The effect of Folic Acid, B12, D, and E Vitamins and Melatonin levels in the follicular fluid taken by the Intracytoplasmic Sperm Injection method on pregnancy.

Objective: It has been demonstrated that the composition of the follicular fluid and many internal/external factors affect success in subfertile couples undergoing intracytoplasmic sperm injection (ICSI). We examined the effect of folic acid, B12, D, and E vitamins and melatonin values in follicular fluid on pregnancy in women with low, normal, and high ovarian reserves who underwent ICSI. Methods: Our study was conducted at Samsun Medical Park Hospital between January 2021 and February 2022. Follicular fluid induction samples were taken from 96 infertile women with low, normal, and high ovarian reserve, and ICSI was applied. Folic acid, B12, D, and E vitamins and melatonin levels were measured in follicular fluid samples by ELISA method. Statistical analyzes were done with SPSS, and ROC curve analyses were used. Results: Nine people with poor reserve, 19 people with normal reserve and 14 people with high reserve became pregnant. Folic acid, Vitamin-D, B12, E and melatonin levels were lower in those with poor ovarian reserve than in those with normal and high ovarian reserve (p<0.05). According to the pregnancy test, the probability of pregnancy was 43,783 times higher with high levels of folic acid, while it was 8,096 times higher for vitamin D. While vitamin B12 levels were 31,474 times more likely to be pregnancies, vitamin E levels were 35,227 times higher. For melatonin, the values showed that the probability of pregnancy increased by 11,564 times. Conclusions: High antioxidants may increase the likelihood of conception in infertile women undergoing ICSI. Therefore, couples who will be treated should be advised to increase these markers, especially melatonin in the follicular fluid.

Assessment of arterial stiffness and epicardial adipose tissue thickness in predicting the subclinical atherosclerosis in patients with ankylosing spondylitis.

OBJECTIVE: Atherosclerosis is a chronic, progressive, inflammatory disease. Recognition of subclinical atherosclerotic vascular changes before clinical manifestation in an asymptomatic population is important for risk stratification and optimal management, which finally leads to the prevention of cardiovascular disease. We aimed to determine the risk of premature subclinical atherosclerosis by evaluating epicardial adipose tissue thickness (EATT) and arterial stiffness parameters in patients with ankylosing spondylitis (AS). METHODS: We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS compared to 60 controls matched for age and sex. Patients with traditional cardiovascular risk factors were excluded. Arterial stiffness parameters and EATT (examined via echocardiography) values of all patients and control groups were measured. RESULTS: There was no difference between basal characteristic and echocardiographic parameters in patients with AS and in the control group. EATT and pulse wave velocity (PWV) were higher in the AS patients compared to the control group. EATT was 5.74 ± 1.22 mm and 4.91 ± 1.21 mm (p < .001) and PWV was 9.90 ± 0.98 m/s and 6.46 ± 0.83 m/s (p = .009) in the AS and control groups, respectively. Also, PWV was significantly correlated with EATT, age, and central blood pressure in patients with AS. CONCLUSIONS: EATT and PWV, markers of atherosclerosis and cardiovascular disease, were significantly higher in patients with AS than the control group. In addition, in this study, it has been shown that there is a significant relationship between PWV and EATT in patients with AS.

Total methylated arginine load as a risk parameter in subjects with masked hypertension.

Asymmetric dimethylarginine, symmetric dimethylarginine, and L-monomethylarginine are originated from the subsequent proteolytic catalysis of methylated arginine residues on different proteins and inhibit the endogenous nitric oxide generation. The changes in total methylarginine load (Asymmetric dimethylarginine plus symmetric dimethylarginine plus L-monomethylarginine) may contribute to hypertension. The aim of this study was to determine serum methylarginine concentrations in patients with masked hypertension and determine the association between these biomarkers and blood pressure measurements. Control group, masked hypertension and hypertension groups consisted of 40 subjects (11 males, 28 females, mean age 48.6 ± 13.1), 28 subjects (14 males, 14 females, mean age 50.9 ± 11.0) and 36 subjects (15 males, 21 females, mean age 54.4 ± 12.3 years), respectively (P= 0.149). Serum total methylarginine load was significantly higher in hypertension group (0.63 ± 0.23) compared to masked hypertension (0.49 ± 0.16) and control groups (0.38 ± 0.13) (P= 0.008 and P< 0.001). While there was no statistically significant difference between healthy control groups [0.147 (0.03-0.29)] and masked hypertension patients [0.144 (0.05-0.42)] for serum symmetric dimethylarginine levels (P= 0.970), it was markedly elevated in hypertension group [0.25 (0.07-0.54)] compared to masked hypertension group [0.14 (0.05-0.42)] (P= 0.001). Serum total methylarginine load was positively correlated with night-time SBP (r = 0.214, P= 0.029). Serum methylarginine levels might be a useful marker for determining the courses of clinical hypertension.

Decrease in Pulse Wave Velocity is Associated with Clinical Improvement in Patients with Ischemic Stroke.

BACKGROUND: Arterial stiffness is an independent determinant of cardiovascular and cerebrovascular risks. The relationship between the increase in arterial stiffness parameters and the severity of stroke has been shown in previous studies. We aimed to investigate the association between clinical improvement and changes in arterial stiffness parameters in patients presenting acute ischemic stroke. METHODS: A total of 107 patients were enrolled in this study. On the first and seventh day of the hospitalization, 24 h non-invasive blood pressure was monitored and arterial stiffness parameters were measured. The National Institutes of Health Stroke Scale (NIHSS) was used to determine the severity of stroke, and the Modified Rankin Scale was used to determine dependency and to evaluate functional improvements. RESULTS: Arterial stiffness parameters of augmentation index (AIx@75) and pulse wave velocity (PWV) were significantly higher in patients who died during hospitalization than patients who were discharged (respectively p <0.001, p = 0.04). In the group with clinical improvement, PWV values measured on the seventh day were significantly lower than PWV values measured on the first day (p = 0.032). When the changes in PWV value measured on the first and seventh day for both groups were analyzed using mixed ANOVA test, p value were significant (p = 0.033). Multivariate binary logistic regression analyses showed that negatively change in PWV and CDBP independently predicts the clinical improvement. CONCLUSIONS: Increased AIx@75 and PWV appear to be associated with higher in-hospital mortality rates in patients with acute ischemic stroke. Additionally, clinical improvement in patients with ischemic stroke is associated with a decrease in PWV .

Comparison of cell cycle components, apoptosis and cytoskeleton-related molecules and therapeutic effects of flavopiridol and geldanamycin on the mouse fibroblast, lung cancer and embryonic stem cells.

Similarities and differences in the cell cycle components, apoptosis and cytoskeleton-related molecules among mouse skin fibroblast cells (MSFs), mouse squamous cell lung carcinomas (SqCLCs) and mouse embryonic stem cells (mESCs) are important determinants of the behaviour and differentiation capacity of these cells. To reveal apoptotic pathways and to examine the distribution and the role of cell cycle-cell skeleton comparatively would necessitate tumour biology and stem cell biology to be assessed together in terms of oncogenesis and embryogenesis. The primary objectives of this study are to investigate the effects of flavopiridol, a cell cycle inhibitor, and geldanamycin, a heat shock protein inhibitor on mouse somatic, tumour and embryonic stem cells, by specifically focusing on alterations in cytoskeletal proteins, cell polarity and motility as well as cell cycle regulators. To meet these objectives, expression of several genes, cell cycle analysis and immunofluorescence staining of intracellular cytoskeletal molecules were performed in untreated and flavopiridol- or geldanamycin-treated cell lines. Cytotoxicity assays showed that SqCLCs are more sensitive to flavopiridol than MSFs and mESCs. Keratin-9 and keratin-2 expressions increased dramatically whereas cell cycle regulatory genes decreased significantly in the flavopiridol-treated MSFs. Flavopiridol-treated SqCLCs displayed a slight increase in several cell cytoskeleton regulatory genes as well as cell cycle regulatory genes. However, gene expression profiles of mESCs were not affected after flavopiridol treatment except the Cdc2a. Cytotoxic concentrations of geldanamycin were close to each other for all cell lines. Cdkn1a was the most increased gene in the geldanamycin-treated MSFs. However, expression levels of cell cytoskeleton-associated genes were increased dramatically in the geldanamycin-treated SqCLCs. Our results revealing differences in molecular mechanisms between embryogenesis and carcinogenesis may prove crucial in developing novel therapeutics that specifically target cancer cells.

Is there any difference between the early age myocardial infarction and late age myocardial infarction in terms of psychiatric morbidity in patients who have survived acute myocardial infarction?

OBJECTIVE: We aimed to compare the rates of psychiatric morbidity in patients who had early age and late age MI in patients who have survived acute myocardial infarction? METHODS: One hundred sixteen patients who were hospitalized in the coronary care unit were included in the study. Psychiatric assessment of the patients was carried out within 1-6months post-MI. Psychiatric interviews were conducted with the Structured Clinical Interview for DSM-IV (SCID-I). Also used were the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and Health Anxiety Inventory (HAI). RESULTS: A total of 116 patients were divided into two groups according to age as an early age myocardial infarction group (EA-MI) and a late age myocardial infarction group (LA-MI). The EA-MI group included 24 patients 45years of age and under. The LA-MI group included 92 patients over 45years of age. Current psychiatric disorders, lifetime psychiatric disorders and lifetime depressive disorders were significantly more frequent in the EA-MI group than in the LA-MI group. CONCLUSION: EA-MI patients have experienced a depressive episode prior to the onset of the MI, whereas in the LA-MI group, the patients typically experienced depressive episodes after MI. Our findings suggest that depression may increase the risk of MI at an early age.

Comparison Between Prospectively Electrocardiogram-Gated High-Pitch Mode and Retrospectively Electrocardiogram-Gated Mode for Dual-Source CT Coronary Angiography.

BACKGROUND: We aimed to report the image quality, relationship between heart rate and image quality, amount of contrast agent given to the patients and radiation doses in coronary CT angiography (CTA) obtained by using high-pitch prospectively ECG-gated "Flash Spiral" technique (method A) or retrospectively ECG-gated technique (method B) using 128×2-slice dual-source CT. MATERIAL/METHODS: A total of 110 patients who were evaluated with method A and method B technique with a 128×2-detector dual-source CT device were included in the study. Patients were divided into three groups based on their heart rates during the procedure, and a relationship between heart rate and image quality were evaluated. The relationship between heart rate, gender and radiation dose received by the patients was compared. RESULTS: A total of 1760 segments were evaluated in terms of image quality. Comparison of the relationship between heart rate and image quality revealed a significant difference between heart rate <60 beats/min group and >75 beats/min group whereas <60 beats/min and 60-75 beats/min groups did not differ significantly. The average effective dose for coronary CTA was calculated as 1.11 mSv (0.47-2.01 mSv) for method A and 8.22 mSv (2.19-12.88 mSv) for method B. CONCLUSIONS: Method A provided high quality images with doses as low as <1 mSv in selected patients who have low heart rates with a high negative predictive value to rule out coronary artery disease. Although method B increases the amount of effective dose, it provides high diagnostic quality images for patients who have a high heart rate and arrhythmia which makes it is difficult to obtain images.

The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that correlates with cardiac events. This study assessed the association between NLR and the presence of chronic coronary total occlusion (CTO). METHODS: The study population included 225 patients, a control group (n = 75), a coronary artery disease group (n = 75), and a CTO group (n = 75). NLR was compared in the three groups. RESULTS: NLR levels were significantly higher in the CTO than in the other two groups (p < 0.001). Bivariate correlation analysis showed a positive correlation between NLR and SYNTAX Score, and multivariate logistic regression analysis found that NLR was an independent predictor of CTO. ROC analysis showed that an NLR cut-off of 2.09 could distinguish between patients with and without CTO (AUC = 0.74; 95% CI, 0.68-0.81), with a specificity of 69.3% and a sensitivity of 61%. CONCLUSION: NLR may be useful as a marker of CTO.

Fragmented QRS in patients with systemic lupus erythematosus.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a variety of clinical features. Cardiac involvement is present in more than half of the patients with SLE. Fragmentation of QRS (fQRS) is presumed marker of cardiovascular risk and has not been previously evaluated in SLE. METHODS: A total of 56 women previously diagnosed with SLE were recruited. In addition, a control group consisting of 51 healthy people was formed. QRS complexes were also evaluated in terms of fragmentations. All patients with SLE and control subjects underwent transthoracic echocardiographic examination. Erythrocyte sedimentation rate and C-reactive protein levels were also obtained. RESULTS: Frequency of fQRS was higher in patients with SLE (41% vs. 21%, p = 0.03). Left ventricular posterior wall thickness and mass index were higher in the patients with SLE. CRP levels and age were significantly higher, and disease duration was significantly longer in the fQRS(+) group (p = 0.02, 0.01, and 0.006, respectively). CONCLUSION: A careful cardiovascular evaluation and follow-up is essential to continuously improve survival in SLE. For this purpose, fQRS may be used for the early detection in patients with SLE.

Assessment of inhomogeneities of repolarization in patients with systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic disease that affects many organ systems and manifests a broad spectrum of laboratory and clinical features. SLE patients have an increased risk of developing cardiovascular disease. The aim of this study was to evaluate inhomogeneities of repolarization by using Tpeak -Tend (Tp-e) interval and Tp-e/QT ratio were measured from the 12-lead surface electrocardiogram (ECG) in patients with SLE. MATERIAL AND METHOD: This study included 69 SLE patients (69 females; mean age 35.8 ± 10.2) and 57 control subjects (57 females; mean age 34.5 ± 8.9). Transthoracic echocardiographic examination was done in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead ECG. These parameters were compared between groups. RESULTS: No statistically significant difference was found between two groups in terms of basic characteristics. Diastolic function parameters were similar between the two groups (P > 0.05). In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QT dispersion (cQTd) were significantly increased in SLE patients compared the control group (49.5 ± 16.4 ms vs. 32.8±11.7 ms and 56.7 ± 19.5 ms vs. 36.4 ± 13.1 ms, all P value < 0.001). Tp-e interval and Tp-e/QT ratio were also significantly higher in SLE patients (82.8 ± 18.9 vs. 72.4 ± 17.6 and 0.22 ± 0.05 vs. 0.19 ± 0.05, P = 0.002 and P = 0.001, respectively). Tp-e interval and Tp-e/QT were positively correlated with disease duration (r = 0.29, P = 0.01 and r = 0.24, P = 0.04, respectively). CONCLUSION: Our study revealed that QTd, cQTd, Tp-e interval and Tp-e/QT ratio increased in patients with SLE. Also, Tp-e interval and Tp-e/QT were positively correlated with disease duration.

Arterial stiffness and carotid intima-media thickness in diabetic peripheral neuropathy.

BACKGROUND: We investigated the relationship between peripheral neuropathy and parameters of arterial stiffness and carotid intima media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: The study included 161 patients (80 females and 81 males), 69 of whom had peripheral neuropathy. All patients underwent 24-h blood pressure monitoring, and arterial stiffness parameters were measured. The CIMT was measured using B-mode ultrasonography and patients also underwent transthoracic echocardiographic examination. RESULTS: Patients with peripheral neuropathy, compared with those without it, were older (54.68±8.35 years vs. 51.04±7.89 years; p=0.005) and had T2DM for longer periods (60 vs. 36 months; p=0.004). Glycated hemoglobin (HbA1c) values (8.55±1.85 mg/dL vs. 7.30±1.51 mg/dL; p<0.001), pulse wave velocity (PWV) (7.74±1.14 m/s vs. 7.15±1.10 m/s; p=0.001), CIMT (anterior 0.74±0.15 mm vs. 0.67±0.13 mm; p=0.01), and left ventricular mass (LVM) index (98.68±26.28 g/m2 vs. 89.71±19.70 g/m2; p=0.02) were all significantly increased in the group with peripheral neuropathy compared to the group without peripheral neuropathy. We determined that duration of diabetes, HbA1c, and LVM index were predictors of peripheral neuropathy. CONCLUSIONS: A significant relationship was found between diabetic neuropathy and increased PWV, a parameter of arterial stiffness, as well as CIMT, a marker of systemic atherosclerosis. Diabetic peripheral neuropathy may be a determinant of subclinical atherosclerosis in T2DM.

The relationship between uric acid and erectile dysfunction in hypertensive subjects.

BACKGROUND: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. METHODS: A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (< 21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. MAIN RESULTS: The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of > 5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. CONCLUSION: UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

Is the thrombus truly free-floating? A case report.

A free-floating thrombus in the left atrium is very rare in mitral stenosis. Such a thrombus can lead to sudden circulatory arrest and syncope or can cause severe cerebral or peripheral thromboembolic events. Clinical diagnosis is difficult, but left atrial thrombus should be suspected if patients with mitral stenosis and atrial fibrillation have intermittent or changing murmurs, emboli, or syncope. We describe the case of a patient with mild mitral stenosis under warfarin therapy, and a left atrial pedunculated thrombus discovered during the investigation for syncope attacks.

[Proprotein convertase subtilisin/kexin type 9 (PCSK9) and inhibitors]. / Proprotein konvertaz subtilisin/keksin tip 9 (PCSK9) ve inhibitörleri.

Hypercholesterolemia is a major risk factor for atherosclerosis. Low-density lipoprotein cholesterol (LDL-C) lowering drugs reduce cardiovascular morbidity and mortality. However, many individuals treated with statins do not achieve their target levels of LDL-C. So, there is great need for new drugs to reduce cholesterol in those patients who have not achieved target levels with statins as well as those who are statin intolerant. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a novel agent, which plays an important role in the regulation of cholesterol metabolism. It increases degradation of the low-density lipoprotein receptor, modulates cholesterol metabolism, and transport. This review will address new therapeutic strategies targeting PCSK9, including monoclonal antibodies, small interfering RNAs, and other small molecule inhibitors.

The relationship between coronary sinus and impaired right ventricular myocardial performance index in mitral stenosis.

OBJECTIVES: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). METHODS: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 ± 12 years) and 20 age- and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 ± 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical four-chamber view during the ventricular systole. RESULTS: The RV MPI was significantly higher in the MS group compared to the control group (0.60 ± 0.11 vs. 0.41 ± 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 ± 1.1 mm vs. 6.5 ± 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). CONCLUSION: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.

[Right atrial perforation after an endocardial screw-in atrial lead implantation]. / Aktif atriyum elektrodu yerlestirilmesi sonrasi sag atriyum delinmesi.

A 24-year-old female underwent implantation of a right-sided dual chamber permanent pacemaker for cardioinhibitory syncope with active fixation atrial lead. Five days after the procedure, the patient developed pleuritic chest pain and difficulty in breathing. Minimal pericardial effusion and right hemopneumothorax were found. The atrial active screw-in lead was visualized just above the right atrial appendage with its helix perforating the right atrial wall, pericardium and pleura, reaching the right mid-lobe. Lead extraction was performed, and a passive bipolar atrial lead was implanted during the same session without any problems.

Effect of candesartan treatment on echocardiographic indices of cardiac remodeling in post-myocardial infarction patients.

OBJECTIVE: Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. MATERIAL AND METHODS: In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups. RESULTS: According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). CONCLUSION: Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.