Diagnostic and prognostic value of Ischemia-modified albumin in patients with Crimean-Congo hemorrhagic fever.

The aim of this study was to determine the diagnostic and prognostic significance of ischemia modified albumin (IMA) levels in patients with Crimean-Congo hemorrhagic fever (CCHF). This retrospective study was conducted with patients with CCHF. IMA levels in patients with CCHF were determined using the rapid colorimetric method. IMA levels of CCHF patients were significantly higher compared with the control group (P = 0.0001). At an IMA cut-off point of 0.555 ABSU (absorbance units), sensitivity was 65.1%, specificity 82.5%, positive predictive values (PPV) 82.5%, and negative predictive values (NPV) 65.1%. IMA levels of patients with hemorrhage were significantly higher compared with patients without hemorrhage (P = 0.005). IMA has been validated as both a new and sensitive ischemia and oxidative stress biomarker. In addition to its diagnostic significance, IMA investigated in CCHF patients at time of arrival may be an important marker with its prognostic role in determining in the early stage whether the disease will follow a hemorrhagic course.

Do hemodialysis adequacy data reflect reality?

Hemodialysis (HD) adequacy requires monitoring in line with standards and at appropriate intervals. However, the use of inappropriate or incorrectly applied techniques in the determination of HD adequacy can lead to highly unfortunate results. This study was intended to identify the path to a solution by determining how far HD adequacy in HD centers in our region reflects reality. Three hundred and thirty HD patients from eight centers were included. On the first visit, predialysis and postdialysis blood collection with the centers' own methods being used were observed and errors were recorded. Kt/V1 was calculated from pre- and postdialysis blood specimens taken by the units themselves. On the second visit, one session later, pre- and postdialysis blood samples were collected in line with guidelines by ourselves, the authors, and Kt/V2 was calculated from these samples. The eight units' total Kt/V2 value was significantly lower compared with Kt/V1 (<0.0001). The level of patients in all centers with Kt/V1 <1.2 was 13.5%, and that of patients with Kt/V2 <1.2 was 22.1%. No center, apart from one unit, managed to complete the collection of blood specimens as recommended by the guidelines. With one exception, blood collection for HD adequacy was not performed using proper technique in any center. This simple but easily overlooked situation, HD being regarded as adequate though in fact it is not, may lead to patients not being treated effectively and accurately and to a rise in mortality and morbidity in the long term.

Thrombin activatable fibrinolysis inhibitor (TAFI) levels in hypertensive patients and a comparison of the effects of amlodipine and ramipril on TAFI levels.

Hypertension is associated with fibrinolysis abnormality. Thrombin-activatable fibrinolysis inhibitor (TAFI) is a novel molecule-linking coagulation and fibrinolysis. The aim of this study was to investigate the levels of TAFI in primary hypertensive patients and to compare the effects of amlodipine and ramipril on TAFI levels. The study was performed with 58 hypertensive subjects and 27 healthy volunteers. Biochemical and hematological parameters and TAFI levels were measured at baseline and after 1-month follow-up. TAFI concentrations increased in hypertensive patients compared with the controls (P = .030). Additionally, TAFI levels decreased with blood pressure control at 1-month follow-up (P = .026). There was no significant difference between TAFI levels in the amlodipine and ramipril groups at baseline. However, after 1-month follow-up, TAFI levels were decreased in the amlodipine group (P = .037) but not in the ramipril group. Our study is the first in the literature to determine increased TAFI levels in primary hypertension patients. In addition, we determined a decrease in TAFI levels in the amlodipine group after 1 month, but none in the ramipril group.

Ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury in a rat ovarian-torsion model.

BACKGROUND/AIMS: To evaluate the ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury in a rat ovarian-torsion model. METHODS: 32 Sprague-Dawley rats were randomly divided into four groups: (1) ischemia group (n = 8) in which only left adnexal torsion was performed for 2 h, but no treatment was given; (2) vehicle group (n = 8) in which left adnexal torsion was performed for 2 h and at the end of 2 h ischemia polyethylene glycol (3% PEG, 1 ml, i.p.) was administered and a 24-hour reperfusion was continued; (3) clotrimazole group (n = 8) in which left adnexal torsion was performed for 2 h and at the end of 2 h ischemia clotrimazole (30 mg/kg, i.p.) was administered and a 24-hour reperfusion was continued, and (4) control group (sham-operated, n = 6) in which no adnexal torsion and no treatment were given. The criteria for ovarian ischemia were follicular cell degeneration, vascular congestion, hemorrhage and infiltration by inflammatory cells. Each specimen was scored for each criterion (0, none; 1, mild; 2, moderate; 3, severe). RESULTS: Clotrimazole significantly decreased plasma levels of serum malondialdehyde, ischemia-modified albumin, and total oxidant status. CONCLUSION: This study showed the ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury.

Acute increase in plasma D-dimer level in ovarian torsion: an experimental study.

BACKGROUND: Torsion of the ovary is a rare but serious cause of gynecologic surgical emergency. Specific laboratory markers that support the preoperative diagnosis of ovarian torsion are not currently available in the clinical routine. The aim of this study was to investigate the diagnostic value of plasma D-dimer level as an early indicator of ovarian torsion in an experimental rat ovarian torsion model. METHODS: Sixteen female adult Sprague-Dawley rats were used for this controlled experimental study. Eight rats in the sham operation group (Group I) underwent a surgical procedure similar to Group II but the ovary was not occluded. In Group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary for a 2-h period of ischemia. Right ovaries were surgically removed at the end of the procedure in each group. Blood was sampled before and after operation to assess plasma D-dimer levels. The main outcome measure was ovarian histopathologic findings scores and plasma D-dimer levels. RESULTS: There was no significant difference in pre-operative plasma D-dimer levels (0.5963 ± 0.2047 mg/l in Group I, 0.6344 ± 0.1348 mg/l in Group II, P = 0.815, Mann-Whitney U-test). However, mean plasma D-dimer value for Group II was significantly higher than that in the control group (1.2267 ± 0.3099 versus 0.6213 ± 0.2346 mg/l, respectively, Mann-Whitney U-test, P < 0.001), following 2 h of ovarian torsion. Ovarian tissue damage scores were also statistically significantly different among groups. CONCLUSIONS: If the observations made in a rat model are extended to humans, plasma D-dimer measurement may be a valuable parameter in the early diagnosis of ovarian torsion.

Relation between serum ischemia-modified albumin levels and rectus abdominis muscle flap viability.

Ischemia is a major cause of flap failure in reconstructive surgery. To detect circulatory compromise, many flap monitoring methods are used; however, there is no any optimal standard method. Ischemia-modified albumin (IMA) is an ischemia marker, which has recently been investigated in many studies and largely validated for early detection of ischemia. In this study, we investigated possible relationship between muscle flap viability and serum IMA levels in experimental flap model. The rectus abdominis muscle flap model was used in 18 New Zealand white rabbits. The study was planned using 3 groups. In group 1, the rectus abdominis muscle flap was harvested as a superior pedicle-based flap in which the inferior pedicle was sacrificed. In group 2, the flap was harvested by severing the superior pedicle. Both pedicles were harvested in group 3. Serum IMA levels were measured before the procedure and 1 hour, 6 hours, and 7 days postoperatively and then compared. In group 3, in which the ischemia was evident, and in group 1, IMA levels were significantly high 1 hour postoperatively (P < 0.05). There was no other significant difference in any of the other studied parameters between the groups. In conclusion, IMA can be used as a biochemical parameter for monitoring muscle flap viability.

Ischemia-modified albumin reduction after coronary bypass surgery is associated with the cardioprotective efficacy of cold-blood cardioplegia enriched with N-acetylcysteine: a preliminary study.

BACKGROUND: The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG). PATIENTS AND METHODS: Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination. RESULTS: Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p < or = 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group. CONCLUSIONS: IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.

Occult inflammation and/or ischemia may be responsible for the false positivity of biochemical Down syndrome screening test.

OBJECTIVE: To determine the possible underlying cause of a false-positive first or second trimester biochemical Down syndrome screening test result by means of second trimester amniotic fluid cytokine level analysis. METHODS: A total of 74 consecutive patients undergoing amniocentesis for karyotype analysis at 16-20 weeks' gestation were included in this prospective age-matched case-control study. The study group (n=38) had abnormal first or second trimester screening test results and normal karyotype results, while controls (n=36) included those admitted for genetic amniocentesis for other reasons who had normal first or second trimester screening test and normal karyotype results. Four markers [interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, and ischemia-modified albumin (IMA)] were studied in amniotic fluid. RESULTS: The mean age of the women in the study and control groups was 34.0+/-5.6 and 33.6+/-7.2 years, respectively. The women in the study and control groups had similar clinical and laboratory characteristics. The mean amniotic fluid IL-6 (414.84+/-83.96 vs. 343.02+/-110.59, p=0.002) and IL-8 (377.61+/-243.31 vs. 261.90+/-201.29, p=0.029), TNF-alpha (24.91+/-5.78 vs. 21.60+/-5.55, p=0.014), and IMA (1.19+/- 0.10 vs. 1.05+/-0.12, p<0.001) values were significantly increased in the study group when compared to controls. CONCLUSION: The higher amniotic fluid cytokine and ischemia-modified albumin levels in patients with false-positive first or second trimester biochemical Down syndrome screening test may result from subclinical fetal membrane inflammation and/or ischemia.

Elevated concentrations of serum ischaemia-modified albumin in PCOS, a novel ischaemia marker of coronary artery disease.

This prospective case-control study comprised 41 consecutive patients with PCOS and 41 non-PCOS control patients matched for body mass index (BMI) and age (mean age, 22.17 +/- 4.45 and 23.29 +/- 3.11 years, respectively). Serum IMA, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), prolactin, thyroid-stimulating hormone, LH, FSH, oestradiol, total testosterone, dehydroepiandrosterone sulphate, high-density lipoprotein (HDL) cholesterol, triglyceride, 17-alpha-hydroxyprogesterone and cortisol concentrations were measured. Compared with the control group, women with PCOS had significantly higher concentrations of LH (P < 0.001), LH/FSH ratio (P < 0.001), fasting insulin (P < 0.001), HOMA (P < 0.001) and total testosterone (P = 0.031). Serum IMA concentrations in PCOS women were significantly higher than control group (0.63 +/- 0.26 versus 0.49 +/- 0.16 absorbance units, respectively, P = 0.003, 95% CI 0.05-0.24). Bivariate analysis revealed that serum IMA concentrations were only well correlated with the Ferriman-Gallwey score (r = 0.416, P = 0.007), total testosterone (r = 0.357, P = 0.022) and BMI (r = 0.3751, P = 0.016) in PCOS group. Serum IMA, which has recently been developed as a clinical marker of ongoing myocardial ischaemia, appears to be elevated in PCOS. This may be due to increased androgen concentrations observed in PCOS.

Serum anti-carbonic anhydrase I and II antibodies and idiopathic recurrent pregnancy loss.

In up to 50% of recurrent pregnancy losses (RPL), the underlying pathophysiological mechanisms remain undetermined. Immunological factors may be involved. The objective of this study was to compare serum concentrations of autoantibodies to carbonic anhydrase (CA) I and II in women with and without RPL. Serum anti-CA-I and anti-CA-II concentrations in 29 women with RPL and 39 women without RPL on menstrual cycle day 3 were assessed and compared for this prospective age-matched controlled study. The mean serum anti-CA-I (0.287 +/- 0.177 versus 0.184 +/- 0.093, P = 0.003) and anti-CA-II (0.496 +/- 0.240 versus 0.344 +/- 0.108, P = 0.001) antibody concentrations were significantly higher in women with RPL, compared with controls. For serum anti-CA-I, an absorbance higher than 0.463 was taken as positive (mean + 3 SD of controls) and was detected in four of 29 patients with RPL (13.79%, 0.287 +/- 0.177). For serum anti-CA-II, an absorbance higher than 0.668 was taken as positive (mean + 3SD of controls) and was detected in seven of 29 patients with RPL (24.14%, 0.496 +/- 0.240). All patients with positive anti-CA-I antibody also had positive anti-CA-II antibody. Antibodies specifically reactive to CA-I and CA-II were found to be present at a higher frequency in the serum of subjects with RPL.

Prognostic Value of Uric Acid for Pulmonary Thromboembolism.

BACKGROUND: Pulmonary thromboembolism is a serious cardiovascular condition with considerable morbidity and mortality. Clinical studies have indicated that hyperuricemia is an independent risk factor for cardiovascular events. The aim of this study was to investigate possible value of the serum levels of uric acid (UA) in predicting 30-d pulmonary thromboembolism-related mortality. METHODS: Pulmonary thromboembolism was confirmed by computed tomography pulmonary angiography, demographic data, troponin, systolic pressure and pulse on admission, and simplified pulmonary embolism severity index assessment. UA levels were analyzed on admission. The primary end point was all-cause mortality during the first 30 d. RESULTS: A total of 337 acute pulmonary thromboembolism subjects, of whom 59% were females, were enrolled. The median (interquartile range) serum UA level was 5.35 (4.1-7.3) mg/dL. Serum UA levels of deceased subjects were higher than those of alive subjects during the study period (6.9 [4.6-10.0] mg/dL vs 5.2 [4.1-7.0] mg/dL, P = .038). In the receiver operating characteristic analysis, the area under the curve was 0.650 (CI 0.732-0.960) for UA levels for all-cause mortality. A level of serum UA ≥ 5 mg/dL showed 73% sensitivity and 88% negative predictive value for all-cause 30-d mortality. A weak correlation was determined between the UA levels and age (r = 0.25, P < .001) and any troponin (r = 0.267, P < .001). Serum UA level was an independent predictor of short-term mortality in pulmonary thromboembolism (odds ratio 1.2, P = .002). CONCLUSIONS: Serum UA levels may be a potential biomarker for predicting outcome in patients with acute pulmonary thromboembolism.

Effects of Turkish pollen and propolis extracts on respiratory burst for K-562 cell lines.

Bee-collected pollen and propolis are apicultural products which are composed of nutritionally valuable substances and contain considerable amounts of polyphenol substances which may act as potent antioxidants. We wanted to show if respiratory burst within a cancer cell lines could be influenced when incubated with pollen and propolis extracts or not. Pollen and propolis extracts at concentrations of 50, 25, 12.5 and 0 mg/ml were prepared by dimethyl sulfoxide (DMSO). K-562 cell cultures and mononuclear cell (MNC) cultures prepared from a peripheral blood sample to serve as control cells were incubated with extracts for 24 h. Determination of respiratory burst was carried out by intracellular dichlorofluorescein (DCFH) test by using flow-cytometric fluorescence analysis. While about 90% and 66% fluorescence was detected at zero concentrations for both K-562 and MNC cultures, fluorescence positivity decreased (between 3.8% and 11.8%) as concentrations of both propolis and pollen extracts increased for K-562 cell culture, but unchanged (between 20% and 83%) for MNC culture. It was concluded that pollen and propolis extracts inhibit respiratory burst within cancer cell lines probably by their antioxidant potentials.

Can be galectin-3 a novel marker in determining mortality in hemodialysis patients?

BACKGROUND: Cardiovascular (CV) mortality is common in hemodialysis (HD) patients. There are some difficulties involved in determining CV risk. Galectin-3 is a molecule with a demonstrated correlation with CV mortality and which is approved in the stratification of heart failure (HF) risk. The purpose of this study was to assess the previously uninvestigated relationship between galectin-3 and cardiac mortality in HD patients. METHODS: Two hundred ninety clinically stable HD patients aged over 18 and on a thrice-weekly intermittent HD program lasting >3 months and 30 healthy individuals were enrolled in this multi-center, prospective, observational study and monitored over 24 months. Blood specimens were collected at the start of the study for the measurement of galectin-3 and other biochemical parameters. At the end of the study, the relations between galectin-3 and other biochemical and demographic parameters and mortality were analyzed. RESULTS: Galectin-3 levels were significantly higher in the HD group compared to the control group (p < 0.001). All-cause mortality was observed in 63 (21%) patients. At multivariate Cox regression analysis, age, low albumin, low DBP, high galectin-3 and high HsCRP were identified as prognostic determinants of all-cause mortality, while age, low albumin, high galectin-3 and high SBP were identified as prognostic determinants of cardiac mortality. CONCLUSION: This study shows, for the first time in the literature, that galectin-3 may be a novel biomarker of cardiac mortality in HD patients. We think that, when supported by further studies, galectin-3 can be a promising biomarker in predicting cardiac mortality in HD patients.

The effect of dexmedetomidine on oxidative stress during pneumoperitoneum.

PURPOSE: This study was intended to investigate the effect of dexmedetomidine on oxidative stress response in pneumoperitoneum established in rats. METHODS: Animals were randomized into three groups, group S: with no pneumoperitoneum, group P: with pneumoperitoneum established, and group D: given 100 mcg intraperitoneal dexmedetomidine 30 min before establishment of pneumoperitoneum. Plasma total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) activity were measured 30 min after conclusion of pneumoperitoneum. RESULTS: The mean TOS level was significantly higher in group P than in the other two groups, and the TOS level was significantly higher in group D than in group S (P < 0.05). Plasma TAS level was found to be lower in group P than in the other two groups, and the TAS level was lower in group D than in group S (P < 0.05). Consequently, the OSI was significantly higher in group P than in groups D and S (P < 0.05). CONCLUSIONS: Ischemia-reperfusion phenomenon that occurs during pneumoperitoneum causes oxidative stress and consumption of plasma antioxidants. Dexmedetomidine decreases oxidative stress caused by pneumoperitoneum and strengthens the antioxidant defense system.

The Diagnostic Value of ß-Human Chorionic Gonadotropin, Progesterone, and Ischemia-Modified Albumin and Their Combined Use in the Prediction of First Trimester Abortions.

Objective. To investigate serum levels of free ß-HCG, progesterone, and ischemia-modified albumin (IMA) and their combined use in the prediction of first trimester abortions. Methods. A total of 156 pregnant women between 5 and 13 weeks of gestational age were included in this study. At admission, serum levels of free ß-HCG, progesterone, and IMA were noted and all cases were divided into two groups; Group I (n = 77) resulted in abortion including missed abortion, incomplete/complete abortion, and inevitable abortion whereas Group II (n = 79) included normal pregnancies. Results. Compared to Group II, the significantly decreased value of free ß-HCG progesterone and significantly increased value of IMA were found in Group I (P < 0.01, P < 0.01, P < 0.01, resp.). When combining all three parameters, sensitivity 75%, specificity 99%, PPV 98%, and NPV 76% were obtained. The multivariate logistic regression analysis revealed the free ß-HCG, progesterone, and IMA independent factors in the prediction of abortions. Conclusions. The combined use of free ß-HCG, progesterone, and IMA levels can be useful in the prediction of first trimester spontaneous abortions.

The effects of spinal, inhalation, and total intravenous anesthetic techniques on ischemia-reperfusion injury in arthroscopic knee surgery.

PURPOSE: To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. METHODS: Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1), 30 min after tourniquet inflation (t2), immediately before (t3), and 5 min (t4), 15 min (t5), 30 min (t 6), 1 h (t7), 2 h (t8), and 6 h (t9) after tourniquet release. RESULTS: MDA and IMA levels increased significantly compared with baseline values in Group S at t2-t 9 and t2-t7. MDA levels in Group T and Group I were significantly lower than those in Group S at t2-t8 and t2-t9. IMA levels in Group T were significantly lower than those in Group S at t2-t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. CONCLUSIONS: TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

New marker of platelet activation, SCUBE1, is elevated in hypertensive patients.

BACKGROUND: Hypertension is associated with an increase in platelet activation and endothelial dysfunction and leads to a tendency to cardiovascular events (CVEs). Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) is a novel platelet activation marker. There are currently no studies showing the level of SCUBE1 in hypertensive patients. The purpose of this study was to determine the level of SCUBE1 in this patient group and to investigate the parameters affecting that level. METHODS: Forty-five newly diagnosed, untreated, stage 1 hypertensive patients and 21 healthy individuals were included. Blood specimens were collected to determine SCUBE1, soluble CD40 ligand, prothrombin time, partial thromboplastin time, fibrinogen, D dimer, hemogram, lipid parameters, blood urea nitrogen, creatinine, and uric acid levels. The relation between SCUBE1 level and demographic data and biochemical parameters was then investigated. RESULTS: SCUBE1 and sCD40L levels obtained from plasma specimens from the hypertensive group were significantly higher than those of the control group (P < 0.001; P < 0.05, respectively). Hypertensive group blood pressure (BP) values and uric acid, low-density lipoprotein, total cholesterol, and triglyceride levels were also statistically higher than those of the control group. Parameters affecting SCUBE1 levels were systolic and diastolic BP, sCD40L, lipid parameters, and uric acid levels. CONCLUSIONS: We show elevated levels of SCUBE1, a novel platelet activation marker, in primary hypertensive patients. We think that, when supported by further clinical studies, this newly described marker may be useful in the monitoring of CVEs in this patient group, in which platelet activation is known to be associated with such events.

Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) level in hemodialysis patients and parameters affecting that level.

BACKGROUND: Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)-domain-containing protein 1 (SCUBE1) is a cell surface protein belonging to the SCUBE gene family. SCUBE1 has been shown to rise in parallel with platelet activation in acute ischemic events. However, there are no studies showing levels in the hemodialysis patient group, in which there is known to be an increase in platelet function impairment and activation. The purpose of this study was to investigate SCUBE1 levels in a hemodialysis patient group and the factors affecting those levels. MATERIALS AND METHODS: One hundred three hemodialysis patients and 21 age-matched healthy controls were included. SCUBE1 and sCD40L levels were investigated from blood specimens collected on pre- and post-hemodialysis sessions. We investigated the correlation between SCUBE1 levels and sCD40L, patients' demographic data, parameters with hemodialysis treatment and routine biochemical tests. RESULT: SCUBE1 levels were significantly higher in the hemodialysis patient group compared with the controls (p=0.000). There was a significant rise in SCUBE1 levels in the post-hemodialysis session (p=0.000). We determined a positive correlation between SCUBE1 and sCD40L (p=0.016, r=0.215). Gender, blood pressure, BUN, creatinine, hematocrit and high-sensitivity C-reactive protein (hsCRP) levels, hemodialysis membrane surface area, amount of ultrafiltration, blood flow rate, dialysis flow rate and carnitine use significantly affected SCUBE1 levels. CONCLUSION: We have shown, for the first time in the literature, that SCUBE1 level, a potential acute ischemia marker, is elevated in hemodialysis patients with no clinical ischemic event, and that various factors affect this elevation.

The role of fibrinolytic and antifibrinolytic activities in the pathophysiology of HELLP syndrome.

OBJECTIVE: To determine the role of the fibrinolytic and antifibrinolytic systems in HELLP syndrome. METHODS: This study consisted of patients with HELLP Syndrome (study group, n = 17), women who were admitted for routine prenatal care (pregnant control group, n = 21) and those presenting for routine gynecologic examination (non-pregnant control group, n = 21). Plasma tissue-type plasminogen activator (tPA), thrombin-activatable fibrinolysis inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT) and thrombomodulin (TM) were measured at admission for all groups. They were again measured after 7 days of biochemical improvement in HELLP Syndrome group. RESULTS: The mean ages of women in the study, pregnant, and non-pregnant control groups were 29.82 ± 4.98, 29.71 ± 5.64, and 27.60 ± 4.21, respectively. Demographically, the patients in all three groups were similar with regard to maternal age, race, and body mass index. Compared to the control groups, the mean tPA, PAI-1, TAFI, TAT, and TM levels were significantly increased in HELLP Syndrome. The mean plasma TAFI antigen concentration 7 days after delivery was significantly lower compared to the baseline (5.84 ± 7.14 % change, p < 0.01). Significant decreases in the mean plasma concentrations were also found in tPA (21.78 ± 20.93 ng/mL mean difference, p < 0.01), PAI-1 (14.22 ± 10.38 ng/mL mean difference, p < 0.001), TAT (0.93 ± 1.19 ng/mL mean difference, p < 0.01), and TM (0.54 ± 0.94 ng/mL mean difference, p < 0.05). CONCLUSION: It is likely that the impaired fibrinolytic and antifibrinolytic systems, in response to thrombus formation, affect the pathophysiology of HELLP syndrome.

The diagnostic and prognostic significance of soluble urokinase plasminogen activator receptor in systemic inflammatory response syndrome.

OBJECTIVES: This study was intended to investigate the value of suPAR, C-reactive protein (CRP) and procalcitonin (PCT) in the determination and prognosis of systemic inflammatory response syndrome (SIRS) patients. METHODS: The study was performed among patients with at least two SIRS criteria. PCT, CRP and suPAR were analyzed from the blood specimens taken. RESULTS: Eighty-five patients were enrolled in the SIRS group (44 bacteremia, 20 urinary tract infection, 12 pneumonia and 9 non-infection), and 53 individuals in the control group. A significant correlation was determined between suPAR, PCT and CRP values in both groups (P<0.0001). A suPAR cutoff value of 2.8ng/mL was associated with an NPV of 87% and PPV of 91%, with 92% sensitivity and 85% specificity. A relatively high suPAR level that might predict fatality was also determined in fatal cases (P=0.001). CONCLUSION: suPAR possesses high sensitivity and specificity levels in terms of differential diagnosis, and high suPAR levels can predict fatality.