Aynur Albayrak

APRI, the FIB-4 score, and Forn's index have noninvasive diagnostic value for liver fibrosis in patients with chronic hepatitis B.

Objectives The aim of this study was to evaluate the potential use of serum transforming growth factor-&bgr;1 (TGF-&bgr;1), tissue inhibitor of metalloproteinase-1 (TIMP-1), fetuin-A, and fibroblast growth factor 21 (FGF21) in the detection of liver fibrosis in patients with chronic hepatitis B (CHB). The value of the noninvasive fibrosis models – that is, the aspartate aminotransferase to platelet ratio index (APRI), the fibrosis index based on the four factors (FIB-4) score, and Forn’s index – was also examined. Materials and methods CHB patients who underwent liver biopsy for the evaluation of fibrosis were included in the study. A total of 73 patients were divided into two groups according to their METAVIR scores (F0–1, no/minimal fibrosis; F2–4, significant fibrosis). Serum levels of TGF-&bgr;1, TIMP-1, fetuin-A, and FGF21 were measured besides APRI, FIB-4, and Forn’s scores. The area under the receiver operating characteristic curve was measured for each parameter, followed by calculation of sensitivity, specificity, and positive and negative predictive values. Results APRI, FIB-4, and Forn’s index scores were significantly higher in patients with significant fibrosis (P<0.05). There was no difference between no/minimal fibrosis and significant fibrosis groups in terms of serum levels of TGF&bgr;-1, TIMP-1, fetuin-A, and FGF21 (P>0.05). The areas under the receiver operating characteristic curve for TGF-&bgr;1, TIMP-1, fetuin-A, FGF21, APRI, FIB-4, and Forn’s index were 0.445, 0.483, 0.436, 0.585, 0.662, 0.687, and 0.680, respectively. Conclusion Our results suggest that serum TGF-&bgr;1, TIMP-1, fetuin-A, and FGF21 are not useful for the assessment of the extent of liver fibrosis in CHB in this patient group. However, APRI, FIB-4, and Forn’s index have a better diagnostic value in patients with significant fibrosis than in those with no/minimal fibrosis.

Efficacy of Topical Mesenchymal Stem Cell Therapy in the Treatment of Experimental Dry Eye Syndrome Model

Purpose. The current study was set out to address the therapeutic efficacy of topically applied mesenchymal stem cells (MSCs) on dry eye syndrome (DES) induced by benzalkonium chloride (BAC) in rats. Methods. Rats were divided into two groups just after establishment of DES. Eye drops containing either bromodeoxyuridine labeled MSCs (n = 9) or phosphate buffer solution (n = 7) were topically applied once daily for one week. Schirmer test, break-up time score, ocular surface evaluation tests, and corneal inflammatory index scoring tests were applied to all rats at baseline and after treatment. All rats were sacrificed after one week for histological and electron microscopic analysis. Results. Mean aqueous tear volume and tear film stability were significantly increased in rats treated with MSCs (P < 0.05). Infiltration of bromodeoxyuridine labeled MSCs into the meibomian glands and conjunctival epithelium was observed in MSCs treated rats. Increased number of secretory granules and number of goblet cells were observed in MSCs treated rats. Conclusion. Topical application of MSCs could be a safe and effective method for the treatment of DES and could potentially be used for further clinical research studies.

Elevated serum angiotensin converting enzyme levels as a reflection of bone marrow renin–angiotensin system activation in multiple myeloma

Introduction: Angiotensin converting enzyme (ACE) is a circulating enzyme that participates in the body’s renin–angiotensin system (RAS) and is localized on the endothelial cell surface in the lung and other vascular beds. It catalyses the conversion of decapeptide angiotensin I to octapeptide angiotensin II. In the present study, we aimed to analyse the possible relationship between the levels of ACE in the context of RAS in multiple myeloma (MM) pathogenesis. Materials and methods: The study was conducted on 25 MM patients (13 males, 12 females; median age 66 years, range 47–88) and 20 healthy controls. The clinical features of MM patients including demographics and laboratory findings were summarized. Serum ACE levels were measured by using commercially available kits. Results: The serum ACE levels of MM patients and controls were 32.60±20.26 and 15.35±6.47 respectively. Serum ACE levels were significantly higher in MM patients compared with control groups (p<0.001). Conclusions: Being an important component of RAS, circulating ACE might be associated with clonal proliferation of malignant plasma cells in the bone marrow microenvironment. Identification of the pathobiological activity of the local RAS in MM would enlighten the biologic basis and clinical management of haematologic disorders.

Treatment Efficacy with Bone Marrow Derived Mesenchymal Stem Cells and Minocycline in Rats After Cerebral Ischemic Injury

ObjectiveWe aimed to investigate the effects of bone marrow derived mesenchymal stem cells (MSCs), minocycline, and these two therapies combined on functional and histological improvement in cerebral ischemic injury created rats.Materials and methodsTwenty-eight Sprague Dawley female rats, weighing 250–300xa0g, were included in the study. Two male rats with similar properties were sacrificed for bone marrow derived MSC production. Group 1 was established as the control group. Group 2 was the group of only minocycline administered rats. Group 3 was the one of only MSCs administered rats. Group 4 was composed of the rats given the combination of MSCs and minocycline. Hematoxylin and eosin staining was done to assess the degeneration of the cells. Immunohistochemical staining was performed to evaluate the regeneration. Motor functions were examined by using Bederson’s score.ResultsCell degeneration was the least in group 4. The cells stained with GFAP were observed mostly in group 4. The cells stained with Neu N in group 1 were statistically lower than in other groups. When the groups were ordered in terms of functional improvement at the end of the second week, group 4 had the most and group 1 had the least.ConclusionsBone marrow derived MSCs can lead to more histological and functional improvement when administered with minocycline, which is a neuroprotective agent as early as 24xa0h following the ischemic injury in a rat model. Minocycline therapy alone can be as effective as bone marrow derived MSCs therapy alone in ischemic cerebral rat model.

A Rare Cause of Fever, Hepatosplenomegaly, and Thrombocytopenia: Hepatosplenic Gamma/Delta T-Cell Lymphoma

Hepatosplenic gamma-delta T cell lymphoma (HSTCL) is a very rarely-encountered form of lymphoma [1, 2]. It constitutes less than 1% of all non-Hodgkin’s lymphomas (NHL). It occurs in males more frequently. Its mean age of occurrence is 35. It is a type of lymphoma that originates from cytotoxic T lymphocytes. This disease has an aggressive clinical course. The prognosis thereof is quite poor [3]. It is a primary extranodal lymphoma, emerging with the sinus or sinusoidal infiltration of the liver and spleen. Bone marrow is virtually always involved. Lymph node involvement is very rare [4]. Patients typically present with systemic symptoms, massive hepatosplenomegaly, anemia, leucopenia and evident thrombocytopenia. It may respond initially to chemotherapy. Recurrence, however, is unavoidable in the majority of cases. The mean survival is less than 2 years [3]. Case Report

Son derece nadir bir durum: Parotis bezinin miks sellüler tip primer Hodgkin lenfoması

Primary mixed cellularity Hodgkin’s lymphoma of the parotid gland is extremely rare. We report here an 80-year old woman who presented with a painless preauricular mass of two months duration. Cytological and histomorphological findings were consistent with mixed cellularity Hodgkin’s lymphoma. Due to the age and the presence of comorbid diseases, the patient only received radiotheraphy and has been in remission for 12 months since the initial diagnosis. Primary Mixed cellularity Hodgkin’s lymphoma of the parotid gland is extremely rare and the prognosis, in addition to the biologic behavior of this disease is yet to be evaluated. J Clin Exp Invest 2012; 3(4): 533-535Parotis bezinin miks selluler tip primer hodgkin lenfomasi son derece nadir gorulur. Biz burada 2 aydir olan agrisiz preaurikular kitle ile basvuran 80 yasinda bir kadin hastayi sunduk. Sitolojik ve histomorfolojik bulgular miks selluler tip hodgkin lenfoma ile uyumlu bulundu. Yas ve komorbid hastaliklarindan oturu hastaya sadece radyoterapi verildi. Hastanin, tanidan itibaren 12 aydir remisyonda takibi devam ediyor. Parotis bezinin Miks selluler tip primer hodgkin lenfomasi son derece nadirdir ve bu hastaligin biyolojik davranisi ve prognozu arastirilmayi beklemektedir.

Akut lenfoblastik lösemili hastada ikinci kemoterapi sonrası gelişen lökomoid reaksiyon

to 50.000 cells/µL. The examined peripheral blood smear appeared as similar to the chronic phase of CML (fig.2). A cytogenetic examination of Philadel phia chromosome [t(9:22] was found to be negative, therefore, CML was excluded in the patient. Hydroxurea was initiated once a day. Leukocytosis recovered to normal range after one week (fig.3) and bone marrow examination revealed remission. Cytogenetic analysis was normal and this leukocytosis was determined as reactive leukemoid reaction. We aimed to report this case owing to the fact that leukocytosis associated with G-CSF, which is used to increase the leukocyte count during neutropenia, has been reported previously but it occurred after second chemotherapy without G-CSF [4]. We know that this condition is a very rare situation.

Serious skin reaction associated with imatinib in a patient with chronic myeloid leukemia.

Imatinib mesylate (STI 571) is one of the fundamental chemotherapeutic agents used in the treatment of the chronic, accelerated and blastic phases of chronic myelocytic leukemia (CML), gastrointestinal stromal tumors and Philadelphia chromosome-positive acute lymphoblastic leukemia. It selectively inhibits receptor tyrosine kinases. Its effects limit the use of this drug. We present a case with a serious skin reaction requiring the discontinuation of the drug and that developed in relation to imatinib therapy. Six months prior, a 61-year-old male patient presenting to the hematology polyclinic with complaints of weight loss and sweating was hospitalized due to high leukocyte value. As a result of the hemogram, biochemistry analyses, peripheral blood smear examination, bone marrow aspiration evaluation, cytogenetic examination using FISH and PCR that were performed, CML was diagnosed. Additionally, to exclude myelofibrosis, we examined a bone marrow biopsy. Imatinib mesylate was started at 400 mg/day orally. In the fourth month of treatment, the patient complained of itching and a skin rash. Although the drug dose was reduced (300 mg/day), his complaints gradually increased. The skin biopsy result was superficial perivascular dermatitis. Imatinib was discontinued, and the patient was started on corticosteroid. The lesions disappeared completely. A month later, the patient was restarted on imatinib mesylate. However, the lesions recurred more prominently. His itching increased. The patient was considered intolerant to imatinib mesylate, and a second-generation tyrosine kinase inhibitor, dasatinib 100 mg/day, was started orally. The follow-up and treatment continues for the patient, who has been taking dasatinib 100 mg/day for the last two months without any skin finding or complaints. Imatinib mesylate-induced skin reactions are associated with the pharmacologic effect of the drug rather than hypersensitivity to the drug. Skin reactions are frequently observed, and this side effect is dose dependent. However, the interesting aspect of our case was that despite dose reduction, skin findings gradually increased, and eventually the drug had to be discontinued.