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Behçet's disease (BD) is a chronic inflammatory vasculitis affecting multiple organs. Uveitis is frequently seen in patients with BD, especially in Turkish population.To investigate vascular endothelial growth factor (VEGF) gene polymorphisms along with the levels of VEGF and VEGF receptors in patients with Behçet's uveitis (BU).Fifty-five BD-associated uveitis patients and 30 ageand sex-matched controls were included in this case-control study. The genotypes of the single nucleotide poymorphisms (SNPs): rs2010963 (+405G), rs3025039 (+936T) and rs699947 (-2598A) of the VEGF-A gene were determined using real-time polymerase chain reaction (RT-PCR) and serum levels of VEGF and VEGF receptors were measured using enzyme-linked immunosorbent assay (ELISA).No associations of the VEGF gene polymorphisms were observed in BD uveitis patients, but arthritis was present in 53.3% of patients not possessing CT genotype in C3025039→T polymorphism (p = 0.024). Although there were no statistically significant differences in serum VEGF-A, VEGF-C and soluble vascular endothelial growth factor receptor-3 (sVEGFR-3) levels (p0.05), serum vascular endothelial growth factor receptor-1 (VEGFR-1) and sVEGFR-3 levels were significantly higher in the BD group (p0.001 and p = 0.001, respectively). In addition, VEGF-C/soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) ratio was significantly higher (p0.001), while VEGF-A/VEGFR-1 and VEGF-C/sVEGFR-3 ratios were significantly lower (p0.001 and p = 0.033, respectively) in BD patients compared to controls. Also, VEGF-C/sVEGFR-3 (p = 0.024, r = 0.37) and VEGF-C/sVEGFR-2 (p = 0.020, r = 0.38) ratios were positively correlated with disease duration.The significant changes in sVEGFR-3 levels and VEGF-C/sVEGFR-3 ratio has shown that lymphangiogenesis processes might take place in the pathogenesis of BD uveitis, and these parameters can be important indicators of evaluation of BD patients with uveitis together with disease duration.

The present study aims to evaluate the relationship between Behçet's uveitis and lymphangiogenesis by determining levels of Vascular endothelial growth factor-C (VEGF-C, its receptors sVEGFR-2, sVEGFR-3 and lymphangiogenesis markers podoplanin (PDPN) and lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1), and C-type lectin domain family 1 member B (CLEC2).55 patients with BD uveitis and 31 healthy control subjects were enrolled in the study.sVEGFR-2, sVEGFR-3, VEGF-C/sVEGFR-2 ratio, PDPN and LYVE-1 levels were higher in the patient group. A positive correlation was found between LYVE-1 and hsCRP levels. PDPN had a strong predictive value for progression with a cut-off value of 2 pg/mL, with 69% sensitivity and 68% specificity (p = 0.001).LYVE-1 and PDPN can be good representatives of the ongoing inflammatory processes in BD uveitis and point out that the disease can be related to lymphangiogenesis.

0000-0001-6416-1442 WOS: 000576685800001 PubMed ID: 33033995 Purpose Obstructive sleep apnea (OSA) is a disorder characterized by recurrent episodes of obstruction of the upper respiratory tract during sleep often accompanied by oxygen desaturations. Antioxidant defense mechanisms are important to prevent OSA-associated diseases and decrease mortality. We aimed to determine the levels of selenium and vitamins A, C, and E in patients with OSA but without any comorbidities and compare the results with a control group, theorizing that the findings may be helpful to understand the antioxidant mechanisms in the pathogenesis of OSA and associated diseases. Methods We designed a case-control study with 146 subjects. Subjects were categorized into four groups by apnea-hypopnea index (AHI) scores: control (n = 32; AHI < 5), mild OSA (n = 32; 5 = 30) groups. Serum levels of selenium were measured by atomic absorption spectrometer. Vitamin A, C, and E levels were measured by high-performance liquid chromatography and ultraviolet (HPLC-UV) detector. Results After adjusting for age, BMI, and gender, serum selenium and vitamin A levels were found to be higher in patients with OSA compared with controls (ANCOVA,p < 0.008, andp = 0.014 respectively), and levels of these markers increased with the severity of the disease. AHI was positively correlated with selenium (r = 0.289; p < 0.001), and vitamin A levels (r = 0.276; p < 0.001). Conclusion These results demonstrated that antioxidant response with increased vitamin A, and selenium concentrations, may be important defense mechanisms in patients with OSA patients who do not have other comorbidities. Antioxidant nutrients or supplements may be implemented as a complementary treatment of OSA to support antioxidant defense. Mugla Sitki Kocman University Scientific Research Projects OfficeMugla Sitki Kocman University [19/087/06/3/4] Mugla Sitki Kocman University Scientific Research Projects Office supported this work under grant number 19/087/06/3/4.

Objectives The aim of the present study is to evaluate the diagnostic powers of fractional magnesium, sodium and potassium as markers of renal tubular damage in normotensive type 2 diabetes mellitus (T2DM) patients with respect to microalbuminuria and estimated glomerular filtration rate (eGFR). Materials and methods Forty healthy volunteers and 91 normotensive T2DM patients were included in the study. Patient group was divided into two according to albuminuria level; 49 were normoalbuminuric and 42 were microalbuminuric. In addition to albumin in urine, urine and serum Na, K, Mg and creatinine values were measured to calculate fractional electrolyte excretion rates. Results In normoalbuminuric and microalbuminuric groups, fractional excretion of magnesium (FEMg) values were found to be significantly higher than the control group (p Conclusion For renal tubular damage predicted by microalbuminuria, FEMg could be accepted as a candidate biochemical marker with diagnostic and prognostic value.

The cytokine storm presented in the hyperimmune response is related to poor prognosis in people with COVID-19. Interleukin-6 (IL-6) is one of the most prominent cytokines, especially on mucosal surfaces during infection, causing the cytokine storm. Polyunsaturated fatty acids (PUFAs) are the precursors of eicosanoids, which play critical roles in immune regulation and inflammation. The balance between ω-3 and ω-6 levels in the cell membrane has a critical role in regulating the equilibrium between proinflammatory and antiinflammatory processes and inducing IL-6 production. The present study focused on inflammatory and antiinflammatory mechanisms in COVID-19 over PUFAs and on relating their levels with disease prognosis and severity.A total of 106 participants were included in the study. They were divided into three groups according to IL-6 level- 1:35 pg/mL, 2: between 35 and 300 pg/mL, and 3:300 pg/mL. Erythrocyte membrane PUFA compositions were analyzed by group.Levels of γ-linolenic acid and ω-6/ω-3 ratios were significantly increased in all comparison groups (P0.05). Total ω-6 and the ratio of arachidonic acid to eicosopentaenoic acid showed a statistically significant difference only between groups 1 and 3 (P0.05). There was a moderately negative correlation between total ω-3 and IL-6 and procalcitonin. There were positive correlations with ω-6/ω-3 ratio inflammatory markers, and the total ω-6 index also showed a moderately positive correlation with IL-6, procalcitonin, and D-dimer levels.The ratio of arachidonic acid to eicosopentaenoic acid, and ω-3 PUFAs, can be systemic signs of poor prognosis, increased lung damage, and high mortality in COVID-19, together with IL-6.

18th National Sleep Medicine Congress - OCT 26-29, 2017 - Bodrum, TURKEY Saruhan, Ercan/0000-0001-6416-1442 WOS: 000495454200003 Objective: Although the presence of a systemic inflammatory response is known in obstructive sleep apnea syndrome (OSAS), there have not been adequate investigations on the association of such a response with the predominance of apneas either in rapid eye movement (REM) or in the non-REM (NREM) phase. In this study, we compared interleukin-23 (IL-23) concentrations, a marker of systemic inflammatory process, in individuals with sleep apnea syndrome, whose apneas where predominant in the REM or NREM phase. Methods: Fifty-four patients aged over 18 years who were diagnosed as having OSAS based on polysomnography were included in the study. The apnea-hypopnea index (AHI) was used to divide patients into groups of AHI(REM)>AHI(NREM) and AHI(NREM)>AHI(REM). In the blood samples drawn from the patients, IL-23 concentrations were measured using enzyme-linked immunosorbent assay. Results:The study included patients with OSAS aged 28-65 years, of whom 29 were AHI(REM)>AHI(NREM) and 25 were AHI(NREM)> N-REM. The AHI(REM) >AHI(NREM) OSAS group had no sex-based variance (14 males, 15 females), but the AHI(NREM) >AHI(REM) group was substantially composed of males (21 males, 4 females). The average AHI( )of the AHI(NREM) >AHI(REM) group (43.34 +/- 21.40) was significantly higher than in the AHI(REM) >AHI(NREM) Nifm group (26.79 +/- 17.32). IL-23 concentrations were higher in patients with AHI(REM) >AHI(NREM) sleep apnea (225.38 +/- 77.29) compared patients with AHI(NREM) >AHI(REM), sleep apnea (183.68 +/- 78.49). Conclusion: In AHI(REM) >AHI(NREM )sleep apnea, the systemic inflammatory response may be more dramatic. Taking the AHI(REM) value into consideration along with the average AHI value seems to be important for treatment modalities.

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.

In literature, it has been reported that adrenomedullin, which is generally thought to have vasodilator, natriuretic and diuretic effects, is synthesized in almost all body, especially CNS, vascular muscles and endothelium, heart, liver, lung, kidney, gastric mocosa, intestinal endothelium and various blood cells. It has been found that the possible effects of adrenomedullin can be demonstrated directly or indirectly by means of active mediators, neuropeptides, enzymes and hormones. It is also suggested that it regulates the endocrine system by affecting the hypothalamic-pituitary axis. It increases in heart failure, acute coronary syndromes, hypertensive conditions, cerebrovascular accessory, chronic renal failure and periodontitis and decreases in peptic ulcer and intestinal diseases. However, it is still not clear whether increase/decrease in adrenomedullin level is a cause of a disease or is a result of damage due to an illness. This peptide, which could be thought to multifunctional, should be considered as a molecule with genetic coding that may have different effects on different tissues and conditions. For all these reasons, we aimed to review the multifonctional behavior of adrenomedullin in the light of the current literature to pioneer new hypotheses and discuss possible mechanisms.

AIM Increased bone turnover is a hallmark of hyperthyroidism. The underlying factors of how thyroid hormones affect bone cells are still under the spotlight. Previous studies indicated serum osteoprotegerin (OPG), receptor activator of NF-kB ligand (RANKL), and interleukin-6 (IL-6) as mediators of the effect of thyroid hormones on bone metabolism. Ultimately, the present research aimed to examine the association of IL-6 with OPG and RANKL in patients with hyperthyroidism. MATERIALS AND METHODS We carried out this study with 39 newly diagnosed and untreated Graves? patients and 43 healthy controls. In addition to routine tests, we measured serum OPG, RANKL, and IL-6 levels. RESULTS Mean age and gender distribution were similar in both groups. The hyperthyroid group had significantly higher OPG (p=0.002) and IL-6 (p

Background Diabetes mellitus (DM) is a multifactorial chronic disease, in which patients need to be treated with insulin in some conditions. Capillary growth is regulated by growth factors like vascular endothelial growth factor (VEGF) and endogenous inhibitors such as the splice variant of VEGF receptor-1 (sVEGFR-1). We aimed to show the levels and the clinical significance of VEGF, sVEGFR-1 in patients with DM on insulin treatment. Materials and methods A total of 83 subjects consisting of patients with the diagnosis of DM (n=47) and healthy control (n=36) were included the study. Plasma levels of VEGF and sVEGFR-1, were measured using the enzyme-linked immunosorbent assay method. Results The average sVEGFR-1 levels of DM group was significantly higher than the control group (0.106±0.052 and 0.073±0.049, respectively; p=0.005). Significantly lower sVEGFR-1 levels were determined in patients receiving metformin vs. without metformin using (0.065±0.016 and 0.118±0.053, respectively; p=0.001). Conclusion This is the first study evaluating and demonstrating the importance of plasma VEGF and sVEGFR-1 levels together in DM patients receiving insulin. Using metformin may have positive effect on angiogenesis in DM. Further studies are required to understand these effects.

Objective In this study, our aim was to investigate the clinical significance of VEGF, sVEGFR-1 in HFpEF patients. Materials and methods Seventy-two participants enrolled in this cross-sectional case-control study including HFpEF patients (n=41) and healthy (n=31) subjects. Blood samples were collected and serum VEGF, sVEGFR-1 analysis, and transthoracic echocardiography were performed. Results and discussion The average sVEGFR-1 level of HFpEF patient group was significantly higher than the control group (respectively 0.136 ng/L (0.04–0.34), 0.06 ng/L (0.01–0.25); p Conclusion Our study is the first study demonstrating the relations among HFpEF, accompanying morbidities, VEGF and sVEGFR-1 levels. Statins and beta blockers may have positive effects on angiogenesis in HFrEF patients via increasing VEGF levels.

Beta-thalassemia major is associated with the increased risk of cardiovascular morbidity and mortality. Asymmetric dimethylarginine (ADMA) has been implicated in the pathogenesis of endothelial dysfunction and atherosclerosis. In this study, we aimed to investigate circulating ADMA concentrations in children with beta-thalassemia major.Thirty-one beta-thalassemia major children aged between 4 and 16 year old and age, gender-matched 36 healthy controls were enrolled in the study. Plasma ADMA was measured along with the soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), P-selectin, and Pentraxin-3.Age, gender and body mass index were similar in two groups. Plasma ADMA, sVCAM-1, and sICAM-1 measurements were significantly higher in beta-thalassemia major patients than the control group (p 0.004 for ICAM-1, p 0.001 for other parameters). There were positive significant correlations between ADMA, sVCAM-1 and sICAM-1 (r = 0.437, p 0.001; r = 0.544, p 0.001; r = 0.405, p 0.001, respectively) in the whole group.The findings of the current study show us that increased plasma ADMA levels in children with beta-thalassemia major may be an early marker for endothelial dysfunction and may play a role in the development of premature atherosclerosis in beta-thalassemia major patients.

Background Immunoglobulin a vasculitis (IgAV) [formerly called Henoch– Schonlein purpura (HSP)] is an IgA mediated systemic vasculitis which primarily affects skin, gastrointestinal system and small vessels of kidneys. Exact pathogenesis of IgAV remains unknown. A fewclinicalstudiesevaluatedthe role of oxidativeinjury in thepathogenesis of vasculitis. Ischemia modified albumine (IMA) and Neopterin increased status of oxidative stress. Objectives The aims of the study are to investigate serum neopterin and IMA levels in patients with IgAV and evaluate the association of these markers with disease activity and relapse. Methods Thirty-four consecutive adult patients (24 males and 10 females) admitted to the rheumatology clinic of ankara Numune Training and Research Hospital meeting the IgAVAmerican College of Rheumatology (ACR) criteria were enrolled in this cross-sectional study. Demographic and clinical features of IgAV and control group were recorded into a predefined protocol. Disease activity was categorized as “remission” or “active” according to BVAS. BVAS ≥1 was accepted “active”.Serum neopterin levels, hsCRP and IMA were evaluated according to BVAS and compared to healthy control group. Results Serum median (IQR) neopterin, IMA levelsandhsCRPwerehigher in thestudygroupthan in controlgroup [2.01 (12.5) ng/mL vs. 1.77 (1.37) ng/mL, 0.67 (0.2) ng/mL vs. 0.43 (0.17) ng/mL, 5.6 (17.1) mg/L vs. 1.55 (1.6) mg/L, p=0.095, p Conclusion Oxidative stress is important in HSP pathogenesis. Roles of hsCRP,Neopterin and IMA as potential markers of diagnosis and disease activity seem to be worth studying in the future studies with larger study groups. Disclosure of interests None declared

Introduction: The use of topical haemostatic agents has been popularised in recent years in many areas of surgery. We aimed to determine whether Ankaferd blood stopper® (ABS) can shorten the bleeding time and decrease the amount of bleeding in a rat abdominal aortic bleeding model. Patients and Methods: A total of 40 rats were randomly divided into four groups (n= 10 in each group). Saline- and ABS-soaked gauzes were applied to rats that had not received any pre-treatment in Groups 1 and 2, while saline- and ABS-soaked gauzes were applied to rats that had received acetylsalicylic acid plus oral clopidrogel for 5 days in Groups 3 and 4. An incision of about 1 mm was made over the aorta just proximal to the iliac bifurcation. Mean bleeding time (MBT) and mean bleeding amount (MBA) were determined and compared. Results: There were no significant differences in the age, weight and blood sample laboratory results of rats. Shorter MBT and less MBA were determined in ABS-soaked groups and the differences were statistically significant. Conclusion: Ankaferd blood stopper® has the potential to reduce the bleeding time and post-operative blood loss after a major aortic surgery.

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients. Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively. Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29–9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29–27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31–12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively). Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease.

Background/aim: Nonalcoholic fatty liver disease (NAFLD) is known as the most common cause of chronic liver disease. It is accepted that the leading cause of death in patients with NAFLD is from coronary events. Blood urea nitrogen (BUN) was used as a prognostic indicator for cardiovascular disease. We aimed to investigate the relationship between BUN levels and metabolic, biochemical, and histopathologic findings of nondiabetic patients with NAFLD. Materials and methods: A total of 195 male patients with biopsy proven NAFLD and 82 healthy controls with normal liver and renal function tests and normal abdominal ultrasonography were enrolled in the study. BUN levels were reviewed retrospectively. Results: The mean BUN levels of patients and controls were 13.07 (11.3?15.41) and 13.31 (10.97?15.87) mg/dL respectively. Patients were grouped as simple steatosis (n = 33, 16.9%), borderline nonalcoholic steatohepatitis (n = 64, 32.8%), and nonalcoholic steatohepatitis (n = 98, 50.3%), and the BUN levels of the histologic subgroups were 13.14 ± 2.89, 14.34 ± 3.04, and 13.71 ± 3.21 mg/dL, respectively. We could not find any differences between the patient group and control group with respect to BUN levels. Conclusion: Our findings showed that there was no relationship between BUN levels and metabolic, biochemical, and histopathologic findings of patients with NAFLD. Further investigations, including in patients with late stages of NAFLD, are required.

Background/Aims: Fetuin-A, a glycoprotein with anti-inflammatory properties, plays an important role in counter-regulating inflammatory responses. It has also been associated with insulin resistance and metabolic syndrome. We aimed to investigate circulating concentrations of fetuin-A and its possible association with hepatic and systemic inflammation in nondiabetic subjects with nonalcoholic fatty liver disease (NAFLD). Patients and Methods: We included 105 nondiabetic male subjects with NAFLD [nonalcoholic steatohepatitis (NASH, n = 86) and simple steatosis (SS, n = 19)]. Plasma levels of fetuin-A and markers of inflammation [high-sensitive C reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and adiponectin] were measured by enzyme-linked immunosorbent assay method. Insulin sensitivity was determined by homeostasis model assessment of insulin resistance (HOMA-IR) index. Results: Fetuin-A was negatively correlated with age (r = −0.27, P = 0.006), however there was no association between fetuin-A and body mass index, waist circumference (WC), glucose, insulin, HOMA-IR, lipid parameters, and inflammatory markers. In addition, no significant association was observed between fetuin-A and histological findings including liver fibrosis. Conclusion: This study demonstrated that plasma fetuin-A levels are not correlated with the hepatic histology and systemic markers of inflammation in nondiabetic subjects with NAFLD. Our data also suggested that age is significantly associated with fetuin-A in this clinically relevant condition.

Introduction Delirium is a common and life-threatening neuropsychiatric syndrome. Diagnosing delirium can be challenging, which increases mortality and mortality rates and health care costs. The biologic model of delirium is not definite yet, but evidence supports a cholinergic deficiency model. Delirium may be the result of processes and drugs that trespass a compromised blood-brain barrier. We aimed to evaluate the possible diagnostic utilization and the role of certain biomarkers, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and insulin like growth factor-1 (IGF-1), in delirium etiology. Methods A total of 93 inpatients that planned to undergo cardiovascular surgery were informed; 35 of them completed the study. Medical history and current cognitive status were evaluated pre-operatively. Participants were followed using Delirium Rating Scale-Revised-98 Turkish (DRS-R98-T) for delirium symptoms, and blood samples were collected post-operatively. Results Delirium was developed more in participants who had worse pre-operative cognitive status. Also, low pre-operative IGF-1 levels were detected in the delirium group. Pre-operative CRP and TNF-α levels were not different between groups. Conclusion Low IGF-1 levels can be used to predict delirium after surgery. However, the complex nature of cytokines and delirium itself make it difficult to utilize cytokines to predict delirium instead of psychometric tools.

Objective: This study aimed to determine significant liver fibrosis and cirrhosis with different FIB-4 cut-off points, and the need for liver biopsy (LB) by optimizing the initially established cut-off points of 1.45 and 3.25. Materials and methods: The study included 201 patients monoinfected with chronic HBV. METAVIR classification was used to determine the stage of fibrosis. ROC analysis and the Youden index were performed to define the optimum cut-off points. Results: A FIB-4 cut-off point of 1.45 and 1.62 generated Youden indexes of 0.51 and 0.55, the accuracy of 78.6% and 81.1% for significant liver fibrosis, respectively. The FIB-4 cut-off was set at 2.40 and 3.25 Youden indexes were 0.46 and 0.16, accuracies were 79.6% and 69.7% for significant liver fibrosis, respectively. A cut-off point of 1.45 and 1.62 for FIB-4 generated Youden indexes of 0.62 and 0.66, the accuracies of 81.6% and 84.1% for cirrhosis, while the FIB-4 cut-off point of 2.40 and 3.25 generated Youden indexes of 0.59 and 0.22, with the accuracies of 90% and 84.1% for cirrhosis, respectively. Conclusions: The FIB-4 cut-off points of 1.62 and 2.40 have higher accuracy and may decrease the need for LB 12% more than the initially established ones in HBV monoinfected patients. © 2017, Turkish Biochemistry Society. All rights reserved. Amaç: Bu çalışmada farklı FIB-4 kesim noktaları ile belirgin karaciğer fibrozisi ve sirozun tespiti ve başlangıçta belirlenen kesim noktalarının (1.45 ve 3.25) optimize edilmesi ile karaciğer biyopsisine olan gereksinimi belirlemek amaçlandı.Gereç ve Yöntemler: Çalışma kronik HBV ile mono-enfekte 201 hasta içermektedir. Fibrozis evresini belirlemek için METAVIR sınıflandırması, optimum kesim noktalarını belirlemek için ise ROC analizi ve Youden indeksi kullanıldı.Bulgular: Belirgin karaciğer fibrozisi için 1.45 ve 1.62 FIB-4 kesim noktalarının Youden indeksleri sırasıyla 0.51 ve 0.55 iken, doğrulukları sırasıyla %78.6 ve %81.1'idi. FIB-4 kesim noktaları 2.40 ve 3.25 olduğunda ise Youden indeksleri sırasıyla 0.46 ve 0.16 iken, doğrulukları sırasıyla %79.6 ve %69.7'idi. Ancak, siroz için 1.45 ve 1.62 FIB-4 kesim noktaları, sırasıyla 0.62 ve 0.66 Youden indeksine, ayrıca %81.6 ve %84.1 doğruluğa sahip iken, 2.40 ve 3.25 FIB-4 kesim noktaları sırasıyla 0.59 ve 0.22 Youden endeksi ile %90 ve %84.1 doğruluğa sahipti.Sonuçlar: 1.62 ve 2.40 FIB-4 kesim noktaları HBV mono enfekte hastalarda daha yüksek doğruluğa sahiptir ve başlangıçta belirlenen kesim noktalarına göre karaciğer biyopsisi gereksinimini %12 oranında daha fazla azaltabilir.

WOS: 000390087600003, PubMed: 28025429, The aim of this clinical study was to determine levels of visceral adipose tissue-derived serpin (vaspin), omentin-1, and tumor necrosis factor-alpha (TNF-alpha) in the gingival crevicular fluid (GCF) of obese and non-obese periodontitis patients following nonsurgical periodontal therapy. Seventy-six subjects were separated into four groups according to periodontal and anthropometric measurements: a periodontal-healthy group, a chronic periodontitis (CP) group, a periodontal-healthy with obesity group, and a CP with obesity group. Nonsurgical periodontal treatment was administered to periodontitis patients. Before treatment and at 6 weeks after treatment, GCF samples were analyzed and clinical periodontal parameters were examined. Enzyme-linked immunosorbent assays were used to measure the levels of vaspin, omentin-1, and TNF-a. Obese and non-obese CP patients displayed higher levels of vaspin and TNF-alpha (P < 0.008), which declined following treatment (P< 0.025), and lower omentin levels (P

Aim To assess the levels of the neutrophil to lymphocyte ratio (N/L) and the platelet to lymphocyte ratio (P/L) in patients with idiopathic acute anterior uveitis (AAU) and to compare with healthy controls. Methods Thirty-six male patients with idiopathic AAU and 36 male healthy subjects were enrolled in this retrospective study. Complete ophthalmological examination and complete blood count measurements results of all subjects were evaluated. Results There was a significant difference in N/L and P/L between idiopathic AAU and control groups (P=0.006, P=0.022). Also, correlation analysis revealed a significant correlation between C-reactive protein (CRP) and N/L (P=0.002; r=0.461). Conclusion Our study for the first time provides evidence of N/L and P/L may be useful biomarkers in patients with idiopathic AAU. N/L is correlated with CRP, so it can be a useful biomarker to predict the prognosis in idiopathic AAU.

Objective: To investigate changes in the levels of gingival crevicular fluid (GCF) chemerin and interleukin-6 (IL-6) in both obese/non-obese individuals with periodontitis following non-surgical periodontal therapy. Methods: Individuals (n = 80) were split into four groupings according to periodontal/anthropometric parameters: (i) periodontal healthy without obesity; (ii) chronic periodontitis (CP) without obesity; (iii) periodontal healthy with obesity; and (iv) CP with obesity. Individuals with periodontitis were treated with non-surgical periodontal therapy. Both GCF sampling procedures and clinical periodontal measures were performed prior to treatment and 6 weeks thereafter. Enzyme-linked immunosorbent assay was utilized to measure both chemerin and IL-6 levels. Results: Greater values for chemerin and IL-6 were observed in obese individuals compared to their non-obese controls and in individuals with CP compared to their periodontal healthy controls (P

The aims of the present study were to determine the levels of vaspin and omentin-1 in gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM), and to evaluate GCF vaspin and omentin-1 levels after non-surgical periodontal therapy. The study included 60 subjects: 15 systemically and periodontally healthy individuals, 15 periodontally healthy patients with T2DM, 15 systemically healthy patients with CP, and 15 patients with both CP and T2DM. GCF and clinical periodontal parameters were examined at the baseline and 6 weeks after periodontal therapy. Levels of vaspin, omentin-1 and tumor necrosis factor-alpha (TNF-?) were measured by ELISA, and their relative ratios were calculated. GCF vaspin and TNF-? levels were significantly higher in the CP groups than in the periodontally healthy groups (P < 0.008) and decreased after therapy in the former (P < 0.025). GCF omentin-1 levels were significantly lower in the CP groups than in the periodontally healthy groups (P < 0.008) and increased after therapy in the former (P < 0.05). Statistically significant positive correlations were found between the total amount of vaspin and TNF-?, glycated hemoglobin (HbA1c), clinical attachment level and gingival index, whereas the level of omentin-1 was negatively correlated with these parameters in all groups (P < 0.05). We found that non-surgical periodontal therapy influenced the GCF levels of both vaspin and omentin-1 in the CP groups. Our results suggest that the levels of vaspin and omentin-1 in GCF could have potential application as inflammatory markers of diabetes, periodontal disease and treatment outcome. © 2016, Sichuan University Press. All rights reserved.

Objective:Gilbert’s syndrome (GS), is a benign condition characterized by unconjugated hyperbilirubinemia related to a decreased hepatic glucuronidating activity without symptoms and signs of liver disease or overt hemolysis. In the present study, we aimed to assess circulating levels of asymmetric dimethylarginine (ADMA), pentraxin-3 (PTX-3) and high sensitivity C-reactive protein (hs-CRP) between patients with GS and controls and determine the correlation of unconjugated bilirubin (UCB) levels with these molecules as prognostic factors for vascular risk stratification and endothelial dysfunction.Methods:Forty two patients with GS and 37 age and sex matched control subjects were enrolled in this study. The diagnosis of GS was made by unconjugated hyperbilirubinemia (1 mg/dL or >17.1 μmol/L) on at least two occasions with normal values of other liver function tests, normal hepatic imaging, and absence of hemolysis.Results:Serum ADMA, PTX-3 and hs-CRP levels were significantly lower in GS than the healthy controls (p=0.037, p=0.025 and p=0.040, respectively). In correlation analysis, UCB was negatively correlated with ADMA, PTX-3 and hs-CRP (r=−0.239, p=0.034; r=−0.280, p=0.012 and r=−0.224, p=0.047, respectively).Discussion and conclusion:The present study showed for the first time that decreased levels of ADMA, PTX-3 and hs-CRP may prove the protective effects of hyperbilirubinemia on the endothelial dysfunction.

Background: The objectives of the present study are to: 1) determine whether gingival crevicular fluid (GCF) chemerin is a novel predictive marker for patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM); 2) analyze the relationship between chemerin and interleukin (IL)-6 in periodontally healthy individuals and in patients with CP and with and without T2DM; and 3) evaluate the effect of non-surgical periodontal therapy on GCF chemerin levels. Methods: Eighty individuals were split into four groups: 20 who were systemically and periodontally healthy (CTRL), 20 with T2DM and periodontally healthy (DM-CTRL), 20 systemically healthy with CP (CP), and 20 with CP and T2DM (DM-CP). Individuals with periodontitis were treated with non-surgical periodontal therapy. GCF sampling procedures and clinical periodontal measures were performed before and 6 weeks after treatment. Enzyme-linked immunosorbent assay was used to measure chemerin and IL-6 levels. Results: Greater values for GCF chemerin and IL-6 levels were found in CP groups than in periodontally healthy groups, inDM-CP than inCP, and in DM-CTRL than inCTRL (P

We read with great interest the recently published article by Wu et al1 in which the authors investigated the associations of circulating omega-6 (ω-6) polyunsaturated fatty acids (PUFAs), including linoleic acid, γ-linolenic acid, dihomo-γ-linolenic acid, and arachidonic acid, with total and cause-specific mortality in a community-based US cohort. They concluded that high circulating linoleic acid, but not other ω-6 PUFAs, was inversely associated with total and coronary heart disease mortality in older adults. However, we think that there are some points that should be emphasized about this …

We read with great interest the recently published article by Seo et al. [1] in which the authors evaluated the association of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with idiopathic sudden sensorineural hearing loss (ISSNHL) and its possibility of emerging as a cheap, reliable, and independent prognostic marker of ISSNHL. They found that NLR and PLR values were significantly high in ISSNHL patients. Moreover, they recommended NLR level as a novel potential marker to predict the patients' prognosis in terms of recovery. However, we think that there are some points that should be discussed about the study. First, NLR, which integrates the detrimental effects of neutrophilia (an indicator of inflammation) and lymphopenia (an indicator of physiologic stress), has emerged as a useful prognostic marker in many studies, as well as studies evaluating patients with idiopathic sudden sensorineural hearing loss [2, 3]. In the original study, despite indicating the presence of any acute inflammation and infection as an exclusion criteria, clinical characteristics provided in Tables 2 and 3 of the original study seem not to be consistent with this information. On the basis of general reference ranges, white blood cell (WBC), neutrophil, and lymphocyte counts of some subjects seem to be compatible with the presence of infection [4]. In such studies aimed at determining predictive markers by using laboratory results, it should be better to identify a specific WBC count range within the exclusion criteria. Determining specific WBC count range as well as clinical conditions likely to affect WBC count could avoid a possible bias in patient selection. Moreover, NLR itself alone without other inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, tumor necrosis factor-alpha, interleukin 6, etc.) has led to the insufficiency of evidence confirming the presence of inflammation and may not accurately provide information about the prognosis of the patients. Second, although presence of diabetes mellitus (DM) was also specified as another exclusion criterion, as understood from the glucose values presented in Tables 2 and 3 of the original study, some patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) were also included in the original study. As is known, NLR values can easily be affected by the existence of inflammation in patients with DM and prediabetes (IFG/IGT) [5]. In a study evaluating the association of NLR with different grades of glucose tolerance and insulin resistance in Asian Indians, it is concluded that NLR can be used as an adjuvant prognostic marker for macro- and microvascular complications in patients with glucose intolerance [6]. Excluding patients with metabolic confounders like IFG and/or IGT, more commonly known as prediabetes, should provide more specific results in the original study. Third, in the original study, it is noted that binary logistic regression model was used to evaluate these values as independent risk factors for recovery of ISSNHL (Table 4 in the original study). In this model authors evaluated lymphocyte, monocyte, NLR, PLR, and glucose. However, before performing the binary logistic regression analysis, univariate logistic regression analysis and correlation analysis should be performed due to the probable associations among the lymphocyte, NLR, and PLR; then significant parameters derived therefrom should be evaluated by binary logistic regression analysis. As is known, correlation of parameters with each other is very important in binary logistic regression analysis. In conclusion, we think that the findings of the present study may be affected by confounding factors mentioned above and additional statistical analysis taking all these factors into account should be performed. In such studies aiming at determining a disease-specific cut-off value, being more discerning in patient selection will provide more accurate results. In this way, further information can be obtained about the association between NLR and sudden sensorineural hearing loss.

Liver fibrosis may be due to a variety of chronic liver diseases and may occur as a result of the healing process of liver damage. Although liver biopsy is accepted as the gold standard method in diagnosis and follow-up of patients with fibrosis currently, due to the serious complications like severe pain, internal bleeding, pneumothorax, and rarely death and even fault in the diagnostic accuracy like sampling error, various assessments by different pathologists and even by the same pathologist, interest in alternative methods is increasing day by day. In the light of these improvements, many studies have been performed on indirect non-invasive biochemical markers that can be used instead of liver biopsy, in the last decade. APRI, Forns index, FIB-4, AST-ALT ratio, age-platelet index, hepascore, fibrotest, fibroindex, fibrometer and fibrosis index are the most commonly used ones of these tests. While having some advantages like ease of accessibility, low complication rate, and lower costs, these tests cannot be used as the gold standard method due to the unsatisfactory diagnostic accuracy values. However, these indices have a high diagnostic value especially in the diagnosis and exclusion of significant fibrosis (METAVIR F2-4) and cirrhosis (METAVIR F4)., Karaciğer fibrozisi karaciğerin çeşitli kronik hastalıklarına bağlı olarak ve karaciğer hasarının iyileşme sürecinin bir sonucu olarak gelişebilir. Hastalardaki fibrozisin tanı ve takibinde günümüzde kullanılan altın standart metot karaciğer biyopsisi olarak kabul görmekle birlikte şiddetli ağrı, kanama, pnömotoraks ve hatta ölüm gibi çok ciddi komplikasyonlara neden olabildiği ve örnekleme hatası, farklı patolog ve hatta aynı patolog tarafından farklı değerlendirmelerin yapılabilmesi gibi tanısal doğruluk sapmalarından dolayı alternatif tanı ve takip yöntemlerine yönelim gün geçtikçe artmıştır. Bu gelişmeler ışığında son on yılda karaciğer biyopsisi yerine kullanılabilecek invazif olmayan dolaylı biyokimyasal belirteçler üzerine çok sayıda araştırma yapılmıştır. APRI, Forns indeks, FIB-4, AST-ALT oranı, yaş-platelet indeksi, hepaskor, fibrotest, fibroindeks, fibrometre ve fibrozis indeksi bu testlerden en çok kullanılanlarıdır. Bu testler kolay ulaşılabilirlik, düşük maliyet ve minimum komplikasyon riskleri gibi avantajlara sahip olsa da ortalama tanısal doğruluk değerlerinin istenen düzeyde olmaması nedeni ile altın standart test olarak kullanılabilmeleri şu an için mümkün değildir. Ancak özellikle belirgin fibrozis (METAVIR F2-4) ve sirozun (METAVIR F4) tanısı ve dışlanmasında bu indekslerin tanısal değeri yüksektir.

Women diagnosed with gestational diabetes mellitus have an increased risk of developing diabetes mellitus, which is a known risk factor for cardiovascular disease and insulin resistance. In the recently published article by Zajdenverg et al., they aimed to identify endothelial dysfunction and cardiovascular risk factors in women with previous gestational diabetes mellitus. However, authors did not evaluate the role of total homocysteine, which has important effects for endothelial dysfunction. Vitamin B12 and folic acid are important vitamins since their deficiency may lead to the probable microvascular abnormalities by increasing the tHcy, which is an independent risk factor for endothelial dysfunction.

We read with great interest the recently published article by Malaguarnera et al. [1]. This study was aimed at evaluating the plasma total homocysteine (tHcy) levels in diabetic patients with and without retinopathy for the progression of diabetic retinopathy. In conclusion, higher plasma levels of tHcy have been found in diabetic patients with proliferative diabetic retinopathy compared to both nonproliferative diabetic retinopathy (DR) and diabetics without retinopathy. However, we would like to share our thoughts and contributions to the original study. First, there was a significant difference between patient groups in terms of age, in the original study. However, there are age specific normal ranges for total homocysteine (tHcy) levels [2]. This is critical because comparison of patient groups with different age distributions may lead to a bias in tHcy results arising from different normal values by age. It should be better to select age-matched patient groups in such studies evaluating parameters with age specific normal values. Second, specimens for tHcy analysis may be fresh or frozen plasma. Since red blood cells continue to produce and release homocysteine after blood sample has been obtained, plasma must be separated promptly [3]. Freshly drawn K2EDTA tubes must be kept in ice water, and plasma should be harvested within 30 min after drawing. Although this may affect the results directly, adding these details about sampling and storage procedure increases the quality of the original study. Third, elevated tHcy levels cause inflammation by increasing arachidonic acid and the proinflammatory prostaglandin E2 [4]. However, tHcy levels in the blood are strongly influenced by diet. Dietary folic acid and vitamins B6 and B12 have the greatest effects [5]. However, none of these vitamins' levels were evaluated in the original study. Moreover, tHcy itself alone without other inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, tumor necrosis factor-alpha, interleukin 6, etc.) may not accurately provide information about the presence of inflammation. In conclusion, plasma total homocysteine (tHcy) levels are important in patients with diabetic retinopathy.

We read with great interest the recently published article by Kilincalp et al. (2014) in which the authors aimed to elucidate the efficiency of the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and the mean platelet volume (MPV) as tools for the preoperative diagnosis of colorectal cancer (CRC) and their usefulness in the follow-up of CRC. They concluded that surgical tumor resection resulted in a significant decrease in NLR, PLR, and MPV. Their results suggest that NLR, PLR, and MPV may be used as easily available additional biomarkers for CRC in screening the general population as well as in postoperative follow-up (Kilincalp et al., 2014). However, we would like to share our thoughts and experiences with Kilincalp et al. (2014). First, as indicated in the original study, some clinical conditions that may affect the total and differential white blood cell (WBC) count were excluded to avoid possible confounders for NLR. As is known, diabetes mellitus (DM) and hypertension (HT) are the most common chronic diseases frequently observed in the current study population evaluated in the original study (CDC Diabetes Public Health Resource). There are several studies indicating that a high level of NLR may reflect ongoing vascular inflammation and play an important role in the pathophysiology of HT, DM, and even prediabetes. Similarly, NLR results can be affected by these metabolic confounders (Pusuroglu et al., 2014; Sefil et al., 2014; Shiny et al., 2014). However, patients included in the original study were not evaluated in terms of DM and HT. In addition, in such studies aimed to determine predictive markers by using laboratory results, it would be better to identify a specific WBC count range within the exclusion criteria (Sertoglu et al., 2014). It is well known that the WBC reference ranges may vary depending on many factors such as the population studied, the individual laboratory, and the instruments (e.g. types of collection tubes) or measurement methods used (e.g. waiting period before analysis) (Sertoglu and Uyanik, 2014). Determining the specific WBC count range as well as clinical conditions likely to affect the WBC count could avoid a possible bias in patient selection. Second, NLR integrates the detrimental effects of neutrophilia (an indicator of inflammation) and lymphopenia (an indicator of physiological stress) and has emerged as a useful prognostic marker in many studies, which claim inflammation as the main cause of pathology (Kayadibi et al., 2014). To assess the value of the NLR in this patient group, it is important to determine whether the increase in NLR is a result of a low count of lymphocytes or a high neutrophil count. However, neutrophil and lymphocyte counts were not provided in the original study. Therefore, it cannot be stated that inflammation alone is responsible for this increase in NLR. Moreover, the lack of data on other inflammatory markers has led to the lack of any evidence confirming the presence of inflammation in these patients. As is known, decreased lymphocyte count has been associated with malnutrition and lymphopenia and it is used as an indicator of malnutrition (Omran and Morley, 2000). As a result, a decrease in the lymphocyte count increases NLR. However, the nutritional status of participants was not evaluated and there is no effective laboratory indicator identifying malnutrition as the cause of lymphopenia in the original study (White et al., 2012). As is known, serum proteins, particularly albumin, have often been used to assess malnutrition. Albumin has a relatively long half-life, ∼14–20 days, and because of this, has been considered a marker of chronic nutritional status (Banh, 2006). Therefore, it would be better to assess at least albumin levels to evaluate the correlation between albumin levels and nutritional status in the current study. In conclusion, NLR itself, alone without other inflammatory markers as well as neutrophil and lymphocyte counts, may not accurately provide information on the presence of inflammation in these patients, and excluding patients with metabolic confounders with an effect on NLR could avoid a possible bias in patient selection.

There is increasing evidence that neutrophil-lymphocyte ratio (NLR) may play a role in predicting recurrence in patients with hepatitis B virus-related hepatocellular carcinoma (HCC) after liver transplantation. In the original study by Yan et al, it was aimed to determine whether an elevated NLR is associated with tumor recurrence. Total tumor size (> 9 cm) and macro-vascular invasion were found to be more significant than NLR according to the multivariate logistic regression analysis. Therefore, substantive significance should be emphasized rather than NLR because total tumor size and macro-vascular invasion are easier and more expressive than NLR in assessing HCC recurrence. NLR and platelet-lymphocyte ratio (PLR) are markers which are easy to obtain and can be used as inflammation indicators. Moreover, assessment of both NLR and PLR may add some value as a good predictor of risk for post-liver transplantation HCC recurrence. However, while the study was constructed on whole blood analysis, further details about the features and performance characteristics of the whole-blood analyzer, and preanalytical/analytical variables should also be mentioned.