Aslı Bolayır

The role of SCUBE1 in the pathogenesis of no-reflow phenomenon presenting with ST segment elevation myocardial infarction

Objective: SCUBE1 [signal peptide-CUB (complement C1r/C1 s)-EGF (epidermal growth factor)-like domain-containing protein 1] might function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Acute myocardial infarction is one of the most common causes of death in modern society. The concept of “no reflow” (NR) refers to a state of myocardial tissue hypoperfusion in the presence of a patent epicardial coronary artery. The main mechanisms of this phenomenon are thought to be high platelet activity and much thrombus burden. So, we researched the role of SCUBE1 in the pathogenesis of NR. Methods: A total of 142 patients with ST elevation myocardial infarction (STEMI) (n=42 with NR and n=100 without NR) and 50 healthy individuals were prospectively case-control recruited between March 2015 and October 2016 from our outpatient clinics of cardiology department. Patients with STEMI were diagnosed according to American Heart Association (AHA) guideline for the management of STEMI. Results: The mean SCUBE1 levels of the control subjects were 34±8.4 ng/mL, the mean SCUBE1 levels of patients with STEMI who were treated successfully with primary percutaneous coronary intervention (PCI) were 51±6.2, and the mean SCUBE1 levels of patients with STEMI who had NR phenomenon after primary PCI procedure were 97.2±8.9 ng/mL. Conclusion: In our opinion, SCUBE1 might contribute to NR phenomenon via thrombus activation and aggregation. The pathophysiology of NR phenomenon is unclear. The present study is the first clinical study that demonstrated that serum SCUBE1 level was significantly higher in patients with NR and that serum SCUBE1 was an independent predictor for the presence of NR in our study population.

Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients

OBJECTIVEnThe inflammatory process is a very important stage in the development and prognosis of acute ischemic stroke (AIS). The monocyte to high-density lipoprotein (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. However, the role of MHR as a predictor of mortality in patients with AIS remains unclear.nnnMETHODSnWe retrospectively enrolled 466 patients who were referred to our clinic within the first 24hours of symptom presentation and who were diagnosed with AIS between January 2008 and June 2016. Four hundred and eight controls of similar age and gender were also included. The patient group was classified into two groups according to 30-day mortality. The groups were compared in terms of monocyte counts, HDL, and MHR values.nnnRESULTSnThe patient group had significantly higher monocyte counts and lower HDL levels; therefore, this group had higher values of MHR compared to controls. Additionally, the monocyte count and MHR value were higher, and the HDL level was lower in non-surviving patients (p<0.001). The MHR value was also observed as a significant independent variable of 30-day mortality in patients with AIS (p<0.001). The optimum cut-off value of MHR in predicting the 30-day mortality for patients with AIS was 17.52 (95% CI 0.95-0.98).nnnCONCLUSIONnOur study demonstrated that a high MHR value is an independent predictor of 30-day mortality in patients with AIS.

The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage

INTRODUCTIONnInflammation may determine the prognosis of intracerebral hemorrhage (ICH), which has high mortality and morbidity rates. Recent studies have increasingly demonstrated eosinopenia as a prognostic factor, particularly in bacteremia, chronic obstructive pulmonary disease, and myocardial and cerebral infarction. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified.nnnMATERIALS AND METHODSnOur study included 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age- and sex-matched controls. During their hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil count/percentage and eosinophil count/percentage; these were also compared between nonsurviving and surviving patients. The significance of eosinopenia in predicting mortality was also evaluated.nnnRESULTSnPatients had a significantly higher neutrophil count/percentage and a significantly lower eosinophil count/percentage than controls; these results were similar between nonsurviving and surviving patients (Pu2009<u2009.001). Consequently, the patient group was divided into 4 subgroups depending on the presence of eosinopenia and/or neutrophilia. The mortality rate was highest (62%) in the group that had both eosinopenia and neutrophilia. Univariate and multivariate logistic regression analyses indicated that neutrophilia and eosinopenia were independent predictors of mortality in ICH (Pu2009=u2009.002; Pu2009=u2009.004) DISCUSSION: These results indicate that eosinopenia can occur in patients with ICH and that although the mechanism is unclear, eosinopenia is closely associated with mortality in these patients, particularly when accompanied by neutrophilia.

The relationship between lymphocyte / monocyte ratio and short-term mortality in acute ischemic stroke patients.

Amac: Lenfosit sayisinin monosit sayisina bolunmesi ile elde edilen lenfosit/ monosit orani(LMO) inflamasyonu gostermede yeni bir belirtec olarak kabul edilmektedir. Son calismalar, LMO duzeyleri ile akut iskemik inme (AII) sonrasi 3 aylik fonksiyonel iyilesme arasinda ters bir iliski oldugunu saptamistir. Bu calismadaki amacimiz LMO’nun AII hastalarinin kisa donem mortalitesini gostermedeki rolunu saptamaktir. Yontem: Calismamiz tek merkezli retrospektif bir calismadir. Ocak 2011- Aralik 2017 yillari arasinda klinigimizde AII tanisi ile izlenmis 508 hasta ile benzer yas ve cinsiyete sahip 512 kontrol calismamiza dahil edildi. Bulgular: Monosit sayisi hasta grubunda yuksekken lenfosit sayisi ve LMO duzeyleri kontrol grubunda yuksek saptandi. Hasta grubu daha sonra 30 gunluk mortaliteye gore iki alt gruba ayrildi. Ilk grupta hayatta kalan hastalar varken(n=396) ikinci gruptaki hastalar AII sonrasi 30 gun icinde exitus olmustu(n=112). Bu iki grup kiyaslandiginda; ikinci grupta lenfosit sayisi ve LMO duzeyleri dusukken, monosit sayisi yuksekti ( p < 0.001). AII sonrasi 30 gunluk mortalite ile iliskili risk faktorlerini belirlemek icin yapilan lojistik regresyon analizi urik asit, CRP ve LMO’nun mortalite gelisimi icin bagimsiz degiskenler oldugunu ortaya koydu. Ayrica islem karakteristigi egrisi analizi ile LMO icin 2.95’in altindaki degerlerin AIIye bagli 30 gunluk mortaliteyi saptamada kullanilabilecegi gosterildi (EAA:0.77, %95 GA:0.67- 0.86,duyarlilik:%72.6,secicilik:%80.7) . Sonuc: Sonuclarimiza dayanarak AII’li hastalardaki dusuk LMO duzeylerinin kisa donem mortalite ile iliskili oldugu soylenebilir.

The relationship between ABO blood types and development of cerebral venous sinus thrombosis

Objective: Several studies in the last few decades demonstrated that patients with non-O blood groups (A, B, AB) have increased prothrombic tendency. In addition, many thrombotic disorders have been shown to be closely related to the blood group. However, the role of blood types in cerebral venous sinus thrombosis (CVST) development is unknown. Method: Our study included 41 patients who visited the Neurology Department at Cumhuriyet University Hospital and who were diagnosed with CVST between the dates 01/01/2008 and 30/09/ 2016, together with 50 ageand sex-matched controls.The patient and control groups were compared in terms of blood group distribution. In addition, the patient group was divided into two groups according to whether they had parenchymal brain lesions or not, and the effect of the blood group on the prognosis was also assessed. Results: While the blood group distribution in the control group reflected the overall distribution of the Turkish population, the proportion of the non-O blood group in the patient group was higher than in the control group, however the difference between the two groups was not statistically significant. Similarly, there was no statistically significant difference in blood group distribution between patients with and without parenchymal lesions in the patient group. Logistic regression analysis showed that the blood group was not an independent variable in the development of CVST. Conclusions: As a result, the percentage of non-O blood group was higher in patients with CVST than healthy controls; however this is not statistically significant. There is a need for more prospective and extensive future studies on this issue.

Ortalama platelet hacmi, platelet dağılım genişliği ve platelet/lenfosit oranının serebral venöz tromboz gelişimindeki rolü

Amac: Ortalama platelet hacmi (OPH) ve platelet dagilim genisligi (PDG), platelet hacmini gosteren parametrelerdir. Buyuk plateletlerin kucuk plateletlere kiyasla enzimatik ve metabolik olarak daha aktif kabul edilmektedir. Artmis OPH ve PDG degerleri ile arteryel tromboz arasindaki iliski gosterilmistir ancak venoz trombozdaki yeri tam olarak bilinmemektedir. Inflamatuar bir gosterge kabul edilen platelet/ lenfosit oraninin artisinin(PLO) bircok hastalikla iliskisi bilinmekteyken venoz trombozda kullanimi ile ilgili az sayida calisma mevcuttur. Bu nedenle bu calismamizdaki amacimiz OPH, PDG ve PLO degerleri ile serebral venoz sinus trombozu(SVST) arasindaki iliskiyi ortaya koymaktir. Yontem: Calismamiza retrospektif olarak Ocak 2008- Eylul 2016 tarihleri arasinda klinigimizde SVST tanisi ile izlenmis 54 hasta ile benzer yas ve cinsiyete sahip 50 kontrol dahil edildi. Hasta ve kontrol grubu OPH, PDG ve PLO degerleri acisindan kiyaslandi. Bunun yaninda hasta grubu kendi icinde beyin parankimal lezyonu olan ve olmayanlar olarak ikiye ayrilarak OPH, PDG ve PLO’nun prognoz uzerindeki etkisi de degerlendirildi. Bulgular: Hasta grubunda kontrollere kiyasla OPH, PDG ve PLO degerleri daha yuksekken parankimal lezyonu olan ve olmayan hastalar arasinda anlamli fark saptanmadi. Ek olarak SVST gelisimi icin OPH ve PDG degerleri anlamli bagimsiz degiskenler olarak saptanirken ROC analizi ile optimum cut-off degerleri OPH icin 8.85 iken, PDG icin 15.75, PLO icin ise 168.53 olarak tespit edildi. Sonuc: Sonuc olarak, OPH, PDG ve PLO degerleri SVST’li hastalarda kontrollerden daha yuksek bulunmustur ancak prognozu belirlemede etkileri saptanmamistir. Ek olarak, OPH ile PDG yuksekliginin SVST gelisimi icin yeni bir bagimsiz risk faktorleri oldugunu soyleyebiliriz.

THE ROLE OF MEAN PLATELET VOLUME, PLATELET DISTRIBUTION WIDTH AND PLATELET / LYMPHOCYTE RATIO IN DEVELOPMENT OF CEREBRAL VENOUS THROMBOSIS

Aim: Mean platelet volume (MPV) and platelet distribution width (PDW) are parameters that indicate platelet volume. It is assumed that large platelets are enzymatically and metabolically more active than small platelets. The relationship between elevated MPV and PDW values and arterial thrombosis has been demonstrated, but their roles in venous thrombosis are not fully understood. While the platelet / lymphocyte ratio (PLR), which is considered to be an inflammatory indicator, is known to be associated with many diseases, there are only a few studies in venous thrombosis. For this reason, our aim in this study is to establish the relationship between MPV, PDW and PLR values and cerebral venous sinus thrombosis (CVST). Materials and Methods: Our study included 54 patients who were diagnosed with CVST in our clinic between January 2008 and September 2016, and 50 controls with similar age and sex. The patients and control groups were compared in terms of MPV, PDW and PLR values. In addition, the patient group was divided into two groups, according to parenchymal brain lesions, and the effect of MPV, PDW, and PLR on prognosis was also assessed. Results: While the MPV, PDW and PLR values were higher in the patient group compared to the controls, there was no significant difference between patients with and without parenchymal lesions. In addition, as MPV and PDW values for CVST development were determined as significant independent variables, optimal cut-off values were identifiedxa0 8.85 for MPV, 15.75 for PDW and 168.53 for PLR in ROC analysis. Conclusion: As a result, MPV, PDW and PLR values were higher in patients with SVST than controls, however their prognostic significance was not determined. In addition, we may suggest that higher MPV and PDW values are new independent risk factors for CVST development.

The associatıon between serum serglycin level and coronary artery disease severity in patients with stable angina pectoris

BACKGROUNDnSerglycin plays a key role in the inflammatory status however the relationship between coronary artery disease (CAD) and serglycin is still unknown.nnnAIMnIn this study, we aimed to investigate association of serglycin levels with CAD severity in patients with stable angina pectoris (SAP).nnnMETHODSnIn total, 100 SAP patients diagnosed by coronary angiography and clinical manifestations, and 100 control subjects matched for age and sex were enrolled in this case-control study. Plasma levels of serglycin, high-sensitivity C-reactive protein (hsCRP), lipid profiles, and clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the SYNTAX score (SS) assessed by coronary angiography.nnnRESULTSnPositively correlated with the SS (r = 0.564, p < 0.001), the plasma serglycin level in the SAP group was higher than that in the control group (11.17 ± 1.82 vs. 19.28 ± 1.88 ng/mL, p < 0.001). The plasma serglycin level was an inde-pendent predictor for both SAP (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054, p < 0.001) and a high SS (OR = 1.087, 95% CI 1.051-1.124, p < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, the plasma serglycin level was found to have a better predictive value for a high SS (area under the curve [AUC] 0.858, 95% CI 0.788-0.929, p < 0.001) compared with hsCRP (AUC 0.665, 95% CI 0.557-0.773, p = 0.006; Z = 2.94, p < 0.001), with an optimal cut-off value of 17.25 ng/mL (sensitivity 94.3%, specificity 68.2%).nnnCONCLUSIONSnPlasma serglycin levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

Adropin and circadian variation of blood pressure

BACKGROUNDnNocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function.nnnAIMnThis study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension.nnnMETHODSnTwenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded.nnnRESULTSnA strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 ± 457 pg/mL; dipper group, 3298 ± 530 pg/mL; normotensive group, 3681 ± 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern.nnnCONCLUSIONSnDecreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.