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Background Elevated serum progranulin (PGRN) levels have been associated with a wide range of different human malignancies. However, data available on the role of PGRN in hematological malignancies are limited. Methods Measurement of the PGRN level in serum of adult de novo acute myeloid leukemia (AML) patients using enzyme-linked immunosorbent assay (ELISA) was performed. Results The mean serum PGRN level in AML patients was higher than that in controls (346.08 pg/ml ± 64.46 vs 155 pg/ml ± 63 respectively; p = 0.001). After a mean duration of follow-up equaling 140 days, patients with high serum PGRN (i.e., higher than 370.5 pg/ml) had inferior overall survival (OS) in comparison to patients with low serum PGRN (i.e., lower than 370.5 pg/ml) (OS = 25% vs 60.7%, mean survival = 107 days vs 256.5 days, p = 0.007). On the other hand, remitted patients on day 28 with high serum PGRN (i.e., higher than 307.5 pg/ml) did not differ from those with low serum PGRN (i.e., lower than 307.5 pg/ml) regarding disease-free survival (DFS) (DFS = 78.6% vs. 87.5%, mean survival = 301.3 days vs. 283.5 days, p = 0.789). Moreover, the serum PGRN level was associated with inferior OS (p = 0.024) on multivariate analysis. Conclusion Adult de novo AML patients have elevated serum PGRN levels and a high PGRN level is associated with an inferior OS.

To report a rare case of pattern dystrophy-like retinal changes in a young β-thalassemia major patient with a very high serum ferritin level.Observational case report of a β-thalassemia major patient with bilateral pattern dystrophy-like retinal changes.An 18-year-old man experienced blurring of vision in both eyes. Patient had a very high serum ferritin level and had a history of using various iron-chelating drugs. Funduscopy revealed bilateral widespread retinal pigment epithelium changes with macular involvement, which resembled pattern dystrophy-like changes. Fundus autofluorescence imaging showed extensive area of decreased autofluorescence signal interspersed with increased autofluorescence signals, whereas optical coherence tomography demonstrated macular retinal pigment epithelium thinning and interdigitation zone disruption corresponding to retinal pigment epithelium damage and atrophy.Pattern dystrophy-like changes should be considered as a possible manifestation of retinal changes in patients with β-thalassemia major. Iron overload, which is indicated by a very high serum ferritin level, might have a role in the formation of this rare retinal manifestation in β-thalassemia major.

Previous studies demonstrated that diabetic stroke patients had a poor prognosis and excess complement system activation in the peripheral blood. In this study, the association of serum complement levels with the prognosis of diabetic stroke was examined. Patients with acute ischemic stroke were recruited and were divided into two groups according to their history of diabetes. Baseline data on the admission, including C3 and C4 were collected. Neurologic function at discharge was the primary outcome and was quantified by the National Institutes of Health Stroke Scale (NIHSS). A total of 426 patients with acute ischemic stroke (116 diabetic strokes and 310 non-diabetic strokes) were recruited in this study. There were significant differences between the two groups in hypertension, coronary disease, triglyceride, high-density lipoprotein cholesterol, fasting blood sugar, C4, and mortality rates. Furthermore, the values of complement protein levels were divided into tertiles. In the diabetic stroke group, serum C4 level at the acute phase in the upper third was independently associated with NIHSS score at discharge and concurrent infection. These associations were not significant in non-diabetic stroke. High serum C4 level at admission, as a unique significant predictor, was associated with unfavorable clinical outcomes in the diabetic stroke, independently of traditional risk factors.

Polymer-mediated intracellular protein delivery systems are important for the development of protein-based biotechnologies and therapeutics. However, intracellular delivery of cargo proteins in the presence of serum remains challenging due to competitive binding of serum proteins with the polymers. Here, we reported a dendrimer engineered with a high density of 4-diethylaminophenyl groups on the surface to address this issue. The dendrimer showed a pH-responsive phase-transition behavior and could assemble with cargo proteins into stable nanoparticles in serum solutions. It efficiently delivered cargo proteins into living cells, and exhibited a pH-responsive disassembly behavior after cell internalization. As a result, various cargo proteins were delivered into the cytosol of living cells with maintained bioactivity. This study provided a convenient and efficient strategy to design polymers with high serum-tolerance in cytosolic protein delivery.

Introduction: Gestational Diabetes Mellitus (GDM) has a negative impact on maternal and perinatal outcome and several long-term complications. The evidence from different experimental studies have shown that high serum ferritin concentration can lead to pancreatic β-cell dysfunction and impaired glucose metabolism leading to GDM. Aim: To determine the association of increased serum ferritin level in first trimester and GDM in course of pregnancy. Materials and Methods: A prospective observational study was conducted in 204 women in Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, India, during the period from January 2015 to December 2015. The blood samples were collected and screened for GDM by Oral Glucose Tolerance Test (OGTT) at the beginning of the study and then assayed for serum ferritin level who were screened negative. The women were divided into four groups by quartiles of serum ferritin levels (Q1 to Q4). Then they were followed-up with OGTT at 24-28 weeks and again at 32-34 weeks. Statistical analysis was done by using paired t-test, Chi-square test and Fisher’s- exact test. Results: The participants had an average serum ferritin concentration of 77.44 ng/mL. GDM prevalence within each serum ferritin quartile was 7.84%, 11.76%, 19.61% and 23.53% respectively (p-value=0.016). The odds ratio for GDM in the ferritin Q2-Q4 was 1.57 (CI=0.41-5.92), 2.87 (CI=0.84-9.83) and 3.62 (CI=1.08-12.11) compared with Q1, respectively. In addition, primigravida and women with high Haemoglobin (Hb) level (>13 gm%) have an increased risk of developing GDM. Conclusion: Elevated serum ferritin level is associated with increased incidence of GDM irrespective of other risk factors. Iron supplementation should therefore be individualised based on serum ferritin in early pregnancy to minimise the risk of GDM.

Aim:Digoxin is an anti-arrhythmic drug that also has a positive inotropic property. It is mainly used to control heart rate in nonvalvular atrial fibrillation, and improve ejection fraction in heart failure. In recent years, the frequency of digoxin and a combination of new drug using has been increasing. Therefore, to assess the pharmacokinetic interaction between direct oral anticoagulant agents and cardiovascular drugs is necessary for intoxications. Material and Methods:Patients Serum Digoxin Concentrations levels and digoxin intoxications were evaluated according to risk factors investigated retrospectively Patients Serum Digoxin Concentrations levels 2.4 ng/ml toxicity. Results:The study consisted of 248 females (60.2%) and 160 males (39.2%). The mean age of the patients was 70.5 years. The average age of patients was 70.5 years. Serum digoxin concentrations of 408 patients; 44.81% were detected in the low therapeutic range, 34.41% in the therapeutic range, 6.23% in the high therapeutic range, 14.55% in the toxic therapeutic range. The mean glomerular filtration rate was 58.45, and the mean Serum Digoxin Concentration was 1.36 ng/ml. The statistically significant relationship between age and Patients Serum Digoxin Concentration was 16.3% (p

Objectives Obesity is often the result of a high-calorie and unbalanced diet for a long time and can sometimes be associated with hyperphagia and eating disorders. Neurotensin (NT) is an anorexigenic peptide, which is secreted from the central nervous system and intestines, and increases intestinal fat absorption. In the literature, conflicting results regarding serum NT level in obesity and the relation of NT with metabolic parameters were reported. Besides, there is no data regarding the relation of NT with eating disorders or food preference in obese individuals. We aimed to evaluate the relation of serum NT level with metabolic parameters, hyperphagia, binge eating disorder (BED) and food preference in obese adolescents. Methods The study included 65 obese adolescents and 65 healthy controls. Anthropometric measurements, biochemical analyzes and body fat analyzes were performed in all cases. Hyperphagia score, presence of BED and three-day food intake records were also evaluated. Results NT level was significantly higher in obese adolescents than in controls and it was not associated with metabolic parameters, hyperphagia or food preference. In the obese group, NT level was not significantly different according to the presence of BED. Conclusions Serum NT level is high in obese adolescents; however, it is not associated with metabolic parameters, hyperphagia, BED or food preference.

Background: There are no data on circulating concentrations of sFas (proapoptotic protein of extrinsic pathway) and Bcl2 (antiapoptotic protein of intrinsic pathway) in COVID-19 patients. Thus, our objective study was to determine whether an association exists between serum concentrations of sFas and Bcl2 and COVID-19 patient mortality. Methods: This observational and prospective study of COVID-19 patients was performed in eight Intensive Care Units (ICU) from Canary Islands (Spain). Serum levels of sFas and Bcl2 at ICU admission were determined. Mortality at 30 days was the end-point study. Results: Surviving patients (n = 42) compared to non-surviving (n = 11) had lower APACHE-II (p

Background: The relationship between anti-Ro52/SS-A antibody (anti-Ro52) and the clinical manifestations of Sjögren's syndrome (SS) has not been fully clarified. We determined the clinical factors relevant to SS patients with anti-Ro52. Methods: We conducted a retrospective study of 149 subjects suspicious for SS and 50 healthy control subjects. We analyzed items of the American-European Consensus Group (AECG) criteria and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Results: SS was documented in 115 subjects. Anti-Ro52 was observed in 70 SS patients. Anti-Ro52 positivity showed a significantly higher association with anti-Ro60 positivity than with anti-centromere antibody (ACA) positivity (p < 0.05). Regarding the difference in the anti-Ro52 concentration, we observed six significantly relevant components: two AECG components and four non-AECG components. The anti-Ro52 concentration well-discriminated three clinical factors (ROC AUC >0.75), i.e., ACA seropositivity, ESSDAI score ≥1, and RF, and it moderately discriminated high serum IgG, focus score ≥1, and anti-La/SS-B antibody seropositivity (ROC AUC >0.7). A linear relationship between the ESSDAI score and the anti-Ro52 concentration was observed. Conclusion: A significant association between clinical factors (including the ESSDAI) and the anti-Ro52 concentration were revealed. Anti-Ro52 was more highly associated with anti-Ro60 positivity than with ACA positivity.

Struma ovarii is a rare dermoid tumor of the ovary (1% of all ovarian tumors and 2,7% of ovarian teratomas), with more than 50% of the overall tissue being thyroid. Approximately one third of the cases present ascites. Pseudo-Meigs syndrome has been reported in fewer than 10 cases and 5-8% present thyroid hyperfunction. However, only 26 cases reported the association of ascites or pseudoMeigs’ syndrome, elevated cancer antigen 125 and benign struma ovarii in the literature. The authors submit a case of benign struma ovarii that presented as a pelvic mass with ascites and highly elevated CA 125 serum levels and an extensive literature survey on this topic.

Metabolic acidosis is a usual complication of progressive chronic kidney disease and is associated with morbidity and mortality. The correction of metabolic acidosis is a main goal of dialysis. In prevalent hemodialysis patients, acid-base homeostasis depends on many factors, mainly net acid production, amount of alkali given by the dialysate bath and duration of the interdialytic period. At present, the main concern in prevalent hemodialysis patients is not over patients with metabolic acidosis, but rather about the growing numbers of patients with metabolic alkalosis. Several large cohort studies have shown significant associations between high predialysis bicarbonate, as well as blood pH, and morbidity and mortality risk. Based on recent guidelines, we should keep predialysis serum bicarbonate concentrations at 24-26 mEq/L, although this is opinion-based and there is no consensus on the issue. Furthermore, there should be specific focus on the patient´s nutritional status and reversible comorbidities.

Hyperuricemia and gout are metabolic diseases characterized with high serum urate and impact human health significantly. Although some drugs have been developed to treat gout, hyperuricemia represe...

Introduction: The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. Methods: A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin 1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. Results: Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, p = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; p = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; p = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; p = 0.063). Conclusion: Time-averaged serum ferritin levels >1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

Objectives. High levels of non high density lipoprotein cholesterol (non-HDL-C) are known to contribute to an increased risk of ischemic stroke. This systematic review was conducted to identify the relationship between high non-HDL-C levels and the risk of ischemic stroke. Material and methods. This systematic review using PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement guideline, with a pre-determined search strategy. The search was conducted in Pubmed Central (PMC) and Pubmed from 2009 until 2020 with inclusion criteria, patients with a diagnosis of ischemic stroke, age >18 years, with non-HDL-C levels. The title and abstract of these articles were reviewed for relevance, based on inclusion criteria. This systematic review using STROBE to evaluate the quality in individual study which consists of 22 domains. Results. In the final stage, this systematic review identifies six cohort study consisting 166.720 participants. Overall, the quality in individual studies based on STROBE is good. We reported that there are two studies report that high non-HDL-C levels can significantly increase the risk of ischemic stroke. Meanwhile, there are four studies that report there was no significant relationship between high non-HDL-C levels and the risk of ischemic stroke. Conclusions. Overall, this systematic review provides the result about relationship between high levels of nonHDL-C and the risk of ischemic stroke, there are two studies with a larger population support that high levels of non-HDL-C can increase the risk of ischemic stroke. However, further studies is needed with a large population that specifically identify the relationship between non-HDL-C levels and risk of ischemic stroke and makes a better adjustments for confounding variables.

Suzan A AlKhater,1,2 Rana A Albalwi,2 Sara A Alomar,1 Anfal A Alsultan,1 Halah R Almuhaidib,1 Rahaf A Almousa,1 Sarah M Alanezi,1 Raghad K Alghamdi,1 Hwazen A Shash1,2 1College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Pediatrics, King Fahad Hospital of the University, Al-Khobar, Saudi ArabiaCorrespondence: Hwazen A ShashDepartment of Pediatrics, King Fahd Hospital of the University, Al Khobar 31952, Saudi ArabiaTel +966540353333Email hashash@iau.edu.saPurpose: Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns.Patients and Methods: A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy.Results: There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P < 0.01 by chi-square overall comparison).Conclusion: Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.Keywords: hemolytic disease of the newborn, neonatal jaundice, neonatology, screening

Purpose: COVID-19 severity, characteristics of psychiatric symptoms using a brief psychiatric rating scale, and sociodemographic variables were explored and evaluated. Methods: An exploratory study was conducted during the COVID-19 pandemic, from July 13th to July 26th 2020, in an isolation facility at the COVID-designated Sola hospital in Ahmedabad, India. A total of 201 inpatients diagnosed with COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) were included in this study. We assessed the presence and severity of psychiatric symptoms using the Brief Psychiatric Rating Scale (BPRS). Results: Of the 201 COVID-19 patients, 63 (31.3%), 36 (18%), 16 (8%) and 14 (7%) experienced anxiety, tension, somatic concern and depressed mood respectively. The effect of the severity of COVID-19 on the mean of the total BPRS score was statistically significant (F = 17.2, p = 0.000). In the severe COVID-19 group, the mean of the total BPRS score (22.6 +/- 4.8) was significantly higher than in the moderate (20.3 +/- 4.0) and mild (19.1 +/- 2.2) COVID-19 groups. High levels of serum ferritin, IL-6 and D-dimer were associated with the presence of neuropsychiatric symptoms like hallucinatory behavior and disorientation. Conclusions: The majority of COVID-19 patients experienced anxiety, tension and somatic concern. The presence of serious psychiatric symptoms like hallucinatory behavior and disorientation were predominantly seen in severe COVID-19 patients with significantly high serum inflammation and coagulation markers.

Chronic kidney disease results in high serum urea concentrations leading to excessive protein carbamylation, primarily albumin. This is associated with increased cardiovascular disease and mortality. Multiple methods were used to address whether carbamylation alters albumin metabolism. Intravital two-photon imaging of the Munich Wistar Frömter (MWF) rat kidney and liver allowed us to characterize filtration and proximal tubule uptake and liver uptake. Microscale thermophoresis enabled quantification of cubilin (CUB7,8 domain) and FcRn binding. Finally, multiple biophysical methods including dynamic light scattering, small-angle X-ray scattering, LC-MS/MS and in silico analyses were used to identify the critical structural alterations and amino acid modifications of rat albumin. Carbamylation of albumin reduced binding to CUB7,8 and FcRn in a dose-dependent fashion. Carbamylation markedly increased vascular clearance of carbamylated rat serum albumin (cRSA) and altered distribution of cRSA in both the kidney and liver at 16 h post intravenous injection. By evaluating the time course of carbamylation and associated charge, size, shape, and binding parameters in combination with in silico analysis and mass spectrometry, the critical binding interaction impacting carbamylated albumin’s reduced FcRn binding was identified as K524. Carbamylation of RSA had no effect on glomerular filtration or proximal tubule uptake. These data indicate urea-mediated time-dependent carbamylation of albumin lysine K524 resulted in reduced binding to CUB7,8 and FcRn that contribute to altered albumin transport, leading to increased vascular clearance and increased liver and endothelial tissue accumulation.

At present, the serum ferritin level is not included in the list of prognostic factors; however, it is known that its increased serum level in patients with malignant neoplasms relates with the tumor burden, the degree of disease activity and correlates with a worse prognosis in patients with hematologic malignancies.The normalization of serum ferritin level during remission period confirms the involving of hyperferritinemia in mechanisms of tumor progression and may testify for clinical importance of measurement of serum ferritin level in patients, including those with malignant lymphomas. Objective:The aim of this study was to assess of the prognostic significance of high ferritin levels at the onset of the disease in patients with malignant lymphomas. Materials and methods:98 patients with malignant lymphomaswere enrolled in this study, including 72 patients (73.5%) with non-Hodgkins lymphomas (NHL) and 26 patients (26.5%) with Hodgkin’s lymphoma (HL). The increased serum ferritin level (more than 350 ng/ml) was found in 53 (54.2%) patients with malignant lymphomas at the onset of disease and its average concentration was 587,62±131,6 ng/ml (8.3 times higher values of control group, p

Inflammation is one of the hallmarks of cancer and plays a crucial role in the development and progression. The objective of the present study was to investigate if high serum YKL-40 is related to poor prognosis in cervical cancer (CC) patients. A prospective biomarker study of 116 patients with CC (FIGO stage Ia

Background: Uremic pruritus or more accurately termed ‘chronic kidney disease-associated pruritus’ (CKD-aP) is chronic itch in patients with advanced or end-stage renal disease without evidence of any other active disease that could explain the pruritus. The pathogenesis of CKD-aP is complex and not fully clarified. Some preliminary studies indicate that CKD-aP is a systemic inflammatory disease with a deranged balance of T helper (TH) cell differentiation toward TH1 predominance especially IL-2. This study aimed to elucidate further the association of interleukin-2 serum levels with CKD-aP in patients undergoing regular hemodialysis (HD).Methods: This was an analytical cross-sectional study. Sampling was taken with consecutive sampling technique. This study was carried out on 72 patients on regular HD consist of 36 patients with CKD-aP and 36 patients without CKD-aP after meeting the inclusion and exclusion criteria. Blood samples were obtained at Hemodialysis Unit Sanglah General Hospital and IL-2 serum levels were measured at Clinical Pathology Laboratory Sanglah General Hospital Denpasar between July 2019 and August 2019. Mann-Whitney U Test was used to compare IL-2 serum between CKD-aP and non-CKD-aP group.Results: Results in this study we found higher median IL-2 level (17.1 ng/l) on pruritus group versus those without pruritus (13 ng/mL) (p

Tuberculous peritonitis is difficult to diagnose due to the disadvantages of ascitic culture and peritoneal biopsy. Although previous reports suggested that very high serum soluble interleukin-2 receptor (sIL-2R) levels may reflect the clinical activity of tuberculosis, little is known about the diagnostic utility of serum sIL-2R for tuberculous peritonitis. We describe a case of tuberculous peritonitis with chronic myelogenous leukemia. The abnormally high serum sIL-2R value and negative findings for other possible causes including lymphoma suggested tuberculous peritonitis and we administered anti-tuberculosis treatment before definitive diagnosis. Abnormally high serum sIL-2R levels may contribute to earlier diagnosis of tuberculous peritonitis, along with ruling out other potential differential diagnoses.

The Apolipoprotein-related MORtality RISk (AMORIS) study in Sweden revealed that serum uric acid (SUA) was significantly associated with hepatobiliary cancer occurrence. However, the association with postoperative hepatocellular carcinoma (HCC) recurrence has not been reported.A total of 256 surgically resected HCC patients were included (from January 2003 to December 2017) in this study. Comparisons in terms of clinicopathologic factors and long-term outcomes were made between patients with high SUA (6.1 mg/dl) at the time of hepatectomy and low SUA. Besides, SUA data at one postoperative year (1POY) of the same cohort were collected and analyzed in the same manner.About 88.8% of tumor relapse sites were the remnant liver. High SUA levels were associated with male and well-differentiated HCCs. Recurrence-free survival (RFS) of high SUA patients was significantly inferior to low SUA patients [median survival time (MST): 22.7 vs. 28.5 mo,High SUA implies a significant risk factor of activating hepatocarcinogenesis. Keeping the SUA level low may be recommended after HCC resections.

Apoptotic cell death leads to secondary brain injury after spontaneous intracerebral hemorrhage (SIH). There is an association between serum caspase-3 levels and late mortality (at 6 months) in patients with SIH in basal ganglia. The new objective of this study was to determine whether there exists an association between serum caspase-3 levels and early mortality (at 30 days) in patients with SIH at different sites and not only in basal ganglia.Patients with severe supratentorial SIH (defined as Glasgow Coma Scale 9) admitted in 6 Spanish hospitals were included in this observational and prospective study. Patients with SIH due to aneurysm, arteriovenous malformation, and anticoagulant or fibrinolytic treatment were excluded. Serum caspase-3 levels at days 1, 4, and 8 of SIH were determined. Thirty-day mortality was the end-point study.Non-surviving (n = 53) showed higher serum caspase-3 levels at days 1 (p 0.001), 4 (p 0.001), and 8 (p 0.001) than survivor patients (n = 64). Multiple logistic regression analysis showed an association of serum caspase-3 levels 0.167 ng/mL with 30-day mortality (Odds Ratio = 47.007; 95% CI = 4.838-456.727; p = 0.001).The new findings of our study are that serum caspase-3 levels are associated with early mortality in patients with severe supratentorial SIH at different sites and that those levels during the first week of SIH are higher in non-survivors than in survivors.

Omalizumab is more effective in severe allergic patients with eosinophilic asthma than those with non-eosinophilic asthma. IL-18, a unique cytokine involved in allergic but non-eosinophilic inflammation, might be associated with the latter condition. We aimed to clarify the roles of IL-18 related pathways in insufficient response to omalizumab treatment.Patients with severe allergic asthma who completed 2-year omalizumab treatments at Kyoto University Hospital were included in this study (UMIN000002389). Associations between pretreatment levels of serum free IL-18 in addition to other mediators and asthma phenotypes including responses to omalizumab treatment were analyzed. Changes in serum free IL-18, periostin and total IgE levels during the treatment were also examined.Twenty-seven patients (19 females, average age of 55.7 years) were examined. Fifteen incomplete responders who experienced exacerbations in the second year, were significantly and more frequently obese and showed significantly earlier asthma onset, lower blood eosinophils and more exacerbations before omalizumab treatment than complete responders. Significantly more patients showed high baseline serum free IL-18 levels (≥141 pg/mL, a threshold for the highest tertile) among the incomplete responders than complete responders. Patients with high serum free IL-18 levels shared similar characteristics with incomplete responders, showing significant reductions in serum total IgE levels during omalizumab treatment. Finally, serum free IL-18 levels negatively correlated with serum periostin levels at baseline and in change ratios.High baseline serum free IL-18 levels may predict reduced omalizumab efficacy in severe allergic patients with type-2 low asthma, regarding reduction of exacerbations.

Introduction Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6–6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. Methods The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. Results Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40–71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14–22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4–38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1–5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. Conclusions Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.

Purpose: Severe damage to the femoral head in patients with osteonecrosis has a high impact on morbidity. Despite early diagnosis, the treatment outcome is still unsatisfactory. This study aimed to explore the expression of vascular endothelial growth factor (VEGF) and cyclic guanine monophosphate (cGMP) serum level as the risk factors of femoral head osteonecrosis in alcohol-exposed Wistar rats. Methods: This was an experimental study using randomized post-test only control group design, with samples using 10–14 weeks Wistar male rats. Rats were then divided into 6 groups: 3 groups without intervention, and 3 groups with intervention using 40% alcohol given perorally. Each one group from intervention and control group was euthanized by the end of the week for 3 consecutive weeks. Proximal femurs were examined under microscope for osteonecrosis, immunohistochemically for VEGF, and blood serum for cGMP levels. Results: VEGF expression in the femoral head of alcohol-exposed Wistar rats was lower than those not exposed to alcohol (p

Purpose Diabetic retinopathy (DR) can increase the risk of mild cognitive impairment (MCI), which has been confirmed by previous researches. With the frequent occurrence of MCI in patients with DR, the early detection of MCI has become a research hot-spot. The aim of this study was to investigate the relationship between neuron-specific enolase (NSE) and MCI in patients with DR. Patients and Methods A total of 124 patients with DR, including 56 MCI patients and 68 normal cognition patients, were recruited in this cross-sectional study. The demographic and clinical data of patients were collected through questionnaires. Serum NSE was measured using electrochemiluminescence immunoassay. The Minimum Mental State Examination (MMSE) scale was used to evaluate the cognitive function of the participants. Results Compared with the normal cognition group, serum NSE levels and HbA1c levels in the MCI group were higher, while MMSE scores and educational level were lower (P

The mechanisms of urgently presenting acute heart failure (AHF) are not clear. We evaluated the serum catecholamine values of AHF patients immediately after admission. A total of 1,475 AHF patients were screened, and 484 who were admitted from their homes and in whom serum catecholamine could be evaluated immediately after admission were analyzed. The patients were divided into three groups according to the time interval from the onset of symptoms to admission (OA):3 hours (early-OA group; n = 283), 3-24 hours (middle-OA group; n = 142), and ≥24 hours (late-OA group; n = 59). In the early-OA group, the systolic blood pressure (SBP) was significantly higher, orthopnea was more frequent, the pH value was significantly decreased, and the use of noninvasive positive-pressure ventilation was required significantly more often than in the other groups. The serum noradrenaline level was significantly increased in the early-OA group (1.96 [1.02-3.60] ng/mL) than in the middle-OA (1.49 [0.73-3.41] ng/mL) and late-OA (1.40 [0.91-2.42] ng/mL) groups, and the adrenaline level was significantly increased in the early-OA group (0.36 [0.13-1.17] ng/mL) than in the late-OA (0.22 [0.09-0.52] ng/mL) group. A multivariate logistic regression model indicated the early-OA group was independently associated with the SBP140 mmHg (odds ratio [OR]: 2.219, 95% CI: 1.375-3.581), midnight/early morning admission (OR: 3.158, 95% CI: 2.048-4.868), and high serum catecholamine value (adrenaline0.96 ng/mL, noradrenaline3.39 ng/mL, and dopamine0.21 ng/mL) (OR 2.091, 95% CI: 1.161-3.767). In conclusion, urgently presented AHF might be induced by an endogenous catecholamine surge, which causes an excessive rise in blood pressure leading to increased after-overload and volume-shift lung congestion.

Matrix metalloproteinase (MMP)-9, a member of the endoproteinase family, is involved in the neuroinflammation of spontaneous intracerebral hemorrhage (SIH). High circulating MMP-9 levels have been associated with poor functional outcome in patients with SIH. The objectives of this study were to determine whether serum MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP)-1 levels in SIH patients were higher in nonsurviving than surviving patients, if they were associated with early mortality, and if they could be used as biomarkers of prognosis.This observational prospective study included patients with severe supratentorial SIH (defined as Glasgow Coma Scale9) from 6 Spanish Intensive Care Units. Serum MMP-9 and TIMP-1 levels were determined at the time of severe SIH diagnosis. Thirty-day mortality was the endpoint study.Nonsurviving patients (n = 46) showed higher serum TIMP-1 (P0.001) and MMP-9 levels (P = 0.01) than surviving patients (n = 54). The area under the curve by serum TIMP-1 levels for the prediction of 30-day mortality was 74% (95% confidence interval = 64%-82%; P 0.001). Multiple logistic regression analysis showed an association between serum TIMP-1 levels223 ng/mL and 30-day mortality (odds ratio = 13.993; 95% confidence interval = 2.864-68.356; P = 0.001) after controlling for intracerebral hemorrhage score, glycemia, midline shift, and early evacuation of SIH. There was an association between circulating levels of TIMP-1 and MMP-9 (rho = 0.25; P = 0.01).The novel aspects our study include that serum TIMP-1 and MMP-9 levels in SIH patients were higher in nonsurviving than in surviving patients and that serum TIMP-1 levels were associated with early mortality and could be used as biomarkers for predicting mortality.

Background: Non-alcoholic fatty liver disease (NAFLD) is emerging as one of the most common causes of chronic liver disease world-wide. It has strong association with obesity, type 2 diabetes mellitus (T2DM) and metabolic syndrome. We aimed to investigate the prevalence of metabolic syndrome in newly detected T2DM patients having NAFLD with high serum alanine aminotransferase (ALT) level. Methods: In this cross-sectional study, 110 newly detected T2DM patients with high serum ALT level were evaluated. To find out the etiology of high serum ALT level, abdominal ultrasonography was done to detect NAFLD cases along with other relevant investigations. All NAFLD cases then underwent further evaluation for the prevalence of metabolic syndrome. Results: Out of 110 study subjects, NAFLD was detected in 80 (72.7%) individuals. According to International Diabetic Federation (IDF) criteria, metabolic syndrome was detected in 56 (56/80, 70%) of NAFLD cases. Among the 56 patients with NAFLD, male were 24 (42.9%) and female were 32 (57.1%) and 14 (14/56, 25%) cases had all five components of metabolic syndrome. Metabolic syndrome was found in all female NAFLD subjects (32, 100%). Mean age of patients with metabolic syndrome was 43.11±10.77 years and mean body mass index (BMI) was 27.87±3.72 kg/m2. Hypertension was found in 37.5% cases. High BMI (e”25 kg/m2) was found in 87.5% cases. Mild, moderate and severe fatty liver were found in 28.6%, 46.4% and 25% cases respectively. Dyslipidemia was found in all (56, 100%) NAFLD subjects with metabolic syndrome. Metabolic syndrome had significant correlation with BMI (p 0.00), abdominal obesity (p 0.00) and serum triglyceride level (p 0.04). Conclusion: Over two-thirds of T2DM patients having NAFLD had metabolic syndrome in this study. Birdem Med J 2020; 10(1): 21-25

Background Programmed death ligand 1 (PD‐L1) inhibitor has been approved as one of the standard therapies for various cancers. Some reports have shown that serum PD‐L1 level is associated with advanced tumor stages and poor prognosis; however, corresponding pathological information in esophageal cancer patients is lacking. Therefore, we evaluated the clinicopathological and prognostic impact of serum PD‐L1 levels in surgically treated esophageal cancer. Methods A total of 150 patients who underwent radical resection for esophageal cancer were included in the study. Preoperative serum PD‐L1 levels were analyzed using the enzyme‐linked immunosorbent assay kit. A cutoff level of 65.6 pg/mL was used to divide the patients into two groups, and univariate and multivariate analyses were conducted to compare the clinicopathological characteristics and prognoses between these two groups. Results Although significant associations between serum PD‐L1 levels and clinicopathological variables were observed, serum PD‐L1 level was significantly associated with high neutrophil counts, high CRP levels, low albumin levels, and high squamous cell carcinoma antigen levels. Furthermore, serum PD‐L1 level was associated with poor overall survival independent to TNM factors. Conclusions High preoperative level of serum PD‐L1 is a prognostic factor for poor overall survival in patients with surgically treated esophageal cancer., High preoperative level of serum PD‐L1 is a prognostic factor for poor overall survival in patients with esophageal cancer.

Objective. Assessment of the dynamics of cortisol in the serum as a criterion for the effectiveness of treatment of patients with traumatic brain injury (TBI). Material and methods. Of the 42 patients operated because of TBI, two groups were formed. Group 1 – 36 patients with a favorable outcome, group 2 – 6 patients with an unfavorable outcome. Comparison of cortisol between the groups was made at 4 stages of the study. Results. The value of cortisol in groups 1 and 2 the initial one was 533.2 (378.1; 860.0), 2097.3 (866.9; 2568.5) nmol /l, respectively; when removing the hematoma – 432.5 (258.8; 897.8), 1592.8 (1095.9; 3586.6) nmol /l; the end of the operation – 433.0 (218.0; 1021.5), 1183.2 (816.7; 2071.38) nmol /l; after surgery – 493.5 (351.6; 880.9), 1449.8 (1334.5; 2141.2) nmol /l. At all stages, p

Higher circulating soluble cluster of differentiation 40 ligand (sCD40L) levels at admission of an ischemic stroke have been found in nonsurvivor than in survivor patients. The objectives of this study were to determine whether serum sCD40L levels during the first week of a severe malignant middle cerebral artery infarction (MMCAI) are higher in nonsurvivor than in survivor patients and whether they could be used as biomarker of mortality prediction.This multicenter study included patients with severe MMCAI (defined as Glasgow Coma Scale score9). We determined serum sCD40L concentrations at days 1, 4, and 8 and performed receiver operating characteristic analyses to determine their capacity for 30-day mortality prediction.Nonsurvivors (n = 34) showed higher sCD40L levels on days 1 (P0.001), 4 (P = 0.004), and 8 (P0.001) than did survivor patients (n = 34). Areas under the curve of serum sCD40L concentrations at days 1, 4, and 8 of severe MMCAI for 30-day mortality prediction were 83% (P 0.001), 89% (P0.001), and 87% (P0.001), respectively.The findings that nonsurvivors showed higher serum sCD40L levels during the first week of MMCAI than did survivors and that serum sCD40L levels during the first week of MMCAI could be used as a mortality predictor biomarker are 2 novel findings.

Substance P is a neuropeptide belonging to the tachykinin family and is involved in neuroinflammation. In a previous study by our team, we found higher serum substance P levels on day 1 of traumatic brain injury (TBI) in nonsurviving than in surviving patients. Thus, the objective of this study was to determine whether serum substance P levels during the first week of TBI could predict early mortality.This was a multicenter, observational, and prospective study. We included patients with an isolated severe TBI, defining isolated as9 points in non-cranial aspects of Injury Severity Score and severe as9 points of Glasgow Coma Scale. We determined serum substance P concentrations at days 1, 4, and 8 of TBI. We performed receiver operating characteristic analyses to determine the capacity of serum substance P levels at day 1, 4, and 8 of TBI to predict 30-day mortality.Nonsurviving (n = 34) compared with surviving patients (n = 90) had greater serum substance P levels on day 1 (P0.001), 4 (P0.001), and 8 (P0.001) of TBI. The areas under curve of serum substance P concentrations at days 1, 4, and 8 of TBI to predict 30-day mortality were 76% (P0.001), 87% (P0.001), and 89% (P0.001), respectively.The new finding of our study is that the presence of elevated serum substance P levels during the first week of TBI is associated with increased mortality.

Background Lung injury is common in coronavirus disease 2019 (COVID-19) patients. The severity of lung injury appears to be reflected in serum Krebs von den Lungen-6 (KL-6), a glycoprotein expressed on type II alveolar epithelium. This study aims to assess the role of serum KL-6 in reflecting the severity of lung injury in COVID-19 patients. Methods A systematic search was conducted in Scopus, PubMed, Wiley Online Library, and ProQuest. Articles were screened based on several eligibility criteria and assessed for study quality using Newcastle-Ottawa Scale. Results This systematic review included four studies involving a total of 151 adult COVID-19 patients. Pooled analysis revealed that serum KL-6 was significantly higher in severe patients (SMD = 1.16; 95% CI = 0.69–1.63) with moderately high pooled sensitivity (79%; 95% CI = 61–91%) and specificity (86%; 95% CI = 72–95%). Conclusion High serum KL-6 may depict more severe lung injury in COVID-19 patients with moderately high sensitivity and specificity.

Background: The prevalence of high serum uric acid is increasingly rising in recent years, and diet behavior is perceived to be associated with it. This study aimed to explore the relationship between eating away from home (EAFH) and the risk of high serum uric acid in adults in South China.Methods: The data utilized in this study were from Guangdong Nutrition and Health Survey (NHS) 2015. Serum uric acid concentration was detected. EAFH in the past week was investigated. We defined EAFH as food consumption away from home. Dietary data were collected by 24-h recalls on 3 consecutive days. A generalized linear mixed-effects model was applied to compute the odds ratio (OR) and its corresponding 95% CI.Results: A total of 3,489 individuals were included in this study. A 1.27-fold OR (95% CI: 1.05–1.52, P = 0.012) of high serum uric acid was identified in adults with EAFH in comparison with those without EAFH. With respect to men, a 1.66-fold OR (95% CI: 1.3–2.1, P < 0.001) of high serum uric acid was observed. We also observed that men with EAFH had higher intakes of red meat, poultry, vegetable, carbohydrate, protein, fat, and total energy, while a lower grain intake than those without EAFH. However, there was a lack of significant association between EAFH and the odds ratio of high serum uric acid in women. Women with EAFH did not have higher consumptions of red meat, vegetable, fish, fat, and water than those without EAFH.Conclusions: This study found that EAFH was associated with an increased odds ratio of high serum uric acid in men, but not in women.

Bronchogenic cysts that occur within the diaphragm are rare and difficult to diagnose preoperatively. We experienced the case of a patient with an abnormally high serum carbohydrate antigen 19‐9 (CA19‐9) level before surgery. The diagnosis of intradiaphragmatic bronchogenic cyst was made at the time of surgery. The patient was a 50‐year‐old woman with upper abdominal pain with an incidentally elevated serum CA19‐9. Although the tumour location could not be established on images, a tumour within the diaphragm was confirmed during the operation. The diaphragm was incised and the tumour was removed together with the capsule. Bronchial cysts were diagnosed histopathologically, and immunohistochemical examination revealed that the bronchial epithelial cells were positive for CA19‐9. When managing patients with bronchogenic cysts in the diaphragm, it is difficult to make a preoperative diagnosis or determine the location of the tumour; thus, careful planning is required before surgery., Bronchogenic cysts that occur within the diaphragm are rare and difficult to diagnose preoperatively. Here, we report the case of a patient with an abnormally high serum carbohydrate antigen 19‐9 (CA19‐9) level before surgery. The diagnosis of intradiaphragmatic bronchogenic cyst was made during surgery. When managing patients with bronchogenic cysts in the diaphragm, a preoperative diagnosis or location of the tumour can be difficult; thus, careful planning is required before surgery.

Aims: This study aims to access the predicting value of serum uric acid (UA) and high-sensitivity C reactive protein (hs-CRP) concentration on three-year cardiovascular-related mortality in patients performing continuous ambulatory peritoneal dialysis (CAPD). Methods: A total of267 CAPD patients [150 male (56.2%); mean age 48.93 ± 13.58 years] were included in our study. All patients had measured serum UA and hs-CRP concentration. A high-sensitivity particle-enhanced immunoturbidimetric assay determined serum hs-CRP; serum UA levels were determined using an enzymatic colorimetric assay. All patients were followed for three years to detect cardiovascular-related mortality by cardiologists and stroke specialists. Results: Mean serum UA level was 415.16 ± 84.28 µmol/L, 58.4% of patients had increased serum UA level. Median serum hs-CRP level was 2 (1-4) mg/L, 12.4% of patients had increased serum hs-CRP level. During 36 months of follow-up, 41 patients (15.4%) had cardiovascular-related mortality. The results of Cox proportional hazards regression showed that hypertension, diabetes, high serum UA and hs-CRP were risk factors that related to cardiovascular-related mortality (p

Aims: Coronary artery disease (CAD) is an inflammatory disorder. Recently low vitamin D and high lipoprotein ‘a’ (Lp‘a’) have been linked in causation of coronary artery disease. This study was conducted to see the the combined effect of these two modifiable risk factors i.e. low vitamin D and high Lp‘a’ in etiology of CAD. Methods: It was a cross sectional study. Triple vessel disease patients (n=31) admitted for bypass surgery were taken as cases and age and gender matched healthy persons were taken as controls (n=30). Serum vitamin D estimation was done by competitive ELISA method. Serum Lp‘a’ estimation was done by immunoturbidimetric assay. Results: when subjects were compared for dual risk factor (Vitamin D deficiency and Hyperlipoproteinemia‘a’), it was observed that the odds of having disease were very high (OR=30.00; p=0.0004) than the single risk factor (OR for Hypovitaminosis D = 3.33; p=0.03 and OR for Hyperlipoproteinemia ‘a’ = 5.00; p=0.004). The Pearson’s correlation coefficient for the relationship between serum Vitamin D and Lipoprotein ‘a’ shows no correlation (r = ̶ 0.1019). Conclusion: Risk of having CAD increases many folds when subject has vitamin D deficiecy as well as high Lp‘a’.

PURPOSE To assess polar vessel presence and enhancement 4DCT imaging and their relation with biochemical and histopathological features. METHODS Patients with primary hyperparathyroidism and preoperative 4DCT imaging were screened retrospectively and those with histopathologically proven diagnosis of PA were included. Biochemical findings, densitometric measurements (HUprecontrast, HUarterial, HUvenous, HUwash-in, HUwash-out, HUretained) and CTvolume of PA on 4DCT, presence of a polar vessel (PV), and histopathological features were recorded. Correlations between serum PTH, calcium levels and densitometric measurements of PA on 4DCT were investigated. Differences between subgroups created according to PV presence were also evaluated. RESULTS Thirty-nine patients were enrolled (F/M = 32/7, median age = 57, interquartile range = 50-62 years). In all patients, serum PTH levels positively correlated with CTvolume (r = 0.398, p = 0.012) but negatively correlated with HUarterial (r = - 0.366; p = 0.022), HUvenous (r = - 0.452; p = 0.004) and HUretained (r = - 0.421; p = 0.008). In PV (-) PAs, PTH levels were positively correlated with CTvolume (r = 0.608, p ≤ 0.002) and negatively with HUarterial (r = - 0.449, p ≤ 0.028), HUvenous (r = - 0.560, p = 0.004), HUwash-in (r = - 0.460, p = 0.024), and HUretained (r = - 0.539, p = 0.007). No correlation between PTH levels and densitometric measurements was found in PV (+) PAs. HUwash-in and HUwash-out were significantly higher in PV (+) PAs compared to PV (-) PAs (p = 0.021 and p = 0.033, respectively). Histopathologic features revealed no difference according to the presence of PV. CONCLUSION PTH levels might have an association with imaging findings of PAs, especially when categorized with respect to PV presence. PTH levels were negatively correlated with degree of enhancement in PV (-) PAs. Therefore, radiologists should be aware that in patients with high serum PTH levels and without a discernible PV, PA might be difficult to localize.

CASE DESCRIPTION A 14-year-old 5.6-kg (12.3-lb) castrated male Toy Poodle was evaluated because of high serum activities of alkaline phosphatase and alanine amino-transferase and the presence of a hepatic mass. CLINICAL FINDINGS Abdominal CT revealed a large (approx 6.8 X 7.1 X 6.5-cm) soft tissue mass along the midline of the liver. The mass either originated from the papillary process of the caudate lobe or the left medial liver lobe. TREATMENT AND OUTCOME A partial liver lobectomy was performed, and approximately a third of the mass was successfully removed and submitted for histologic examination. Consultation with the oncology service was advised to determine whether radiation therapy could be used to treat the residual disease. On 5 consecutive days, the dog underwent imaging-guided intensity-modulated radiotherapy-stereotactic body radiation therapy (4 Gy/treatment) with a simultaneous integrated boost to the center of the tumor. The dog received a base dose of 20 Gy that was then boosted to 28 Gy. In the 10-month period after completion of radiation therapy, the hepatocellular mass continued to decrease in size, and overall improvements in the dog's serum liver enzyme abnormalities were evident. CLINICAL RELEVANCE There are few treatment options for dogs with incompletely excised hepatocellular carcinomas. On the basis of the positive outcome in this case, radiation therapy could be useful following incomplete surgical removal of hepatocellular carcinomas in dogs. (J Am Vet Med Assoc 2021;259:392–395)

Atopic dermatitis is the most common form of eczema often developed before the first year of life. Nevertheless, when the presentation is atypical or related to infections the diagnostic represents a challenge for the pediatricians. It is important to maintain a high index of suspicion for the detection of primary immunodeficiency associated to severe eczema. One of them is the autosomal dominant hyper-IgE syndrome characterized by recurrent skin and respiratory infections, atopic dermatitis, eosinophilia, and high serum IgE concentrations. In this paper, we report a 1 months and 29 days old baby girl diagnosed with hyper-IgE and a skin involvement since birth.

Copeptin is a stable peptide derived from cleavage of the precursor of arginine-vasopressin (AVP), [1,2] that can be easily measured by using a simple rapid assay. Copeptin has been related with an increased incidence of stroke and cardiovascular mortality in individuals with diabetes, mainly type 2 [3,4]. It is also a risk predictor for end-stage renal disease, coronary heart disease, and all-cause mortality in people with type 1 diabetes (T1DM) [5]. However, we have recently reported that copeptin does not appear to be a reliable marker for the screening of asymptomatic peripheral arterial disease in a population of patients with T1DM [6]. We here explore the putative relationships between serum copeptin level and carotid intima-media thickness (cIMT) in asymptomatic T1DM-patients comprehensively investigated for subclinical carotid atherosclerosis.

The attractiveness of the human face plays an essential role in mating as it may signal the genetic suitability of a mate. The controversial ‘ovulatory shift hypothesis’ postulates that women in the fertile phase of the menstrual cycle would prefer faces of masculine men with high testosterone that signals ‘good genes’, whereas in the non-fertile phase they prefer traits signaling the willingness to provide parental care. To examine relationships between men’s testosterone and women’s preferences for men’s faces on day 13 of the menstrual cycle, 19 young women rated the attractiveness of images of the natural faces of 77 young men. Using advanced Bayesian multilevel modeling we showed that the attractiveness of men’s faces is significantly lower in men with a high concentration of serum total testosterone, even taking into account the concentration of serum estrogen in the raters. The average men’s face composited from images of 39 faces rated above pool median attractiveness rate, was slightly narrower than the average face composited from 38 less attractive faces. Our results challenge the ‘ovulatory shift hypothesis’ as faces of males with high circulating testosterone were rated as less attractive than faces of males with lower testosterone by women on the fertile phase of the cycle.