Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Evaluation of multidrug resistance-1 gene C>T polymorphism frequency in patients with asthma.

OBJECTIVES: Asthma is a chronic inflammatory lung disease characterized by bronchial hyperresponsiveness and airflow obstruction. Genetic and oxidative stress factors, in addition to pulmonary and systemic inflammatory processes, play a pivotal role in the pathogenesis of asthma. The products of the multidrug resistance-1 gene protect lung tissue from oxidative stress. Here, we aimed to evaluate the association between the multidrug resistance-1 gene C>T polymorphism and asthma with regard to oxidative stress-related parameters of asthmatic patients. METHODS: Forty-five patients with asthma and 27 healthy age-matched controls were included in this study. Blood samples were collected in tubes with ethylenediaminetetraacetic acid. DNA was extracted from the blood samples. The multidrug resistance-1 gene polymorphism was detected by polymerase chain reaction and a subsequent enzyme digestion technique. The serum levels of total oxidant status and total antioxidant status were determined by the colorimetric measurement method. RESULTS: The heterozygous polymorphic genotype was the most frequent in both groups. A significant difference in the multidrug resistance-1 genotype frequencies between groups indicated an association of asthma with the TT genotype. A significant difference between groups was found for wild type homozygous participants and carriers of polymorphic allele participants. The frequency of the T allele was significantly higher in asthmatic patients. The increase in the oxidative stress index parameter was significant in the asthma group compared with the control group. CONCLUSIONS: The multidrug resistance-1 gene C/T polymorphism may be an underlying genetic risk factor for the development of asthma via oxidant-antioxidant imbalance, leading to increased oxidative stress.

Evaluation of multidrug resistance-1 gene C>T polymorphism frequency in patients with asthma

OBJECTIVES:Asthma is a chronic inflammatory lung disease characterized by bronchial hyperresponsiveness and airflow obstruction. Genetic and oxidative stress factors, in addition to pulmonary and systemic inflammatory processes, play a pivotal role in the pathogenesis of asthma. The products of the multidrug resistance-1 gene protect lung tissue from oxidative stress. Here, we aimed to evaluate the association between the multidrug resistance-1 gene C>T polymorphism and asthma with regard to oxidative stress-related parameters of asthmatic patients.METHODS:Forty-five patients with asthma and 27 healthy age-matched controls were included in this study. Blood samples were collected in tubes with ethylenediaminetetraacetic acid. DNA was extracted from the blood samples. The multidrug resistance-1 gene polymorphism was detected by polymerase chain reaction and a subsequent enzyme digestion technique. The serum levels of total oxidant status and total antioxidant status were determined by the colorimetric measurement method.RESULTS:The heterozygous polymorphic genotype was the most frequent in both groups. A significant difference in the multidrug resistance-1 genotype frequencies between groups indicated an association of asthma with the TT genotype. A significant difference between groups was found for wild type homozygous participants and carriers of polymorphic allele participants. The frequency of the T allele was significantly higher in asthmatic patients. The increase in the oxidative stress index parameter was significant in the asthma group compared with the control group.CONCLUSIONS:The multidrug resistance-1 gene C/T polymorphism may be an underlying genetic risk factor for the development of asthma via oxidant-antioxidant imbalance, leading to increased oxidative stress.

Visfatin and ghrelin: can they be forthcoming biomarkers or new drug targets for asthma?

BACKGROUND & AIM: Asthma represents chronic inflammation of the airways and is associated with bronchial hyperresponsiveness and reversible airway obstruction. A novel adipokine visfatin and an appetite-modulating hormone ghrelin play a role in several diseases related with inflammation. Although visfatin is a pro-inflammatory adipokine, ghrelin mainly exerts anti-inflammatory effects. However, very little is known about the role of visfatin and ghrelin in asthma. In the present study, we aimed to investigate the role of visfatin and ghrelin in asthma by evaluating their serum levels in asthmatic patients. MATERIALS AND METHODS: This study was performed on 27 asthma and 23 healthy controls. Blood samples were collected in tubes without EDTA. Serum levels of visfatin and ghrelin were measured by human ELISA assay kits. Statistical analyses were performed by SPSS 16.0 package program and differences were considered statistically significant at p < 0.05. RESULTS: Serum levels of visfatin and ghrelin were significantly higher in asthma group (respectively; p = 0.001, p = 0.002). CONCLUSION: While visfatin has a pro-inflammatory role, ghrelin exerts an anti-inflammatory effect in asthma. Therefore, visfatin can be a forthcoming biomarker and ghrelin may be a new anti-inflammatory drug target to diagnose and treat asthmatic patients.

Balanced oxidative status by nesfatin-1 in intestinal ischemia-reperfusion.

OBJECTIVE: Ischemia causes reversible or irreversible cell or tissue damage and reperfusion can exaggerate cellular damage. Microvascular dysfunction is induced and causes enhanced fluid filtration in capillaries. At the acute phase of reperfusion more oxygen radicals are activated. Nesfatin-1 protects brain against oxidative damage and heart against ischemia/reperfusion damage. In our study, we aimed to investigate the acute effect of chronic peripheral nesfatin-1 administration in intestinal ischemia/reperfusion created rats. METHOD: Two-months-old, 28 Wistar Albino male rats, weighing an average of 200-250 g, were used and randomly divided into four experimental groups (n=7) as; Laparotomy, Ischemia/Reperfusion, Nesfatin-1+Laparotomy, Nesfatin-1+Ischemia/Reperfusion. Serum levels of total oxidant status (TOS) and total antioxidant status (TAS) were determined by colorimetric measurement method. The plasma levels of endotelin-1 and endothelial nitric oxide syntheses (eNOS) were analyzed by rat ELISA assay kits. RESULTS: Plasma levels of endothelin-1 significantly increased, plasma level of eNOS, serum levels of TOS and TAS significantly decreased in nesfatin-1 applied groups. Additionally, The oxidative stress index (OSI) parameters decreased significantly in three groups compared to laparotomy. CONCLUSION: Chronic peripheral nesfatin-1 administration can decrease eNOS level and OSI at the acute phase of ischemia/reperfusion. We suppose that it can be protective for ischemia/reperfusion injury by balancing oxidant capacity. On the other hand, this effect of nesfatin-1 is not related with micro-circular compensation and increases anti-oxidant capacity.

Angiotensinogen gene M235T and angiotensin II-type 1 receptor gene A/C1166 polymorphisms in chronic obtructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) occurs irreversibly and is characterized by progressive airflow obstruction. Renin angiotensin system (RAS) has many different key enzymes and receptors that have a role for different systemic processes. We aimed to determine genotype and allele frequencies of angiotensinogen (AGT) M235T and angiotensin II-type 1 receptor (AT1-R) A/C1166 polymorphisms in patients with COPD. This study was performed on 56 unrelated COPD patients and 29 healthy subjects. DNA samples for each individual were isolated from peripheral blood by phenol/chloroform method, analyzed by polymerase chain reaction and enzymatic digestion methodologies. The distribution for each of AGT genotypes were 23.2% for MM (13), 75.0% for MT (42) and 1.8% for TT (1) in the COPD group; 37.9% for MM (11), 34.5% for MT (10) and 27.6% for TT (8) in the control group. The distribution of AGT genotypes was found significantly different between groups (X(2) = 18.604; df = 2; P = 0.000). The frequencies for each of the AT1-R genotypes were found as 53.6% for AA (30), 42.9% for AC (24), 3.6% for CC (2) in the COPD group; 55.2% for AA (16), 41.4% for AC (12) and 3.4% for CC (1) in the control group. The distribution of AT1-R genotypes did not change significantly between groups. Allele frequencies of interested genes were not significantly different between groups. We suggest that AGT polymorphism may play a role for the development of COPD. We believe these data can be served for large scale population genetics research, considering the frequency of AGT and AT1-R genes and alleles in COPD patients in the Turkish population.

MDR-1 gene C/T polymorphism in COPD: data from Aegean part of Turkey.

OBJECTIVE: Genetic factors, in addition to oxidative stress factors, have been implicated in the development of chronic obstructive pulmonary disease (COPD). Multi-drug resistant-1 (MDR-1) is a gene located on chromosome 7 and the products of this gene protect lung tissue from oxidative stress. We searched the frequency of MDR-1 gene C/T polymorphism in patients with COPD and aimed to explain the association between MDR-1 gene and COPD development. METHODS: 47 patients with COPD and 64 healthy control participants were placed in this study. DNAs were extracted from blood samples and MDR-1 amplification of DNA was performed using polymerase chain reaction and enzyme digestion techniques. RESULTS: The frequencies of MDR-1 genotypes were found 17.0% for CC, 51.1% for CT and 31.9% for TT in the COPD group and 39.1% for CC, 53.1% for CT and 7.8% for TT in the control group. The distribution of MDR-1 gene C alleles were found 32.3% in COPD group and 67.7% in control group; T alleles were found 55.1% in COPD group and 44.9% in control group. There was statistically significant difference between the groups for genotype and allele frequency of MDR-1 gene (P = 0.001). CONCLUSION: TT genotype of MDR-1 gene was significantly more frequent in COPD patients. MDR-1 gene C/T polymorphism may play a role in COPD development.

Relationship between respiratory tract complaints, functional status, and smoking in hairdressers, auto painters, and carpenters.

BACKGROUND AND AIM: It was observed that occupation and smoking increased each other's effects on the development of airway diseases. We aimed to search the relationship between respiratory symptoms, smoking, and occupation. MATERIALS AND METHODS: 225 employees in Düzce, Turkey, were applied a survey questioning respiratory complaints, pulmonary function tests (PFTs) and cotinine measurements in urine. RESULTS: Cough (26.7%), phlegm (30.7%), and chest tightness (21.3%) were encountered more in carpenters compared to other groups and phlegm was statistically higher at significant level compared to other groups. The complaints of cough (30.4%), phlegm (27.4%), and chest tightness (21.5%) were significantly higher in individuals whose cotinine level was above 500 ng/mL and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, maximum midexpiratory flow rate (MMFR) values were significantly lower. Dyspnea complaint of auto painters whose cotinine level was below 500 ng/mL was significantly higher and also expected MMFR% value of this group was significantly lower compared to other groups. While age had independent effect on respiratory function tests, type of the job was found to be independently effective on MMFR. CONCLUSION: Smoking increases respiratory complaints of employees. In auto painters, the occupation causes airway disease regardless of smoking.

Respiratory symptoms and pulmonary function tests in security and safety products plant workers.

OBJECTIVE: Lock and key factory workers are under the risk of metal pneumoconiosis and occupational asthma. In this cross-sectional study, it's aimed to evaluate the relationship between metal dust exposure and respiratory symptoms, pulmonary function tests of workers in different section of lock and key factory. METHODS: 54 male workers (mean age, 32.8 ± 5.4) in a security and safety products plant were evaluated for respiratory symptoms, pulmonary function tests and smoking habits. Results have been interpreted by comparison of the painting (28/54) and grinding group workers (26/54). RESULTS: There was no significant difference between painting (32.1 ± 4.8) and grinding (33.6 ± 6.1) groups regarding mean age (P > 0.05). Smokers were in significantly higher in grinding group (18/26). Cough and sputum were reported 14.3% (4/28) in painting and 3.8% (1/26) in grinding workers (P > 0.05). Chest tightness was seen in 7.1% and 7.7% of painting and grinding workers, respectively (P > 0.05). But no chest tightness was reported in both groups when they were away work. Breathlessness was seen in 10.7% and 7.7% of painting and grinding workers, respectively (P > 0.05). Breathlessness was similar in both groups (7.1% vs. 3.8%) when they were away work. When comparing painting and grinding workers respiratory functions no significant difference observed. Chest radiography in painting and grinding workers showed hyperlucency (3.6% vs.11.4%), respectively. CONCLUSION: Painting groups in lock and key factory workers had more but statistically insignificantrespiratory complaints. Interestingly, chest tightness was only observed when both groups were at work. It was thought that ventilation and using personal protective equipment in factory could provide significant benefits.

Pulmonary Cement Embolism following Percutaneous Vertebroplasty.

Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment.

Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

Serum IgE antibodies against hazelnut in hazelnut processing workers.

Aim. Previous studies have shown a higher sensitization rate to hazelnut in processing workers but no relation was found between the respiratory symptoms in workplace and hazelnut sensitization. Material and Method. To evaluate the association between the hazelnut sensitization and workplace-related respiratory complaints, hazelnut processing workers had undergone a questionnaire included work-related respiratory symptoms, smoking history, pulmonary function testing, and measurement of serum IgE antibodies against hazelnut. Results. This study consisted of 88 hazelnut processing workers (79 females and 9 males), aged 14-59 years (Mean ± SD: 33.8 ± 10.5 years). The mean working duration was 38.8 ± 36.6 months (min: 1-max: 180). Specific IgE against hazelnut allergens was positive in 14 of cases (17.1%). There was no significant difference between the cases with and without specific IgE against hazelnut allergens regarding respiratory symptoms, history of allergy, smoking status and spirometric values. Conclusion. 17.1% of the hazelnut processing workers were seropositive against hazelnut. Being sensitized to hazelnut was not found to be associated with work-related respiratory symptoms in this study. Further studies are needed in hazelnut workers respiratory health to search topics other than asthma.

Is obstructive sleep apnea syndrome a risk factor for pulmonary thromboembolism? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In many studies, obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease. Conversely, there are few reports establishing possible relation between OSA and venous thromboembolism (VTE). In this study, the aim is to evaluate OSA via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of obstructive sleep apnea syndrome (OSAS) may be a risk factor for pulmonary embolism.</p><p><b>METHODS</b>Fifty consecutive patients who were diagnosed with pulmonary embolism (PE) were evaluated prospectively for OSAS. Polysomnographic examination was conducted on 30 volunteer patients. The frequency of OSAS in PE was determined and PE cases were compared to each other after being divided into two groups based on the presence of a major risk factor.</p><p><b>RESULTS</b>The study consisted of a total of 30 patients (14 females and 16 males). In 56.7% of the patients (17/30), OSAS was determined. The percent of cases with moderate and severe OSAS (apnea hipoapnea index > 15) was 26.7% (8/30). Patients who had pulmonary thromboembolism (PTE) without any known major VTE risk (n = 20), were compared to patients with VTE risk factors (n = 10), and significantly higher rates of OSAS were seen (70% and 30% respectively; P = 0.045). The mean age of the group with major PE risk factors was lower than the group without major PE risk factors (52 years old and 66 years old, respectively; P = 0.015), however, weight was greater in the group with major PE risk factors (88 kg and 81 kg, respectively; P = 0.025). By multivariate Logistic regression analysis, in the group without any visible major risk factors, the only independent risk factor for PE was OSAS (P = 0.049).</p><p><b>CONCLUSIONS</b>In patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high. PTE patients with OSA symptoms (not syndromes) and without known major risk factor should be examined for OSA. There seems to be a relationship between OSA and PTE. However, whether this relationship is a causal relationship or a relationship due to common risk factors or long-term complications of OSA is not clear. Further comprehensive studies on those special topics are needed to clarify these points.</p>