The clinical utility of TRACP-5b to monitor anti-resorptive treatments of osteoporosis.

TRACP-5b can be used to monitor the response of treatments in osteoporosis. We investigated the effect of feeding on levels of TRACP-5b and how these markers perform in a clinical setting. After feeding, there was no effect on levels TRACP-5b. It has similar diagnostic accuracy to CTX and PINP. INTRODUCTION: Bone turnover markers (BTMs) can be used to monitor response to osteoporosis treatment. However, some are affected by food intake and are not suitable to measure in a clinical setting. An assay is available which is capable of detecting the active isoform 5b of tartrate resistance acid phosphatase (TRACP-5b) and it may have minimal biological variation. Our aims were to investigate the effect of feeding on levels of TRACP-5b and compare this to CTX and PINP and then to compare the diagnostic accuracy of TRACP-5b to CTX and PINP in patients with osteoporosis given commonly used treatments. METHODS: Eighteen patients were recruited to investigate the effect of feeding on BTMs. Ninety-seven patients (74 females and 23 males) receiving 5 mg annual intra-venous zoledronate (mean age 70) and 97 patients receiving no treatment were recruited as group-matched controls. Sixteen patients receiving 60 mg subcutaneous denosumab every 6 months, (mean age 76) and 16 matched controls were recruited. Seventy-six patients were receiving oral bisphosphonates: 70 mg alendronate weekly, 35 mg risedronate and 150 mg monthly ibandronate (4%). Thirty of these patients had BMD measured at the total hip and lumbar spine. An estimate of compliance was not determined. Eighty patients receiving no treatment were recruited as group-matched controls. TRACP-5b (ELISA, Nittobo) and CTX and PINP were measured in serum in the non-fasting state between 0800 and 1700. RESULTS: After feeding, there was no effect on levels TRACP-5b and significant reductions in CTX and PINP, 29% and 10%, respectively (p < 0.001). In the zoledronate and denosumab groups, there were no differences in the areas under the curves (AUCs) between TRACP-5b, PINP and CTX. In the oral bisphosphonates group, the AUCs between TRACP-5b and PINP and TRACP-5b and CTX were significantly different, p < 0.01 and p = 0.001, respectively. TRACP-5b was negatively correlated with BMD. CONCLUSION: TRACP-5b is not affected by food intake, unlike CTX and PINP. All three BTMs correlate with change in BMD at the lumbar spine and total hip. TRACP-5b has similar diagnostic accuracy to CTX and PINP with commonly used treatments for osteoporosis with the exception of oral bisphosphonate therapy.

A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix.

BACKGROUND: Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers. METHODS: We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method. RESULTS: None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability. CONCLUSION: VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients.

Rising CEA levels in a patient with colon carcinoma: metachronous medullary thyroid cancer.

INTRODUCTION: Carcinoembryonic antigen (CEA) is a commonly used tumor marker, and its value in colon cancer is well established. However it is overexpressed in many different tumors. Here we report a case of colorectal cancer with high postoperative CEA levels that were associated with medullary thyroid carcinoma. CASE: A 60-year old man was operated for colon cancer. Postoperative CEA level was 107.6 ng/mL, while preoperative CEA level was unknown. For the detection of distant metastasis or local recurrence, we performed 18-flouro deoxyglycose (FDG) positron emission tomography (PET) and computed tomography (CT). We observed an increased FDG accumulation in the right lobe of the thyroid. The patient had cystic and non-metabolic lesions in the liver, and started a treatment with FOLFOX regimen. After 3 months of chemotherapy CEA was still as high as 146 ng/mL. There was no pathologic FDG uptake other than the thyroid nodule in PET-CT. Fine needle aspiration of the thyroid nodule revealed a follicular neoplasia. The patient underwent total thyroidectomy and histopathology revealed a medullary thyroid carcinoma. Postoperative CEA levels then lowered to normal ranges. CONCLUSION: The case we here report was a stage III colorectal cancer with high CEA levels. Our focus on searching a residual/metastatic disease made us blind to other possible explanations; in fact, none of us noticed the thyroid nodule. This case reminds us not to forget that high CEA levels can be associated with conditions other than colon cancer, such as thyroid medullary carcinoma.

Activity levels of (210)Po and (210)Pb in some fish species of the Izmir Bay (Aegean Sea).

Concentrations of ²¹°Po and ²¹°Pb were determined in the edible muscle tissue of twelve species of marine fish collected from Izmir Bay in the Aegean Sea Region of Turkey during the 2006-2007. ²¹°Po activity concentrations in fish samples were found to vary from ND to 400±9 Bq kg⁻¹ dry weight and ²¹°Pb activity concentrations were found to vary from ND to 15±3 Bq kg⁻¹ dry weight. The highest dose contribution due to ²¹°Po to humans was found to be 8.908 µSv y⁻¹.

Retention rate of clobazam, topiramate and lamotrigine in children with intractable epilepsies at 1 year.

UNLABELLED: Clobazam (CLB), Topiramate (TOP) and Lamotrigine (LAM) are newer second-line antiepileptic drugs (AEDs) used in children. This is a single-centre retrospective observational study of the efficacy, tolerability and retention rate in 224 separate treatment episodes in 194 children, aged 0.1-16.7 years (median 9.4) over an 8 year period. The median age of epilepsy onset was 3.3 years (range 0-15.1). 79% started CLB, TOP or LAM as at least the 3rd AED, with 39% having been withdrawn from at least 2 AEDs. 53% had generalised and 37% idiopathic epilepsies. The maintenance doses for CLB ranged 0.12-3.50 mg/kg/day (mean 0.7); for TOP 0.45-32.0 mg/kg/day (mean 7.1) and for LAM 1.13-16.0 mg/kg/day (mean 5.6). The study comprised 75 person-treatment years for CLB, 56 for TOP, 124 for LAM. RESULTS: CLB, TOP and LAM were well tolerated with 51%, 37% and 69% remaining on treatment beyond 1 year respectfully. 1 serious adverse event for CLB (inducing seizures) and 2 for LAM (rashes) were reported, and 60%, 47% and 39% had possibly and probably related adverse events for CLB, TOP and LAM respectively. Beyond 12 months seizure improvement (< 50% seizure frequency compared to baseline) was reported in 43%, 35% and 44% on CLB, TOP and LAM, including 5% and 8% remaining seizure free on CLB and LAM respectively. CONCLUSION: Our results demonstrate the efficacy and tolerability of CLB, TOP and LAM in children with difficult to treat epilepsies and a good response in CLB and LAM, and a reasonable response in TOP beyond 12 months.

Distributions of 210Pb around a uraniferous coal-fired power plant in Western Turkey.

In the present study the spatial and the vertical distributions of 210Pb were investigated in the soils around a uranifereous coal fired power plant (CPP) in Yatagan Basin, in Western Turkey. The variation of 226Ra activity along the soil profiles was studied to assess the unsupported 210Pb distribution in the same samples. 226Ra was measured by gamma spectroscopy and 210Pb activities were determined from 210Po activities using radiochemical deposition and alpha spectroscopy. The total 210Pb activity concentrations in bulk core samples varied in the range of 38-250 Bq kg(-1) in the study sites and of 22-78 Bq kg(-1) in reference site. In the sectioned cores sampled from the study areas the ranges for activity concentrations of 226Ra, total 210Pb and unsupported 210Pb are 24-77; 39-344 and 4-313 Bq kg(-1), respectively. Corresponding ranges for reference site are 37-39; 39-122 and 1-83 Bq kg(-1).

Conversion of the monocortical iliac bone graft to the three-dimensional prism bone graft.

INTRODUCTION: The iliac crest is the most common bone graft donor site. However, harvesting of tri or bi-cortical iliac bone graft is associated with some potentially serious complications and cosmetic deformity. We would like to present a case in which we used a new technique converting the mono-cortical iliac graft to the three-dimensional prism bone graft in order to reconstruct an acquired first metatarsal defect and to avoid the potentially serious complication of the iliac crest bone harvest. CASE REPORT: A six-year-old boy was referred to our institution due to the posttraumatic deformity of his left foot. He had a short big toe and dorsoflexion contracture of first metatarso-phalengeal joint due to the first metatarsus defect and previous skin graft. To reconstruct the bony defect, 4 x 3 cm monocortical bone graft was harvested from the anterior aspect of the ilium by using the peel-off technique. Then, the mono-cortical graft was converted to the prism with the appropriate osteotomies. This custom shaped tri-cortical prism bone graft was placed into the first metatarsal defect. Lateral arm fascia-cutaneous free flap was used for soft tissue reconstruction. The patient was able to walk without support and wear regular shoes and started playing freely with his friends at four months after the reconstruction. CONCLUSION: This is a single case report and demonstrates that a successful result can be obtained with this technique. Although the prism bone graft technique seems to offer a solution to a potential rather than a real problem, it offers a thick and three-dimensional cortico-cancellous bone graft without violating the iliac crest. Thus, the risk of serious complications resulting from the tricortical iliac crest graft or bicortical full thickness graft harvesting can be eliminated. Moreover, epiphysis of the immature iliac crest can be preserved in a growing child.

Subclinical dysfunction of cochlea and cochlear efferents in migraine: an otoacoustic emission study.

Otoacoustic emission (OAE) testing enables us to identify the cochlear component of a hearing disorder and to monitor objectively minute changes in cochlear status undetectable by other audiological methods. Contralateral sound-induced suppression is mediated by medial superior olivary complex efferents which induce hyperpolarization counteracting the amplifying effects of outer hair cell (OHC) activity. The aim of this study was to assess functions of cochlea and its efferents in migraine using OAE testing and contralateral suppression of transiently evoked OAEs (TEOAE). Fifty-three migraineurs (106 ears) and 41 healthy subjects (82 ears) were included and pure tone audiometry (PTA), speech discrimination scores (SDS), distortion product OAE (DPOAE), TEOAE and contralateral suppression of TEOAEs were tested. PTA and SDS of migraineurs and controls were not different (P > 0.05). DPOAEs were tested between 1 and 6 kHz and a significant difference was detected only at 5 kHz frequency, where DPOAE amplitudes in migraine with aura (MA) were lower than in controls (P < 0.03). The mean amplitudes of TEOAEs were statistically insignificant between controls and migraine groups. Contralateral sound stimulus induced significant decrease in amplitudes of TEOAE (P = 0.005) in controls. In patients with migraine without aura and MA, mean amplitudes of TEOAEs were not suppressed by contralateral sound stimulus (P > 0.05). As PTA, SDS and DPOAE tests demonstrate normal functioning of inner ear between 1 and 4 kHz, absence of suppression of the TEOAEs by contralateral sound stimulation indicates the presence of dysfunction either in the medial olivocochlear complex in the brainstem or at the synaptic transmission between olivocochlear efferents and OHCs in the cochlea. Disruption in the contralateral suppression may be one of the mechanisms predisposing to the phonophobia symptom associated with migraine headache.

Estimates of soil erosion using cesium-137 tracer models.

The soil erosion was studied by 137Cs technique in Yatagan basin in Western Turkey, where there exist intensive agricultural activities. This region is subject to serious soil loss problems and yet there is not any erosion data towards soil management and control guidelines. During the soil survey studies, the soil profiles were examined carefully to select the reference points. The soil samples were collected from the slope facets in three different study areas (Kirtas, Peynirli and Kayisalan Hills). Three different models were applied for erosion rate calculations in undisturbed and cultivated sites. The profile distribution model (PDM) was used for undisturbed soils, while proportional model (PM) and simplified mass balance model (SMBM) were used for cultivated soils. The mean annual erosion rates found using PDM in undisturbed soils were 15 t ha(-1) year(-1) at the Peynirli Hill and 27 t ha(-1) year(-1) at the Kirtas Hill. With the PM and SMBM in cultivated soils at Kayisalan, the mean annual erosion rates were obtained to be 65 and 116 t ha(-1) year(-1), respectively. The results of 137Cs technique were compared with the results of the Universal Soil Loss Equation (USLE).

Novel cytogenetic findings revealed by conventional cytogenetic and FISH analyses in leukaemia patients.

AIM: To describe novel cytogenetic findings in four leukaemia patients. METHODS: Conventional cytogenetic (CC) and fluorescence in situ hybridization (FISH) analyses were performed on bone marrow samples of four leukaemia patients. RESULTS: In this study, t(3;10)(q11;q25) and t(2;22)(p21;q11.2) were detected as novel translocations. t(8;16;21)(q22.1;q13;q22) and t(1;6;9;22)(p36.1;p21.3;q34;q11) were found as variant translocations, and these variant translocations were confirmed by Interphase-FISH and Multi-colour-FISH. CONCLUSION: Newly identified cytogenetic findings can lead us to characterize cytogenetic evolution of the haematological malignancies. Further investigations are certainly warranted to resolve the prognostic impact of these new cytogenetic abnormalities.

Effect of lipoprotein apheresis on oxidative stress and antioxidant status in familial hypercholesterolemic patients.

Extracorporeal low-density lipoprotein (LDL) apheresis is an established and highly effective therapy for the patients with familial hypercholesterolemia (FH) not adequately responding to diet and drug therapy alone. This study was designed to measure the effect of lipid apheresis on oxidant and antioxidant status in a patient with FH. The levels of plasma lipid peroxidation were determined as thiobarbituric acid-reactive substances. The activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were established in one subject with FH before and after lipid apheresis. The pre- and post lipid apheresis procedures witness a significant decrease in oxidative stress (p < 0.05) but the erythrocyte levels of CAT, SOD and GPx were unchanged.

Investigation of in vitro antimicrobial activity of honey.

Apitherapy or therapy with bee products as honey is an old tradition. In this study, the antimicrobial activity of 84 honey samples were investigated against 8 bacteria potential pathogens and 2 fungi. Honey samples were obtained from 10 different floral sources. The findings indicate that honey samples with thyme, thyme + acorn, pine + carob, pine + carob + anis and pine + chestnut are more effective than the other honey of floral sources. The results of the survey show that most of honey samples at 50% (w/v) can completely inhibit the growth of all of the tested bacteria. The fungi were less sensitive than the bacteria to the antimicrobial activity of honey. The sensitivity of microorganisms to sugar solutions with similar sugar contents as some honey samples which have high antimicrobial activity were also assayed. This sugar solutions inhibited a narrow range of bacteria and did not inhibit any of the fungi tested. In conclusion, these results encourage further studies to investigate possible benefits of the use of honey among therapies in the treatment of bacterial infections.

Accumulation rates and sediment deposition in the Gökova Bay in Aegean Sea Turkish Coast.

Sediment accumulation rates were estimated from the vertical distribution of excess 210Pb in sediment cores collected at six stations in the Gökova Bay near the heavily industrialized Turkish Coastal zone of the Aegean Sea. Total 210Pb was determined by measuring 210Po activities. The sediment accumulation rates were calculated to vary from 0.32+/-0.01 cm yr(-1) (0.17 +/- 0.01 g cm(-2) yr(-1)) to 1.92 +/- 0.20 cm yr(-1) (1.13 +/- 0.10 g cm(-2) yr(-1)). The unsupported 210Pb flux was calculated from the accumulated dry matter of the examined slices and their unsupported 210Pb concentrations. The flux of unsupported 210Pb varies between 62 +/- 5 and 105 +/- 8 Bq m(-2) yr(-1). The average depositional flux was found to be considerably higher for cores from the Mediterranean.

Maternal serum screening for Down's syndrome, open neural tube defects and trisomy 18.

Maternal serum screening identifies women at an increased risk of a pregnancy with Down's syndrome or trisomy 18 or an open neural tube defect. The triple test, consisting of maternal serum alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin was carried out by a chemiluminescence immunoassay method in our laboratory. The study consisted of 373 pregnant women. The gestational range for the study group was 14-22 weeks. The mean maternal age for the study group was 28.53 +/- 5.46 years (range 17.4 to 43.5 years); 9.1% of the women were considered at high risk for Down's syndrome based on the test results. In our study the detection rate for Down's syndrome by prenatal karyotyping was 66.6%. Maternal serum screening allows reduction of the number of women requiring amniocentesis without a significant decrease in the detection rate.

Osteoporosis after renal transplantation: single center experience.

BACKGROUND: Osteoporosis is a major source of morbidity after renal transplantation. The aim of this retrospective study was to determine the independent influences of different parameters on bone mineral density (BMD) in various parts of the body after renal transplantation. METHODS: BMD was measured in 130 of 954 renal allograft recipients who underwent surgery between 1985 and 1999. RESULTS: Time since transplantation and cumulative prednisolone doses were significantly higher in patients who had osteoporosis of the lumbar vertebrae (P=0.06 and 0.034, respectively). Logistic regression analysis revealed that cumulative prednisolone dose was the only significant predictor of low vertebral BMD (P=0.02, r=0.33). For the neck of the femur, high blood urea nitrogen and low Mg levels were found to be the predictors of low bone density (P=0.002 and 0.04, respectively). Although parathyroid hormone levels were higher in femoral osteoporosis patients than in those not affected at this site, the difference was not statistically significant (P=0.294). Time since transplantation, cumulative prednisolone dose, and cyclosporine A dose were all found to have a major negative impact on BMD in the radius region (P=0.001, 0.000, 0.001, respectively). Regression analysis showed that cumulative prednisolone dose (P=0.0008, r=0.34), time since transplantation (P=0.005, r=0.27), body mass index (P=0.01, r=-0.21), male gender (P=0.02, r=-0.21), and age (P=0.04, r=0.16) all had major effects on radius BMD. In conclusion, the radius seems to be one of the major parts of the skeleton affected by factors introduced after renal transplantation.

Antimicrobial Effects of Propolis Extracts on Escherichia coli and Staphylococcus aureus Strains Resistant to Various Antibiotics and Some Microorganisms.

ABSTRACT Propolis is collected by worker honey bees from the trees. The bees pack propolis on their hind legs, carry it to their colony, and use it as a sterilant in the hive. Propolis has also been used by humans since early times for various purposes and, especially, as a medicine because of its antimicrobial properties. In this study, antimicrobial effects of propolis samples on three Escherichia coli and two Staphylococcus aureus strains that are multiresistant to antibiotics and on Salmonella typhimurium, Bruceila abortus, Proteus mirabilis, Streptococcus pyogenes, Bacillus cereus, Candida tropicalis, and Aspergillus niger were studied. Propolis extracts were prepared with acetone and dimethyl sulfoxide (DMSO). At concentrations of 10 and 25 ml, propolis extracts affected all of the microorganisms in acetone and DMSO in concentrations of 10.0, 50.0, and 100.0 ppm. The results detected in this in vitro study provided evidence that propolis may be used as an antimicrobial agent against many microorganisms.