Systolic blood pressure ≤110 mm Hg is associated with severe coronary microvascular ischemia and higher risk for ventricular arrhythmias in hypertrophic cardiomyopathy

Background

Coronary microvascular dysfunction (CMD) and hypertension (HTN) occur frequently in hypertrophic cardiomyopathy (HCM), but whether blood pressure (BP) influences CMD and outcomes is unknown.

Objective

The purpose of this study was to test the hypothesis that HTN is associated with worse CMD and outcomes.

Methods

This retrospective study included 690 HCM patients. All patients underwent cardiac magnetic resonance imaging, echocardiography, and rhythm monitoring; 127 patients also underwent rest/vasodilator stress 13NH3 positron emission tomography myocardial perfusion imaging. Patients were divided into 3 groups based on their rest systolic blood pressure (SBP) (group 1 ≤110 mm Hg; group 2 111-140; group 3 >140 mm Hg) and were followed for development of ventricular tachycardia (VT)/ventricular fibrillation (VF), heart failure (HF), death, and composite outcome.

Results

Group 1 patients had the lowest age and left ventricular (LV) mass but the highest prevalence of nonobstructive hemodynamics and restrictive diastolic filling. LV scar was similar in the 3 groups. Group 1 had the lowest rest and stress myocardial blood flow (MBF) and highest SDS (summed difference score). Rest SBP was positively correlated with stress MBF and negatively correlated with SDS. Group 1 had the highest incidence of VT/VF, whereas the incidences of HF, death, and composite outcome were similar among the 3 groups. In multivariate analysis, rest SBP ≤110 mm Hg was independently associated with VT/VF (hazard ratio 2.6; 95% confidence interval 1.0-6.7; P = .04).

Conclusion

SBP ≤110 mm Hg is associated with greater severity of CMD and coronary microvascular ischemia and higher incidence of ventricular arrhythmias in HCM.

Antimicrobial and antibiofilm forming activity of Origanum munzurense against some Gram-Positive bacteria and yeast

In vitro antimicrobial and antibiofilm forming activities of Origanum munzurense extract were investigated against some gram-positive bacteria and yeast strains. Liquid microdilution method and microplate method were used for antimicrobial and antibiofilm forming activities, respectively. Minimal inhibitory concentration values were found to be 2 mg/ml for Enterococcus faecalis ATCC 29212, 64 mg/ml for Listeria monocytogenes RSKK 02028, 2 mg/ml for L. monocytogenes RSKK 472, 2 mg/ml for Bacillus cereus NRRL 569 , 128 mg/ml for S. aureus ATCC 25923, 32 mg/ml for S. aureus (MRSA) ATCC 43300 strain, 64 mg/ml for Candida tropicalis ATCC 13803, 2 mg/ml for C. albicans ATCC 90028, 1 mg/ml for S. aureus FRI 918 and 1 mg/ml for Staphylococcus epidermidis ATCC 12228 strain. The extract prevented the biofilm formations of E. faecalis ATCC 29212, S. aureus FRI 918 and S.epidermidis ATCC 12228 at concentrations of 2 mg/ml, 500 µg/ml and 250 µg/ml, respectively. No biofilm formation was observed for the other bacteria tested.As a result, Origanum munzurense extract has antibacterial and antibiofilm activity on the selected pathogenic microorganisms tested. Due to these properties of O. munzurense, it could be considered as a plant-based antimicrobial agent to be used especially in the food industry.

Metabolomics characteristics associated with milk yield and milk quality in sheep

Standart süt testleri, süt verimi ve kalitesi gibi izleme özelliklerini içerir. Standart süt testlerinin yapılmasına ek olarak, süt özelliklerini belirlemek için potansiyel biyobelirteçler olarak hareket edebilecek metabolitleri değerlendirmek artık mümkün. Bu çalışma İvesi koyunlarında süt verimi ve kalitesi ile ilgili metabolomik parametreleri belirlemek amacıyla yapılmıştır. Çalışmamızda süt verimi yüksek 13, süt verimi düşük 13 olmak üzere toplam 26 İvesi koyunu incelenmiştir. Metabolomik analiz için sıvı kromatografi tandem kütle spektrometrisi kullanıldı. Aspartik asit, ornitin, anserin ve sistatiyonin düzeyleri açısından iki grup arasında farklı düzeylerde istatistiksel olarak anlamlı fark vardı (P<0.05 ve P<0.01). Süt verimi ile aspartik asit (r=-0,630) ve anserin (r=-0. 522) seviyeleri (P<0.01). Laktoz seviyeleri ile lizin (r=−0.501), alfa-aminoadipik asit (r=−0.524) ve hidroksilizin (r=−0.511) seviyeleri arasında anlamlı bir negatif korelasyon bulundu (P<0.01). Somatik hücre sayısı ve alanin (r=0,493), aspartik asit (r=0,418), prolin (r=0,421), alfa-aminoadipik asit (r=0,407), beta-alanin (r=0,433) ve tiyaprolin (r =0.434) seviyeleri (P<0.05) pozitif korelasyon gösterdi. Sonuçlarımız, koyun sütü verimi ve süt kalitesiyle ilgili metabolik olaylar hakkında, süt üretimini iyileştirmek ve koyun sütünün bileşenlerini geliştirmek için daha ileri araştırmalara rehberlik edebilecek önemli bilgiler sağlar. Somatik hücre sayısı ve alanin (r=0,493), aspartik asit (r=0,418), prolin (r=0,421), alfa-aminoadipik asit (r=0,407), beta-alanin (r=0,433) ve tiyaprolin (r =0.434) seviyeleri (P<0.05) pozitif korelasyon gösterdi. Sonuçlarımız, koyun sütü verimi ve süt kalitesiyle ilgili metabolik olaylar hakkında, süt üretimini iyileştirmek ve koyun sütünün bileşenlerini geliştirmek için daha ileri araştırmalara rehberlik edebilecek önemli bilgiler sağlar. Somatik hücre sayısı ve alanin (r=0,493), aspartik asit (r=0,418), prolin (r=0,421), alfa-aminoadipik asit (r=0,407), beta-alanin (r=0,433) ve tiyaprolin (r =0.434) seviyeleri (P<0.05) pozitif korelasyon gösterdi. Sonuçlarımız, koyun sütü verimi ve süt kalitesiyle ilgili metabolik olaylar hakkında, süt üretimini iyileştirmek ve koyun sütünün bileşenlerini geliştirmek için daha ileri araştırmalara rehberlik edebilecek önemli bilgiler sağlar.

Sensitivity of [18F]FDG PET/CT and classification of the primary tumor site in patients with carcinoma of unknown primary

BACKGROUND

The aim of this study is to find the sensitivity of the [18F]FDG PET/CT and the classification of the primary sites of carcinoma of unknown primary (CUP) as a single-center experience.

MATERIAL AND METHODS

Sixty-eight patients with a mean age of 62.43 ± 12.78 years were included in this study retrospectively. Sixty-five patients had biopsy or surgery after PET/CT, which revealed pathological diagnoses of malign primary tumors, while primary tumor site could not be detected in three patients with histopathological examination. We evaluated the primary site of CUP with [18F]FDG PET/CT.

RESULTS

Primary sites of three patients were not determined by histopathological examination. Malign lesions indicating the primary site of tumor were identified in 52 of 68 patients with PET/CT correctly. The primary tumor was lung cancer in 14 patients, cholangiocellular cancer in 9 patients, lymphoma in 9 patients, pancreas cancer in 6 patients, gastric cancer in 4 patients, ovary cancer in 4 patients, colon cancer in 4 patients, breast cancer in 3 patients, hepatocellular cancer in 2 patients, rectal cancer in 2 patients, sarcoma in 2 patients, esophagus, renal cell cancer, squamous cell cancer, endometrium cancer, malign melanoma, and multiple myeloma in 1 patient with histopathological examination. PET/CT was false positive in one patient. There were 13 patients in whom primary tumor could not be localized by PET/CT, but was diagnosed by histopathological evaluation.

CONCLUSIONS

PET/CT should be the first-line diagnostic tool for CUP, other diagnostic imaging tools should be applied after a negative whole-body PET/CT.

Refined palm oil fractions: Effect of skim milk powder and maltodextrin on emulsion properties and microencapsulation by spray drying

The aim of this study was to investigate microencapsulation of palm oil fractions (palm olein (POL) and 90% palm olein+10% palm stearin (POS)) using skim milk powder (SMP) and maltodextrin (MD) by spray drying. Twenty-seven emulsions with POL were prepared to determine appropriate solid content (SC) and oil/coating material ratio (O/CM) of the emulsions to be fed into the spray dryer. Emulsion properties, such as viscosity and stability, were affected by SC and coating materials. The effects of coating materials used in microencapsulation of POL and POS were also tested by using different ratios of SMP and MD. The microencapsulation efficiency (69.28–84.97%), the microencapsulation yield (14.50–31.79%), and the peroxide value (4.12–7.07 meq O2/kg oil) of the powders were affected by the coating materials (P < 0.05).

Machine Learning Methods for Identifying Atrial Fibrillation Cases and Their Predictors in Patients With Hypertrophic Cardiomyopathy: The HCM-AF-Risk Model

Background

Hypertrophic cardiomyopathy (HCM) patients have a high incidence of atrial fibrillation (AF) and increased stroke risk, even with low CHA₂DS₂-VASc (congestive heart failure, hypertension, age diabetes, previous stroke/transient ischemic attack) scores. Hence, there is a need to understand the pathophysiology of AF/stroke in HCM. In this retrospective study, we develop and apply a data-driven, machine learning–based method to identify AF cases, and clinical/imaging features associated with AF, using electronic health record data.

Methods

HCM patients with documented paroxysmal/persistent/permanent AF (n = 191) were considered AF cases, and the remaining patients in sinus rhythm (n = 640) were tagged as No-AF. We evaluated 93 clinical variables; the most informative variables useful for distinguishing AF from No-AF cases were selected based on the 2-sample t test and the information gain criterion.

Results

We identified 18 highly informative variables that are positively (n = 11) and negatively (n = 7) correlated with AF in HCM. Next, patient records were represented via these 18 variables. Data imbalance resulting from the relatively low number of AF cases was addressed via a combination of oversampling and undersampling strategies. We trained and tested multiple classifiers under this sampling approach, showing effective classification. Specifically, an ensemble of logistic regression and naïve Bayes classifiers, trained based on the 18 variables and corrected for data imbalance, proved most effective for separating AF from No-AF cases (sensitivity = 0.74, specificity = 0.70, C-index = 0.80).

Conclusions

Our model (HCM-AF-Risk Model) is the first machine learning–based method for identification of AF cases in HCM. This model demonstrates good performance, addresses data imbalance, and suggests that AF is associated with a more severe cardiac HCM phenotype.

Sex-specific cardiac phenotype and clinical outcomes in patients with hypertrophic cardiomyopathy

BACKGROUND

It is unknown whether sex-specific differences in mortality observed in HCM are due to older age of women at presentation, or whether women have greater degree of LV myopathy than men.

METHODS

We retrospectively compared clinical/imaging characteristics and outcomes between women and men in our overall cohort composed of 728 HCM patients, and in an age-matched subgroup comprised of 400 age-matched patients. We examined sex-specific differences in LV myopathy, and dissected the influence of age and sex on outcomes. LV myopathy was assessed by measuring LV mass, LVEF, global peak longitudinal systolic strain (LV-GLS), diastolic function (E/A, E/e'), late gadolinium enhancement (LV-LGE) and myocardial blood flow (MBF) at rest/stress. The primary endpoint was a composite outcome, comprising heart failure (HF), atrial fibrillation (AFib), ventricular tachycardia/fibrillation (VT/VF) and death; individual outcomes were defined as the secondary endpoint.

RESULTS

Women in the overall cohort were older by 6 years. Women were more symptomatic and more likely to have obstructive HCM. Women had smaller LV cavity size, stroke volume and LV mass, higher indexed maximum wall thickness (IMWT), more hyperdynamic LVEF and higher/similar LV-GLS. Women had similar LV-LGE and E/A, but higher E/e' and rest/stress MBF. Female sex was independently associated with the composite outcome in the overall cohort, and with HF in the overall cohort and age-matched subgroup after adjusting for obstructive HCM, LA diameter, LV-GLS.

CONCLUSIONS

Our results suggest that sex-specific differences in LV geometry, hyper-contractility and diastolic function, not greater degree of LV myopathy, contribute to a higher, age-independent risk of diastolic HF in women with HCM.

No association of serum PSA with vitamin D or total oxidant-antioxidant capacity in healthy men

Background and aim: Vitamin D deficiency and oxidative stress were suggested to be related to prostate cancer risk. We aimed to investigate the association of serum PSA concentration with vitamin D and total oxidant/antioxidant levels. Materials and methods: A total of 95 healthy men were enrolled for the cross sectional study. Serum PSA, 25(OH)D, serum total oxidant status, and total antioxidant status were measured. Results: Serum PSA was significantly negatively correlated with serum total oxidant status (r= -0.309, p = .003) but there was no significant correlation between PSA and 25(OH)D (p = .383) or total antioxidant levels (p = .233). After adjustment for age BMI and smoking status with multiple regression analysis, there was no significant association between serum PSA and total oxidant status. Conclusion: We find no evidence for an association between PSA and vitamin D levels or serum total oxidant/antioxidant levels.

Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy

BACKGORUND

Quantification of myocardial blood flow (MBF) by positron emission tomography (PET) is important for investigation of angina in hypertrophic cardiomyopathy (HCM). Several software programs exist for MBF quantification, but they have been mostly evaluated in patients (with normal cardiac geometry), referred for evaluation of coronary artery disease (CAD). Software performance has not been evaluated in HCM patients who frequently have hyperdynamic LV function, LV outflow tract (LVOT) obstruction, small LV cavity size, and variation in the degree/location of LV hypertrophy.

AIM

We compared results of MBF obtained using PMod, which permits manual segmentation, to those obtained by FDA-approved QPET software which has an automated segmentation algorithm.

METHODS

13N-ammonia PET perfusion data were acquired in list mode at rest and during pharmacologic vasodilation, in 76 HCM patients and 10 non-HCM patients referred for evaluation of CAD (CAD group.) Data were resampled to create static, ECG-gated and 36-frame-dynamic images. Myocardial flow reserve (MFR) and MBF (in ml/min/g) were calculated using QPET and PMod softwares.

RESULTS

All HCM patients had asymmetric septal hypertrophy, and 50% had evidence of LVOT obstruction, whereas non-HCM patients (CAD group) had normal wall thickness and ejection fraction. PMod yielded significantly higher values for global and regional stress-MBF and MFR than for QPET in HCM. Reasonably fair correlation was observed for global rest-MBF, stress-MBF, and MFR using these two softwares (rest-MBF: r = 0.78; stress-MBF: r = 0.66.; MFR: r = 0.7) in HCM patients. Agreement between global MBF and MFR values improved when HCM patients with high spillover fractions (> 0.65) were excluded from the analysis (rest-MBF: r = 0.84; stress-MBF: r = 0.72; MFR: r = 0.8.) Regionally, the highest agreement between PMod and QPET was observed in the LAD territory (rest-MBF: r = 0.82, Stress-MBF: r = 0.68) where spillover fraction was the lowest. Unlike HCM patients, the non-HCM patients (CAD group) demonstrated excellent agreement in MBF/MFR values, obtained by the two softwares, when patients with high spillover fractions were excluded (rest-MBF: r = 0.95; stress-MBF: r = 0.92; MFR: r = 0.95).

CONCLUSIONS

Anatomic characteristics specific to HCM hearts contribute to lower correlations between MBF/MFR values obtained by PMod and QPET, compared with non-HCM patients. These differences indicate that PMod and QPET cannot be used interchangeably for MBF/MFR analyses in HCM patients.

Correction to: Comparison of two software systems for quantification of myocardial blood flow in patients with hypertrophic cardiomyopathy

The following information is missing from the Funding footnote on the first page of the published article: "This study was partly funded by NIH RO1 HL092985." The last/corresponding author is incorrectly listed on the first page of the published article: The correct name is Abraham MR.

Correlations between the Maximum Standard Uptake Value of Positron Emission Tomography/Computed Tomography and Laboratory Parameters before and after Treatment in Patients with Lymphoma

Background:

After the first examination of patients with lymphoma diagnosis, important laboratory tests such as complete blood count; albumin, kidney and liver function tests; uric acid; β2-microglobulin; C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); and lactate dehydrogenase (LDH) examinations are recommended. In this study, our aim was to find the relationship between laboratory parameters and the maximum standard uptake value (SUV_max) of positron emission tomography/computed tomography (PET/CT) in patients with lymphoma at the diagnosis and after treatment.

Methods:

Thirty-four lymphoma patients treated at Mustafa Kemal University Internal Medicine Clinic between 2014 and 2017 were included in this retrospective study. Results of CRP, ESR, LDH, albumin, and white blood cell (WBC) count were recorded before each PET scan test, and each parameter was analyzed for correlation with SUV_max measurements.

Results:

Spearman's correlation test showed that the after-treatment SUV_max values were significantly correlated with the after-treatment LDH, ESR, and CRP values (for LDH, ESR, and CRP, R²: 0.453, 0.426, and 0.351; P = 0.007, 0.012, and 0.042, respectively). On the other hand, albumin and WBC count did not show a significant correlation with the after-treatment SUV_max values (all P > 0.05).

Conclusions:

CRP, ESR, and LDH values may also be good predictors in patients for whom PET/CT imaging cannot be performed.

Effects of heat-treated hempseed supplementation on performance, egg quality, sensory evaluation and antioxidant activity of laying hens

1. This study was conducted to determine the effects of raw and heat-treated hempseed (HHS, Cannabis sativa L.) on performance, egg quality and antioxidant activity in laying hens. 2. A total of 108 laying hens, aged 36 weeks, were divided into three treatment groups with 12 replicates and each replicate contained three laying hens. The treatments were as follows: (1) Control (no hempseed), (2) 15% raw hempseed (RHS) in diet and (3) 15% HHS in the diet. Experiments lasted for 12 weeks. 3. Feed intake of the RHS group was lower than those of the control and HHS groups. Egg weight, egg mass, shell weight, shell surface area and shell thickness of the HHS group were significantly (P < 0.05) higher than that of the RHS group. Roche (DSM) colour fan values of the RHS group were higher than that of the HHS group (P < 0.01). 4. Palmitic, palmitoleic and oleic acids of egg yolk were significantly (P < 0.05) decreased in the RHS and HHS groups; however, linoleic, α-linolenic and docosahexaenoic acids (DHA) of egg yolk increased (P < 0.05) for both treatment diets compared to the control group. 5. Both RHS and HHS supplementation to layer diets did not influence malondialdehyde (MDA) and superoxide dismutase (SOD) activity and blood lipid profile. 6. It was concluded that HHS was superior in improving the egg quality of laying hens as compared to the RHS.

EDTA interference in electrochemiluminescence ACTH assay

Background

As plasma is the recommended sample type for Roche adrenocorticotropic hormone (ACTH) assay, we evaluated the effect of EDTA concentration on Cobas ACTH assay.

Methods

Samples containing twofold and fourfold higher concentrations of EDTA were prepared by adding plasma to empty K2EDTA tubes and by making under-filled EDTA tubes. All measurements were performed with four replicates.

Results

Increased EDTA concentration resulted in a significant decrease in ACTH concentration. Fifty-per cent-filled EDTA tube showed 19% decrease in ACTH concentration and 25% filled EDTA tube showed 50% decrease in ACTH concentration.

Conclusion

We recommend that inadequately filled EDTA specimens should be rejected when using Cobas ACTH assay.

The Effectiveness of Temperature Versus Aprotinin in Maintaining the Preanalytical Stability of Adrenocorticotrophin

OBJECTIVE

To investigate the effect of temperature and protease inhibitor on adrenocorticotrophin (ACTH) stability.

METHODS

We collected blood specimens from 10 donors into K3 EDTA (ethylenediaminetetraacetic acid) and K3 EDTA + aprotinin tubes. Plasma specimens were held at room temperature and at 2 °C to 8[Formula: see text] for 0, 2, 4, 8, 24, and 72 hours. ACTH concentrations in 4 storage conditions were compared with repeated-measures analysis of variance (ANOVA) at each time point.

RESULTS

ACTH concentrations substantially decreased after a 72-hour time period. At the 72nd hour, standard EDTA tubes and EDTA + aprotinin tubes stored at 4[Formula: see text] showed the optimal stability. EDTA + aprotinin tubes stored at room temperature performed more strongly than standard EDTA tubes stored at room temperature.

CONCLUSION

Our results show that refrigerated storage is more effective than protease inhibitor addition to maintain ACTH stability. We recommend using aprotinin tubes, especially for specimens standing at room temperature.

Comprehensive dental management in a Hallermann-Streiff syndrome patient with unusual radiographic appearance of teeth

Hallermann-Streiff syndrome (HSS) is a genetic disorder characterized by proportionate dwarfism, birdlike facies, hypotrichosis, skin atrophy, dyscephaly, bilateral microphthalmia, congenital cataracts, a narrow, weak, beaked nose, a hypoplastic mandible, and orodental anomalies. Occurrence is sporadic and distinct patterns of inheritance have not been found. This case report describes the dental management of a 3-year-old girl patient with HSS, who had unusual radiographic appearance of teeth. Furthermore, dental treatments and a 30-month follow-up period of the patient with this rare tooth structure malformation have been presented.

S1000A12, Chitotriosidase, and Resolvin D1 as Potential Biomarkers of Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterised by periodic inflammatory attacks. We investigated changes in monocyte-granulocyte derived S10012A and chitotriosidase in both the attack and silent period of FMF for better estimation of inflammation. Endogenous resolvin was determined for utility to restrict inflammation. This study included 29 FMF patients (15 M/14 F) and 30 healthy controls (15 M/15 F). Serum levels of highly sensitive C-reactive protein, serum amiloid A (SAA), S100A12, chitotriosidase, and resolvin D1 were measured. Age, sex, body mass indexes, and lipids were similar between patients and controls. Biomarkers including hs-CRP, SAA, S100A12, chitotriosidase, and resolvin D1 were higher in the attack period of FMF patients compared to controls (P < 0.001). When FMF patients in the silent period were compared with their attack period, hs-CRP, SAA, and chitotriosidase were found elevated in the attack period (P < 0.001, P < 0.001, and P = 0.02 respectively). Serum levels of SAA, S100A12, chitotriosidase, and resolvin D1 in the silent period of FMF patients were still found elevated compared to healthy controls, indicating subclinical inflammation (P < 0.001, P < 0.001, P = 0.009, and P < 0.001 respectively ). In subgroup analysis, patients with M694V homozygote and heterozygote mutations had higher S10012A and hs-CRP compared to other mutation carriers. Our findings indicate that chitotriosidase and S10012A are useful in diagnosis and detection of subclinical inflammation and/or assessment of disease activity in FMF patients. They could be more informative for inflammation in various disease states compared to hsCRP and SAA. Resolvin D1 is elevated in both the attack and silent periods of FMF. It may be helpful to restrict inflammation.

Can red cell distribution width be a marker of disease activity in ulcerative colitis?

AIM

The current study aimed to investigate the association between disease activity and red cell distribution width (RDW) levels in ulcerative colitis and to determine whether RDW can be used as a marker of disease activity in non-anemic ulcerative colitis.

METHODS

The RDW levels of 310 ulcerative colitis patients who underwent colonoscopy were analyzed retrospectively. The patients were divided into two groups (active disease and remission) according to the endoscopic activity index. In addition, the accuracy of RDW in determining disease activity in non-anemic patients was assessed. The efficacy of RDW in determining disease activity was compared to that of white blood cell count, platelet count, C-reactive protein, and erythrocyte sedimentation rate.

RESULTS

Two hundred and six (66.5%) patients had active disease, and 104 (33.5%) were in remission. The mean RDW levels in patients with active ulcerative colitis and in those in remission were 16.8±2.9 and 15.5±1.4, respectively (P<0.001). Ninety-six (46.6%) patients in the active disease group and 89 (85.6%) in the remission group were non-anemic, and their respective RDW levels were 15.4±1.2 and 15.3±1.1 (P=0.267). The sensitivity and specificity of RDW in determining inflammation were 41% and 91%, respectively (AUC 0.65, P<0.001).

CONCLUSIONS

This study demonstrated that RDW can be used as a marker for disease activity in ulcerative colitis, but it did not have the same efficacy in the non-anemic group.

Effect of hempseed (Cannabis sativa L.) on performance, egg traits and blood biochemical parameters and antioxidant activity in laying Japanese Quail (Coturnix coturnix japonica)

1. This study was conducted to determine the effects of hempseed (HS) on performance, egg traits, serum lipid profile and antioxidant activity in Japanese quail (Coturnix coturnix japonica). 2. A total of 120 eight-week-old laying quail were divided into 4 experimental groups with 10 replicates. The treatments were as follows: (1) control diet (C, no HS in the diet); (2) 5% HS in the diet (HS5); (3) 10% HS in the diet (HS10); and (4) 20% HS in the diet (HS20). The quail were fed the experimental diets from 8 to 14 weeks of age. 3. There was no significant difference in body weight, feed intake and feed conversion ratio of the birds overall in the experiment. The egg production was not influenced by the HS contents in the diet; however the HS10 diet increased egg weight and egg-specific gravity. The carcass traits were not affected by the HS contents. 4. The serum triglyceride, cholesterol and the high density lipoprotein were not significantly altered; however, low density lipoprotein (LDL) concentration in HS-supplemented groups were lower than that of the C group. 5. The malondialdehyde, superoxide dismutase, catalase and nitrogen oxide concentrations were not significantly affected, but in the HS10 and HS20, glutathione peroxidase (GSH-Px) concentration was higher than in the C and HS5 groups. 6. The omega-3 fatty acid content of eggs increased linearly with increasing dietary HS content in the diet. 7. In conclusion, HS could be a potential feed and health benefit as a natural antioxidant in relation to decreasing serum LDL and increasing GSH-Px concentration in the liver of laying quail.

Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome

OBJECTIVE

To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns.

METHODS

A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2).

RESULTS

The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=-0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02).

CONCLUSION

Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome.

Exercise heart rates in patients with hypertrophic cardiomyopathy

The exercise heart rate (HR) profile and its relation to cardiac function and arrhythmias were investigated in patients with hypertrophic cardiomyopathy (HC). Chronotropic response (CR) and heart rate recovery (HRR) were computed during and after treadmill exercise testing in 273 patients with HC and 95 age-matched healthy controls. Patients with HC had higher prevalence of chronotropic incompetence and lower HRR1-5min compared with controls. Exercise capacity, diastolic function (assessed by E/e') and left atrial volume index were associated with HRR1min and CR in HC. Septal myectomy was associated with reduction in chronotropic incompetence but did not affect HRR1min. In conclusion, impaired CR and HRR1min are associated with advanced disease and do not appear to be independent clinical markers indicating high-risk status in HC. Improving CR by titrating doses of negative chronotropic agents, myectomy, and atrial pacing may be useful to increase exercise capacity in patients with HC.

Endometrial adenocarcinoma in young-aged women: a Turkish population study

PURPOSE OF INVESTIGATION

The present study aims to investigate the incidence, clinicopathological features, and experience of treat- ment outcomes of patients with endometrial adenocarcinoma (EC) at ≤ 40 years of age in a gynecologic oncology reference center in Ankara, Turkey.

MATERIALS AND METHODS

This retrospective study included 577 patients with EC, diagnosed and treated between 2007 and 2013.

RESULTS

The incidence of EC ≤ 40 years of age was 5.1% (n: 30). The mean age at diagnosis was 35.5 (range: 27-40). Most of the patients with EC were overweight or obese. However, 23% had normal body mass index (BMI). Infertility was seen as a risk factor in 38.4%. The mean duration of postoperative follow-up was 38.3 months with rates of disease persistence and recurrence 14.2% and 28.5%, respectively.

CONCLUSION

The disease is diagnosed usually in its early stage and has a good prognosis. Appropriately selected patients with fertility desire have the opportunity to conceive with conservative management.

Changes in liquid emptying in migraine patients: diagnosed with liquid phase gastric emptying scintigraphy

Gastric stasis is suspected mostly to be encountered during acute migraine attack. The aim of this study is to evaluate the liquid phase gastric emptying and motility in migraine patients in ictal and interictal periods in comparison to normal subjects with gastric emptying scintigraphy. Seven women with migraine and age, sex matched controls who applied to the Neurology Department from May 2009 to May 2010 were compared. Gastric emptying study with a standard liquid was performed one time in the non-migraineur group and two times in the migraineur group. Non-migraineur controls and migraineurs were compared. The mean T1/2 was longer in ictal period in migraineurs. The T1/2 of migraineurs interictally and the control groups were similar. The T1/2 of migraineurs ictally and migraineurs interictally were also compared. We also considered the percentage of the radioactive material remaining in the stomach. There were no significant differences between non-migraineurs and migraineurs interictally. However, increased amount of radioactive material remaining in the stomach was observed in migraineurs ictally. We concluded that the liquid emptying was delayed in spontaneous migraine attacks in migraine without aura, however in the interictal period the emptying of liquids did not differ between migraineurs and non-migraineurs.

Postload hyperglycemia is associated with increased subclinical inflammation in patients with prediabetes

BACKGROUND/AIMS

In this present study, we aimed: (i) To clarify if prediabetes is associated with subclinical inflammation independent of underlying obesity, and (ii) to evaluate the effect of postload glucose concentration on subclinical inflammation markers in a group of patients with elevated fasting glucose.

MATERIAL AND METHODS

In a cohort of 165 patients with newly detected fasting hyperglycemia, according to 75 g oral glucose tolerance test (OGTT), subjects were classified either as newly diagnosed type 2 diabetes (diabetes group, n = 40), impaired fasting glucose (IFG) plus impaired glucose tolerance (IGT) (IFG/IGT group, n = 42) or IFG only (IFG group, n = 83). A control group (n = 47) consisted of age- and body mass index (BMI)-matched healthy subjects with a normal OGTT. Circulating concentrations of lipids, insulin, interleukin-6 (IL-6), interleukin-8 (IL-8) and high sensitive C-reactive protein (hsCRP) were measured. HOMA index was calculated.

RESULTS

Subclinical inflammation markers were elevated in patients with diabetes and IFG/IGT compared to healthy controls and also IFG patients (diabetes vs. control: p < 0.05 for hsCRP, IL-8, and IL-6; IFG/IGT vs. control: p < 0.05 for hsCRP, and IL-6; diabetes vs. IFG: p < 0.05 for hsCRP, and IL-6; IFG/IGT vs. IFG: p < 0.05 for hsCRP, and IL-6). In multiple regression analysis, postload glucose concentration was independently associated with circulating hsCRP and IL-6 concentrations when the data was controlled for age, gender, BMI and lipid concentrations (p < 0.05 for hsCRP, and IL-6).

CONCLUSION

Our results suggest that patients with prediabetes, independent of underlying obesity, have increased concentrations of subclinical inflammation which is mostly driven by postload glucose concentrations.

Biomarkers and cytokines of bone turnover: extensive evaluation in a cohort of patients with ankylosing spondylitis

Background

Ankylosing spondylitis (AS) is a chronic inflammatory disease of spine and sacroiliac joints; it is characterized by new bone formation, and the disease processes can be accompanied by osteoporosis. In the present study, we investigated changes in bone mineral density (BMD) and in the levels of various bone turnover-related biomarkers and cytokines in a cohort of AS patients, with regard to clinical parameters, disease activity, and treatment regimen.

Methods

55 AS patients and 33 healthy controls included in the study. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI), and radiologic changes were scored by the Bath Ankylosing Spondylitis Radiologic Index (BASRI). Patients were also evaluated with the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Bone mineral density (BMD) assessed by dual energy X-ray absorptiometry. Various biomarkers and cytokines of bone turnover including osteoprotegerin (OPG), serum band 5 tartrate-resistant acid phosphatase (TRAP-5), soluble receptor activator of nuclear factor kappa-B ligand (sRANKL), secreted frizzled-related protein 1 (sFRP-1), Dickkopf-related protein 1 (DKK-1), and sclerostin were studied.

Results

The levels of TRAP-5, NTX, sRANKL, sclerostin, sFRP-1, DKK-1, and IFNγ, were similar between the patients and controls (p > 0.05), while BMD of femoral neck, and OPG levels were significantly lower in AS patients (p < 0.05). In a subgroup analysis, patients with active disease had significantly higher concentrations of OPG compared with the inactive group. Rest of the biomarkers and cytokines of bone turnover were similar between the active and inactive disease groups. Subgroup analysis of patients receiving anti-TNFα agents and conventional therapy revealed that OPG concentrations were significantly lower in the patients receiving biological drugs, while BAP and DKK-1 were significantly higher in the patients treated with conventional agents.

Conclusions

In this cross-sectional study we showed that OPG levels were significantly lower in AS patients compared to healthy subjects. On the other hand, the levels of wingless (Wnt) signal pathway inhibitors seem not altered. Ectopic bone formation in AS may be related to dysfunction of these molecules at the cellular level.

Vertical rectus abdominis myocutaneous flap for vaginal reconstruction after radical pelvic surgery for Stage II vaginal carcinoma

Primary carcinomas of the vagina are uncommon, occurring only 2-3% of all gynecological malignancies. In women with early stage of disease, primary surgery, consisting of radical vaginectomy (plus hysterectomy in patients with tumors involving the upper vagina) and systematic dissection of lymphatic drainage of tumor, is a valid option. In these patients, a rectus abdominis myocutaneous (RAM) flap may be favorably used for vaginal reconstruction during radical pelvic surgery. Here we describe a case of Stage II vaginal carcinoma treated with radical pelvic surgery and vertical-RAM (V-RAM) flap reconstruction.

Current cardiac imaging techniques for detection of left ventricular mass

Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.

Myocardial perfusion is preserved in patients with psoriasis without clinically evident cardiovascular disease

BACKGROUND

Psoriasis is associated with a premature atherosclerosis due to the chronic inflammatory process. To evaluate the effect of disease process on myocardial perfusion, we planned to perform 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) in patients with psoriasis.

METHODS

The study group consisted of 28 psoriasis patients (17 men, 11 women), aged 18-76 years, and mean age 41.2 +/- 14.1 years. The patients were selected among those who were older than 18 years and longer than 10 years of disease duration with more than two times of systemic treatment. All patients underwent 99mTc-MIBI myocardial perfusion SPECT with the same day protocol.

RESULTS

We detected various risk factors including smoking habits in 7, family history of cardiovascular disease in 4, hypertension in 1, hyperlipidemia in 9 patients. We completed myocardial perfusion SPECT for each patient and found normal perfusion pattern in SPECT images.

CONCLUSION

We detected that myocardial perfusion is preserved in the patients with psoriasis. The majority of acute heart attacks are caused by noncritical coronary stenosis and this may be an explanation for increased cardiovascular risk in these patients despite normal coronary perfusion.

Primary adenocarcinoid tumor of the ovary arising in mature cystic teratoma. A case report

Primary carcinoid tumors of the ovary are rare, forming 0.3 % of all carcinoid tumors and less than 0.1 % of ovarian malignancies. We present a case of a 47-year-old woman with abnormal vaginal bleeding and abdominal discomfort. Pelvic ultrasonography revealed a right-sided, 4 cm solid ovarian mass. At laparoscopy, a smooth surfaced, firm and mobile right adnexal mass with solid and cystic portions was detected and the tumor was excised. Pathologic and immunohistochemical examination revealed carcinoid tumor. After the evaluation of gastrointestinal and respiratory systems by imaging and endoscopic studies, no evidence of tumor tissue or metastases were found. Based on this finding, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and appendectomy were performed and pelvic-paraaortic lymph nodes were also removed. All histological findings were similar to the features of mature cystic teratoma and carcinoid tumor. Examination of the resected lymphatic, omental and appendiceal tissue indicated no tumoral invasion. Thus, the diagnosis was primary ovarian carcinoid arising from a mature cystic teratoma. This case, in the setting of a normal appendix and negative workup for an extraovarian origin, is one of a primary ovarian adenocarcinoid tumor. The primary carcinoid tumor should be differentiated from a metastatic carcinoid inside the ovary, which is always bilateral. It is important to be aware of this unusual entity in diagnoses of ovarian tumors, even in the absence of any clinical symptoms of carcinoid syndrome.

Tear clearance measurement in patients with dry eye syndrome using quantitative lacrimal scintigraphy

OBJECTIVE

The aim of this study was to evaluate the tear clearance in patients with dry eye syndrome using quantitative lacrimal scintigraphy.

MATERIALS AND METHODS

We investigated 21 patients (42 eyes; 18 women, 3 men; mean age, 63.19 +/- 13.33 years) with dry eye syndrome. Additionally, for the sake of comparison, 12 normal subjects of the same age group (24 eyes; 10 women, 2 men; mean age, 68.25 +/- 2.63 years) were included. Lacrimal scintigraphy, Schirmer-1 test, BUT, and rose bengal ocular surface vital staining were performed in these cases.

RESULTS

According to the results of lacrimal scintigraphy, the mean value of T 1/2 was 4.16 +/- 1.22 minutes and the mean value of RI was 14.15% +/- 2.30% in normal subjects. However, in patients with dry eye syndrome, these values were 20.59 +/- 1.97 minutes and 55.64% +/- 6.90%, respectively. Consistent with the results of ophthalmologic tests, the mean Schirmer-1 value was 12.46 +/- 2.10 mm, the mean value of BUT was 14.36 +/- 3.40 seconds, and the mean staining value of the rose bengal was 1.98 +/- 0.80 in normal subjects, whereas these values were 1.36 +/- 0.49 mm, 5.46 +/- 1.33 seconds, 6.62 +/- 0.86, respectively, in patients with dry eye syndrome. When we compared the results of lacrimal scintigraphy and the results of ophthalmologic tests, an inverse correlation was noted between both the T1/2 and RI values and both the Schirmer-1 and BUT values in all subjects (p < 0.001). However, there was a greater positive correlation between the rose bengal ocular surface staining value and both the T1/2 and RI values in all cases (p < 0.001).

CONCLUSION

In the current study, it was concluded that although the lacrimal drainage system was normal, tear clearance was significantly delayed in dry eye patients. With this study, we have shown that quantitative lacrimal scintigraphy, which is an objective, practical, and noninvasive method, appears to be useful for the assessment of the tear clearance in patients with dry eye syndrome.

Thyroid function: fetal-maternal relationship at term

The present study was undertaken to examine serum parameters of thyroid function at term in normal pregnant women and their normal fetuses. Paired sera from 56 mothers and their respective newborn infants' umbilical cord were obtained at parturition. Maternal and fetal TSH, FT4, T4, FT3 and T3 levels were measured and the differences between these two groups were analysed. The levels of fetal serum TSH (8.86 +/- 5.82 IU/ml) were significantly higher than maternal TSH levels (3.32 +/- 3.3 IU/ml) (P < 0.001), but there was no significant difference between the fetal and maternal T4, FT4 and T3. On the other hand, cord FT3 levels (1.7 +/- 1.2 pg/dl) were significantly lower than maternal levels (2.7 +/- 1.4 pg/dl) (P < 0.001).