Omer Uysal

Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease

OBJECTIVE To investigate the distribution of waist circumference (WC) and waist-to-hip ratio (WHR), their relationships with a number of established risk factors and their relevance to cardiovascular morbidity in a random sample of Turkish general adult population. DESIGN Cross-sectional population-based study. SUBJECTS The subjects comprised 958 men and 1014 women, aged 25-74 years. MEASUREMENTS Waist circumference was measured midway between the lower rib and iliac crest while that of the hip at the level of trochanters. Mean of two blood pressure measurements was used for analysis. Plasma total cholesterol (Cho) and triglyceride (Trg) concentrations were measured by the enzymatic dry method with a Reflotron apparatus. RESULTS Overall mean WC measured 93+/-12 cm in men, and 88.6+/-13 cm in women. Mean WHR was 0.919+/-0.077 and 0.823+/-0.074, respectively, and a rise by about 0.001 was associated with each year of age. In multiple regression analysis a model was utilized that included age, body mass index (BMI), systolic and diastolic blood pressure (BP), plasma total Cho and Trg and category of smoking. This revealed age, BMI, and Trg as independent determinants of WHR in both genders, and diastolic BP in women alone. Age, BMI, and diastolic BP proved to be independently associated with WC in both genders, while Cho did so in men alone, Trg and systolic BP in women alone. Partial correlation coefficients on univariate analysis between all four variables of blood pressure and plasma lipids and either WC or WHR, controlled for age, were highly significant though moderately weak in both genders. These were stronger in men than in women, and stronger with respect to WC than to WHR. Cigarette smoking men and women had significantly lower WC or WHR than nonsmokers and ex-smokers, though these associations did not prove to be independent. When the relevance of WC and WHR to CHD risk was tested in this cohort (for the age bracket 45-74 years) comprising 138 cases with a clinical diagnosis of CHD, only WHR in women proved to be significantly associated. Odds ratio for a value of >0.845 was 1.6. CONCLUSION WC and WHR are strongly associated with BMI and age as well as with parameters reflecting insulin resistance such as diastolic blood pressure and plasma triglycerides. WHR was significantly associated with coronary heart disease in Turkish women.

C-reactive protein and coronary heart disease in Western Turkey ☆

C-reactive protein (CRP) has been recognized as a useful marker for coronary or cardiovascular risk in healthy subjects or patients with coronary heart disease (CHD) in industrialized societies. We assessed whether CRP could serve as a marker of prevalent CHD risk in a cross-sectional study of a population with low cholesterol levels (4.61 mmol/L in men and 4.82 mmol/L in women) but higher prevalence of other risk factors. In 1,046 participants of the Turkish Adult Risk Factor Survey in 2000, high-sensitivity CRP as well as other risk variables were evaluated, and CHD was diagnosed, based on clinical findings and Minnesota coding of electrocardiograms at rest. Almost an equal number of men and women > or = 30 years of age constituted the population sample of the western regions of Turkey. Geometric mean value of CRP was 1.9 mg/L (interquartile range 0.8 to 4.3), without revealing a significant difference in gender. CRP was correlated with many variables, notably those involving central obesity, fibrinogen, and apolipoprotein-B, but not with smoking status (regardless of age adjustment). In multiple regression models, blood fibrinogen, waist circumference, total cholesterol, and physical activity grade were independently associated with log CRP concentrations. Among many risk variables, CRP quartiles and systolic blood pressure were, besides age and gender, the only significant independent determinants of CHD. The age-adjusted odds ratio for CHD in the highest as opposed to the lowest quartile was 4.48 (p < 0.001). Even after adjustment for the 5 previously mentioned determinants of CRP, a 4.2-fold increased risk of CHD still persisted between the highest and lowest quartiles. Thus, the observed increased risk was not in large part due to the intermediary effects of fibrinogen, nor were some indicators of insulin resistance, but interaction appeared to be independent of these effects. Thus, CRP values serve as a marker of prevalent CHD risk in populations with low cholesterol levels. This association is independent of, or in addition to, the effects of conventional risk factors, suggesting that the contribution of chronic low-grade inflammation to the atherothrombotic process is present even in the setting of low cholesterol levels.

Microperimetric Changes After Photodynamic Therapy for Central Serous Chorioretinopathy

PURPOSE To evaluate the effect of half-dose verteporfin photodynamic therapy (PDT) on macular function in cases of central serous chorioretinopathy (CSC). DESIGN Interventional case series. METHODS A total of 24 eyes from 24 cases of CSC were included in this study. In each eye, at baseline and 1, 3, and 6 months after half-dose PDT, logMAR best-corrected visual acuity (BCVA); central 10-degree, 20-degree, and paracentral 10-degree to 20-degree retinal sensitivity; and also mean retinal sensitivity results for each case over the area that was treated with half-dose PDT (PDT spot area) by MP-1 microperimetry and optical coherence tomography (OCT) foveal morphologic changes were assessed. The MP-1 microperimetry sensitivity map was overlaid onto an indocyanine green angiography image recorded on a Heidelberg scanning laser ophthalmoscope using dedicated MP-1 software to evaluate the PDT laser spot area. RESULTS After treatment, BCVA and central 10-degree, 20-degree, paracentral 10-degree to 20-degree, and PDT laser spot area retinal sensitivity were improved significantly. In OCT in 20 of 24 eyes (83%), subretinal fluid (SRF) was resolved 1 month after half-dose PDT. At 3 and 6 months after treatment, SRF was resolved at all eyes. None of the patients in this study developed any systemic or ocular adverse events associated with verteporfin treatment. CONCLUSION Half-dose verteporfin PDT induced a significant increase in central 10-degree, 20-degree, paracentral 10-degree to 20-degree, and also PDT laser spot area retinal sensitivity over 6 months in cases of CSC.

Normal Diaphragmatic Motion and the Effects of Body Composition Determination With M-Mode Sonography

Objective. To evaluate the quantitative measurement of diaphragmatic motion in healthy subjects and to investigate the effects of different variables such as body mass index and waist circumference on the diaphragmatic motion. Methods. The study included 164 healthy subjects. The subjects were grouped according to age, sex, body mass index, and waist circumference. Measurements of diaphragmatic motion were made by a 3.5‐MHz sonographic unit in the M‐mode of the system. The posterior diaphragm on both sides was identified, and measurements were performed during deep inspiration. Results. The mean diaphragmatic motion measurements ± SD were 49.23 ± 10.98 and 50.17 ± 11.73 mm on right and left sides, respectively. Female subjects had statistically significantly (P < .05) decreased diaphragmatic motion (right, 46.93 ± 10.37 mm; left, 47.57 ± 10.36 mm) than male subjects. The mean diaphragmatic motion (right, 40.90 ± 8.89 mm; left, 39.37 ± 9.15 mm) was less in subjects who were underweight (P < .05) when compared with subjects who were of normal weight, overweight, and obese. Subjects who had a waist circumference of less than 70 cm showed a statistically significant decrease (P < .05) in diaphragmatic motion (right, 42.55 ± 9.12 mm; left, 42.24 ± 9.73 mm) when compared with subjects who had a waist circumference of 70 to 85, 85 to 100, and greater than 100 cm. Also, subjects younger than 30 years had statistically significantly (P < .05) decreased diaphragmatic motion (right, 44.57 ± 10.57 mm; left, 44.44 ± 11.37 mm). Conclusions. Sex, body mass index, waist circumference, and age may affect the diaphragmatic motion to some extent. Healthy persons of younger age with a smaller body mass index and waist circumference may show a decreased amount of diaphragmatic motion.

Renoprotective effects of valsartan and enalapril in STZ-induced diabetes in rats

Effects of the angiotensin II type 1 (AT1) receptor antagonist valsartan and the angiotensin-converting enzyme (ACE) inhibitor enalapril were studied in streptozotocine (STZ)-induced diabetes in rats on the basis of microalbuminuria (Ma) and renal morphology. Five groups of Wistar rats were used, one group was the non-diabetic control, one group consisted of untreated STZ-diabetics and 3 groups of STZ-diabetics were treated with either enalapril and/or valsartan for 30 days. Blood glucose (BG) and Ma levels, body and kidney weight and glomerular size were measured. Immunohistochemical staining with an anti-transforming growth factor-beta1 (TGF-beta1) antibody was performed as well. In STZ-diabetics, BG and Ma levels were significantly increased when compared with the non-diabetic group. Although Ma levels in the valsartan-treated group was found to be higher than those in the non-diabetics group after 15 days of treatment, in all treated diabetic groups Ma levels were significantly decreased as compared with STZ-diabetics at the end of the experiment. Thickening of the glomerular and tubular basement membranes, increased mesangial matrix and glomerular size were found in the untreated diabetic group. All these changes were less in the treated groups. A significant increase in TGF-beta1 immunoreactivity was found in glomeruli of untreated STZ-diabetics as compared with non-diabetics. Again, TGF-beta1 expression was decreased in the treated groups as compared with untreated STZ-diabetics. We conclude that valsartan and enalapril have renoprotective effects in diabetic nephropathy. A combined therapy has an advantage because lower dosages of these drugs can be used. Their beneficial effects are related to a blockade of the renin-angiotensin system (RAS) and a decrease in TGF-beta1 expression in glomeruli.

SIRT1 Gene Polymorphisms Affect the Protein Expression in Cardiovascular Diseases

Cardiovascular disease (CVD), the leading cause of death worldwide, is related to gene-environment interactions due to epigenetic factors. SIRT1 protein and its downstream pathways are critical for both normal homeostasis and protection from CVD-induced defects. The aim of this study was to investigate the association between SIRT1 single nucleotide polymorphisms (SNPs) (rs7895833 A>G in the promoter region, rs7069102 C>G in intron 4 and rs2273773 C>T in exon 5 silent mutation) and SIRT1 and eNOS (endothelial nitric oxide synthase) protein expression as well as total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) in CVD patients as compared to controls. The frequencies of mutant genotypes and alleles for rs7069102 and rs2273773 were significantly higher in patients with CVD compared to control group. The risk for CVD was increased by 2.4 times for rs7069102 and 1.9 times for rs2273773 in carriers of mutant allele compared with carriers of wild-type allele pointing the protective role of C allele for both SNPs against CVD. For rs7895833, there was no significant difference in genotype and allele distributions between groups. SIRT1 protein, TAS, TOS and OSI levels significantly increased in patients as compared to control group. In contrast, level of eNOS protein was considerably low in the CVD patients. An increase in the SIRT1 expression in the CVD patients carrying mutant genotype for rs7069102 and heterozygote genotype for all three SNPs was observed. This is the first study reporting an association between SIRT1 gene polymorphisms and the levels of SIRT1 and eNOS expressions as well as TAS, TOS and OSI.

A Remarkable Age-Related Increase in SIRT1 Protein Expression against Oxidative Stress in Elderly: SIRT1 Gene Variants and Longevity in Human

Aging is defined as the accumulation of progressive organ dysfunction. Controlling the rate of aging by clarifying the complex pathways has a significant clinical importance. Nowadays, sirtuins have become famous molecules for slowing aging and decreasing age-related disorders. In the present study, we analyzed the SIRT1 gene polymorphisms (rs7895833 A>G, rs7069102 C>G and rs2273773 C>T) and its relation with levels of SIRT1, eNOS, PON-1, cholesterol, TAS, TOS, and OSI to demonstrate the association between genetic variation in SIRT1 and phenotype at different ages in humans. We observed a significant increase in the SIRT1 level in older people and found a significant positive correlation between SIRT1 level and age in the overall studied population. The oldest people carrying AG genotypes for rs7895833 have the highest SIRT1 level suggesting an association between rs7895833 SNP and lifespan longevity. Older people have lower PON-1 levels than those of adults and children which may explain the high levels of SIRT1 protein as a compensatory mechanism for oxidative stress in the elderly. The eNOS protein level was significantly decreased in older people as compared to adults. There was no significant difference in the eNOS level between older people and children. The current study is the first to demonstrate age-related changes in SIRT1 levels in humans and it is important for a much better molecular understanding of the role of the longevity gene SIRT1 and its protein product in aging. It is also the first study presenting the association between SIRT1 expression in older people and rs7895833 in SIRT1 gene.

The Effect of a Modeling Resin and Thermocycling on the Surface Hardness, Roughness, and Color of Different Resin Composites

STATEMENT OF PROBLEM The application of modeling resin could affect the surface quality and color of resin composites. PURPOSE To evaluate the effects of modeling resin on the microhardness, roughness, and color of composite restorations, with and without thermocycling. METHODS Sixty disc-shaped specimens for each resin composite were prepared in three groups: Group 1: A resin composite disc was cured against a polyester matrix and finished/polished; Group 2: A composite instrument was wetted with Bisco Modeling Resin (Bisco, Schaumburg, IL, USA) to smooth the composite surface, which was cured against a polyester matrix and finished/polished; Group 3: A composite instrument was wetted with modeling resin to smooth the composite surface, which was cured against a polyester matrix. Microhardness, roughness, and color were measured 24 hours after curing and after 10,000 thermocycles. RESULTS Modeling resin significantly influenced the microhardness of GrandioSO (Voco, Cuxhaven, Germany) and Gradia Direct Posterior (GC America, Alsip, IL, USA), and the surface roughness of GrandioSO, Filtek Silorane (3M ESPE, St Paul, MN, USA), and Aelite All Purpose Body (Bisco) (p < 0.05). The microhardness of the Group 1 resin composites was affected by thermocycling (p < 0.05); however, thermocycling had no significant effect on surface roughness (p > 0.05). Tested composites showed clinically perceptible color changes after thermocycling. In Group 1, Filtek Ultimate (3M ESPE) showed the lowest color change (p < 0.05), and in Group 2, Filtek Silorane showed the highest significant color changes (p < 0.05). CONCLUSIONS Modeling resin did not affect the microhardness, surface roughness, and color of Aelite LS Posterior (Bisco), Filtek Ultimate (3M ESPE), and Clearfil Majesty Esthetic (Kuraray Medical Inc, Tokyo, Japan) specimens. Also, thermocycling process only affected microhardness of tested resin composites. CLINICAL SIGNIFICANCE The effect of modeling resin on surface microhardness, roughness, and color stability of composite materials depends on the type of resin composite. In clinical practice, the adverse effects of modeling resin might be alleviated by a proper finishing and polishing procedure.

Iron, nitric oxide, and myeloperoxidase in asthmatic patients.

Plasma nitric oxide (NO), myeloperoxidase (MPO), and iron (Fe) levels were determined in bronchial asthma. The relations among these parameters in different stages of asthma were interpreted. Their association with airway inflammation observed in patients with bronchial asthma as well as the roles and the contributions to the pathological processes were evaluated. A total of 62 individuals, 32 asthmatics and 30 controls, were included into the scope of this study. Plasma nitric oxide metabolites (NOx) and MPO and Fe levels were determined by the Griess reaction, ELISA, and the automated TPTZ (2,4,6-tri[2-pyridyl]-5-triazine) method, respectively. In the asthmatic individuals, plasma NOx, MPO, and Fe concentrations were 133 ± 13 μM, 95 ± 20 ng/ml, and 159 ± 20 μg/dl, respectively; in the control group these values were 82 ± 11 μM, 62 ± 11 ng/ml, and 96 ± 9 μg/dl. Increased values were detected for plasma MPO (p > 0.05), NOx (p < 0.01), and Fe (p < 0.01) concentrations in asthmatic individuals. Considering the facts that NO modulates the catalytic activity of MPO and induces the expression of heme oxygenase as important contributors to the mechanisms causing free Fe release, it is concluded that elevated NOx, MPO, and Fe levels observed in the asthmatic group act in a concerted manner and appear to be involved in the pathogenesis of asthma.

Microperimetric changes after intravitreal bevacizumab injection for exudative age-related macular degeneration

Purpose:  To evaluate the effect of intravitreal bevacizumab on macular function in the cases of exudative age‐related macular degeneration (AMD).