Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Texture analysis of multiparametric magnetic resonance imaging for differentiating clinically significant prostate cancer in the peripheral zone.

BACKGROUND: Texture analysis (TA) provides additional tissue heterogeneity data that may assist in differentiating peripheral zone(PZ) lesions in multiparametric magnetic resonance imaging (mpMRI). This study investigates the role of magnetic resonance imaging texture analysis (MRTA) in detecting clinically significant prostate cancer (csPCa) in the PZ. METHODS: This retrospective study included 80 consecutive patients who had an mpMRI and a prostate biopsy for suspected prostate cancer. Two radiologists in consensus interpreted mpMRI and performed texture analysis based on their histopathology. The first-, second-, and higher-order texture parameters were extracted from mpMRI and were compared between groups. Univariate and multivariate logistic regression analyses were performed using the texture parameters to determine the independent predictors of csPCa. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of the texture parameters. RESULTS: : In the periferal zone, 39 men had csPCa, while 41 had benign lesions or clinically insignificant prostate cancer (cisPCa). Themajority of texture parameters showed statistically significant differences between the groups. Univariate ROC analysis showed that the ADC mean and ADC median were the best variables in differentiating csPCa (p < 0.001). The first-order logistic regression model (mean + entropy) based on the ADC maps had a higher AUC value (0.996; 95% CI: 0.989-1) than other texture-based logistic regression models (p < 0.001). DISCUSSION: MRTA is useful in differentiating csPCa from other lesions in the PZ. Consequently, the first-order multivariate regressionmodel based on ADC maps had the highest diagnostic performance in differentiating csPCa.

[Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Acute Brucellosis and Brucellar Spondylodiscitis]. / Akut Brusellozis ve Brusellar Spondilodiskitte Serum Nötrofil Jelatinaz Iliskili Lipokalin Düzeyleri.

Brucellosis is a zoonotic infectious disease caused by Brucella spp., an intracellular bacterium. The complications of acute Brucellosis may affect all organs and systems. The most common complication of the disease is musculoskeletal system involvement. The neutrophil gelatinase-associated lipocalin (NGAL) is a marker of neutrophil formation and acts as a siderophore-binding protein to prevent bacterial iron uptake and its use as a marker in the diagnosis and follow-up of bacterial infections is being investigated. The aim of this study was to measure the serum levels of NGAL in patients with acute Brucellosis and Brucellar spondylodiscitis, and to determine whether there is a correlation between NGAL levels and the progression and complications of the disease. This prospective case control study was conducted with 240 patients and 120 healthy controls. The diagnosis of acute Brucellosis was established when a person was asked to take an STA test due to clinical symptoms within the past eight weeks, and the test result that exceeded 1/160, or a 4-fold titer increase was found in the STA test after an interval of two weeks, and/or there was Brucella spp. growth in the blood culture. A contrasted lumbar magnetic resonance (MR) scan was performed on patients diagnosed with acute Brucellosis who had lower back pain. Presence of spondylodiscitis was assessed radiologically with contrasted lumbar MR images. NGAL levels were determined with ELISA assay. The median NGAL value was found to be 456.67 ng/L (101.41-5804.41 ng/L) in patients with acute Brucellosis and 113.84 ng/L (58.29-542.34 ng/L) in the control group. The median NGAL value was statistically higher in the patients than the control group (p= 0.001). Brucellar spondylodiscitis was detected in 57 (23.7%) of 240 patients diagnosed with acute Brucellosis. The median NGAL value was 1885.62 ng/L (143.21-5804.41 ng/L) in patients with Brucellar spondylodiscitis, and 356.87 ng/L (101.41-1874.07 ng/L) in those who did not have Brucellar spondylodiscitis. This difference was statistically significant (p= 0.001). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were found to be higher in patients who had Brucellar spondylodiscitis. Blood cultures were drawn from 186 (77.5%) of the 240 patients diagnosed with acute Brucellosis. The blood culture positivity rate was 36.02%. Patients whose blood cultures were positive had higher NGAL levels (p= 0.001). The blood culture positivity rate was higher in patients who were diagnosed with Brucellar spondylodiscitis (p= 0.001). A regression analysis showed that female gender and high levels of NGAL, ESR, and alanine aminotransferase (ALT) could be used as predictors of Brucellar spondylodiscitis. The explanatoriness of the model was 82.3%. Although determination of NGAL levels is seen as a useful marker in the diagnosis of acute Brucellosis and predicting the presence of Brucellar spondylodiscitis, more comprehensive studies are required to be used in clinical practice in regions where Brucellosis is endemic.

[Evaluation of Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) and Bone Morphogenetic Protein-7 (BMP-7) Serum Levels in Patients Followed Up With A Diagnosis of COVID-19]. / COVID-19 Tanisiyla Takip Edilen Hastalarda Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) ve Kemik Morfogenetik Protein-7 (BMP-7) Serum Düzeyinin Degerlendirilmesi.

Coronavirus disease 2019 (COVID-19) is a global health problem caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 infection may present with clinical pictures ranging from asymptomatic or mild forms to respiratory failure requiring intensive care follow-up and mechanical ventilation. The course of this disease with different clinical presentations raises many immunological questions. This study aimed to evaluate the serum levels of Annexin-1 (ANXA-1), Annexin-2 (ANXA-2) and bone morphogenetic protein-7 (BMP-7) in patients diagnosed with COVID-19 and to investigate whether these markers are associated with lung involvement. The study was conducted in 173 patients who were followed and treated with the diagnosis of COVID-19 and 51 healthy control group. Patients were primarily divided into two groups based on the presence of typical lung involvement (ground glass opacities, consolidation, and both) in the thoracic computed tomography (CT) scans for COVID-19. Those who found to have involvement in thoracic CT scans were divided into three groups as mild (< 33%), moderate (34-66%), and severe (> 67%) according to the extent of their lesions. Of the 173 patients included in the study, 130 had typical thoracic CT involvement for COVID-19, while 43 did not. ANXA-1, ANXA-2 and BMP-7 values were found to be higher in the patients than the control group (p= 0.001, p= 0.001, p= 0.001). ANXA-2 levels were higher in patients with thoracic CT involvement than those without thoracic CT involvement (p= 0.023). In addition, when the patients were evaluated according to their thorax CT involvement levels, it was found that as the lung involvement levels increased, ANXA-2 increased, ANXA-1 decreased, and BMP-7 levels did not change. While the increase in ANXA-2 was statistically significant, the decrease in ANXA-1 was not found statistically significant. When the relationship between the laboratory parameters and the thorax CT involvement level was evaluated; it was found that , the lymphocyte and thrombocyte counts decreased as the thorax CT involvement increased, and lactate dehydrogenase (LDH), ferritin, procalcitonin (PCT), C-reactive protein (CRP), D-dimer and troponin levels were increased. While no significant correlation was found between ANXA-1 and BMP-7 and laboratory parameters, a positive correlation was found between ANXA-2 and leukocyte count, LDH, troponin, PCT, ferritin, D-dimer, and CRP. The data obtained in our study suggest that the ANXA-2 level at the time of admission was related with the lung involvement and the level of involvement of the disease. As a result, molecular studies are needed today to understand the pathogenesis of COVID-19 and to investigate new treatment targets. Evaluation of ANXA-2 level may be important in predicting the level of lung involvement due to COVID-19.

Unplanned irradiation of internal mammary lymph nodes in breast cancer.

AIMS: To evaluate the incidental dose to the internal mammary chain (IMC) in patients treated with three-dimensional conformal radiotherapy, to estimate the predictors affecting the magnitude of IMC receiving dose and to determine the predictive role of clinical parameters on survival. MATERIALS AND METHODS: Between 2009 and 2015, 348 patients undergoing RT for breast cancer were retrospectively analyzed. All patients underwent our department's routine procedure for breast cancer. The internal mammary lymph nodes were contoured according to Radiation Therapy Oncology Group (RTOG) concensus. Based on each patient's dose-volume histograms, the mean doses (D mean) to internal mammary gland were analyzed. Overall survival and disease-free survival were also evaluated. RESULTS: The median follow-up time was 38 (range 3-80) months. The D mean to IMC was 32.8 Gy and the dose delivered to IMC showed a greater coverage in modified radical mastectomy (MRM) group compared with breast conserving surgery (34.6 vs 26.7 Gy). The T-stage of tumor and the N-stage of tumor affected the incidental dose to IMC. The tumor size, the number of involved lymph nodes, the percentage of involved lymph nodes, hormonal status, advanced T-stage and advanced N-stage were the prognostic factors that affect survival. CONCLUSION: The IMC received meaningful incidental irradiation dose when treated with two opposite tangential fields and ipsilateral supraclavicular fossa with a single anterior field. The real effect of incidental dose on survival and the hypothesis about the benefit of incidental irradiation of IMC should be examined in clinical studies.

Urinary kidney injury molecule-1 levels in renal stone patients.

OBJECTIVE: To study kidney injury molecule-1 (KIM-1) biomarker levels, indicating renal tubular damage, in patients with kidney stones and in those who underwent minimally invasive method stone treatment. PATIENTS AND METHODS: Sixty patients with renal stones between 10 and 20 mm were included into the present study. Patients who were divided into three cohorts underwent micropercutaneous nephrolithotomy (microperc), retrograde intrarenal stone surgery (RIRS), and percutaneous nephrolithotomy (PNL). Urine samples were obtained from all participants before, 4 h and 14 days after the procedure. In all the samples obtained, urinary KIM-1 and creatinine (Cr) levels were measured and KIM-1/Cr ratios (ng/mg creatinine) were calculated. RESULTS: Preoperative urine KIM-1/Cr ratio was higher than postoperative 14th day. The bigger the renal stone size, the higher was the ratio (correlation coefficient 0.353, p = 0.006). According to preferred treatment procedure, there was a statistically significant decrease in preoperative and postoperative 4th hour and 14th day urine KIM-1/Cr rates in the RIRS and PNL, yet none in the microperc group (p = 0.010, p = 0.001, p = 0.212, respectively). CONCLUSION: In renal stone patients, the elevated urine KIM-1/Cr ratio levels increase further according to stone size. KIM-1/Cr ratio is a promising marker might be helpful in monitoring the damage created by stone disease.

Tissue thioredoxin reductase-1 expression in astrocytomas of different grades.

Thioredoxin (Trx) is a redox active protein that regulates several physiological and biochemical functions, such as growth, apoptosis and cellular defense. The function of Trx itself is regulated by thioredoxin reductase (TrxR). Studies performed in a variety of human primary tumors have shown that thioredoxin reductase 1 (TrxR1) is overexpressed in tumoral tissues compared with corresponding normal tissues. This study was designed to determine the expression of TrxR1 in astrocytoma tissues of different World Health Organization (WHO) grades (grade I-IV). The proliferative (Ki-67) and apoptotic indices of the specimens were also investigated for correlation analysis. Astrocytoma tissues were extracted from the histopathological specimens of 40 patients. These samples included seven histologically normal brain tissues that served as a control group and ten tumoral samples for each grade of astrocytoma (grade I-IV). The histologically normal brain tissues were obtained from the non-tumoral portions of the pathological specimens of grade I (2 cases), grade II (2 cases), grade III (2 cases) and grade IV (1 case) astrocytomas. TrxR1 expression was evaluated using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunostaining. The proliferative and apoptotic indices of the specimens were investigated by Ki-67 immunostaining and TUNEL assay, respectively. TrxR1 expression, as assessed by qRT-PCR, increased significantly with astrocytoma grade (p = 0.01). The immunostaining intensity of TrxR1 in grade IV astrocytomas was significantly greater than that in the control tissue and all other astrocytoma grades (p < 0.001). Similarly, immunostaining intensity of TrxR1 in the grade III astrocytomas was significantly greater than that in the control group and grade I astrocytomas (p < 0.001). All astrocytoma tissues showed more intense staining in ascending grades, but the differences between grade I and the control, grade II and the control, grades II and I, grades III and II were not statistically significant (p > 0.05). Ki-67 index values increased significant in accordance with grade progression (p = 0.01). The apoptotic index values were not significantly different in any group (p > 0.05); however, the differences between grade IV and the control and between grades IV and I were statistically significant (p < 0.05). Expression of TrxR1, as assessed by both qRT-PCR and immunostaining, correlated highly with both the astrocytoma grade and Ki-67 index.

An evaluation of matrix metalloproteinase-9 (Mmp-9) and tissue inhibitor metalloproteinase-1 (Timp-1) Serum levels and the Mmp-9/Timp-1 Ratio in Covid-19 patients.

Background: The progression of COVID-19 has different clinical presentations, which raises a number of immunological questions. Objectives: This study aimed to investigate MMP-9 and TIMP-1 levels in patients diagnosed with COVID-19 and whether the MMP-9/TIMP-1 ratio is associated with lung involvement in COVID-19. Methods: This study was conducted with 192 patients and 45 healthy controls. ELISA was used to measure the MMP-9 and TIMP-1. Results: The MMP-9 and TIMP-1 levels of the patients were found to be higher than those of the controls. MMP-9 and TIMP-1 were detected more in patients with lung involvement on chest CT scans than in those with no lung involvement on chest CT scans. A comparison of lung involvement levels revealed no difference was found between the groups. The MMP-9/TIMP-1 ratio was 5.8 in the group with lung involvement on chest CT scans and 6.1 in the group without lung involvement on chest CT scans. No difference was found between the two groups. A comparison with respect to lung involvement levels showed that the MMP-9/TIMP-1 ratio difference was found between the groups. Conclusion: Diagnostic and treatment methods targeting MMP-9 activity or neutrophil activation may be important in predicting lung involvement in COVID-19 and directing clinical outcomes.

Assessment of Quality of Life Following Radiotherapy in Patients with Rectum Cancer.

PURPOSE: The aim of the present study is to investigate the effects of radiotherapy (RT) on quality of life (QoL) and influencing factors. METHODS: Data of 106 patients who completely filled out the three questionnaires were evaluated in this prospective study. Quality of life was evaluated with cancer-specific QLQ-C30 and colorectal cancer module QLQ-CR29 created by European Organization for Research and Treatment of Cancer (EORTC). All statistical analyses were done with SPSS version 22 software. A p level of < 0.05 was accepted as statistically significant. RESULTS: Median age was 61 (27-86). Of the patients, 77 (72.6%) were male and 29 (27.4%) were female. When QLQ-C30 questionnaires were evaluated, it was observed that physical, role, cognitive, and emotional function scores were impaired following RT, however returned to pre-RT levels on control. According to the results of QLQ-CR29 questionnaire, after RT, impairment was observed in urination frequency, urinary incontinence, stool frequency, dysuria, fecal incontinence, embarrassment, and sexual interest in male scales; however, they returned to pre-RT values on control. When evaluated with regard to age, financial difficulty, global health score, mucus in stool, dysuria, dyspareunia, and abdominal pain were observed to be poorer in the young; urination frequency and urinary incontinence were observed to be poorer in the elderly. CONCLUSION: Although both functional and symptom scales were shown to impair, most of them were detected to be temporal and patients could well tolerate radiotherapy. Additional assessment is required for evaluating the late effects of treatments on QoL.

Patient Knowledge, Attitudes, and Behaviors Associated with Organ Donation.

BACKGROUND This study compared the knowledge, attitudes, and behaviors associated with organ donation and transplantation among patients undergoing dialysis versus those visiting family health centers (FHCs). MATERIAL AND METHODS This cross-sectional study included patients undergoing hemodialysis treatment at the Meram Medical Faculty and those visiting FHCs in Meram district for other reasons. RESULTS The study participants were 128 individuals visiting FHCs and 111 patients undergoing dialysis. Of these, 169 individuals (70.7%) correctly answered the question "What is brain death?" The knowledge level in the FHC group was higher than that in the dialysis group. Less than half of the individuals indicated willingness to donate an organ. Furthermore, subjects in the dialysis group were more likely than those in the FHC group to answered "no" to the question "Would you be willing to donate an organ to someone of a different religion?" CONCLUSIONS Positive attitude towards organ transplantation and donation does not necessarily reflect positive behavior these 2 groups.

Radiation-induced hypothyroidism in patients with breast cancer: a retrospective analysis of 243 cases.

This study aims to estimate the incidence of hypothyroidism (HT) and to evaluate the predictors affecting the development of HT after radiotherapy (RT) for breast cancer, with a focus on radiation dose-volumetric parameters. Between 2009 and 2015, 243 patients undergoing RT for breast cancer were retrospectively analyzed. Free triiodothyronine (FT3), free thyroxin (FT4), and thyrotropin (TSH) were monitored before and after RT. The relation between the doses to thyroid gland (Dmean, Dmax, Dmin), percentage of thyroid volume receiving > 10 Gy, 20 Gy, 30 Gy, 40 Gy, and 50 Gy (V10 to V50), absolute thyroid volume, and HT were analyzed. The risk of HT according to radiation fields and the other clinic factors were also evaluated. The median follow-up was 41 (range; 6 to 130) months. Sixty-seven percent of the patients received RT to the breast/chest wall and ipsilateral supraclavicular fossa. Of 243 patients, 51 (21%) were diagnosed with HT. The median time to the onset of HT was 27 (range; 5 to 64) months. There were no significant relationships observed between Dmin or V10 to V50 and HT. The surgery type, clinical stage, nodal status, RT field, Dmean, and Dmax were statistically significant predictors for HT in univariate analysis. The Dmean was the only prognostic factor predicting HT in multivariate analysis, and Dmean > 21 Gy was a threshold value for the evolvement of HT. In this study, we present evidence that postoperative irradiation of patients with breast cancer may frequently lead to HT. Patients who have received RT for breast cancer, especially irradiation on the supraclavicular region, may require thyroid function screening after RT.

Impaired Thiol-Disulfide Balance in Acute Brucellosis.

The objective of this study was to examine a novel profile: thiol-disulfide homeostasis in acute brucellosis. The study included 90 patients with acute brucellosis, and 27 healthy controls. Thiol-disulfide profile tests were analyzed by a recently developed method, and ceruloplasmin levels were determined. Native thiol levels were 256.72 ± 48.20 µmol/L in the acute brucellosis group and 461.13 ± 45.37 µmol/L in the healthy group, and total thiol levels were 298.58 ± 51.78 µmol/L in the acute brucellosis group and 504.83 ± 51.05 µmol/L in the healthy group (p < 0.001, for both). The disulfide/native thiol ratios and disulfide/total thiol ratios were significantly higher, and native thiol/total thiol ratios were significantly lower in patients with acute brucellosis than in the healthy controls (p < 0.001, for all ratios). There were either positive or negative relationships between ceruloplasmin levels and thiol-disulfide parameters. The thiol-disulfide homeostasis was impaired in acute brucellosis. The strong associations between thiol-disulfide parameters and a positive acute-phase reactant reflected the disruption of the balance between the antioxidant and oxidant systems. Since thiol groups act as anti-inflammatory mediators, the alteration in the thiol-disulfide homeostasis may be involved in brucellosis.

Is serum high-mobility group box 1 (HMGB-1) level correlated with liver fibrosis in chronic hepatitis B?

BACKGROUND: High-mobility group box 1 (HMGB1), identified as an alarmin molecule, was shown to have a role in virus-triggered liver injury. We aimed to evaluate the association between serum levels of HMGB1 and liver fibrosis. METHOD: This cross-sectional case-control study included 189 chronic hepatitis B (CHB) patients and 51 healthy controls. All patients underwent liver biopsy and modified Knodell scoring system used to determine the fibrosis level in CHB patients. Serum HMGB1 levels were determined with enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean serum HMGB1 levels of patients (58.1 ±â€Š54.7) were found to be higher than those of the control group (7.1 ±â€Š4.3) (P = .001). HMGB1 levels of patients with advanced-stage fibrosis (stage 4 and 5) were detected to be higher than those of patients with early-stage fibrosis (stage 1-3). However, this difference was not statistically significant (P > .05). Albumin levels of fibrosis 3 and 4 patients were lower than fibrosis 1 and 2 patients. ALT, HBV DNA, and AFP levels of fibrosis 5 patients were significantly higher than fibrosis 1 and 2 patients, and their platelet and albumin levels are lower than fibrosis 1 and 2 patients (P < .001). In a logistic regression model, fibrosis levels were correlated with ALT values and inversely correlated with albumin levels. CONCLUSION: In this study, we demonstrated that serum HMGB1 levels increase in the early course of liver injury and this increase is not correlated with severity of the liver damage.

High thioredoxin reductase 1 expression in meningiomas undergoing malignant progression.

Thioredoxin (Trx) is a redox active protein that regulates several physiological and biochemical functions, such as growth, apoptosis and cellular defense. The function of Trx itself is regulated by thioredoxin reductase (TrxR). This study was designed to determine the expression of TrxR1 in meningioma tissues of different World Health Organization grades (grade I-III). Meningioma tissues were extracted from the histopathological specimens of 29 patients. These samples included seven histologically normal meningeal tissues that served as a control group and 12 grade I, 12 grade II and 5 grade III meningioma samples. TrxR1 expression was evaluated using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunostaining. The proliferative and apoptotic indices of the specimens were investigated by Ki-67 immunostaining and TUNEL assay, respectively. TrxR1 expression, as assessed by qRT-PCR, increased significantly with meningioma grade (p < 0.001). The immunostaining intensity of TrxR1 increased significantly with meningioma grade (p < 0.001). Ki-67 index values increased significantly in accordance with grade progression (p < 0.001). The apoptotic index values were not significantly different in any group (p > 0.05). Trx system seems to be involved in the malignant progression of meningiomas. Further, large studies are required to elucidate the exact role of this system.

Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B.

BACKGROUND: Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. OBJECTIVES: To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. PATIENTS AND METHODS: This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. RESULTS: In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). CONCLUSIONS: AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.

Are bone morphogenetic protein-7 (BMP-7) serum levels correlated with development of hepatic fibrosis?

INTRODUCTION: Bone morphogenetic protein-7 (BMP-7) is a key protein in organogenesis and liver development. The protein has been studied in the context of liver fibrosis and regeneration. The aim of the present study was to explore any possible association between fibrosis levels (as revealed by liver biopsy) and serum BMP-7 levels. METHODOLOGY: A total of 189 patients with chronic hepatitis B and 51 healthy controls were enrolled in the study. RESULTS: The study group contained 120 (63.5%) males and 69 (36.5%) females, and the control group contained 25 males (49.0%) and 26 females (51%). In general, serum BMP-7 values of patients were higher than those of controls (p = 0.001). Serum BMP-7 values of patients with liver fibrosis of stages 1, 2, 3, or 4 were higher than control values (all p values = 0.01), but the serum BMP-7 levels of patients with stage 5 fibrosis were similar to that of controls. Associations between fibrosis stage and the serum levels of BMP-7, ALT, HBVDNA, platelets, and albumin were all statistically significant (p = 0.001). The AUROC for the BMP-7 level in advanced stage fibrosis was found to be 0.23. The data were analyzed using the binary logistic regression analysis (backward stepwise method) and BMP-7, HBVDNA, and platelet levels were found to be risk factors associated with fibrosis (p values 0.031, 0.040, and 0.001, respectively). CONCLUSIONS: BMP-7 may play anti-inflammatory and anti-fibrogenic roles in the pathogenesis of chronic hepatitis B infection.

[Comparison of the level of depression and anxiety in inactive hepatitis B carriers and chronic hepatitis B patients]. / Inaktif hepatit B tasiyicilari ve kronik hepatit B hastalarinin depresyon ve anksiyete düzeylerinin karsilastirilmasi.

OBJECTIVE: The aim of this study was to evaluate the relative contribution of chronic illness and the physical effects such illness on the mental status of chronic hepatitis B patients by comparing them to inactive hepatitis B carriers, based on Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores. MATERIALS AND METHODS: The study included 444 participants: 249 HBsAg-positive inactive carriers (IC group) and 195 chronic hepatitis B patients (CH group) that were undergoing follow-up at Adiyaman University Research and Education Hospital, Department of Infectious Diseases Department. HBV carrier status and chronic hepatitis B were diagnosed based on European Association for the Study of Liver (EASL) guidelines. The HDRS and HARS were administered to all the participants via psychiatric interview. RESULTS: The overall mean HDRS score was 6.2 ± 8 and the overall mean HARS score was 6.0 ± 7.1. Mean HDRS score in the IC group was 7.5 ± 5.8, versus 8.8 ± 6.6 in the CH group; the difference was significant (P = 0.037). Mean HARS score were similar in both groups (P > 0.05). There wasn't a difference in anxiety or depression scores based on participants'gender or age (P > 0.05). Additionally, there wasn't a correlation between duration of illness, and family history of hepatitis or cirrhosis, or anxiety or depression scores (P > 0.05). Anxiety scores were higher among the participants with comorbidity, in both CHB and IC groups (P= 0.005 and P = 0.001, respectively). Depression scores were higher among the IC group participants with comorbidity (P= 0.003). that can occur during the treatment and follow-up of chronic hepatitis patients. The presence of comorbidity in chronic hepatitis patients increases the risk of psychiatric complications. CONCLUSION: Psychiatric comorbidity, particularly anxiety and depression, are important problems.