Association of Intermittent and Continuous Hypoxaemia with Carotid and Brachial Arterial Intima-Media Thicknesses

ABSTRACT Objective: To assess the carotid and brachial arteries' intima-media thicknesses (IMTs) in cases with intermittent (obstructive sleep apnoea syndrome (OSAS)) and continuous (chronic obstructive pulmonary disease (COPD)) hypoxaemia together with other confounding demographic and biochemical factors. Methods: The study was prospectively performed on 197 patients allocated in three groups: 80 with severe OSAS, 80 with severe COPD patients and 37 healthy controls. These groups were compared in terms of demographics, biochemical markers and IMTs of the right and left carotid and brachial arteries. Results: Carotid and brachial arterial IMTs were found to be higher in both patient groups than the control group (p < 0.001). Similarly, levels of haemoglobin, haematocrit, cholesterol, triglycerides, low-density lipoproteins (LDL), C-reactive protein and D (domain)-dimer were significantly increased in patient groups. Oxygen saturations (p < 0.001) and ejection fractions (p = 0.001) were found to be worse and D-dimer levels (p = 0.010) were elevated more prominently in COPD patients, whereas, cholesterol (p < 0.001), hemoglobin (p = 0.004) and LDL (p = 0.001) levels were higher in the OSAS group. Except the right carotid IMT, which was increased significantly in OSAS patients, IMT measurements were similar in the OSAS and COPD groups (p < 0.001). Conclusion: We have shown that both intermittent and continuous hypoxia result in remarkable alterations in carotid IMT and brachial IMT. Further prospective trials are warranted to confirm and extend these findings, including the biochemical markers, which may aid in the diagnosis and follow-up of patients suffering from hypoxaemia.

Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

A histological and immunohistochemical study of the effects of N-acetyl cysteine on retinopathy of prematurity by modifying insulin-like growth factor-1.

Retinopathy of prematurity (ROP) is a vasoproliferative disorder that occurs in premature infants and may lead to permanent visual impairment. We investigated both the possible protective role of N-acetyl cysteine (NAC) for preventing ROP and the role of IGF-1 in the disorder. Forty-five newborn rats were divided into three groups. Group 1 was raised in room air as controls. Group 2 was exposed to 60% oxygen for 14 days after birth, then transferred to room air. Group 3 was exposed to the same conditions as group 2, but received intraperitoneal injections of NAC on postnatal days 7-17. After 35 days, both eyes of all rats were processed for histology. Some sections were stained with hematoxylin and eosin to assess structural changes and other sections were immunostained to determine the location of IGF-1. Frozen sections also were prepared and stained for adenosine triphosphatase to detect retinal blood vessels. Compared to the controls, more blood vessels, many of which were abnormal, and increased IGF-1 expression were observed in group 2. In group 3, abnormal blood vessels and IGF-1 expression were less evident. NAC appeared to be an effective vascular-protective agent for ROP by decreasing IGF-1 expression.

Role of epidermal stem cells in repair of partial-thickness burn injury after using Moist Exposed Burn Ointment (MEBO(®)) histological and immunohistochemical study.

Moist Exposed Burn Ointment (MEBO(®)) is widely used topical agent applied on skin burn. This study investigated the effect of MEBO topical application on activation and proliferation of epidermal stem cells through the immunohistochemical localization of cytokeratin 19 (CK19) as a known marker expressed in epidermal stem cells. Biopsies from normal skin and burn wounds were taken from 21 patients with partial thickness burn 1, 4, 7, 14, 21, and 28 days after treatment with MEBO. Tissue sections were prepared for histological study and for CK19 immunohistochemical localization. In control skin, only few cells showed a positive CK19 immune-reaction. Burned skin showed necrosis of full thickness epidermis that extended to dermis. Gradual regeneration of skin accompanied with an enhancement in CK19 immune-reactivity was noted 4, 7, 14 and 21 days after treatment with MEBO. On day 28, a complete regeneration of skin was observed with a return of CK19 immune-reactivity to the basal pattern again. In conclusion, the enhancement of epidermal stem cell marker CK19 after treatment of partial thickness burn injuries with MEBO suggested the role of MEBO in promoting epidermal stem cell activation and proliferation during burn wound healing.

Structural changes and immunohistochemical localisation of epidermal growth factor receptor in the true vocal fold of female albino rats administered anabolic, androgenic steroids, and effects of anti-androgen therapy.

BACKGROUND: Anabolic steroid abuse by women is associated with a number of adverse effects, including laryngeal changes. The epidermal growth factor receptor is related to regulation of the cell life cycle. This study aimed to investigate the structural changes and immunohistochemical localisation of epidermal growth factor receptor in rat vocal folds following anabolic steroid administration, and also to assess the effect of anti-androgens. MATERIAL AND METHODS: Thirty-two adult female albino rats were divided into: group I (controls), group II (receiving anabolic steroids for two months) or group III (receiving anabolic steroids plus anti-androgen for two months). RESULTS: Group II rat true vocal folds showed thicker epithelial layers with many mitotic figures, thicker lamina propria and thicker muscle fibres; epithelial cells were also immunohistochemically positive for epidermal growth factor receptor. Group III rats showed similar changes, but thin muscle fibres and extravasated red blood cells within the lamina propria. CONCLUSION: Anabolic steroids caused structural and immunohistochemical changes within the female rat true vocal fold. Co-administration of anti-androgens did not prevent these changes, suggesting that anti-androgens have a limited role in the management of such changes in humans.

Effect of ramipril therapy on abnormal left atrial appendage function.

This study investigated whether ramipril treatment has a beneficial effect on left atrial appendage (LAA) function in patients with systemic hypertension in sinus rhythm. Patients with untreated systemic hypertension and normal left ventricular systolic function in sinus rhythm (n = 20; six males/14 females; age 35 - 69 years, mean ± SD 52.8 ± 8.9 years) were evaluated using transthoracic and transoesophageal echocardiography at baseline and after 6 months of treatment with 5 mg/day ramipril. Mean systolic and diastolic blood pressures decreased significantly after ramipril therapy. Baseline LAA emptying velocity was below the age-related reference value for this parameter, indicating abnormal LAA function. There were significant increases in the LAA filling and emptying velocities after ramipril treatment. It is concluded that the decrease in blood pressure and haemodynamic improvements brought about by ramipril therapy resulted in improved LAA function in hypertensive patients with normal left ventricular systolic function in sinus rhythm.

Use of plasma clearance of technetium Tc 99m pentetate to estimate renal clearance during postnatal development in pigs.

OBJECTIVE: To compare renal clearance of technetium Tc 99m pentetate with plasma clearance by use of a glomerular filtration rate technique in pigs from 3 to 24 weeks of age. ANIMALS: 24 female pigs. PROCEDURE: At the time of investigation, 5 pigs were 3 weeks old, 6 pigs were 6 weeks old, 8 pigs were 12 weeks old, and 5 pigs were 24 weeks old. Plasma clearance of technetium Tc 99m pentetate was measured by the use of a single injection technique followed by collection of multiple blood samples until 5 hours after the injection. Simultaneously, urine was collected through a urinary catheter, and the renal clearance of technetiumTc 99m pentetate was calculated. Plasma clearance of technetium Tc 99m pentetate was correlated with the renal clearance (r = 0.95). Plasma clearance was higher than renal clearance at all ages (mean, 5.8%), indicating extrarenal clearance of technetium Tc 99m pentetate or methodologic errors. Volume of distribution increased with increasing age but decreased as a fraction of body weight. CONCLUSIONS: Plasma clearance of technetium Tc 99m pentetate estimates renal clearance with acceptable precision when using single injection technique and multiple biood samples in pigs from 3 to 24 weeks of age.