The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome.

AIM: We aimed to investigate the metabolic effects of HIIT exercise on PCOS patients and how it affects adiponectin, vaspin and leptin. MATERIAL AND METHODS: Twenty women with PCOS were included in the study and were divided into two groups. HIIT program was applied for 10 PCOS and Medium Intensity Continuous Training (MICT) program was applied for other 10 PCOS. At the beginning and at the end of the study, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), insulin, Adiponectin, Leptin, Vaspin levels of both PCOS groups were evaluated. RESULTS: When PCOS patients by performed HIIT exercise for 12 weeks, we found that the levels of leptin and vaspin did not change while adiponectin levels increased. Moreover serum levels of insulin, TG, total cholesterol, LDL-C decreased but levels of HDL-C increased. CONCLUSION: HIIT increased in the adiponectin levels in women with PCOS and provided more weight loss.

Pancreatic ductal adenocarcinoma and chronic pancreatitis may be diagnosed by exhaled-breath profiles: a multicenter pilot study.

BACKGROUND: The diagnosis of pancreatic adenocarcinoma and chronic pancreatitis often rely on expensive and invasive diagnostic approaches, which are not always discriminative since patients with chronic pancreatitis and pancreatic adenocarcinoma may present with similar symptoms. Volatile organic compounds (VOCs) in expired breath, could be used as a non-invasive diagnostic biological marker for detection of pancreatic pathology. Detection and discrimination of pancreatic pathology with an electronic nose has not yet been reported. PURPOSE: The objective of this pilot study was to determine the diagnostic potential of an electronic nose to identify pancreatic adenocarcinoma and chronic pancreatitis by analyzing volatile organic compoundg (VOC) profiles in exhaled air. PATIENTS AND METHODS: In a multicenter study, the exhaled air of 56 chronic pancreatitis patients, 29 pancreatic adenocarcinoma patients, and 74 disease controls were analyzed using an electronic nose based on 3 metal oxide sensors (MOS). The measurements were evaluated utilizing an artificial neural network. RESULTS: VOC profiles of chronic pancreatitis patients could be discriminated from disease controls with an accuracy of 0.87 (AUC 0.95, sensitivity 80%, specificity 92%). Also, VOC profiles of patients with pancreatic adenocarcinoma differed from disease controls with an accuracy of 0.83 (AUC 0.87, sensitivity 83%, specificity 82%). Discrimination between chronic pancreatitis and pancreatic adenocarcinoma showed an accuracy of 0.75 (AUC 0.83, sensitivity 83%, specificity 71%). CONCLUSION: An electronic nose may be a valuable diagnostic tool in diagnosis of pancreatic adenocarcinoma and chronic pancreatitis. The current study shows the potential of an electronic nose for discriminating between chronic pancreatitis, pancreatic adenocarcinoma and healthy controls. The results from this proof-of-concept study warrant external validation in larger cohorts.

Hepatic Arterial Reconstruction Using Right Gastroepiploic Artery in Living Donor Liver Transplantation.

BACKROUND: Hepatic artery (HA) anastomosis is still a challenge in living donor liver transplantation due to the short- and small-caliber graft artery. PATIENTS AND METHODS: If the recipient HA is damaged, reconstruction of HA is a significant problem. This paper reports on the results of using our alternative artery source in patients who had HA depredation for a variety of reasons, including transarterial chemoembolization. We used the right gastroepiploic hepatic artery for HA reconstruction in 5 patients. RESULTS: None of the patients experienced HA thrombosis. Only one patient who underwent retransplantation due to chronic rejection had biliary leakage. The mean follow-up time was 7.4 months; no graft loss or patient mortality was observed. The right gastroepiploic hepatic artery can be used securely for HA reconstruction in patients with a damaged HA.

Liver Transplantation in Patients With Complete Portal Vein Thrombosis: Renoportal or Varicoportal Anastomosis Using Cryopreserved Vein Grafts.

BACKGROUND: Despite technical developments in transplantation surgery, complete portal vein thrombosis still remains a challenge for restoration of adequate portal vein inflow. Renoportal or varicoportal anastomosis provides an effective alternative solution for patients with complete portal vein thrombosis. This study describes our experience with renoportal and varicoportal anastomosis during liver transplantation. PATIENTS AND METHODS: Between January 2014 and May 2016, 5 patients with complete portal vein thrombosis underwent extra-anatomic portal anastomosis. In 3 cases, varicoportal anastomosis was performed and for the others, end-to-end renoportal anastomosis. We used iliac cryopreserved vein grafts to restore portal anastomosis in 3 cases. Epidemiology, risk factors, surgical techniques, complications, and outcomes of these procedures were evaluated over short- and long-term follow-ups. RESULTS: The follow-up time is 3 years for our first renoportal case, which was performed in a cadaveric liver transplantation; it was also first nationwide case. The other renoportal anastomosis was practiced in a living donor liver transplantation and the follow-up time is 8 months. The patient and graft survival rates were 100% at the last follow-up. The follow-up times are 10.9 and 4 months for the patients with varicoportal anastomosis. One of these patients died due to recurrence of hepatocellular carcinoma. The other two patients are alive with good graft functions. CONCLUSION: Our experience suggests that reno-varicoportal anastomosis is a useful technique for patients with complete portal vein thrombosis and cryopreserved grafts may be safely used.

The relation of protein C and protein S levels with cardiovascular risk in patients with diabetic neuropathy.

BACKGROUND: This study was conducted to determine the clinically significance of protein C and protein S levels as a cardiovascular risk marker in patients with diabetic neuropathy. METHODS: We included 71 subjects. 50 of them were diabetics, 27 of them also had diabetic neuropathy(DN), 21 subjects were non diabetic. We evaluated these 3 group subjects' protein C, protein S, fibrinogen, prothrombine time (PT), activated partial thromboplastine time (aPTT), total cholesterol, levels and Framingham Coronary Risk Score (FCRS). RESULTS: Non diabetic group's protein C levels were higher than patients with DN (p<0.05) and diabetic patients without DN (p<0.05). But there were no difference in terms of protein C levels between patients with DN and diabetic patients without DN. FCRS of control group was lower than diabetic subjects(p<0.01). CONCLUSIONS: We found that protein C and S levels were much lower in diabetic patients than non diabetics.There was no difference between diabetic patients with DN and diabetic patients without DN in terms of protein C and protein S levels. Further, we couldn't detect any finding that we can say protein C and Protein S levels can be used as a cardiovascular risk assessment marker in diabetic neuropathic patients.

Diagnostic performance of real-time strain sonoelastography in BI-RADS 4 and 5 breast masses.

PURPOSE: The purpose of this study was to evaluate the diagnostic performance of sonoelastography by using real-time strain ratio and qualitative 5-stage elasticity score in breast lesions for which ultrasonographic evaluation suggested malignancy (BI-RADS 4 and 5 lesions). MATERIALS AND METHODS: From January 2012 to October 2012, 168 solid breast lesions were investigated using sonoelastography. The strain ratios and the elasticity scores were calculated. Final diagnosis was made by histopathological analysis. Areas under the curve and cut-off points were used to assess diagnostic performance of sonoelastography. The sensitivity, and specificity of these two imaging tests were compared using McNemar test. RESULTS: The strain ratios of malignant lesions (mean value=9.3) and benign lesions (mean value=3.75) were significantly different (P<0.00001). Using a cut-off value of 4.79, strain ratio had 78.8% sensitivity, 78.3% specificity, 86.7% positive predictive value (PPV) and 67% negative predictive value (NPV). Using a 5-stage elasticity score system, a 83.3% sensitivity, 74.6% specificity, 85.7% PPV and 71.0% NPV were obtained. CONCLUSION: Our study indicates that sonoelastography has good clinical value to discriminate between benign and malignant breast lesions. There are no differences in terms of diagnostic performance in differentiating malignant from benign lesions when strain ratio or color scoring are used alone. However the diagnostic performance is increased when strain ratio and color scoring evaluations are used in combination.

Tear function alterations in patients with polycystic ovary syndrome.

OBJECTIVE: Complaints of dry eye are prevalent worldwide and are known to be associated with insulin resistance (IR) and hyperandrogenism. However, dry eye is often overlooked in the context of polycystic ovary syndrome (PCOS). The aim of the present study was to evaluate whether or not there is any relation between tear functions and PCOS, which is a multifaceted disorder associated with IR or hyperandrogenism. PATIENTS AND METHODS: A total of 35 women with polycystic ovary syndrome (PCOS) were enrolled in this study, along with 27 healthy controls. Body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and free testosterone levels on the third day of menstruation were recorded, as well as hirsutism score (using the Ferriman Gallwey scoring system), insulin resistance (homeostasis model assessment), neutrophil-to- lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), and mean platelet volumes (MPV). A complete ocular examination was followed by administration of the ocular surface disease index (OSDI) questionnaire and Schirmer and tear break-up time (TBUT) tests. RESULTS: Schirmer and OSDI results were similar between groups, but TBUT was significantly lower in the PCOS group (p = 0.002). There were negative correlations between FG score and TBUT test (r = -0.406, p = 0.001) and between NLR and Schirmer test (r = -0.294, p = 0.025). CONCLUSIONS: Although subjective dry eye symptoms do not present in all patients, these results confirm that tear reduction, which can cause further complications in patients with PCOS, can be detected by careful examination and sensitive tests.

Familial Takayasu arteritis in a mother and daughter. A report of two cases.

Takayasu arteritis (TA) is a chronic granulomatous panarteritis, predominantly affecting the aorta and its main branches. Infections, genetic factors as suggested by familial clustering, and autoimmunity may play a role in its pathogenesis. In this report, we describe familial TA in a mother and daughter with diverse clinical manifestations. In addition to being a familial form of vasculitis, both of our cases demonstrated amyloidosis, chronic renal disease thought to be due to ischemic nephropathy, and hypertensive nephrosclerosis.

Single-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy.

Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of single-balloon enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24-83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92%). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.

Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial.

BACKGROUND AND STUDY AIMS: Double-balloon enteroscopy (DBE) is the first choice endoscopic technique for small-bowel visualization. However, preparation and handling of the double-balloon enteroscope is complex. Recently, a single-balloon enteroscopy (SBE) system has been introduced as being a simplified, less-complex balloon-assisted enteroscopy system. PATIENTS AND METHODS: This study was a randomized international multicenter trial comparing two balloon-assisted enteroscopy systems: DBE vs. SBE. Consecutive patients referred for balloon-assisted enteroscopy were randomized to either DBE or SBE. Patients were blinded with regard to the type of instrument used. The primary study outcome was oral insertion depth. Secondary outcomes included complete small-bowel visualization, anal insertion depth, patient discomfort, and adverse events. Patient discomfort during and after the procedure was scored using a visual analog scale. RESULTS: A total of 130 patients were included over 12 months: 65 with DBE and 65 with the SBE technique. Patient and procedure characteristics were comparable between the two groups. Mean oral intubation depth was 253 cm with DBE and 258 cm with SBE, showing noninferiority of SBE vs. DBE. Complete visualization of the small bowel was achieved in 18 % and 11 % of procedures in the DBE and SBE groups, respectively. Mean anal intubation depth was 107 cm in the DBE group and 118 cm in the SBE group. Diagnostic yield and mean pain scores during and after the procedures were similar in the two groups. No adverse events were observed during or after the examinations. CONCLUSIONS: This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel.

Complications of single-balloon enteroscopy: a prospective evaluation of 166 procedures.

BACKGROUND AND STUDY AIM: Double-balloon enteroscopy (DBE) has proven to be a relatively safe method for small-bowel evaluation, with a complication rate of 1 %. The main concern after diagnostic DBE is acute pancreatitis. Single-balloon enteroscopy (SBE) has emerged as a viable alternative to DBE. Until now, no incidence of pancreatitis has been reported for SBE. The aims were to evaluate complication rate and occurrence of hyperamylasemia and to identify the risk factors for hyperamylasemia after SBE. PATIENTS AND METHODS: Prospectively, consecutive patients undergoing peroral ("proximal") or combined approach SBE were included. Complications were assessed at 1 and 30 days afterwards. Serum amylase and C-reactive protein (CRP) were assessed immediately before and 2 - 3 hours after SBE. RESULTS: 166 SBE procedures were performed in 105 patients (53-male; mean age 51 years, range 9 - 87). The indications for SBE were: anemia (n = 55), Crohn's disease (n = 31) and abdominal complaints suspicious for inflammatory bowel disease (n = 5), Peutz-Jeghers syndrome (n = 1) and other (n = 13). Therapeutic interventions were performed during 21 procedures (13 %). One perforation (1 / 21 therapeutic interventions, 4.8 %) occurred after dilation of a benign stricture. While 13 patients (16 %) had post-SBE hyperamylasemia, none had complaints suggesting acute pancreatitis. Factors such as sex, indication, procedure duration, number of passes, route of SBE, findings, and/or treatment showed no significant correlation with presence of hyperamylasemia. CONCLUSIONS: SBE appears to be a safe diagnostic endoscopic procedure. The incidence of hyperamylasemia and pancreatitis after peroral SBE seems comparable to that after DBE.

Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: has the insertion technique improved?

BACKGROUND AND STUDY AIM: Reported complications of double-balloon enteroscopy (DBE) include post-enteroscopy pancreatitis. Hyperamylasemia after proximal DBE is reported frequently, but the relationship to development of pancreatitis remains unclear. Hyperamylasemia may be related to balloon inflation in the pancreatic head region. The aims of the study were to identify risk factors for hyperamylasemia and to determine the incidence of hyperamylasemia and pancreatitis when a modified cautious DBE insertion protocol was used. PATIENTS AND METHODS: In a prospective study, involving consecutive patients undergoing a proximal DBE, serum amylase activity was assessed immediately before and after the procedure. RESULTS: 135 patients were included (men 78, women 57; mean age 49 years [range 17 - 88]). The mean total procedure time was 73 minutes (range 30 - 150 minutes), and mean number of passes during the proximal DBE was 14 (6 - 24). While patients (17 %) developed hyperamylasemia after the DBE procedure, only one patient with hyperamylasemia had clinical symptoms indicating a mild acute pancreatitis (0.7 %). Total procedure time and number of passes correlated significantly with the occurrence of hyperamylasemia. CONCLUSIONS: We found a low incidence of hyperamylasemia and pancreatitis post-DBE. Theoretically, this could result from the modified insertion technique, with local strain and friction of the small bowel as remaining causes of hyperamylasemia, a notion supported by the significant relation between hyperamylasemia and duration of DBE and total number of passes. We therefore advise use of the cautious insertion technique and, if possible, reduction of duration and of number of passes in every proximal DBE.

Prevalence of Dirofilaria immitis in dogs from Hatay province, Turkey.

The present study was conducted to determine the prevalence of canine dirofilariosis in Hatay province, south of Turkey. A total of 269 blood samples were collected from owned dogs in this multi-centre survey between March and July 2006. Blood samples were examined by modified Knott and enzyme-linked immunosorbent assay (ELISA) techniques to detect circulating microfilariae and antigens of Dirofilaria immitis, respectively. Seventy out of 269 dogs (26.0%) were positive for D. immitis. However, 61.4% of positive dogs had occult infection. The prevalence of canine dirofilariosis was heterogeneous in Hatay province, with higher values in shoreline (33.0%) and riverside (30.9%) areas followed by the lowland (25.5%) or mountainous (15.2%) areas. No statistically significant differences were observed in relation to sex (females, 33.3%; males, 24.4%, P>0.05). When evaluating the prevalence of D. immitis by age, the highest prevalence was observed in dogs older than 4 years of age. Large breeds (29.6%) and the dogs living outdoors (30.2%) showed a higher prevalence in comparison to small breeds (21.4%) and the dogs living indoors (10.5%), respectively. In conclusion, according to the results of this study canine dirofilariosis had a high prevalence in Hatay province. Therefore, prophylaxis against heartworm is advisable to decrease the incidence of canine dirofilariosis.

Anticancer effects of thiazolidinediones are independent of peroxisome proliferator-activated receptor gamma and mediated by inhibition of translation initiation.

The thiazolidinedione (TZD) class of peroxisome proliferator-activated receptor (PPAR) gamma ligands, known for their ability to induce adipocyte differentiation and increase insulin sensitivity, also exhibits anticancer properties. Currently, TZDs are being tested in clinical trials for treatment of human cancers expressing high levels of PPARgamma because it is assumed that activation of PPARgamma mediates their anticancer activity. Using PPARgamma(-/-) and PPARgamma(+/+) mouse embryonic stem cells, we report here that inhibition of cell proliferation and tumor growth by TZDs is independent of PPARgamma. Our studies demonstrate that these compounds block G(1)-S transition by inhibiting translation initiation. Inhibition of translation initiation is the consequence of partial depletion of intracellular calcium stores and the resulting activation of protein kinase R that phosphorylates the alpha subunit of eukaryotic initiation factor 2 (eIF2), thus rendering eIF2 inactive. PPARgamma-independent inhibition of translation initiation most likely accounts for the anticancer properties of thiazolidinediones.