Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study.

BACKGROUND: Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies. PURPOSE: The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment. METHODS: This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence. RESULTS: The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit.

Reliability and validity of the Turkish Nose Obstruction Symptom Evaluation (NOSE) scale

Background/aim: The aim of this study was to validate the Turkish Nasal Obstruction Symptom Evaluation (T-NOSE) scale. Materials and methods: The NOSE scale was translated into Turkish. A prospective study was conducted involving adult subjects with nasal obstruction and a control group. The patients were divided into three groups, namely nasal septum deviation (NSD), septoplasty, and control groups. Internal consistency, test-retest reliability, validity, responsiveness, and the magnitude of the effect of surgery were all investigated. Results: In total, 253 subjects were enrolled in the study. Cronbach's alpha was 0.938 and 0.942 upon test and retest, respectively, which proved good internal consistency. The mean kappa value was 0.82, indicating a high level of reproducibility. The difference between postoperative and control groups was not statistically significant (P < 0.05). The T-NOSE score of the NSD group was 65.67 ± 16.77, while it was 10.75 ± 12.25 for the control group (P < 0.01). The mean score improved following septoplasty (P < 0.001). The magnitude of the effect of surgery was considered high. The correlation between the visual analogue scale and NOSE scores was 0.948. Conclusion: The T-NOSE scale is a valid instrument with good internal consistency, reliability, reproducibility, validity, and responsiveness.

The association of fatty pancreas with subclinical atherosclerosis in nonalcoholic fatty liver disease.

INTRODUCTION: Ectopic fat accumulation in many tissues has been shown to be a risk factor for developing cardiovascular disease. No study to date has investigated whether fatty pancreas plays a role in the development of subclinical atherosclerosis. We aimed to assess the relationship between fatty pancreas and subclinical atherosclerosis in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) and healthy controls. PATIENTS AND METHODS: One hundred patients with biopsy-proven NAFLD and 38 healthy controls were included. Transabdominal ultrasonography examination was performed on all the cases with high-resolution ultrasonography (Acuson S3000) using 6 mHz convex probes. The measurements of carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) were performed to investigate the relationship between fatty pancreas and atherosclerosis. RESULTS: The rate of newly diagnosed DM and prediabetes in the NAFLD patients was 6 and 21%, respectively. Most of the patients with NAFLD (97%) were found to have an increased echogenicity of the pancreas at ultrasound examination. Grade of fatty pancreas was correlated positively with cf-PWV levels (P<0.05), whereas no correlation was found with CIMT (P>0.05). The presence of fatty pancreas was associated significantly with higher CIMT and cf-PWV levels (P<0.05). The results for cf-PWV and CIMT did not remain significant after adjustment for confounding factors. Although the levels of cf-PWV and CIMT increased with increasing grade of fatty pancreas, there was no significant association. CONCLUSION: We have shown for the first time that fatty pancreas is a contributing factor for the development of atherosclerosis in patients with NAFLD. This study also confirms the strong association between NAFLD and fatty pancreas.

Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters.

OBJECTIVE: Non-Hodgkin's lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of 18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging 18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL. METHODS: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging 18F-FDG PET/CT have been performed and quantitative parameters of SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL. RESULTS: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUVmax, SUVmean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUVmax, SUVmean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis. CONCLUSION: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.

The relationship between erythrocyte membrane fatty acid levels and cardiac autonomic function in obese children.

OBJECTIVE: Childhood obesity is a worldwide health concern. Studies have shown autonomic dysfunction in obese children. The exact mechanism of this dysfunction is still unknown. The aim of this study was to assess the relationship between erythrocyte membrane fatty acid (EMFA) levels and cardiac autonomic function in obese children using heart rate variability (HRV). METHODS: A total of 48 obese and 32 healthy children were included in this case-control study. Anthropometric and biochemical data, HRV indices, and EMFA levels in both groups were compared statistically. RESULTS: HRV parameters including standard deviation of normal-to-normal R-R intervals (NN), root mean square of successive differences, the number of pairs of successive NNs that differ by >50 ms (NN50), the proportion of NN50 divided by the total number of NNs, high-frequency power, and low-frequency power were lower in obese children compared to controls, implying parasympathetic impairment. Eicosapentaenoic acid and docosahexaenoic acid levels were lower in the obese group (p<0.001 and p=0.012, respectively). In correlation analysis, in the obese group, body mass index standard deviation and linoleic acid, arachidonic acid, triglycerides, and high-density lipoprotein levels showed a linear correlation with one or more HRV parameter, and age, eicosapentaenoic acid, and systolic and diastolic blood pressure correlated with mean heart rate. In linear regression analysis, age, dihomo-gamma-linolenic acid, linoleic acid, arachidonic acid, body mass index standard deviation, systolic blood pressure, triglycerides, low-density lipoprotein and high-density lipoprotein were related to HRV parameters, implying an effect on cardiac autonomic function. CONCLUSION: There is impairment of cardiac autonomic function in obese children. It appears that levels of EMFAs such as linoleic acid, arachidonic acid and dihomo-gamma-linolenic acid play a role in the regulation of cardiac autonomic function in obese children.

Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis.

BACKGROUND: Fecal microbial transplantation (FMT) provides to replace beneficial bacteria with more favorable microbiomes in recipient with dysbiosis. The aim of the present study was to prospectively investigate the efficacy of FMT by assessing the clinical and endoscopic response in patients with ulcerative colitis (UC) who had failed anti-inflammatory and immunosuppressive therapy. METHODS: In this prospective and uncontrolled study, 30 patients with UC were included. All medications except mesalazine were stopped 4 weeks before FMT. Colonoscopy was performed both before and after FMT. To assess the efficacy of FMT, Mayo scores were calculated at week 0 and week 12. A total of 500 mL extracted fresh fecal suspension was administered into the 30 to 40 cm proximal of terminal ileum of recipients. RESULTS: After FMT, 21 of the (70%) 30 patients showed clinical response, and 13 of the 30 (43.3%) patients achieved clinical and endoscopic remission at the week 12. Nine patients (30%) were accepted as a nonresponder at the end of the week 12. There was no significant difference among donors concerning both the rate of clinical remission and clinical response. No adverse events were observed in the majority of patients during FMT and 12 weeks follow-up. Seven patients (23.3%) experienced mild adverse events such as nausea, vomiting, abdominal pain, diarrhea, and fewer after FMT. CONCLUSION: FMT could be considered as a promising rescue treatment modality before surgery in patients with refractory UC. Besides, FMT also appears to be definitely safer and more tolerable than the immunosuppressive therapy in patients with UC (NCT02575040).

The association of nonalcoholic fatty liver disease with genetic polymorphisms: a multicenter study.

INTRODUCTION: Growing evidence suggests that multiple factors, such as insulin resistance, nutritional factors, gut microbiota, and hormones released from the adipose tissue, act together on genetically predisposed individuals. We aimed to investigate whether various single-nucleotide polymorphisms (SNPs) play a role in the development of nonalcoholic fatty liver disease (NAFLD) and severity of liver damage in the Anatolian population. METHODS: Two hundred and sixteen patients with biopsy-proven NAFLD and 150 control participants, aged 18-70 years, were consecutively enrolled in this multicenter study. Blood samples were genotyped for the PNPLA3 (rs738409), IL28B (rs12979860, rs12980275, rs8099917), PPAR-α 227 ALA, PPAR-γ pro 12 ALA, SOD2 C47T, and LOX-1 IVS4-14 polymorphisms using the custom-made LightSNiP assays on a LightCycler 480 II instrument. RESULTS: Genotypic distributions of PNPLA3 rs738409 SNPs were different between NAFLD and control participants, but not for other SNPs. The PNPLA3 rs738409 GG polymorphism was associated with a 27-fold increased risk of development of NAFLD (odds ratio=27.8, 95% confidence interval: 3.5-218.4; P=0.002). Patients with the PNPLA3 GG genotype had higher nonalcoholic fatty liver disease activity score levels compared with patients with the PNPLA3 CC genotype (P<0.005). NAFLD patients without fibrosis had a higher frequency of IL28B rs12979860 TT and rs12980275 GG genotypes compared with NAFLD patients with fibrosis (P<0.005). CONCLUSION: The present study proposes that polymorphisms in the PNPLA3 gene have highly predictive value in the development of NAFLD and are independently associated with the severity of liver histology in patients with NAFLD. The results of this study suggest that IL28B rs12979860 TT or rs12980275 GG may play an important protective role against the development of advanced fibrosis and even cirrhosis.

The Relationship between Symptom Severity and Low Vitamin D Levels in Patients with Schizophrenia.

BACKGROUND: In recent years, the relationship between schizophrenia and environmental factors has come into prominence. This study investigated the relationship between vitamin D levels and the positive and negative symptoms of schizophrenia by comparing vitamin D levels between patients with schizophrenia and a healthy control group. METHODS: The study included 80 patients diagnosed with schizophrenia and 74 age- and sex-matched controls. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to evaluate symptom severity. The 25-hydroxyvitamin D (25OHD) levels of all subjects both patients and healthy controls were analyzed in relation to measurements of symptom severity. RESULTS: There were no significant differences between the groups in terms of age, sex, or physical activity. Their mean 25OHD levels were also similar (23.46±13.98ng/mL for the patient group and 23.69±9.61ng/mL for the control group). But when patients with schizophrenia were grouped based on their vitamin D levels, the results indicated a statistically significant differences between their vitamin D levels and their total SANS, affective flattening, and total SAPS, bizarre behavior and positive formal thought disorder scores (p = 0.019, p = 0.004, p = 0.015, p = 0.009 and p = 0.019, respectively). There is a negative correlation between 25OHD levels and SANS total points (r = -0.232, p = 0.038); a negative correlation for attention points (r = -0.227, p = 0.044) and negative correlation with positive formal thoughts (r = -0.257, p = 0.021). CONCLUSION: The results of this study show a relationship between lower levels of vitamin D and the occurrence of positive and negative symptoms, along with increased severity of symptoms at lower levels of vitamin D, suggesting that treatment for schizophrenia should include assessment of patients' vitamin D levels. We recommend that patients with schizophrenia should be assessed with regard to their vitamin D levels.

The Effect of Antipsychotics on Bone Mineral Density and Sex Hormones in Male Patients with Schizophrenia.

BACKGROUND: The aim of this study was to compare the bone mineral density (BMD) of male schizophrenia patients with those of healthy controls in order to determine the relationship between BMD and hormonal changes. SUBJECTS AND METHODS: The study sample included male outpatients between 18 and 55 years old, diagnosed with schizophrenia who had used prolactin-raising antipsychotics (n=23) and prolactin-sparing antipsychotics (n=19) for at least twelve months, along with an age - matched healthy control group. A socio-demographic form was administered, BMD and T-score measurements were performed with a DEXA test, and hormone levels were measured with commercial test kits. RESULTS: The prolactin levels of the prolactin-raising group (PRG) were significantly higher than those of the healthy control group (CG) and the prolactin-sparing group (PSG). While prolactin levels were normal in the CG, hyperprolactinemia was found in 15.8% (n=3) of patients in the PSG and 65.2% (n=15) of subjects in the PRG. Estradiol levels for the PRG and PSG were similar but significantly lower than those of the CG. There was a statistically significant difference between the PRG, PSG and CG in terms of their L1-4 total actual bone density and T-scores. BMD and T-scores were lower for the PRG in comparison with the PSG and CG, and were consistent with osteopenia. Although not observed for every tested region, a negative correlation was found between age, duration of therapy, duration of illness, and T-scores. A positive correlation was found between subjects BMI and T-scores. A consistent negative correlation was found between total testosterone and L1-4 total T-scores when corrected according to prolactin and estradiol. A linear regression analysis found significant relationships between age, BMI, duration of therapy, duration of illness, chlorpromazine equivalent dose, estradiol and testosterone affected T-scores for some regions. CONCLUSIONS: The long-term use of prolactin - raising antipsychotic medications as well as hyperprolactinemia and hypoestrogenism accelerate bone degradation.

Relationship Between Self-Injurious Behaviors and Levels of Aggression in Children and Adolescents Who Were Subject to Medicolegal Examination.

Aggression, which is defined as a behavior causing harm or pain, is a behavioral pattern typically expected in children and adolescents who are involved in criminal activities. The aim of this study was to examine the relationship between aggression and self-injurious behavior (SIB) in children and adolescents. The study was performed in 295 cases which were sent for medicolegal examination. The mean age of the subjects was 14.27 ± 1.05 years (age range 10-18 years). The aggression levels of the subjects were determined using the Aggression Questionnaire (AQ), which is an updated form of the Buss-Durkee Hostility Inventory. The mean total AQ score of the subjects with and without SIB was 78.04 ± 21.0 and 62.75 ± 18.05, respectively (p < 0.01). There were significant statistical differences between the two groups with respect to their subscale scores (p < 0.01). It was concluded that the levels of aggression increased in children and adolescents who were involved in criminal activities when the SIBs increased.

Prognostic Predictors of Fertility in Young Adult Patients With Varicocele: Peak Retrograde Flow Velocity and Reflux Grade.

OBJECTIVES: The purpose of this study was to determine prognostic factors affecting semen parameters in patients with varicocele during the postadolescent period. METHODS: This study was approved by the Institutional Review Board. Between May 2013 and May 2015, we prospectively obtained demographic and sonographic data from postadolescent patients with varicocele. Potential risk factors affecting semen parameters, including age at diagnosis, height, weight, body mass index, varicocele laterality, varicocele grade, left testicular volume, right testicular volume, total testicular volume, testicular atrophy index, testicular volume differential, right and left maximum vein diameters, peak retrograde flow velocity, reflux flow volume, and reflux grade in both supine and standing positions, were recorded. RESULTS: The left peak retrograde flow velocity, reflux flow volume, and reflux grade in the supine and standing positions, left testicular volume, right testicular volume, total testicular volume, and follicle-stimulating hormone level were found to be associated with abnormal semen parameters (P < .05). By multivariate analysis, the follicle-stimulating hormone level was associated with the sperm concentration and morphologic characteristics, and the left peak retrograde flow velocity in the standing position was associated with deterioration of sperm motility and morphologic characteristics. Additionally, the left reflux grade in the standing position was associated with the sperm concentration, and the left testis volume was associated with motility. CONCLUSIONS: The left peak retrograde flow velocity and reflux grade in the standing position were significantly associated with all semen analysis parameters. This finding supports the use of testicular duplex Doppler sonography as a noninvasive tool for evaluation of testicular function in patients with varicocele and helps clinicians determine patients' fertility status.

Medical ozone therapy reduces shock wave therapy-induced renal injury.

OBJECTIVES: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. METHODS: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. RESULTS: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). CONCLUSION: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Pentraxin 3 Is a Predictor for Fibrosis and Arterial Stiffness in Patients with Nonalcoholic Fatty Liver Disease.

Objective. The aim of the present study was to investigate whether pentraxin 3 (PTX3) can be a new noninvasive marker for prediction of liver fibrosis in patients with NAFLD. We also aimed to evaluate the relationship between PTX3 and atherosclerosis in patients with NAFLD. Method. Fifty-four male patients with biopsy-proven NAFLD and 20 apparently healthy male volunteers were included. PTX3 levels were determined, using an ELISA method (R&D Sysytems, Quantikine ELISA, USA). To detect the presence of subclinical atherosclerosis in NAFLD, measurements of CIMT, FMD, and cf-PWV levels were performed. Results. PTX3 levels in NAFLD patients with fibrosis were higher than both NAFLD patients without fibrosis and controls (P = 0.032 and P = 0.028, respectively), but there was no difference between controls and NAFLD patients without fibrosis in terms of PTX3 levels (P = 0.903). PTX3 levels were strongly correlated with cf-PWV (r = 0.359, P = 0.003), whereas no significant correlation was found with other atherosclerosis markers, CIMT and FMD. Conclusion. Elevated plasma PTX3 levels are associated with the presence of fibrosis in patients with NAFLD, independently of metabolic syndrome components. This study demonstrated that for the first time there is a close association between elevated PTX3 levels and increased arterial stiffness in patients with NAFLD.

Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF).

OBJECTIVE: To develop widely accepted international severity score for children and adult patients with familial Mediterranean fever (FMF) that can be easily applied, in research and clinical practice. METHODS: Candidate severity criteria were suggested by several FMF expert physicians. After three rounds of Delphi survey, the candidate criteria, defined by the survey, were discussed by experts in a consensus meeting. Each expert brought data of clinical manifestations, laboratory findings and physician's global assessments (PGAs) of minimum 20 patients from their centres. We used the PGAs for disease severity as a gold standard. Logistic regression analysis was used to evaluate the predicting value of each item, and receiver operating characteristic curve analysis was performed to demonstrate the success of the criteria set. RESULTS: A total of 281 patients consist of 162 children and 119 adults with FMF were enrolled and available for validity analysis: Nine domains were included in the final core set of variables for the evaluation of disease severity in FMF. The International Severity Score for FMF (ISSF) may reach a maximum of 10 if all items are maximally scored. The threshold values to determine: severe disease ≥6, intermediate disease 3-5, mild disease ≤2. Area under the curve was calculated as 0.825 for this set in the whole group. CONCLUSIONS: The initial validity of ISSF both in children and adult with FMF was demonstrated. We anticipate that it will provide a robust tool to objectively define disease severity for clinical trials, future research as well as for therapeutic decisions in managing patients with FMF.

Changes in pulmonary function in hyperbaric chamber inside attendants: a case-control study.

BACKGROUND: Inside attendants (IAs) [are] exposed to high pressure during hyperbaric oxygen (HBO2) therapy. The aim of this study was to evaluate the alterations of pulmonary functions in IAs over time. METHODS: IAs in our hyperbaric center constituted the IA group (n=11). A sex- and age-matched control group (n=15) was constituted from hospital staff who had not dived or been exposed to hyperbaric environments before. We measured the respiratory function of all subjects at two time points: 1) at the start of the study; and 2) 12 months after the first measurement. The following parameters were recorded: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), rate of FEV1 to FVC (FEV1/FVC%), forced expiratory flow at 25% to 75% vital capacity (FEF25-75%), forced expiratory flow at 50% vital capacity (FEF50%), forced expiratory flow at 25% vital capacity (FEF25%). RESULTS: Both groups were similar in terms of age, sex, smoking and body mass index. We found that FEV1, FEV1/FVC%, FEF25-75% and FEF50% significantly reduced in both groups after 12 months (p⟨0.05). However, the rate of change in all parameters was similar in both groups (p⟩0.05). In the IA group, the total number of exposures within the 12 months was positively correlated with the rate of reduction in FEF25% (r=0.788, p=0.004). CONCLUSION: Working as an IA does not deteriorate pulmonary function in the short term. However, there is a need for long-term follow-up studies.

Performance of Different Diagnostic Criteria for Familial Mediterranean Fever in Children with Periodic Fevers: Results from a Multicenter International Registry.

OBJECTIVE: Our aims were to validate the pediatric diagnostic criteria in a large international registry and to compare them with the performance of previous criteria for the diagnosis of familial Mediterranean fever (FMF). METHODS: Pediatric patients with FMF from the Eurofever registry were used for the validation of the existing criteria. The other periodic fevers served as controls: mevalonate kinase deficiency (MKD), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), cryopyrin-associated periodic syndrome (CAPS), aphthous stomatitis, pharyngitis, adenitis syndrome (PFAPA), and undefined periodic fever from the same registry. The performances of Tel Hashomer, Livneh, and the Yalcinkaya-Ozen criteria were assessed. RESULTS: The FMF group included 339 patients. The control group consisted of 377 patients (53 TRAPS, 45 MKD, 32 CAPS, 160 PFAPA, 87 undefined periodic fevers). Patients with FMF were correctly diagnosed using the Yalcinkaya-Ozen criteria with a sensitivity rate of 87.4% and a specificity rate of 40.7%. On the other hand, Tel Hashomer and Livneh criteria displayed a sensitivity of 45.0 and 77.3%, respectively. Both of the latter criteria displayed a better specificity than the Yalcinkaya-Ozen criteria: 97.2 and 41.1% for the Tel Hashomer and Livneh criteria, respectively. The overall accuracy for the Yalcinkaya-Ozen criteria was 65 and 69.6% (using 2 and 3 criteria), respectively. Ethnicity and residence had no effect on the performance of the Yalcinkaya-Ozen criteria. CONCLUSION: The Yalcinkaya-Ozen criteria yielded a better sensitivity than the other criteria in this international cohort of patients and thus can be used as a tool for FMF diagnosis in pediatric patients from either the European or eastern Mediterranean region. However, the specificity was lower than the previously suggested adult criteria.

Nuclear factor-erythroid 2, nerve growth factor receptor, and CD34-microvessel density are differentially expressed in primary myelofibrosis, polycythemia vera, and essential thrombocythemia.

Because of the presence of various overlapping findings, the discrimination of polycythemia vera (PV) from prefibrotic/fibrotic primary myelofibrosis (PF/F-PMF) and essential thrombocythemia (ET) may be challenging, particularly in suboptimal bone marrow biopsy specimens. In this study, we assessed whether differences in the expression of nuclear factor-erythroid 2 (NF-E2), nerve growth factor receptor (NGFR; CD271), CD34, CD68, p53, CD3, CD20, and CD138 by immunohistochemistry could be useful in separating among them. Higher frequencies of nuclear positive erythroblasts with NF-E2 were observed in ET and PV cases (50% ± 13.3% and 41.5% ± 9.4%, respectively) when compared with both PF-PMF (21% ± 11.7%) and F-PMF (28.5% ± 10.8%). We found that with a cutoff level of at least 30% nuclear staining for NF-E2 in erythroblasts, we could reliably exclude the possibility of PMF. Conversely, NGFR+ stromal cells per high-power field (HPF) was significantly increased in F-PMF (53.5 ± 19.1/HPF) and PF-PMF (13.5 ± 3.8/HPF) compared with ET (4.4 ± 2.2/HPF) and PV (6.6 ± 3.3/HPF). Similarly, differences in CD34-microvessel density was remarkable in F-PMF and PF-PMF cases in comparison with PV and ET (49.9 ± 12.1/HPF, 29.3 ± 12.4/HPF, 13.7 ± 4.6/HPF, and 11.9 ± 5.1/HPF, respectively). Thus, the assessment of NF-E2 and NGFR expression and the evaluation of CD34-microvessel density may provide additional support in reaching a correct diagnosis in these cases of myeloproliferative neoplasms.

Evaluation of transforming growth factor-ß2 for radiation-induced diarrhea after pelvic radiotherapy.

AIMS AND BACKGROUND: Radiotherapy (RT) plays a central role in the management of cancers located in the abdomen and pelvis. However, radiation-induced toxicity remains a major concern for patients receiving RT to the abdominopelvic region. In this context, our study aims to evaluate the use of transforming growth factor (TGF)-ß2-enriched formula for amelioration of radiation-induced diarrhea for patients undergoing pelvic RT. METHODS AND STUDY DESIGN: Between September 2013 and September 2014, 86 malnourished patients undergoing RT for pelvic cancers who received oral nutritional supplementation with or without TGF-ß2-enriched formula were assessed retrospectively in 3 groups. Oral diphenoxylate-atropine tablets were used at onset of diarrhea in all groups. Kruskal-Wallis and chi-square tests were used in the comparison of continuous and categorical variables, respectively. RESULTS: Patients receiving nutritional supplemention with TGF-ß2-enriched formula (groups I and II) experienced a significantly lower median number of diarrhea episodes compared to patients receiving nutritional supplementation with other products (group III), which was statistically significant (p<0.05). Also, number of patients experiencing grade 2 and grade 3 diarrhea was significantly lower in groups I and II compared to group III (p<0.05). CONCLUSIONS: Nutritional supplemention with TGF-ß2-enriched formula offers amelioration of radiation-induced diarrhea for patients receiving pelvic RT. Since this is the first study assessing the use of nutritional supplementation with TGF-ß2-enriched formula for patients undergoing pelvic RT, future prospective studies are needed to confirm the results.

Nonalcoholic fatty liver disease is an independent risk factor for atherosclerosis in young adult men.

INTRODUCTION: The possible cause of accelerated atherosclerosis in NAFLD may be the relationship with the MetS and its components. Our primary goal was to evaluate the relationship between NAFLD and subclinical atherosclerosis in adult male patients between 20 and 40 years of age. Moreover, we aimed to investigate the changes in this association according to the presence or absence of MetS. METHOD: Sixty-one male patients with biopsy-proven NAFLD and 41 healthy male volunteers were enrolled. In order to exclude any interference of confounding factors, we studied a specifically selected group with no additional cardiovascular risk. PWV, CIMT and FMD levels were measured in all patients and controls. RESULTS: The levels of cf-PWV were significantly higher in SS and NASH patients compared to the control group (P < 0.001); no significant difference was found between SS and NASH patients (P > 0.05). We found significantly decreased FMD levels in patients with SS and NASH compared with control subjects (P < 0.001). Subjects with NASH had significantly greater CIMT measurements than the SS and controls (P = 0.026, P < 0.001, respectively). Although, NAFLD patients with MetS had increased cf-PWV and CIMT and reduced FMD compared to healthy subjects (P < 0.05), no significant difference existed between NAFLD with Mets and NAFLD without MetS in terms of cf-PWV, CIMT and FMD (P > 0.05) CONCLUSION: The present study showed that the presence of NAFLD leads to increased risk of endothelial dysfunction and atherosclerosis in adult male patients, independent of MetS.

PARP inhibition prevents acetaminophen-induced liver injury and increases survival rate in rats.

BACKGROUND/AIM: Acetaminophen (APAP) overdose results in severe liver damage that may develop into acute liver failure. Recent studies have demonstrated that inhibition of poly(ADP-ribose) polymerase (PARP) decreases tissue necrosis and inflammation. We evaluated the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, in a rodent model of APAP-induced hepatotoxicity. MATERIALS AND METHODS: Twenty-four Sprague-Dawley rats were divided equally into 3 experimental groups: sham group, APAP group, and APAP + 3-AB group. In the experimental treatment groups APAP was administered orally at 1 g/kg and, in the APAP + 3-AB group, 3-AB was administered intraperitoneally at a dose of 20 mg/kg exactly 1 h after APAP treatment. Surviving animals were euthanized 48 h after initial APAP administration. Blood samples and liver tissues were collected for histopathological and biochemical analysis. RESULTS: A panel of oxidative stress parameters, as well as serum aspartate aminotransferase, alanine aminotransferase, neopterin, and nitrite/nitrate and histological injury scores, were significantly reduced among the APAP + 3-AB treatment group relative to the group treated with APAP alone (P < 0.05, APAP vs. APAP + 3-AB). CONCLUSION: The present study demonstrates that 3-AB inhibited APAP-induced hepatic injury and reduced neopterin levels. Results of the present study indicate that PARP inhibitors may be an effective adjuvant therapy resulting in improved outcomes in APAP-induced hepatotoxicity.