[Relationship between serum level of CD40 ligand and persistent lone atrial fibrillation]. / Serum CD40 ligand düzeyi ile tek basina israrci atriyum fibrilasyonu iliskisi.

OBJECTIVE: Inflammation is thought to play a role in the pathogenesis of atrial fibrillation. The relationship between CD40 ligand (CD40L), a prothrombotic and proinflammatory molecule, and lone atrial fibrillation was presently investigated for the first time. Levels of serum CD40L were also tested, regarding potential to distinguish patients with lone atrial fibrillation from healthy individuals. METHODS: Presently included were 35 patients with lone persistent atrial fibrillation and a control group of 30 healthy individuals. Serum levels of CD40L and high-sensitive C-reactive protein (hs-CRP) were measured, and transthoracic echocardiography was performed. RESULTS: Mean serum CD40L, hs-CRP, left ventricular end-diastolic diameter, and left atrial diameter values were significantly higher in the group with lone persistent atrial fibrillation than in the control group (7.4±3.5 ng/mL vs 4.3±1.2 ng/mL, p<0.0001; 3.7±1.6 mg/L vs 1.7±0.8 mg/L, p<0.0001; 53.0±4.2 mm vs 46.0±3.8, p<0.0001; 43.5±3.5 mm vs 33.7±3.5, p<0.0001, respectively). Serum CD40L levels were positively correlated with left atrial diameter (r=0.81, p<0.0001) and hs-CRP (r=0.72, p<0.0001). Receiver operating characteristic curve analysis revealed that serum CD40L at the optimal cut-off level of >4.5 ng/mL successfully discriminated patients with lone atrial fibrillation from controls (area under the curve: 0.847; 95% confidence interval: 0.759-0.934; p<0.0001). CONCLUSION: The present findings suggest that CD40L levels play a crucial role in the development of lone atrial fibrillation. In addition, results support that regular clinical follow-up of these patients is necessary, due to increased cardiovascular disease risk, determined by elevated CD40L levels.

The sensitivity and specifity of DR-70 immunoassay as a tumor marker for non-small cell lung cancer.

INTRODUCTION: Lung cancer is the most important causes of the cancer related mortality. Patients with lung cancer are usually diagnosed at advanced or locally advanced stage, for this reason early diagnosis of lung cancer is very important. For early detection of lung cancer some methods are emphasized such as low-dose computed tomography or tumor biomarkers. In this study we aimed to evaluate DR-70 sensitivity and specificity as a tumor marker in detection of non-small cell lung cancers. PATIENTS AND METHODS: Between May 2013 and April 2014, the serum samples from 88 non lung cancer patients, 86 patients with chronic obstructive pulmonary disesase were obtained. Blood samples from each participant were analyzed for DR-70 level. RESULT: Totally 174 patients were enrolled to the study (152 male, 22 female). Histopathologically 47(53.4%) patients were diagnosed with squamous cell lung cancer, 34 (38.6%) with adenocarcinoma, and 7 (8%) with non-small cell lung cancer. The mean serum DR-70 levels in lung cancer patients (2.43 ± 1.82 µg/mL) was significantly higher compared to the 86 non-cancerous subjects (1.15 ± 0.70 µg/mL) (p< 0.01). DR-70 exhibited clinical sensitivity and specificity of 54.5 and 83.7%, respectively, at an optimal cut off at 1.98 µg/mL. It could be said that the risk of the presence of the disease is 6.171 times higher in the cases where DR-70 level is 1.98 µg/mL and higher. CONCLUSION: DR-70, a marker used to measure fibrin degradation products, generated by all major cancers, may helps to find high risk lung cancer patients.

Role of human neutrophil gelatinase associated lipocalin (NGAL) and Matrix Metalloproteinase-9 (MMP-9) overexpression in neoplastic colon polyps.

To explore the role of Human neutrophil gelatinase associated lipocalin (NGAL) and Matrix Metalloproteinase-9 (MMP-9) overexpression in neoplastic polyps and might used as a marker to separate those from non-noeplastic polyps. The study was performed on total 65 cases, 40% (n = 26) of them females and 60% (n = 39) of them males, in Haydarpasa Numune Education and Research Hospital between March 2012 and June 2012. The assessment of immunostained sections was performed by a random principle by one experinced pathologists to the clinico-pathological data. NGAL expression was based on the presence of cytoplasmic and membranous staining. The NGAL intensities of the cases show highly statistically significantly difference according to the pathological results (p < 0.01). The NGAL prevalences of the cases show highly statistically significantly difference according to the pathological results (p < 0.01). The NGAL ID scores of the cases show highly statistically significantly difference according to the pathological results (p < 0.01). We could hypothesize that NGAL and MMP-9 overexpression in neoplastic polyps might be used as a marker to separate those from non-noeplastic polyps. However, in this study, we determined that NGAL overexpression could not distinguish dysplasia from adenocancer. Finally, we suggest NGAL and MMP-9 as an immunohistochemical marker for colonic dysplasia. To determine dysplasia in early steps of colorectal adenoma-carcinoma sequence, it could help to determine new targets in preventive cancer therapy for colorectal cancer. We suggest development of standards for study method, introduction to routine practice by investigating in future studies including many patients.

Serum concentrations of galectin-3 in patients with cardiac syndrome X.

OBJECTIVE: Microvascular dysfunction has been reported in cardiac syndrome X (CSX), even though the underlying mechanisms still remain uncertain. Galectin-3 has been recently recognized as a biomarker of cardiovascular fibrosis and inflammation. We sought to investigate the role of galectin-3 in the CSX. METHODS: We studied 115 consecutive CSX patients (mean age 55.43 ± 8.71 years, 36 men) and 74 healthy controls (mean age 54.53 ± 10.07 years, 31 men). Serum concentrations of galectin-3 and high-sensitive C-reactive protein (hs-CRP) were measured on the blood samples. RESULTS: Galectin-3 concentrations were significantly higher in patients with CSX compared to controls (0.90 ng/ml; IQR, 0.40-1.70 ng/ml vs 0.40 ng/ml; IQR, 0.36-0.44 ng/ml, p < 0.0001). Although, the prevalence of diabetes mellitus, hypertension and family history of coronary artery disease (CAD) were significantly higher among patients with CSX, following adjustment for diabetes mellitus, hypertension, and family history of CAD, serum galectin-3 concentrations were still found significantly increased in patients with CSX. Galectin-3 concentrations correlated positively with hs-CRP (r = 0.16, p = 0.03). In addition, concentrations of galectin-3, hs-CRP, fasting glucose, uric acid and family history of CAD were determined as independent predictors of the CSX. CONCLUSION: It was found that galectin-3 serum concentrations are higher in patients with CSX compared to healthy controls. Further studies on larger population are needed to confirm the relation between the fibrosis and the CSX, as well as to explore the potential role of galectin-3 in the CSX.

Urinary gamma-glutamyl transferase-to-creatinine ratio as an indicator of tubular function in Bence Jones proteinuria.

Increased urinary gamma-glutamyl transferase (GGT) activity suggests early renal tubular damage. The aim of this study was to evaluate the urinary GGT activity as a marker of renal injury in different types of Bence Jones Proteinuria (BJP). One hundred and three individuals with BJP were included in the study. Urinary GGT activity, urinary GGT-to-creatinine ratio and urinary protein-to-creatinine ratio were studied. Urine samples were tested by immunofixation agarose gel electrophoresis. Total urinary excretion of kappa and lambda light chains were measured by nephelometric method. There were no significant differences in demographic characteristics of the patients in Lambda BJP, Kappa BJP and Control groups. GGT-to-creatinine ratio of the Lambda BJP group was significantly higher than Kappa BJP group and controls (p = 0.018 and 0.002, respectively). There was no correlation between the quantitative kappa and lambda BJP and urinary GGT-to-creatinine ratio. Our data have demonstrated that urinary GGT-to-creatinine ratio could be a tubular damage marker of lambda light chain proteinuria.

The correlation between tenascin-C expression, and formation of intestinal stricture.

OBJECTIVE: A strong correlation exists between tenascin-C induction, and acute inflammation. Generally increased tenascin-C concentrations are correlated with various inflammatory, and infectious diseases. In patients with diagnosis of Inflammatory Bowel Disease (IBD) presence of tenascin-C in colonic mucosa demonstrates tissue repair, and its mucosal concentrations are correlated with local disease activity Therefore plasma levels of tenascin-C have been demonstrated to be a helpful indicator of the activity of inflammatory bowel diseases. In this study, firstly in the literature, we aimed to display the correlation between tenascin-C expression, and formation of intestinal stricture. METHODS: A total of 43 patients (male, n=19; 44.2%; and female, n=24, 55.8%) aged between 19, and 63 years, with clinically, endoscopically, radiologically, and histopathologically confirmed definitive diagnosis of Crohn's disease who were examined, diagnosed, and treated in the Gastroenterology Clinic of Haydarpasa Numune Training and Research Hospital between January 2011, and April 2012 were investigated. Serum tenascin-C levels were measured using commercial sandwich enzyme-linked immunosorbent assay Human Tenascin-C Purified Protein kit (Chemicon, Millipore(R), USA). Study groups were categorized based on the type of the disease as inflammatory (n=17; 39.5%), obstructive (27.2%), and fistule formation (n=10; 23.3%) Crohn's disease. For statistical analysis SPSS (Statistical Package for Social Sciences) Statistics 15 program was used. RESULTS: Median tenascin- C value in the obstructive group (6.57 ng/mL; range, 4.26-21.87 ng/mL) was statistically significantly higher than that detected in the inflammatory (1.74 ng/mL; range,1.29-3.16 ng/mL), and fistulizing (1.44 ng/mL; range, 0.74-2.47 ng/mL) groups (p=0.002). CONCLUSION: Intestinal fibroblasts have an important role in the stricture formation process in CD. Transforming growth factor (TGF)-b1 cytokine is in the center of this process. A strong correlation exists between tenascin-C induction, and acute inflammation. As a known fact, serum tenascin-C levels can be used in the determination of activity of IBD. Starting from this point, serum tenascin-C levels can be useful in the categorization of the Crohn's disease without the need for invasive methods. In the future, studies with larger patient series investigating use of serum tenascin-C in the prediction of stricturing Crohn's disease should be conducted.

Prognostic Significance of DR-70 Levels in Dysplastic Colorectal Polyps.

Background. To investigate the relationship between DR-70 serum levels and dysplastic colon polyps. Materials and Methods. A total of 130 patients with adenomatous polyps detected by colonoscopy and divided into two groups including low versus high grade polyp, along with 50 healthy blood donors were included in the study. Blood samples from each participant were analyzed for serum CEA and DR-70 levels. Results. No statistically significant differences were observed between the two groups in terms of age or gender. The median DR-70 level was 0.5 µ g/mL in the healthy control group and 1.1 µ g/mL in group 1b (i.e., the high grade polyp) (P < 0.001). DR-70 was higher in group 1b as compared to group 1a (P < 0.001). However, the median DR-70 values for the low grade polyp group (i.e., group 1a) and the control group were similar (P = 0.067). In order to determine independent predictors of high grade dysplasia, CEA, DR-70, polyp size, and age parameters were subjected to multiple logistical regression analyses via the Enter method; the model was statistically significant (P < 0.001). Conclusions. DR-70, a marker used to measure FDP, which is generated by all major cancers, is a potential marker to identify patients with advanced adenomatous polyps, that is, precursors of colorectal cancer.

Relationship between neutrophil gelatinase-associated lipocalin (NGAL) levels and inflammatory bowel disease type and activity.

BACKGROUND AND AIM: Neutrophil gelatinase associated lipocalin (NGAL) is a recently identified molecule, which is bacteriostatic, has tissue destructive effects and is pro-inflammatory with chemoattractant molecule binding properties. Our aim was to investigate the relationship between serum NGAL levels and the type and level of disease activity of IBD. METHODS: A total of 92 patients [43 with Crohn's disease (CD) and 49 with ulcerative colitis (UC)], and 30 age- and sex-matched healthy controls (HC) were included in this study. Serum NGAL levels were measured using ELISA. RESULTS: Serum NGAL levels were elevated in the IBD group [median 171, range (57-312) ng/mL] compared to the HC group [107 (45-234) ng/mL] (p<0.0001) and were elevated in UC patients [188 (74-312) ng/mL] compared to CD patients [168 (57-279) ng/mL] (p=0.006). When NGAL levels were further analysed based on localization of the CD and UC, the levels in ulcerative pancolitis [233 (144-312) ng/mL] were significantly higher (p=0.004) than the left-sided colitis [156 (103-309) ng/mL]. Similarly, NGAL levels were significantly higher in colonic CD [207 (125-249) ng/mL] than ileal CD [114 (78-210) ng/mL], and also in ileocolonic CD [198 (57-279) ng/mL] than ileal CD (p=0.033). When CD and UC groups were further categorized as active and inactive according to clinical and endoscopic activity indices, serum NGAL concentrations did not differ between inquiescent versus active stages. When a cut-off level of 129 ng/mL was used to distinguish IBD from HC, a sensitivity of 76.1% and a specificity of 60.9% was reached. CONCLUSIONS: The serum NGAL levels in the IBD group was significantly higher than the HC group. Serum NGAL levels were higher in more extensive colonic involvement.