A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate

OBJECTIVES

To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer.

MATERIALS AND METHODS

The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values.

RESULTS

PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations.

CONCLUSION

PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Time for a new paradigm shift from STE/non-STEMI to ACO/non-ACOMI?

Introduction

Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and cause a substantial amount of false catheterization laboratory activations.

Purpose

We sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy.

Methods

A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 hours and angiographic appearance.

Results

In non-STEMI group, 282 patients were re-classified as having ACO. This subgroup had a higher ACO frequency and myocardial damage compared to NSTEMI group. More importantly, in-hospital and long-term mortality rates was similar to STEMI patients. The ECG reviewers prospectively classified 35.6% of ECGs as STEMI and 35.5% of ECGs as ACOMI; 25.6% being shared in the both definitions. Both unweighted and weighted diagnostic accuracy of STEMI/non-STEMI and ACOMI/non-ACOMI approaches for ACO and long-term mortality were presented in Table 1. The diagnostic accuracy of the ACOMI/non-ACOMI approach was superior to the STEMI/non-STEMI approach in three out of four comparisons. We also sought to compare ECG subtypes according to early (ECG-to-PCI time<120 min) and late (ECG-to-PCI time over 120 min) coronary intervention (Figure 1).

Conclusions

We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI.

Figure 1

Funding Acknowledgement

Type of funding source: None

The association of acute-to-chronic glycemic ratio with no-reflow in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Introduction

In the present study, we investigate the association of acute-to-chronic (A/C) glycemic ratio with no-reflow (NR) development in ST elevation myocardial infarction (STEMI) patients following primary percutaneous coronary intervention (PCI).

Material and methods

This retrospective study included 905 consecutive STEMI patients who were treated with primary PCI. The A/C glycemic ratio was determined as admission blood glucose (ABG) divided by the estimated average glucose (eAG). We evaluated two primary models (full model and reduced model).The primary outcome was the presence of NR.

Results

The incidence of NR was 22.7% (206 cases) in the present study. We divided the study population into three tertiles (T1, T2, and T3) based on the ABG/eAG ratio. There was a stepwise increase of the frequency of NR development from the T1 to T3 group (36 patients [12%] vs. 70 patients [23%] vs. 100 patients [33%]; respectively [p <0.001, for each group comparison]). In a full model, the ABG/eAG ratio (OR; 2.274, 95% CI; 1.587–3.26, p<0.001) was associated with NR. After the performance of a step-down backward variable selection method, the thrombus grade, the ABG/eAG ratio, the infarct-related artery diameter, and age remained in the reduced model. The ABG/eAG ratio (contributing 25.3% of the explainable outcome in the model) was one of the strong predictors of NR in the reduced model.

Conclusion

To the best of our knowledge, this might be the first study showing a significant relationship between the ABG/eAG ratios with NR in STEMI patients after primary PCI.

Figure 1

Funding Acknowledgement

Type of funding source: None

Relationship between pulmonary edema development and left atrium mechanical functions in patients with left ventricular hypertrophy

Background

Since there is no proven treatment to reduce mortality in heart failure with preserved ejection fraction patients, to identify the predictors of decompensation are important in these patients.

Purpose

In this study, we aimed to evaluate the left atrium (LA) mechanical functions in patients with left ventricular hypertrophy (LVH) presenting with dyspnea and to investigate the predictors of pulmonary edema (PE).

Methods

This study was designed as a single-center cross-sectional study. Patients with LVH who presented to the emergency department with dyspnea were divided into two groups as PE (n=30) and non-PE (n=100). Mechanical functions of the LA were evaluated by speckle-tracking echocardiography. As a statistical method, diagnostic modelling was performed to demonstrate the relationship between demographic and echocardiographic features with the diagnosis of the patient (with or without PE). First, a basal model was created consisting of age, gender, body mass index (BMI), left ventricular mass index (LVMI), creatinine (Model 0). Then, different models were created by adding reservoir strain (S) (Model 1), conduit S, pump S, reservoir strain rate (SR), conduit SR and pump SR to the basal model, respectively. It was analyzed how each model made changes in performance criteria compared to the basal model.

Results

When the relationship between left atrial strain parameters and PE were analyzed, LA reservoir S (OR: 1.74 (1.14–2.64); p: 0.003) and LA pump SR (OR: 1.69 (1.07–2.64); p: 0.023) had found to be significantly associated with the development of PE. Another parameter associated with PE was admission creatinine value (OR: 1.52 (1.08–2.15), p-value: 0.016). In our study, LVMI is not a predictor for PE but, when the interaction of LA reservoir S and LVMI was considered, it is observed that decreased LA reservoir S is associated with more PE, especially in individuals with higher LVMI.

Conclusion

In this study, we found that the LA reservoir S is significantly associated with the development of PE in patients with LVH, especially in individuals with higher LVMI.

Interaction of reservoir S and LVMI

Funding Acknowledgement

Type of funding source: None

Caloric restriction improves the redox homeostasis in the aging male rat heart even when started in middle-adulthood and when the body weight is stable

Evidence indicates that maintenance of redox homeostasis is fundamental for cellular longevity. Caloric-restriction (CR) is said to decrease the formation of oxidatively modified cellular macromolecules and improve health. On the other hand, some studies indicate that many CR studies are flawed, because ad libitum fed rats are not well-controlled. Thus, it is claimed that purported beneficial effects of CR could be not due to real CR effect, but due to control animals going obese. Also, it remains to be elucidated whether effects of CR could be observed even when CR is started in mid-adulthood. Male Sprague-Dawley rats were grouped as: non-CR 6-month-old rats (n = 7), 24-month-old rats subjected to 40% CR for 6 months between 18th and 24th months (n = 8), and non-CR 24-month-old animals (n = 8). We investigated 16 previously validated biomarkers of macromolecular redox homeostasis, ranging from protein and lipid oxidation to glycation and antioxidative capacity. In the present study, the protein, lipid and antioxidant capacity redox homeostasis biomarkers overwhelmingly indicate that, CR, even though not started very early in adulthood, could still offer potential therapeutic effects and it could significantly improve various redox homeostasis biomarkers associated with disease reliably in the heart tissue of aging male Sprague-Dawley rats. Therefore, the effects of CR likely operate through similar mechanisms throughout adulthood and CR seems to have real ameliorative effects on organisms that are not due to confounding factors that come from ad libitum fed rats.

A case of Cryptococcus neoformans meningitis in a patient with abnormal levels of isolated immunological markers

Cryptococcal meningitis is considered rare in immunocompetent patients and is mainly a disease of immunocompromised patients. We report a case of cryptococcal meningitis, due to Cryptococcus neoformans, in an apparently healthy individual with abnormal levels of isolated immunological markers. Regardless of the patient's immune status, the result of the disease can be serious unless the disease is diagnosed early.

Free radical reaction products and antioxidant capacity in beating heart coronary artery surgery compared to conventional bypass

Oxygen-derived free radicals are important agents of tissue injury during ischemia and reperfusion. The aim of this study was to investigate changes in protein and lipid oxidation and antioxidant status in beating heart coronary artery surgery and conventional bypass and to compare oxidative stress parameters between the two bypass methods. Serum lipid hydroperoxide, nitric oxide, protein carbonyl, nitrotyrosine, vitamin E, and β-carotene levels and total antioxidant capacity were measured in blood of 30 patients undergoing beating heart coronary artery surgery (OPCAB, off-pump coronary artery bypass grafting) and 12 patients undergoing conventional bypass (CABG, on-pump coronary artery bypass grafting). In the OPCAB group, nitric oxide and nitrotyrosine levels decreased after reperfusion. Similarly, β-carotene level and total antioxidant capacity also decreased after anesthesia and reperfusion. In the CABG group, nitric oxide and nitrotyrosine levels decreased after ischemia and reperfusion. However, protein carbonyl levels elevated after ischemia and reperfusion. Vitamin E, β-carotene, and total antioxidant capacity decreased after ischemia and reperfusion. Significantly decreased nitration and impaired antioxidant status were seen after reperfusion in both groups. Moreover, elevated protein carbonyls were found in the CABG group. The off-pump procedure is associated with lower degree of oxidative stress than on-pump coronary surgery.

A comparative study of mandibular fractures in the United States and Turkey

This study compared the data on mandibular fractures that occurred in a city in the United States and one in Turkey between 1991 and 2000. The 210 Turkish patients had 252 mandibular fractures, whereas the 665 US patients had 1042 mandibular fractures. Males accounted for 84% (560 patients) and females for 16% (105 patients) of the cases in the US. The male:female ratio was 5.5:1. In Turkey, males accounted for 76% (160 patients) and females for 24% (50 patients) of cases. The male:female ratio was 3.2:1. Assault (53.7%) was the most common cause of fracture in the US, whereas in Turkey the most common cause was a motor vehicle accident (36.2%). The most common site of mandibular fracture in the US was the angle (27.57%); in Turkey the most common site was the body (28.97%). Many of these variations may be related to socioeconomic, cultural and environmental differences between the two countries.

Serum uric acid levels in cardiovascular diseases

OBJECTIVE

Comparison of the serum uric acid levels of healthy people (n=71) and patients with cardiovascular diseases (CVD) (n=62).

SUBJECTS AND METHODS

The patients included had either experienced acute myocardial infarction (AMI) (n=31), atherosclerosis (AT) (n=23) or ischaemia (n=8). The mean values (x+/-SD) of serum uric acid levels of the control group, the patients with CVD as a whole, and patients with AMI, AT and ischaemia were 4.15+/-0.45 mg%, 5.6+/-2.06 mg%, 5.96+/-2.60 mg%, 5.38+/-1.22 mg% and 4.94+/-1.40 mg%, respectively. A statistically higher level of serum uric acid was found in the controls compared to the CVD patients (P < 0.05).

CONCLUSION

The higher serum uric acid levels found in CVD patients suggests that any protective antioxidant effect which uric acid has is overwhelmed by other negative effects on pathogenesis.