Oxidative Stress and Spontaneous Reperfusion of Infarct-Related Artery in Patients With ST-Segment Elevation Myocardial Infarction.

In the pathogenesis of atherosclerosis, oxidative stress plays a major role in plaque instability, rupture, and erosion, which subsequently leads to thrombus formation and causes total infarct-related artery (IRA) occlusion. We investigated the relationship between spontaneous reperfusion (SR) of IRA and oxidative stress in patients with anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. A total of 341 consecutive patients with anterior STEMI were prospectively included in the present study. Patients were divided into 2 groups according to their thrombolysis in myocardial infarction (TIMI) flow grade: SR group (66 patients, TIMI flow 3) and non-SR group (275 patients, TIMI flow 0-2). On multivariate logistic regression analysis, oxidative stress index (ß = 0.868, 95% confidence interval [CI] = 0.806-0.934, P < .001), neutrophil to lymphocyte ratio, uric acid, mean platelet volume, Killip 2 to 4 class, and initial SYNTAX score were independently associated with SR. Oxidative stress as well as inflammation may play a pivotal role in the pathogenesis of SR in patients with STEMI.

Role of first trimester total testosterone in prediction of subsequent gestational diabetes mellitus.

AIM: To assess the role of first trimester maternal testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels in prediction of development of gestational diabetes mellitus (GDM). METHODS: Four hundred and fifty pregnant women were included in this prospective cohort study. All pregnant women with a singleton pregnancy who were not diabetic, had no family history of diabetes, had no history of previous GDM, were of white race and non-smokers were enrolled. Total testosterone and DHEA-S were measured at 11-14 weeks of gestation. The patients were called for routine pregnancy visits and followed accordingly. Forty-two patients did not come to their visits and were excluded. During gestational weeks 24-28, the remaining 408 patients were screened for GDM. The total testosterone and DHEA-S levels were compared between patients with and without GDM. Regression and receiver-operator curve analysis were performed. RESULTS: GDM developed in 22 women (5.7%). Compared with women without GDM, first trimester total testosterone levels were higher among women in whom GDM subsequently developed. The DHEA-S level did not differ. Age, total testosterone and body mass index were found to be independent predictors of GDM development. A total testosterone value of 0.45 ng/mL was found to predict development of GDM with a sensitivity of 63.6% and a specificity of 62.7%. CONCLUSION: First trimester total testosterone has a low testing power for GDM screening with low sensitivity and specificity values and cannot be used as a marker alone. It may have a role in combination with other markers.

[The relationship between epicardial adipose tissue and endothelial dysfunction in patients with type 2 diabetes mellitus]. / Tip 2 diyabetli hastalarda epikart yag yastikçigi ile endotel fonksiyon bozuklugunun iliskisi.

OBJECTIVES: Epicardial adipose tissue (EAT) has been shown to be related to cardiovascular risk. The aim of the present study was to investigate the relationship between EAT and endothelial function in patients with type 2 diabetes mellitus (DM). STUDY DESIGN: Type 2 DM patients were divided into two groups according to their brachial flow-mediated dilatation (FMD) values. The endothelial dysfunction (ED) group consisted of 46 patients with FMD change of <7%, while 46 patients with FMD change of >7% were accepted as the non-ED group. EAT thickness was measured on the right ventricular free wall from the transthoracic echocardiographic parasternal long- and short-axis views. The patients' demographic, anthropometric and laboratory findings were recorded. RESULTS: The mean diameter of EAT was 8.0±1.8 cm in the ED group and 6.6±1.2 cm in the non-ED group (p<0.001). The HbA1c levels were significantly higher in the ED group than non-ED group (8.55 [7.30-9.80], 7.45 [6.50-9.30], respectively; p=0.042). There were a negative correlation between FMD values and EAT (r=-0.437, p<0.001). The FMD values were weakly and negatively correlated with DM duration and HbA1c levels (r=-0.216, p=0.038; r=-0.266, p=0.010, respectively). EAT thickness was strongly correlated with body mass index (BMI) and waist length (r=0.405, p<0.001; r=0.515, p<0.001, respectively). The neutrophil count was significantly higher in the ED group than in the non-ED group. In multivariate logistic regression analysis, HbA1c and EAT diameters were found as predictors of ED in type 2 DM (odds ratio (OR): 1.887, 95% confidence interval (CI): 1.298-2.743, p=0.001; OR: 1.485, 95% CI: 1.054-2.093). CONCLUSION: EAT thickness predicts ED in patients with type 2 DM.

Is the red cell distribution width strong predictor for treatment response in primary glomerulonephritides?

BACKGROUND: Novel biomarkers are needed to predict the response to treatment in patients with nephrotic syndrome (NS) due to primary glomerulonephritides (PGN). We aimed to test the predictive value of red blood cell distribution width (RDW) for estimation of response to therapy in adult patients with NS. Study design, setting & participants, and intervention: We performed a prospective study including 176 patients with NS due to PGN. Patients were divided into three groups according to their response to the treatment. Group 1 was composed of patients with complete remission whereas group 2 was composed of patients with partial remission and group 3 was composed of patients who were resistant to the treatment. RESULTS: The highest baseline mean RDW value was found in group 3 patients (17.8 ± 1.8) whereas the lowest in group 1 (13.4 ± 0.7) before treatment (p<0.05). We found a significant decrease in RDW value after an effective treatment in groups 1 and group 2 (p<0.05). However, there was no significant change in RDW values after treatment in group 3 (p>0.05). Most of the patient with complete remission had base-line RDW level ≤ 14% (n=45, 90%) (p<0.001, Kendal Tau: -0.86), and most of the patients who were resistant to the treatment had base-line RDW level p>15% (n=68, 86.1%) (p<0.001, Kendal Tau: -0.87). CONCLUSION: Our results suggest that pre-treatment RDW value is a promising novel biomarker for predicting response to the treatment in adult patients with NS due to PGN.

The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy.

INTRODUCTION AND HYPOTHESIS: It has been suggested that weight reduction decreases the frequency of urinary incontinence (UI) episodes. However, it is not known if this improvement is associated with anatomical changes in the pelvis. The aim of this study was to investigate the effects of weight loss on UI episodes and pelvic floor anatomy. METHODS: Three hundred seventy-eight overweight/obese women were randomly allocated either to behavioral weight loss or to structured education programs. The patients were evaluated by voiding diary, Pelvic Floor Distress Inventory (PFDI), and Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and after 6 months. RESULTS: The women in the intervention group had a mean weight loss of 9.4 %, whereas the weight in the control group remained almost the same (P < 0.001). While there were no change in stress and urge incontinence episodes in the control group, the mean number of stress incontinence episodes per 3-day diary dropped from 7.96 episodes to 3.11, and the mean number of urge incontinence episodes per 3-day diary dropped from 2.85 episodes to 1.08 in the study group (P < 0.05). Regarding the POP-Q system, only genital hiatus, perineal body, and Ap measurements were significantly lower in the weight loss group than in the control group after 6 months. CONCLUSIONS: Weight reduction provides improvement in episodes of UI, decreases the incidence of drops of urine leakage, and increases quality of life related to pelvic floor symptoms. However, there are little to no changes in the parameters of the POP-Q system with weight reduction.