Lipemia impact on HBA1C measurements in patients with and without hemoglobin variant: a rational laboratory use evaluation.

This study aims to compare the HbA1c test results obtained by widely used methods using samples with various lipemia levels and Hb variants, and to determine whether it is possible to correct the lipemia effect in the identical samples. Out of the laboratory information system (LIS), 48 patients with various HbA1c results were identified including patients with and without Hb variants. After the baseline measurements, all samples were spiked with intralipid solution and treated by a subsequent 0.9% saline replacement procedure. HbA1c values were measured four times sequentially with enzymatic and capillary electrophoresis (CE) methods for each sample, and the measurements were categorized as follows: Baseline; Spiked, 5g/L; Spiked, 20g/L; Post-saline replacement. Sequential HbA1c measurements using the CE method did not show a significant difference, but samples containing 20 g/L triglycerides and samples treated with 0.9% saline replacement showed a significant difference when compared to baseline measurements in both patients with and without Hb variants using the enzymatic method (p < 0.001). The correlation between the two methods was strong at baseline measurements (r = 0.977), declined with lipemia (r = 0.968 and r = 0.737 for 5 g/L and 20 g/L triglycerides, respectively), and then increased with 0.9% saline replacement (r = 0.962) in patients without Hb variants. This study revealed that the enzymatic method, but not CE was susceptible to lipemia interference both in patients with and without Hb variants. Lipemia interference could be partially eliminated with 0.9% saline replacement, but enzymatic measurements were still somewhat affected.

Can microalbuminuria be an indicator of renal involvement in pediatric Covid 19 patients?

BACKGROUND: Proteinuria (both tubular and glomerular in origin) and its implications are well-known features of adult patients with COVID19. However currently studies addressing proteinuria and its role in the outcome of kidney and patients of pediatric COVID 19 is scarce. We aimed to evaluate the presence of microalbuminuria in order to detect early renal involvement in pediatric COVID 19 patients. METHODS: We prospectively evaluated 100 pediatric patients hospitalized with COVID 19 between April and July 2020. Clinical presentations, laboratory findings and outcomes were investigated. Microalbuminuria was compared with the age, gender, disease severity, and hemoglobin, platelet, leukocyte count and serum CRP levels of the patients. RESULTS: Twenty seven out of 100 patients had microalbuminuria. Fourteen patients had mild and fourteen had moderate disease. There was not any significant relation according to age and gender. Microalbuminuria was not related to the severity of the disease. Also the mean microalbuminuria level did not differ according to the disease course. Hemoglobin, platelet, leukocyte counts and serum CRP levels were also were not correlated with microalbuminuria levels. CONCLUSION: Although there was no difference between the groups with different disease course; microalbuminuria is detected in an important ratio of pediatric patients with COVID 19 in this study. In the highlight of our findings we suggest that urinary findings of pediatric COVID patients should be carefully evaluated.

The effects of transport by pneumatic tube system on urine analysis.

The pneumatic tube transport system (PTS) is used frequently for the transport of samples in hospitals. Effects of PTS on urine components are unknown. In our study, we aim to examine the influence of PTS on the quality of routine urine microscopic parameters. Urine samples were divided into two groups: group 1 were transported to the laboratory manually and group 2 were transported to the laboratory via the PTS. Each of 187 urine samples was studied with iQ200 automated urine devices for erythrocytes, leukocytes, epithelial cells, crystal, cast and yeast cells. No statistically significant differences were detected between group 1 and group 2 for urine parameters. For erythrocytes, leukocytes, and epithelial cells, the gamma was 0.982, 0.959, and 1.0, respectively. For crystal, cast and yeast cells, the kappa values were 0.952, 0.866, and 1.0, respectively. PTS has no effect on erythrocytes, leukocytes, epithelial cells, crystal, cast, and yeast cells in urine analysis. We concluded that PTS can be used in the transport of urine samples.

Evaluation of BD Barricor™ Plasma Blood Collection Tube for Biochemical Tests.

BACKGROUND: Blood from patients who are receiving anticoagulant therapy may take longer to clot. Anticoagulation is an important component of the dialysis prescription. We compared BD Vacutainer® Barricor™ Plasma Blood Collection Tubes (BD BarrricorTM), BD Vacutainer® PST™ Lithium Heparin Tubes (BD PST™), and BD (Becton-Dickinson, Franklin Lakes, NJ, USA) Vacutainer Serum Separator Tubes (BD SST), as reference tube in dialysis patients to examine whether they had an effect on routine biochemical tests. MATERIALS AND METHODS: A total of 29 chronic hemodialysis patients were included in this study. Samples were collected into BD BarrricorTM, BD PST™, and BD SST tubes after the dialysis. All the tubes were centrifuged by NF 1200R rotor (1,300 g for 10 minutes at 22°C, 1,200 g for 10 minutes at 4°C, 2,400 g for 10 minutes at 22°C, respectively) after the incubation period. Eleven routine clinical chemistry parameters (Creatinine, Urea, Na, K, Cl, AST, ALT, Total Bilirubin, Direct Bilirubin, Calcium, Cholesterol) were analyzed on a Beckman Coulter AU 5800. RESULTS: Results of creatinine, K and cholesterol were statistically significantly different between the SST and LiH (p = 0.014, p = 0.009, and p < 0.001, respectively). In terms of other biochemical parameters we tested for all three tubes there was no clinically significance inspite of the statistically significance. CONCLUSIONS: BD Barricor™ tubes provide fast, clean, high-quality plasma samples, safe results, and may lower times and costs.

Comparison of vacuum and non-vacuum urine tubes for urinary sediment analysis.

Urine collection systems with aspiration system for vacuum tubes are becoming increasingly common for urinalysis, especially for microscopic examination of the urine. In this study, we aimed to examine whether vacuum aspiration of the urine sample has any adverse effect on sediment analysis by comparing results from vacuum and non-vacuum urine tubes. The study included totally 213 urine samples obtained from inpatients and outpatients in our hospital. Urine samples were collected to containers with aspiration system for vacuum tubes. Each sample was aliquoted to both vacuum and non-vacuum urine tubes. Urinary sediment analysis was performed using manual microscope. Results were evaluated using chi-square test. Comparison of the sediment analysis results from vacuum and non-vacuum urine tubes showed that results were highly concordant for erythrocyte, leukocyte and epithelial cells (gamma values 1, 0.997, and 0.994, respectively; p < .001). Results were also concordant for urinary casts, crystals and yeast (kappa values 0.815, 0.945 and 1, respectively; p < .001). The results show that in urinary sediment analysis, vacuum aspiration has no adverse effect on the cellular components except on casts.

Inflammation and chemerin in colorectal cancer.

Chemerin is expressed mainly in the adipose tissue. It is an agonist of chemokine-like receptor-1, which is expressed by the immune system cells. Chemerin stimulates the chemotaxis of the immune system cells, and this indicates the function of chemerin and chemokine-like receptor-1 in the immune response. The tumor microenvironment is very important for determining cancer cell growth and spreading. Therefore, we aimed to investigate the association between colorectal cancer, inflammation, and adipokines including chemerin, adiponectin, and vaspin. The study group consisted of patients with colon cancer, whereas the control subjects consisted of patients with benign conditions, diagnosed with colonoscopy. The two groups were compared in terms of the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, adiponectin, chemerin, and vaspin. A total of 41 (28 men, 13 women) patients with confirmed colon cancer, and 27 (15 men, 12 women) controls without, confirmed by colonoscopy, were enrolled. The median chemerin levels were found significantly higher in the study group than the controls (390 vs. 340 ng/mL, p = 0.032), whereas the mean vaspin and adiponectin levels were not significantly different. The median values for the CRP, fibrinogen, and ESR were significantly higher in the patients with colon cancer, when compared to the control group (6.08 vs. 1.4 mg/L, p < 0.0001; 408 vs. 359 mg/dL, p = 0.002; and 30 vs. 8 mm/h, p < 0.0001, respectively). Our results show that higher levels of circulating chemerin, CRP, fibrinogen, and ESR are associated with an increased risk of developing colorectal cancer.

Comparison of iSED and Ves-Matic Cube 200 Erythrocyte Sedimentation Rate Measurements With Westergren Method.

BACKGROUND: The erythrocyte sedimentation rate (ESR) test is performed widely in laboratories. Besides the traditional Westergren method, new methods have been developed for ESR measurements. We aimed to compare the instruments using new methods, iSED (Alcor Scientific) and Ves-Matic Cube 200 (Diesse Diagnostica Senese, Italy) with the Westergren method. METHODS: Blood samples from 136 patients were taken into EDTA tubes for automated analyzers and citrated tubes for Westergren method. Patients were divided into three groups- low, medium, and high-according to their sedimentation rates. Precision, stability, and interference studies of the methods were performed. RESULTS: The iSED sedimentation method (n = 136) yielded a slope of (0.61-0.84), with an intercept of (-2.32 to 1.89), which resulted in a mean bias of 13; and the Ves-Matic Cube 200 method (n = 136) yielded a slope of (0.85-1.00), with an intercept of (0.00-3.07), which resulted in a mean bias of 1.4 in Passing-Bablok regression analysis compared to the reference method. CONCLUSION: iSED sedimentation showed a poor correlation and a high bias (>10%) with the Westergren method, and Ves-Matic Cube 200 method showed a higher correlation and a lower bias than the iSED device when compared with Westergren reference method. These instruments should be carefully monitored.

Concordance and generalization of an AI algorithm with real-world clinical data in the pre-omicron and omicron era.

All viruses, including SARS-CoV-2, the virus responsible for COVID-19, continue to evolve, which can lead to new variants. The objective of this study is to assess the agreement between real-world clinical data and an algorithm that utilizes laboratory markers and age to predict the progression of disease severity in COVID-19 patients during the pre-Omicron and Omicron variant periods. The study evaluated the performance of a deep learning (DL) algorithm in predicting disease severity scores for COVID-19 patients using data from the USA, Spain, and Turkey (Ankara City Hospital (ACH) data set). The algorithm was developed and validated using pre-Omicron era data and was tested on both pre-Omicron and Omicron-era data. The predictions were compared to the actual clinical outcomes using a multidisciplinary approach. The concordance index values for all datasets ranged from 0.71 to 0.81. In the ACH cohort, a negative predictive value (NPV) of 0.78 or higher was observed for severe patients in both the pre-Omicron and Omicron eras, which is consistent with the algorithm's performance in the development cohort.

The diagnostic value of non-invasive tests for the evaluation of liver fibrosis in chronic hepatitis B patients.

BACKGROUND: Liver biopsy, which is considered the gold standard for the evaluation of hepatic fibrosis in patients with chronic hepatitis B (CHB), has certain limitations. The aim of this study was to investigate the diagnostic performance of non-invasive markers of hepatic fibrosis as potential alternatives to liver biopsy. METHODS: The medical records of 221 patients with a diagnosis of CHB who underwent a liver biopsy were reviewed. Indirect indicators of fibrosis were calculated for each patient based on previously described formulas [Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), cirrhosis discriminant score (CDS), AST-platelet ratio index (APRI), Forns index, FIB-4, Pohl score, AAR-platelet score (AARP), fibro-quotient (FibroQ), AST/platelet/Gammaglutamyl transpeptidase (GGT)/Alphafetoprotein (AFP) (APGA) index, Platelet/Age/Phosphatase (ALP)/AFP/AST (PAPAS) index, Lok's model, Goteborg University Cirrhosis Index (GUCI)]. Diagnostic adequacy of these indices was evaluated by receiver operating characteristic curve analysis. RESULTS: Area under the receiver operating characteristic curves for the FIB-4, Forns, GUCI, APRI, PAPAS, APGA and FibroQ indices were 0.701, 0.680, 0.670, 0.670, 0.639, 0.638 and 0.588, respectively. The AAR, API, CDS and AARP indices, Pohl score and Lok's model were all deemed diagnostically inadequate. FIB-4 had the best diagnostic adequacy whereas AAR had the worst. CONCLUSIONS: Our results suggest that out of the 13 indices evaluated, only FIB-4 index may be useful in estimating the extent of fibrosis in patients with CHB. There is a need for more comprehensive prospective studies to help determine the diagnostic value of non-invasive tests for liver fibrosis.

Carbon monoxide-related deaths in Ankara between 2001 and 2011.

OBJECTIVE: The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey. METHODS: Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10,720 medico-legal autopsy reports were obtained and reviewed by the authors. RESULTS: Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100,000), followed by Karabuk (8.3/100,000), Cankiri (7.8/100,000) and Kirsehir (5.0/100,000). DISCUSSION AND CONCLUSION: These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Evaluation of Ves-Matic Cube 200 for erythrocyte sedimentation rate determination.

BACKGROUND: International Council for Standardization in Haematology suggested Westergren method as the reference method to analyze erythrocyte sedimentation rate (ESR). However, in recent years closed automated systems that measure ESR directly from a capped EDTA blood sample tube have been developed. We evaluated the analytic performance of one of these new methods, the Ves-Matic Cube 200. METHODS: K(2) EDTA and citrated blood samples were taken from 101 randomly selected outpatients in Ankara Numune Education and Research Hospital. The ESR results using Ves-Matic Cube 200 and Westergren as reference method from 101 patients were compared and interference studies were performed. RESULTS: We found the mean difference between the two methods as 0.19 ± 15.85 mm/hr (-3.317 to 2.940 mm/hr, 95% confidence interval). Regression analysis yielded the equation "y = -2.59 + 1.15x" between the two methods (r = 0.82). CONCLUSIONS: Ves-Matic Cube 200 should be monitored carefully for good quality control. Temperature correction should be applied to study control material as recommended by the manufacturer. Ves-Matic Cube 200 device should be monitored carefully, performance studies should be performed, and the results should be checked in order to eliminate the random errors during the routine studies.

Is the serum level of survivin, an antiapoptotic protein, a potential predictive and prognostic biomarker in metastatic pancreatic cancer?

In the present study, we aimed to assess the association between the serum survivin level and overall survival and treatment response rates in metastatic pancreatic cancer (MPC). Serum samples were prospectively collected from 41 patients with newly diagnosed MPC patients and 41 healthy individuals (control group) to assess the survivin levels. The median survivin level was 136.2 ng/mL in patients with MPC and 52 ng/mL in healthy individuals (P = .028). Patients were divided into low- and high-survivin groups according to the baseline median survivin level. Patients with a high serum survivin level compared with a low serum survivin level had shorter median progression-free survival (2.39 vs 7.06 months; P = .008, respectively) and overall survival (3.74 vs 9.52 months; P = .026, respectively). Patients with higher serum survivin levels had significantly worse response rates (P = .007). The baseline high level of serum survivin in patients with MPC may be associated with treatment resistance and poor prognosis. A confirmation will be needed for these results in future large multicenter prospective studies.

COVID-19 patients with altered steroid hormone levels are more likely to have higher disease severity.

PURPOSE: This study aims to evaluate the correlations between the severity of the disease and serum steroid levels by analyzing the serum steroid levels in COVID-19 patients with different levels of disease progression and the control group. METHODS: Morning serum Aldosterone, 11-deoxycortisol, Androstenedione, 17-hydroxyprogesterone, Dihydrotestosterone (DHT), Dehydroepiandrosterone (DHEA), Corticosterone, Dehydroepiandrosterone sulfate (DHEAS), Estrone, Estradiol, Progesterone, 11-deoxycorticosterone, Cortisol, Corticosterone, Androsterone, Pregnenolone, 17-hydroxypregnenolone and 21-deoxycortisol levels were measured in 153 consecutive patients were grouped as mild, moderate, and severe based on the WHO COVID-19 disease severity classification and the control group. Steroid hormone levels were analyzed at once with a liquid chromatography-tandem mass spectrometric method (LC-MS/MS). RESULTS: In our study, nearly all steroids were statistically significantly higher in the patients' group than in the control group (p < 0.001). Also, DHEA was an independent indicator of the disease severity with COVID-19 CONCLUSIONS: Our study reveals that the alteration in steroid hormone levels was correlated with disease severity. Also, steroid hormone levels should be followed up during COVID-19 disease management.

Evaluation of serum thiol-disulphide homeostasis parameters as oxidative stress markers in epilepsy patients.

The present study focuses on the investigation of the dynamic thiol-disulphide homeostasis in patients with epilepsy and understanding the effects of antiepileptic drugs on thiol levels. A total of 148 participants, 75 of whom had epilepsy and 73 were healthy volunteers, were included in the study. Total thiol and native thiol levels of all epilepsy patients and healthy volunteers were measured. Disulphide level, disulphide/native thiol, disulphide/total thiol and native/total thiol ratios were calculated from these values. The results were compared between epilepsy patients and healthy volunteers. A statistically significant difference was found between native thiol level, total thiol level, disulphide level, disulfide/total thiol, disulphide/native thiol and native/total thiol ratios between patients with epilepsy and healthy volunteers (p = 0.002, p = 0.035, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). The drugs used had a significant effect on disulphide, disulphide/total thiol, native/total thiol levels (p values 0.004, 0.009, 0.009, respectively). Decreased levels of serum native, total thiol and increased disulfide levels as parameters of oxidative stress may be considered as parameters to explain the pathogenesis or consequences of epilepsy.

Evaluation of atherogenic laboratory markers in Behçet's disease patients with vascular involvement.

INTRODUCTION: Behçet's disease is a chronic inflammatory vasculitis presenting with immunological and endothelial changes. The aim of the present study is to evaluate blood levels of diagnostic markers which can be used in Behçet's patients with vascular involvement. MATERIAL AND METHODS: Fifty Behçet's patients (22 with vascular involvement) and 30 healthy controls were included in the study. High-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), tumor necrosis factor-α (TNF-α), apolipoprotein A1 (apoA1), apolipoprotein B (apoB), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride, total cholesterol, Lp-plA-2, homocysteine and ischemia modified albumin (IMA) levels were analyzed. Statistical analysis was performed with the SPSS program version 11.0. p < 0.05 was accepted as statistically significant. RESULTS: hsCRP, TNF-α, homocysteine, IMA, apoA1, apoB, HDL, Lp-pla2 and ESR levels in patient and control groups were significantly different (p < 0.001, p = 0.001, p < 0.001, p < 0.001, p = 0.005, p < 0.001, p < 0.001, p < 0.001 and p = 0.003 respectively). In Behçet's patients with vascular involvement, homocysteine, TNF-α and Lp-pla2 levels were significantly higher than in Behçet's patients without vascular involvement (p = 0.035, p = 0.010 and p < 0.001 respectively). CONCLUSIONS: Increased levels of inflammatory and atherogenic markers in Behçet's patients are an expected outcome due to the inflammatory nature of the disease. Especially, elevated levels of homocysteine, TNF-α and Lp-pla2 make them candidate diagnostic tools to be helpful in clinical evaluation of Behçet's disease patients with vascular involvement.

Plasma homocysteine concentrations and serum lipid profile as atherosclerotic risk factors in subclinical hypothyroidism.

BACKGROUND AND OBJECTIVES: Because subclinical thyroid dysfunction may be a risk factor for cardiovascular disease, we evaluated the atherosclerosis tendency in subclinical hypothyroid (SCH) patients. PATIENTS AND METHODS: Fifty-three subclinical hypothyroid patients (serum thyrotropin [TSH] concentrations >4.12 mU/L) were compared with a control group of 50 euthyroid subjects whose age, sex and body mass indices were similar to the patient group. We tested whether serum TSH concentrations were correlated with plasma total homocysteine concentration (tHcy), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides (TG). RESULTS: There was a significant statistical difference between the patient and control groups for normal free T4 (1.02+/-0.17 vs. 0.86+/-0.13, P<.001), TSH (1.64+/-1.02 vs. 6.62+/-2.61, P<.001), TC (185+/-39 vs. 206 +/- 42, P=.01), TG (103+/-54 vs. 132+/-85, P=.04), LDL-C (114+/-33 vs. 127+/-36, P=.04), and TC/HDL-C (3.81+/-106 vs. 4.19+/-1.02, P=.04), respectively. No statistically significant difference was found between the two groups for HDL-C, VLDLC, LDL-C/HDL-C, and tHcy. Serum TSH was significantly correlated with plasma tHcy (r=0.55; P=.001), TC (r=0.52; P=.001), LDL-C (r=0.49; P=.001), TC/HDL-C (r=0.38; P=.002) and LDL-C/HDL-C (r=0.36; P=.004) across all participants. CONCLUSION: Our study suggests that the atherogenicity of SCH is not mediated by hyperhomocysteinemia. Associated hyperlipidemia may explain the observed increased risk of coronary artery disease in patients with SCH.

The association of serum nesfatin-1 and ghrelin levels with metabolic syndrome in patients with schizophrenia.

Nesfatin-1 and ghrelin are two hormones which has opposite effects and play role in food intake. This study was planned on the idea that both metabolic syndrome and psychiatric disorders are associated with nesfatin-1 and ghrelin. In this study, it was aimed to investigate the levels of ghrelin and nesfatin-1 in patients with schizophrenia, by taking confounding factor as the metabolic syndrome (MS). 55 patients with schizophrenia and 33 healthy controls were included in the study.11 out of the 55 patients (%20) has MS. Serum ghrelin and nesfatin-1 levels of schizophrenia patients with MS have been compared with both healthy controls and schizophrenia patients without MS. Patients with schizophrenia had significantly higher serum nesfatin-1 levels compared to healthy controls. But serum ghrelin levels was not different in both groups. Serum nesfatin-1 concentrations were significantly higher in the schizophrenia patients with MS (10.51-350.8pg/ml) with respect to the healthy control group (4.86-68.91pg/ml). There was no significant statistical difference between the three groups in terms of ghrelin levels. Our findings suggests that, MS presence also contributed to significantly high levels of nesfatin-1 level. Nesfatin-1 may have a part in a novel studies regarding the treatment of schizophrenia and its metabolic effects.

Serum S100B, NSE, and GRIA1 levels as neurological biomarkers in lead exposure

Background/aim: The central nervous system is one of the major targets in lead exposure. Biomarkers for the diagnosis and follow-up of lead exposure have not been identified. In this study, serum S100B, neuron-specific enolase (NSE), and glutamate receptor 1 (GRIA1) levels were determined as possible biomarkers for lead neurotoxicity. Material and methods: Twenty-five subjects with chronic lead exposure and 25 controls were included in the study. NSE and S100B were measured by electrochemiluminescence immunoassay with a Cobas E601 analyzer. GRIA1 levels were measured with an ELISA kit using a quantitative sandwich enzyme immunoassay technique. Results: GRIA1 levels were significantly higher in the lead exposure group than in the control group. No significant differences for NSE, S100B, ALT, AST, or creatinine in sera were found between lead exposure and control groups. Conclusion: Subjects with chronic lead exposure are found to have increased glutamate receptor levels and do not seem to have glial or neuronal damage, which can be demonstrated with the elevation of NSE and S100B levels. GRIA1 levels might be used as a biomarker for the neurotoxicity of lead.

Is serum survivin expression a predictive biomarker in locally advanced gastric cancer patients treated with neoadjuvant chemotherapy?

BACKGROUND: The potential prognostic value of survivin is variably reported depending on the gastric cancer. OBJECTIVE: Evaluation of the prognostic and predictive significance of serum survivin and its relation with survival and treatment response rates in patients with locally advanced gastric cancer (LAGC). METHODS: Serum samples were prospectively collected from 50 patients with newly diagnosed LAGC. Serum samples of 32 healthy subjects were also collected as control groups for survivin levels. Serum survivin levels were evaluated at baseline and after three cycles of neoadjuvant chemotherapy in LAGC patients. RESULTS: Median survivin level was 147 IU/L (range = 4.4-4936) at baseline and was 27 IU/L (range = 4.2-4737) after neoadjuvant chemotherapy. The difference between survivin levels of the control group (26 IU/L, range = 3.8-1430) and pre-treatment patient group was statistically significant (p< 0.001). Clinical response to mDCF regimen was classified as progressive (progressive disease) and non-progressive groups (partial response + stable disease). Baseline survivin levels were similar between patients in progressive and non-progressive groups (p= 0.55). Survivin levels were significantly reduced after chemotherapy in non-progressive group (p< 0.001). In contrast, serum survivin levels increased in a stepwise fashion from baseline to post-chemotherapy in patients with progressive disease (p= 0.06). Patients were divided into low and high survivin groups according to baseline median survivin levels. Median DFS was 12.4 and 14.6 months for low and high groups, respectively (p= 0.18). Moreover, median OS was 14.4 and 24.9 months for low and high group, respectively (p= 0.14). CONCLUSION: It can be suggested that serum survivin can be used as a predictor of response to chemotherapy- but not survival- in LAGC patients receiving neoadjuvant mDCF chemotherapy. However, large multicenter prospective studies are required to confirm these results.

Irisin levels in the progression of diabetes in sedentary women.

CONTEXT: The recently discovered peptide irisin has been hypothesized to be a regulator of body metabolism. However, studies ended up with controversial results. In the present study, we aimed to investigate irisin levels in sedentary women at different stages of prediabetes. DESIGN, SETTING, AND SUBJECTS: We performed a cross-sectional analysis of circulating levels of irisin in 263 females similar for age and body mass index (BMI) and the groups included 52 normal glucose tolerance (NGT), 60 isolated impaired fasting glucose (IFG), 36 isolated impaired glucose tolerance (IGT), 65 both IFG and IGT and 50 type 2 diabetic patients. All patients were exercising less than 150 min/week. RESULTS: Plasma irisin levels were significantly lower in IFG+IGT (2.86 ± 0.6 µg/mL, p: 0.019) and T2DM (2.83 ± 0,5 µg/mL, p: 0.005) patients compared to NGT (3.16 ± 0.3 µg/mL) patients. After age adjustment there was a negative correlation between irisin and BMI (r: -0.141; p: 0.031), postprandial glucose (PPG) (r: -0.142; p: 0.030), low density lipoprotein-cholesterol (LDL-C) (r: -0.138; p: 0.035) and triglyceride (TG) (r: -0.214; p: 0.001) and a positive correlation between irisin and high density lipoprotein-cholesterol (HDL-C) (r:.142; p: 0.030). After adjustment for age and BMI; PPG (r: -0. 137; p: 0.037), LDL-C (r: -0. 143; p: 0.029) and TG (r: -0.203; p: 0.002) were considered to correlate with irisin levels. Subgroup analysis revealed that TG levels were correlated with irisin levels in IFG (r: -0.347; p: 0.014) and IGT (r: -0.397; p: 0.030) patients. CONCLUSION: In our cohort of sedentary women, irisin levels were lower in patients with IFG+IGT and with diabetes than in patients with NGT. There is no correlation between irisin levels and BMI. Irisin is a myokine decreasing gradually with the progression of glucose intolerance and T2DM and is not correlated with BMI in sedentary women.