Mean platelet volume is associated with aortic arterial stiffness in patients with Behçet's disease without significant cardiovascular involvement.

BACKGROUND: Behçet's disease (BD), is a chronic, systemic vasculitis, which may affect all types and sizes of blood vessels. BD is associated with endothelial dysfunction and chronic inflammation. Endothelial dysfunction is the critical early step in the process of atherogenesis, and it is commonly investigated by measuring arterial stiffness. Mean platelet volume (MPV) has been investigated in relation with both thrombosis and inflammation. We aimed to investigate the relationship between an increased arterial stiffness and MPV in patients with Behçet's disease without significant cardiovascular involvement. METHODS: We studied 36 patients (20 males, mean age: 37.6 ± 11.7 years) who were diagnosed by the international diagnostic criteria of BD and 35 healthy controls (15 males, mean age: 35.0 ± 10.6 years), and the two groups were matched by age and gender. MPV levels and arterial stiffness measurements were compared in these groups. RESULTS: Arterial stiffness was higher in patients with BD compared to control group. (BD and controls; 7.28 m/s, 6.64 m/s; respectively) (p: 0.02). MPV levels were also significantly higher in patients with BD compared to control group. (BD and controls; 8.86 ± 0.81 fl, 8.39 ± 0.96 fl, respectively) (p: 0.02). Additionally, arterial stiffness correlated positively with age, the duration of disease and MPV levels in patients with BD (p: 0.002, 0.03, 0.02 respectively). CONCLUSIONS: In our study, increased MPV is associated with arterial stiffness in patients with BD without significant cardiovascular involvement. It shows that there is a relationship between thrombosis and chronic inflammation in BD. Furthermore, MPV is also a moderate predictor of cardiovascular disease and represents an increase in platelet activation. These findings provide further evidence of a link between inflammation and thrombosis in patients with BD.

Elevated serum levels of endocan in patients with psoriasis vulgaris: correlations with cardiovascular risk and activity of disease.

BACKGROUND: Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leucocyte adhesion molecule expression and leucocyte infiltration. Psoriasis is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is widely regarded as being the initial process in the development of atherosclerosis. Human endothelial cell-specific molecule-1 (endocan) is a novel human endothelial cell-specific molecule. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. OBJECTIVES: To investigate the relationship between serum levels of endocan and both cardiovascular risk and disease activity in patients with psoriasis vulgaris. METHODS: A total of 29 patients with psoriasis vulgaris and 35 control subjects were included in the study. Endocan, high-sensitivity C-reactive protein (hsCRP) and carotid artery intima-media thickness (cIMT) were measured in all subjects. RESULTS: Serum endocan levels were significantly different between the two groups (P < 0.001). In patients with psoriasis, serum endocan levels correlated with Psoriasis Area and Severity Index, hsCRP and cIMT (r = 0.477, P = 0.009; r = 0.484, P = 0.008; r = 0.408, P = 0.02, respectively). CONCLUSIONS: Circulating endocan may represent a new marker that correlates with cardiovascular risk as well as the severity of disease in patients with psoriasis vulgaris. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders. Whether endocan levels could become a treatment target merits further investigation.

The report of male gender and retinopathy status improves the current consensus guidelines for the screening of myocardial ischemia in asymptomatic type 2 diabetic patients.

BACKGROUND AND AIMS: American Diabetes Association (ADA), French-speaking Societies for diabetes & cardiology (ALFEDIAM-SFC) and Cardiac Radionuclide Imaging (CRI) have proposed guidelines for the screening of silent myocardial ischemia (SMI). The aim of the study was to evaluate their diagnostic values and how to improve them. METHODS AND RESULTS: 731 consecutive type 2 diabetic patients with ≥1 additional risk factor were screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent coronary artery disease (CAD) by coronary angiography. A total of 215 (29.4%) patients had SMI, and 79 of them had CAD. ADA (Odds Ratio 1.7 [95% Confidence Interval: 1.2-2.5]; p < 0.05), ALFEDIAM-SFC (OR 1.5 [1.0-2.5], p < 0.05) and CRI criteria (OR 2.0 [1.4-2.8], p < 0.01) predicted SMI. Considering the presence of male gender and retinopathy added to the prediction of SMI allowed by ADA criteria (c statistic: area under the curve AROC 0.651 [0.605-0.697] versus 0.582 [0.534-0.630]), p < 0.01 and ALFEDIAM-SFC criteria (AROC 0.672 [0.620-0.719] versus 0.620 [0.571-0.670], p < 0.05). CRI prediction of SMI was improved by considering the presence of macroproteinuria and retinopathy (AROC 0.621 [0.575-0.667] versus 0.594 [0.548-0.641], p < 0.01). Severe retinopathy (OR 3.4 [1.2-9.4], p < 0.05), smoking habits (OR 2.1 [1.1-4.2], p < 0.05) and triglyceride levels (OR 1.3 [1.0-1.6], p < 0.05) were independent predictors of CAD in the patients with SMI. CONCLUSION: Current guidelines criteria are able to predict SMI but prediction may be improved by considering male gender and the presence of retinopathy. CAD is more frequent in the patients with SMI who are current smokers, have severe retinopathy and higher triglyceride levels.

Reirradiation for recurrent head and neck carcinoma.

PURPOSE: To present the outcome and toxicity profile of reirradiation (re-RT) in patients with recurrent head and neck cancer (HNC). METHODS: From 1995 to 2009, 35 patients underwent re-RT at our institution. Twenty-seven (77%) patients were initially diagnosed with stage III/IV disease. The median total doses of irradiation -first and second courses- were 66.0 Gy (range 54.0-70.0) and 55.8 Gy (range 32.5-66.6), respectively. The median time from the first course of irradiation to re-RT was 25.2 months (range 8-136). Six (17%) patients underwent salvage surgery before reirradiation. Concurrent chemotherapy was administered to 18 (51%) patients. RESULTS: With a median follow-up of 12.9 months (range 2.5-109.6), the 1- and 2-year locoregional control (LRC) rates were 41 and 9%, respectively. The 1- and 2-year disease free survival (DFS) rates were 30 and 7%, respectively. The 1- and 2-year overall survival (OS) rates were 42.9 and 7.9%, respectively. Grade 3 acute toxicity was reported in 7 (20%) patients while grade 3-4 late radiation-induced complications were seen in 8 (23%) patients. In univariate analysis, an improvement in OS was observed in patients with initial N0/N1 stage vs. those with N2/N3 stage (p=0.004). Prior neoadjuvant chemotherapy was associated with significantly inferior OS (p=0.028), while neoadjuvant chemotherapy in recurrence was predictive of improved LRC (p=0.041). CONCLUSION: re-RT in HN cancer is associated with poor prognosis, especially in patients with inoperable disease. Complications due to treatment are not infrequent. Nonetheless, our outcomes remain encouraging and applicable to a carefully selected patient population.

Exosomes, cancer's little army.

In an attempt to conceptualize the process of cancer formation, Hanahan and Weinberg [2000] have outlined six universal characteristics of tumorigenesis, and labelled them as the "hallmarks of cancer". These hallmarks include; unlimited proliferation, evading growth suppressors, resisting cell death, replicative immortality, inducing angiogenesis, initiating invasion and metastasis. Cancer cell signalling is crucial for initiating and controlling cellular pathways that are involved in these hallmarks. The intricate network of communication between cancer cells and other cancer or non-cancer cells is still being investigated, and is yet to be fully understood. Initially it was proposed that the main form of communication between cells within the tumour microenvironment are soluble growth factors, and gap junctions. Then, researchers reported another form of cell-to-cell communication, through the release of spherical particles called exosomes. It is believed that these exosomes enable communication through the transfer of active components from the releasing cell, and off-loading it into the recipient cell. As researchers continue to examine the development of the cancer hallmarks and the pathways involved, it became evident that cancer cell-derived exosomes play a major role in almost all of them. This review will examine the role played by cancer cell-derived exosomes in development of cancer.