classification system described by Sugaya et al. Results: The mean follow-up duration was 33.3±11.8 months. No difference was observed in the demographic data of the two groups. Significant improvement was observed in the postoperative shoulder scores of the groups; however, no difference was observed between the groups. Re-tear was detected in 10 patients of the TOE group and 9 patients of the ATO group. Age, tear size, and retraction level could cause re-tear. CONCLUSION: In the treatment of rotator cuff tears, the ATO and TOE techniques may achieve considerable improvements in shoulder functions in the short term. LEVEL OF EVIDENCE: Level III, Therapeutic study.

[Data on prevalence of obesity and waist circumference in Turkey: Systematic review, meta-analysis and meta regression of epidemiological studies on cardiovascular risk factors]. / Türkiye'de obezite sikligi ve bel çevresi verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalismalarin sistematik derleme, meta-analiz ve meta-regresyonu.

OBJECTIVE: Obesity is the most important epidemic of the 21st century and its incidence is increasing steadily in Turkey. The aim of this study was to assess the current status and temporal change in the prevalence of obesity in Turkey with a systematic review and metaanalysis of epidemiological studies conducted in the last 15 years. METHODS: Ovid Medline, the Web of Science Core Collection and the Turkish Academic Network and Information Center (ULAKBIM) databases, as well as the web pages of the Turkish Ministry of Health, the Turkish Statistical Institute, and cardiology, nephrology and endocrinology associations were searched for epidemiological studies conducted within Turkey the last 15 years. Research focusing on local data was excluded. Studies included in the analysis were assessed with a special bias score and categorized as having low or high risk of bias. Body mass index (BMI), waist circumference, obesity and prevalence of abdominal obesity were calculated as crude values. Meta-regression analysis was performed to assess heterogeneity and change over time. RESULTS: The agreement between the two investigators on the selection and bias scoring of the studies was excellent (kappa=0.95), but the heterogeneity between the studies was high. BMI (10 studies, n=93.554) was calculated as 28.2 kg/m2 for women and 26.5 kg/m2 for men. The prevalence of obesity (12 trials, n=106.553) was 33.2% in females and 18.2% in males. In 6 studies (n=66.591) that included a measurement of waist circumference, the values were 89.72 cm in women and 93.57 cm in men. Especially in women, the prevalence of abdominal obesity (5 studies, n=62331) was greater than that of general obesity (50.8% in women vs 20.8% in men). Meta-regression analysis revealed that the variance of the obesity prevalence between the studies could partly be explained by the age differences, but there was no temporal change in the prevalence of obesity during the years the studies were conducted. CONCLUSION: The prevalence of obesity, especially abdominal obesity, is considerably high in Turkish women and increases with advancing age. This finding points out that nationwide action plans against obesity, especially for women, should be designed and implemented by health policy makers.

Increased acylation stimulating protein levels in young obese males is correlated with systemic markers of oxidative stress.

OBJECTIVE: As little is known about relationship between acylation stimulating protein (ASP) and oxidative stress, whether there is any link between ASP and oxidative stress in young obese males were investigated. DESIGN AND METHODS: Forty-five obese (median body mass index (BMI) = 36.99 (IQR = 3.65) kg m(-2)) male subjects (median age = 22 (IQR = 6) years) and 24 age-matched (median age = 22.5 (IQR = 4.8) years) healthy male volunteers (median body mass index (BMI) = 23.67 (IQR = 2.45) kg m(-2)) were recruited into the study. All obese subjects have BMI > 30 kg m(-2), while all controls have BMI < 25 kg m(-2). RESULTS: Fasting plasma ASP, lipid hydroperoxide, high sensitivity C-reactive protein (hs-CRP), fasting insulin, triglyceride, LDL-cholesterol levels and HOMA-IR were higher, whereas the mean HDL-cholesterol levels and glutathione peroxidase (GPx) enzyme activity were significantly lower in obese subjects than controls. The linear regression analysis showed that lipid hydroperoxide was independently associated with only BMI, while ASP was independently associated with BMI and triglyceride. CONCLUSIONS: The present data support the concept that obesity occurs under condition of compex interactions by adipokines, insulin, inflammation, and oxidative stress.

Are increased carotid artery pulsatility and resistance indexes early signs of vascular abnormalities in young obese males?

PURPOSE: To provide insight into the factors by which obesity in itself may directly lead to early arterial damage, we aimed to determine early sonographic markers of obesity-related vascular dysfunction in young obese males. METHODS: Thirty-five young obese males and 23 age-matched healthy male volunteers were recruited into the study. Common carotid artery pulsatility index and resistance index were calculated from blood flow velocities curves obtained by pulsed Doppler ultrasonography. RESULTS: The mean pulsatility index, resistance index, body mass index, waist circumference, systolic and diastolic blood pressure, homeostasis model assessment for insulin resistance, plasma fasting glucose, insulin, C-peptide, triglycerides, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein were statistically higher in obese subjects than in healthy controls. CONCLUSIONS: Our results suggest that depressed vessel compliance and increased vascular resistance are features of young, obese, normotensive subjects independently of and in addition to cardiovascular risk factors. As changes in arterial wall properties may be incipient in young obese subjects, future studies will be required to demonstrate whether early intervention such as diet and exercise in this population can improve vascular functions.

Frequency of inherited variants in the MEFV gene in myelodysplastic syndrome and acute myeloid leukemia.

We investigated the frequency of inherited variants in the MEFV gene, which is mutated in familial Mediterranean fever (FMF), in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Eight MEFV gene variants (M694I, M694V, M680I (G/C-A), V726A, R761H, E148Q and P369S) were analyzed in 33 MDS patients, 47 AML patients and 65 healthy controls; none had a history or family history compatible with FMF. We identified two homozygous (E148Q/E148Q), one compound heterozygous (M694V/E148Q) and five heterozygous inherited variants in the MEFV gene in AML patients. We also identified nine heterozygous variants in MDS patients, while we found 11 heterozygous variants in controls. The mean overall frequency of inherited variants in the MEFV gene rate was higher in MDS (χ² = 4.241; P = 0.039) and AML (χ² = 3.870; P = 0.043) patients than in healthy controls. In conclusion, this study reports high frequency of inherited variants in the MEFV gene in patients with MDS and AML. However, the hypothesis that MEFV is a cancer susceptibility gene at this point remains speculative. Additional evidence from future studies is needed to allow a more thorough evaluation of this hypothesis.

Increased iron and oxidative stress are separately related to cognitive decline in elderly.

AIM: The aim of this study is to examine the relation between body iron, oxidative stress and cognitive function in elderly. METHODS: Eighty-seven elderly residents from nursing homes were the subjects of our study. Cognitive status was screened by the Mini-Mental State Examination (MMSE). Of the 87 eligible subjects, 46 patients who obtained 24 or fewer points on the MMSE scale were considered as subjects with cognitive dysfunction. The control group consisted of 41 subjects who obtained more than 24 points on the MMSE. Routine biochemical analyses, parameters of iron metabolism, malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) were determined in all subjects. RESULTS: There were statistically significant increases in serum iron, transferrin saturation, ferritin and MDA levels; whereas there was a statistically significant decrease in serum GSH-Px enzyme activity and serum sodium levels in subjects with cognitive dysfunction. A significant negative correlation was found between serum iron, transferrin saturation, ferritin and MMSE score. There was a negative correlation between MMSE score and serum MDA; however, a positive significant correlation was found between MMSE score and both GSH-Px enzyme activity and serum sodium. CONCLUSION: Our study provides evidence of increased markers of iron deposition and oxidative stress in patients with cognitive dysfunction. It seems likely that these markers negatively affect the MMSE score. Interestingly, we did not find any correlation between the markers of iron deposition and oxidative stress. Future studies will be required to demonstrate whether diminishing iron and oxidative stress will enhance MMSE score and thereby ameliorate cognitive impairment.

High Frequency of Inherited Variants in the MEFV Gene in Acute Lymphocytic Leukemia.

In the present study, we aimed to determine the frequency of inherited variants in the MEFV (Mediterranean FeVer), the gene responsible for familial Mediterranean fever (FMF), gene in patients with acute lymphocytic leukemia (ALL). The eight MEFV gene variants (M694I, M694V, M680I (G/C-A), V726A, R761H, E148Q and P369S) were detected in 36 patients with ALL and 65 healthy controls; none had own and/or family history compatible with FMF. We identified 11 heterozygous inherited variants in the MEFV gene in both ALL patients and controls. The mean overall frequency of inherited variants in the MEFV gene rate was higher in ALL patients than healthy controls (P = 0.040). It is interesting to note that M680I/0 is predominant variant in patients with ALL. In addition, E148Q variant frequency was also significantly higher in the patient group than the controls (P = 0.012). In conclusion, overall frequency of inherited variants in the MEFV gene was found to be higher in patients with ALL. Based on the present data, it is difficult to reach a definitive conclusion regarding the possibility that inherited variants in the MEFV gene could represent a causative role in ALL. However, the data of our study may provide some new insights in understanding of individual genetic differences in susceptibility to these neoplasms. Further investigations are needed to determine the actual role of inherited variants in the MEFV gene in pathogenesis of ALL.

High frequency of MEFV gene mutations in patients with myeloid neoplasm.

We aimed to investigate the rate of MEFV, the gene mutated in familial Mediterranean fever, mutations in patients with myeloid neoplasm and to determine if known mutations of MEFV cause a tendency for myeloid neoplasms. The frequency of the five most common MEFV gene mutations (M694V, M680I, V726A, E148Q and M694I) was determined in 26 patients with myeloid neoplasm. We identified 1 homozygous (E148Q/E148Q), 1 compound heterozygous (M694V/E148Q) and 5 heterozygous MEFV gene mutations; none had their own and/or family history compatible with familial Mediterranean fever. The mean overall mutation rate was 0.269. We found a high frequency of carriers in patients with myelodysplastic syndrome (66.6%), polycythemia vera (33.3%) and acute myeloid leukemia (28.6%). However, there was no MEFV gene mutation in patients with chronic myeloid leukemia. In conclusion, this study reports for the first time a possibly high prevalence of MEFV gene mutations in patients with myeloid neoplasm, especially myelodysplastic syndrome, polycythemia vera and acute myeloid leukemia. Our findings could open new perspectives for MEFV gene mutations in myeloid neoplasms and its association with tumor promotion. Further research is needed to determine the actual role of MEFV gene mutations in these malignancies.

Relationship between anaemia and cognitive functions in elderly people.

BACKGROUND: The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people. METHODS: This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folstein's Mini-Mental State Examination (MMSE). RESULTS: The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring. CONCLUSION: In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.

Quality of sleep in Turkish family caregivers of cancer patients.

The aim of this research was to determine the quality of sleep, reasons for sleep disturbances, and nonpharmacological strategies versus sleep disturbances of cancer patients' family caregivers. A descriptive, cross-sectional study design was used. Ninety family caregivers were included. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), demographic data form, and open-ended questions about reasons for sleep disturbances and nonpharmacological strategies used by family caregivers. Descriptive statistics, Kruskal-Wallis variance analysis, and Bonferoni-corrected Mann-Whitney U test were performed using SPSS program. The PSQI score of 72.22% of the caregivers was above 5, which indicated poor sleep quality. The most commonly determined reasons for sleep disturbances were "emotional distress because of the patient's illness" (83.33%), "financial problems" (36.66%), and "inadequate support system" (34.44%); 76.92% of caregivers used at least 1 nonpharmacological strategy, which included mostly "lifestyle practices" (54.28%) and "behavioral practices" (25.71%). The total PSQI scores of caregivers having an illness were significantly higher than those of caregivers having no illness (Z = 3.230; P = .001). Total PSQI scores did not differ by sex, age, education, marital status, or duration of caregiving (P > .05). This study implies that caregivers are in need of support by healthcare professionals to provide a positive environment during the care process.

The value of calcaneal bone mass measurement using a dual X-ray laser Calscan device in risk screening for osteoporosis.

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score < or = -2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r= -0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r= -0.229, p=0.001), breast feeding time (r= -0.064, p=0.001), and age at menarche (r= -0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.33, p=0.001) at the femoral neck were statistically significant. CONCLUSION: Bone mineral density measurements in the calcaneus using a dual energy X-ray laser are valuable for screening Turkish women over 40 years of age for the risk of osteoporosis.

Does harvesting of radial artery in the early postoperative period perturb the palmar blood supply and functions?

OBJECTIVE: The aim of this prospective study was to assess whether the removal of the radial artery (RA) caused any alteration in the function or power of hand on postoperative 15th day. METHODS: The study group included 25 patients with objective or subjective complaints on postoperative 15th day regarding harvest site following coronary bypass surgery by using RA. Patients were examined for bilateral forearm function (soft touch and pin-prick neural sensation, handgrip power). The ulnar artery and palmar arcus Doppler measurements such as peak systolic and end-diastolic velocity, and radius of the arteries have been measured both at rest and following handgrip test. The operated arm was evaluated and compared with the opposite arm. Wilcoxon test was used to compare continuous variables. RESULTS: Among 18 patients complained a loss of sense in the RA excised arm, the sensory defects were documented in 5. Among 7 patients presented with a feel of strength loss, handgrip power revealed a nonsignificant decrease of strength in the harvested arm. After squeezing test, ipsilateral ulnar artery peak systolic velocity increased from 86+/- 15 to 105+/- 15 cm/sec (<0.001), end-diastolic flow velocity from 28+/- 5 to 36+/- 8 cm/sec (<0.001) without any change in the ulnar artery radius. In contrast, no significant change in the flow velocity and the diameter of palmar arcus was noted before and after squeezing test. The comparison of the ulnar artery radius and blood flow velocity parameters in the RA excised arm to those of contralateral one after exercise test demonstrated no difference. CONCLUSIONS: With an assumption of appropriate selection, removal of RA does not change the forearm blood supply and functions with little sensory disturbances in the early postoperative period.

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13 percent of the subjects had osteoporosis, while another 56 percent had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r=-0.229, p=0.001), breast feeding time (r=-0.064, p=0.001), and age at menarche (r=-0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- ...

Increased asymmetric dimethylarginine levels in young men with familial Mediterranean fever (FMF): is it early evidence of interaction between inflammation and endothelial dysfunction in FMF?

OBJECTIVE: Unlike in many other chronic inflammatory rheumatic diseases, studies investigating endothelial dysfunction and atherosclerosis in familial Mediterranean fever (FMF) are limited, and the results are controversial. Asymmetric dimethylarginine (ADMA) is considered an indicator for endothelial dysfunction and a sensitive marker for cardiovascular risk. There have been no reports on serum ADMA levels in patients with FMF. METHODS: We aimed (1) to determine serum ADMA concentrations in 38 young male patients with FMF and 23 age- and body mass index-matched healthy volunteers; (2) to evaluate its correlations with MEFV mutations, C-reactive protein (CRP) levels, and lipid profile; and (3) to compare effects of colchicine on circulating ADMA concentrations. RESULTS: In patients with FMF, ADMA and CRP levels were higher than in healthy controls. The mean levels of ADMA and CRP were higher during acute attacks than in attack-free periods. Patients taking colchicine had lower serum ADMA levels than non-colchicine users. There was a positive strong correlation between ADMA and CRP in patients with FMF. Stepwise linear regression analysis in patients with FMF revealed that age and CRP levels were independently associated with serum ADMA levels. CONCLUSION: Our data imply that higher serum ADMA levels in FMF may indicate inflammation-related "endothelial dysfunction." It seems likely that regular use of colchicine is effective in preventing the development of and reversing not only amyloidosis but also endothelial dysfunction in patients with FMF.

Prophylactic intramedullary nailing in monostotic fibrous dysplasia.

Fibrous dysplasia of bone is an enigma with no known cure. Treatment currently consists of curettage and bone-grafting in an attempt to eradicate the lesion and to prevent progressive deformity. This study presents the results of prophylactic intramedullary nailing in 10 patients with monostotic fibrous dysplasia, pain increasing with movement, and scintigraphically established activity. Ten patients with monostotic fibrous dysplasia in their upper or lower extremities treated between 2001 and 2003 were included in the study. Seven patients were male and 3 were female; their mean age was 26.9 years. The mean duration of follow-up was 33.5 months. Closed intramedullary nail without reaming was used in all cases. Bone grafting was not performed. Patients were allowed full weight bearing on the affected extremities on the second postoperative day. Mean VAS for functional pain was 5.33 +/- 0.65 preoperatively and 2.26 +/- 0.57 at final follow-up (p < 0.05). Radiographs showed no changes in lesion size, and the intramedullary fixation appeared to be stable. Prophylactic intramedullary nailing appeared to be beneficial in monostotic fibrous dysplasia with scintigraphically proven activity and functional pain. It also avoids problems that may occur following pathological fracture.

Harvesting of the radial artery: subfasciotomy or full skeletonization: a comparative study.

BACKGROUND: Long fasciotomy of the posterior aspect of the radial artery (RA) for the purpose of sympathectomy is one of the surgical techniques for the preparation of this graft. We compared the early results of this technique with those of the RA graft harvested as a pedicle in the conventional fashion. METHODS: The study patients have been selected from the patients who underwent coronary artery bypass grafting (CABG) using the RA graft harvested either with a long posterior fasciotomy (group 1) or as a whole with a pedicle in the classical manner (group 2). Only the patients with a flow study have been included. The flow index was described as the bleeding amount of the RA in a minute per body surface area (mL/m2 min). The flow index has been performed before and after fasciotomy in group 1, and after full skeletonization in group 2. The clinical and demographic parameters and flow indices were measured and compared between the groups, and in group 1, before and after fasciotomy. RESULTS: From 218 patients with CABG using the RA between January 1998 and August 2005, a total of 57 patients were recruited into the study. Group 1 consisted of 25 patients. Thirty-two patients constituted group 2. Subfascial dissection of the RA increased the blood flow index from 48 +/- 20 mL/m2 min to 51 +/- 19 mL/m2 min (p < 0.001). The comparison of the clinical, perioperative characteristics of the patients was not different between the groups. CONCLUSIONS: The necessity of total skeletonization of the RA should not be the only option when the aim is to reduce the spasm. While subfascial dissection (sympathectomy) of the pediculed RA alone provides a satisfactory increase in the blood flow index, it also reduces the manipulation time as well as the risk of injury to the graft.

Morphometric analysis of metacarpophalangeal and proximal interphalangeal palmar plates.

Palmar plates are being used as a source of graft in radial or ulnar collateral ligament reconstruction, pulley reconstruction, and volar plate arthroplasty. The purpose of this study is to determine morphometric and major histological differences of palmar plates in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints among fingers, and supply sufficient data which would be useful in reconstruction procedures. Ninety-six MCP and 96 PIP palmar plates of 12 well-preserved formalin-fixed cadavers were measured focusing on their length, width, central thickness, and lateral thickness and statistically analyzed using ANOVA. Randomized three male and three female cadavers' specimens were examined histologically after staining with Masson's trichrome. For central thickness of the PIP joint level, there was significant difference among fingers, caused by the middle and little fingers. For lateral thickness of the PIP joint level, there was significant difference which was originated from little fingers. MCP palmar plates were significantly thicker than PIP joint levels for most of the fingers. There were thicker and denser collagen bands in MCP than PIP palmar plates. The relation of size-related parameters was not close with the thickness parameters. The predicted sizes and thicknesses of palmar plates vary according to fingers. The data collected for each finger in this study should be used as a guide in reconstructive procedures that use palmar plates as source of graft.

Paraoxonase/arylesterase ratio, PON1 192Q/R polymorphism and PON1 status are associated with increased risk of ischemic stroke.

OBJECTIVES: In recent years, importance of enzyme activity measurements, in addition to genotyping, in epidemiological studies relating paraoxonase 1 (PON1) and vascular disease was emphasized. This is the first report evaluating paraoxonase and arylesterase activities as risk factors for ischemic stroke. In addition, PON1 192Gln(Q)/Arg(R) and 55Leu(L)/Met(M) polymorphisms were also analyzed. DESIGN AND METHODS: The study population was comprised of 108 ischemic stroke patients and 78 controls. Enzyme activities were determined by spectrophotometric assays and for genotyping, standard PCR protocols followed by restriction enzyme digestions were used. RESULTS: The prevalence of the PON1 192RR genotype was increased among stroke patients (16.7%) as compared to controls (9.0%, P=0.129). Paraoxonase and arylesterase activities and PON1 activity ratio (paraoxonase/arylesterase) were found to be lower in patients than in controls. Logistic regression analysis revealed PON1 activity ratio (odds ratio, OR=0.697, 95% CI, 0.541 to 0.898, P=0.005), PON1 192RR genotype (OR=3.434, 95% CI, 1.159 to 10.178, P=0.026) and PON1 status (PON1 activity ratio combined with PON1 192RR genotype; OR=1.406, 95% CI, 1.038 to 1.905, P=0.028) as significant predictors of stroke. CONCLUSIONS: This study identified PON1 activity ratio, PON1 192RR genotype and PON1 status as important risk factors for ischemic stroke.

Metformin decreases circulating acylation-stimulating protein levels in polycystic ovary syndrome.

AIM: There are no studies that examine the circulating acylation-stimulating protein (ASP) levels in patients with polycystic ovary syndrome (PCOS). The present study was designed to determine the ASP levels in PCOS and to evaluate the effect of metformin on plasma fasting ASP concentrations. METHODS: Twenty women with PCOS and 20 healthy controls matched for age and body mass index (BMI) were included in the study. We determined ASP and other biochemical parameters before and after treatment. RESULTS: Baseline levels of plasma ASP, complement 3 (C3), waist-to-hip ratio (WHR), homeostasis model assessment-insulin resistance index (HOMA-IR), fasting insulin, triglycerides (TG) and very-low-density lipoprotein cholesterol (VLDL-C) were significantly higher in patients than in controls. After 3 months of metformin treatment, BMI, WHR, ASP, C3, fasting glucose, fasting insulin, HOMA-IR, total cholesterol, TG, VLDL-C and free testosterone decreased significantly, whereas apolipoprotein A-I and high-density lipoprotein cholesterol increased significantly. CONCLUSIONS: The major novel information of the present study is that ASP and C3 values are markedly increased in non-obese patients with PCOS, with a decrease evidenced with metformin treatment.