Sabahattin Muhtaroglu

The role of nitric oxide in testicular ischemia-reperfusion injury*

PURPOSE This study was designed to determine the role of nitric oxide (NO) in the ischemia-reperfusion (I/R) injury process in testes. METHODS Fifty prepubertal male rats were divided into 5 groups each containing 10 rats. After 4-hour torsion and 4-hour detorsion, bilateral orchiectomies were performed for measurement of tissue malondialdehyde (MDA) level and histopathologic examination. The results were compared statistically. The groups were labeled as group 1, basal values of biochemical parameters in testes; group 2 (control group), torsion plus detorsion; group 3, torsion plus N-monomethyl-L-arginine (L-NMMA) plus detorsion; group 4, torsion plus L-arginine plus detorsion; group 5, sham operation. RESULTS The highest MDA values were determined in the L-arginin group in ipsilateral testes. Group 3 and group 4 were statistically different from control group. Histological examination showed that specimens from group 4 had a significantly (P < .05) greater histological injury than group 3, and contralateral testes showed normal testicular architecture in all groups. CONCLUSIONS These results suggest that NO plays an important role in damaging the testis with I/R. Although inhibition of NO synthesis with L-NMMA significantly improves I/R injury in testes, enhancing NO production by providing excess of L-arginine increases such damage. In the early periods of detorsion, there is no damage to contralateral testes after unilateral testicular torsion.

Evaluation of endothelial dysfunction, lipid metabolism in women with polycystic ovary syndrome: relationship of paraoxonase 1 activity, malondialdehyde levels, low-density lipoprotein subfractions, and endothelial dysfunction

The aim of this study was to assess relationship of insulin resistance, oxidant-antioxidant status, endothelial dysfunction, lipid metabolism, and their contribution to the risks of cardiovascular disease in women with polycystic ovary syndrome (PCOS). Forty-five women with PCOS and 17 healthy women were included in this study. Nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), Apo A1, Apo B, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride, small, dense LDL cholesterol (sdLDL-C), large buoyant LDL cholesterol (LbLDL-C) levels, and paraoxonase 1 (PON1) activity were measured in serum/plasma obtained from study groups. Insulin resistance [homeostasis model assessment (HOMA) index] and serum sex hormone binding globulin (SHBG), total testosterone (tT), free testosterone (fT), androstenedione, and dehydroepiandrosteronsulfate (DHEAS) levels were also evaluated. Significantly decreased SHBG, NO, HDL-C levels, and PON1 activities, but increased tT, fT, androstenedione, DHEAS, HOMA index, MDA, ET-1, LDL-C, sdLDL-C, and LbLDL-C values were found in PCOS patients compared with those of controls. There was a positive correlation between MDA and fT levels; and a negative correlation between PON1 activity and fT. Our data show that insulin resistance, dyslipidemia, endothelial dysfunction, and oxidative stress might contribute to the excess risk of cardiovascular disease reported in PCOS patients.

The Importance of Cardiac Biomarkers on Remodelling After Myocardial Infarction

Background The purpose of this study is to evaluate the importance of tenascin-C ( TNC), N-terminal pro brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) on LV remodelling after myocardial infarction (MI). Methods Fifty-seven stable patients with subacute anterior MI who had total or subtotal occlusion in the infarct-related left anterior desending artery in coronary angiography were enrolled the study. 18 of patients who had total occlusion received only medical theraphy, 19 of patients who had total occlusion received successful PCI+ medical theraphy and 20 of patients who had subtotal occlusion received successful PCI+ medical theraphy. Left ventricular volumes and ejection fractions (EF) were measured with echocardiography. Serum TNC, NT-proBNP and CRP levels were measured at admission and a month after treatment. Results There was significant increase in LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) baseline to follow-up in total-PCI group. Baseline to follow-up; a borderline significant increase was observed in LVEDV in the total-medical group. No significant difference was seen in LV volumes and EF in the subtotal-PCI group. NT-proBNP, TNC and CRP levels were decreased in all groups. The decrease in NT-proBNP and CRP values were significant in the total-medical and subtotal-PCI group but in the total-PCI group they were not significant. The decrease of TNC was significant in all groups but the lowest decrease was seen in the total-PCI group. Conclusion TNC, NT-proBNP and CRP reflect LV remodelling in accordance with echocardiography after MI. Keywords Tenascin-C; NT-pro BNP; CRP; Remodelling; Myocardial infarction

Experimental Inhalation of Chlorine Gas Produced with a Different Method; Effects of N-Acetyl Cysteine on Acute Pulmonary Damage

ABSTRACT The two most common gas inhalation injuries encountered in emergency departments are carbon monoxide and chlorine inhalations. In this study, chlorine was produced through a method different to the previous experimental models. Rats were subjected to inhale chlorine, after which the effects of N-acetylcysteine on pulmonary damage were evaluated. A total of 50 rats were equally divided into five groups. Group 1 received nothing. Groups 2 and 3 were taken as 6 h, groups 4 and 5 as 24 h control and N-acetylcysteine groups, respectively. Firstly, 200 ppm chlorine gas was given for 20 min. Then, 40 mg/kg N-acetylcysteine was given intraperitoneally. The same procedure with the same dose was repeated 3 h later. The same procedures were applied to the control group but this time saline was used. Tissue samples of lungs were taken. Glutathione levels of the rats in the N-acetylcysteine group sacrificed at 24 h were significantly higher than those of the control group. Histopathological evaluation of the pulmonary tissues of the rats sacrificed at 6 and 24 h revealed mild-to-moderate degrees of tissue damage. The degree of tissue damage at 6 h and 24 h N-acetylcysteine group rats was lower than that in the control group. As a result, tissue damage resulting from experimental chlorine inhalation can be alleviated by N-acetylcysteine. This is mainly the result of the antioxidant effects of the N-acetylcysteine.

Serum inhibin B levels reflect contralateral testicular damage following unilateral testicular trauma.

Introduction: The aim of this study was to evaluate contralateral testicular damage (CTD) following unilateral blunt testicular trauma (BTT) and testicular capsule laceration (TCL) by the serum inhibin B level which is an accepted marker of spermatogenesis. Methods: Fifty peripubertal male Wistar albino rats were divided into 5 groups each containing 10 rats. Group 1 was the control group. Group 2 was the BTT group in which the right testicle was placed on a firm surface and a metal rod weighing 215 g was dropped onto the testicle from a height of 5.5 cm. Group 3 was the TCL group in which right testicular tunica albuginea was lacerated using the needle of 4/0 silk suture. Group 4 had right orchiectomy initially. Group 5 was the sham group. In all groups, 3-ml blood samples were taken and bilateral orchiectomies were performed 6 weeks after initial manipulations. Results: Groups 2 and 3 had decreased inhibin B levels (p < 0.001), although the orchiectomy group had normal levels. Histological analyses showed lower Johnsen scores for both trauma groups in the ipsilateral and contralateral testes (p < 0.05). Conclusions: Serum inhibin B levels decrease following unilateral testicular trauma reflecting CTD.

Effects of Prenatal Flutamide on Testicular Development, Androgen Production and Fertility in Rats

Introduction: To investigate the effects of blocking prenatal androgen with the anti-androgen flutamide on testicular weight (TW), seminiferous tubular diameter (STD), testicular biopsy score (TBS), testicular testosterone (TT), and fertility. Materials and Methods: Ten pregnant Wistar albino rats were injected with flutamide (100 mg/kg) on gestational days 16 and 19. Rats injected with the solvent were used as controls. Male pups from these dams were evaluated for testicular descent on postnatal day 22. The ability of each male to produce offspring was tested when the animals were aged 130 days. The rats were killed when 180 days old, and the testes were removed. Results: Sixteen of the 24 male rats (66.6%) exhibited cryptorchidism (6 unilateral, 10 bilateral) in the flutamide-treated group. Three of the rats with normally descended testicles were fertile, but none of the cryptorchid rats was fertile in flutamide-treated group. The average TW, mean STD, TBS and TT levels of the flutamide-treated rats was significantly lower than in the solvent-injected rats. However, there was no significant difference in these values between descended and undescended testes in flutamide-treated rats. Conclusion: Blocking of prenatal androgen with flutamide interferes with testicular development by inhibiting testicular descent, and also effects testicular morphology and function in both the descended and undescended testes of rats.

Effects of bupivacaine infiltration on beta-endorphin and cortisol release and postoperative pain following inguinal herniorrhaphy in children

This study was undertaken to investigate the effects of bupivacaine on beta-endorphin (BE) and cortisol (C) release and postoperative pain in children. Thirty children aged 1 month to 2 years undergoing outpatient inguinal hernia under general anesthesia were randomized into three groups. Wound infiltration in group 1 patients (precisional group) was performed with 0.5 ml/ kg 0.25% bupivacaine following anesthesia induction but prior to surgery. Group 2 patients (postincisional group) had wound infiltration with bupivacaine following repair of the hernia but before skin closure. Group 3 patients (control group) did not receive any local anesthetic. In the post-anesthesia care unit (PACU) objective pain assessments were performed every 5 min using a standardized ten-point objective pain scale. Plasma C concentrations increased at the end of the operation in all groups, but this increase was significant only in the control group (P < 0.001). There was no significant difference between the pre- and postincisional groups with regard to pre- and postoperative C alterations (P > 0.05). Although plasma BE concentrations increased significantly at the end of the operation in the control group (P < 0.001), no significant difference was found between pre- and postoperative values in the infiltration groups. There was a more marked difference in BE release between the preincisional and control groups (P < 0.001) than the postincisional group (P < 0.05). Although the objective pain scores were not statistically different upon PACU arrival, the patients in the infiltration groups achieved a pain score of 0 much more quickly than those in the control group (P < 0.05). These findings suggest that wound infiltration with bupivacaine decreases the stress response to surgery and postoperative pain.

Effects of naloxone on beta-endorphin and cortisol release in sepsis

We investigated the effects of the opiate antagonist naloxone on the release of beta-endorphin and cortisol in rats subjected to sepsis. Sepsis was induced in weanling male Wistar albino rats (3–4 weeks old, 75–90 g) by cecal ligation and double perforation (CLP). Forty animals were randomly allocated to four groups. Group 1 was given naloxone hydrochloride 0.5 mg/kg subcutaneously after CLP and this treatment was repeated at 2-h intervals until the rats were killed. Group 2 rats underwent a sham operation. Group 3 (control group) rats had CLP. Group 4 consisted of nonoperated animals used to establish normal reference values. Eighteen hours after CLP or sham operation, the rats were killed by cervical dislocation and a blood sample was drawn via cardiac puncture to determine the beta-endorphin and cortisol levels. The beta-endorphin levels were significantly higher in the control group than in the sham-operated, naloxone-treated (NT), and nonoperated rats (P<0.05). However, there were no significant differences in plasma beta-endorphin levels between sham-operated, NT and nonoperated rats (P>0.05). Plasma cortisol levels were significantly higher in the control group compared with the other three groups and this difference was more significant in sham-operated and nonoperated rats (P<0.01). However, no difference existed between sham-operated, NT, and nonoperated rats (P>0.05). This study demonstrates that the endogenous opioid system may play a role in the activation of the pituitary-adrenal axis following sepsis, and shows that the increase in beta-endorphin and cortisol could be blocked by naloxone.

An evaluation of two different screening criteria in gestational diabetes mellitus

Abstract Background: The objective of this study was to identify the gestational diabetes mellitus (GDM) prevalence difference according to American Diabetes Association (ADA) criteria and International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for 75 g oral glucose tolerance test (OGTT). Methods: This study was conducted at Erciyes University Department of Obstetrics and Gynecology. A total of 320 pregnant who met the criteria were included in the study and 75 g OGTT was applied. Irrespective of the first results, the test was applied to most participants 2 weeks later. Results: The GDM prevalence was found to be 9.1% according to the ADA criteria and 19.4% according to the IADPSG criteria. According to the ADA criteria, GDM prevalence was found to be statistically significantly high (p < .05) in patients with risk factors. According to the IADPSG criteria no relationship was found between GDM prevalence and any of the risk factors (p > .05). The patients diagnosed with GDM were observed not to reach the threshold levels for HbA1c. Conclusion: According to the IADPSG criteria, GDM prevalence doubles and leads to an increase in healthcare costs and workloads. HbA1c has no role in the diagnosis of GDM.

The association of sialic acid levels with nitric oxide and C-reactive protein in patients with diabetic foot ulcer / Diyabetik ayak ülseri olan hastalarda sialik asit düzeylerinin nitrik oksit ve C-reaktif protein ile ilişkisi

Abstract Objective: The present study aimed to evaluate the association of serum sialic acid (SA) levels with nitric oxide (NO) and C-reactive protein (CRP) in patients with diabetic foot ulcer. Methods: This study included total 56 type 2 diabetic patients (27 of them had diabetic foot ulcer and 29 without it) and 22 healthy volunteers. Serum SA, NO and CRP levels were measured with spectrophotometric and nephelometric methods respectively. Results: Serum SA levels were higher in diabetic foot group than diabetes group (p<0.05). CRP and NO levels were found to be significantly higher in diabetic foot group compared to the diabetes (p<0.001 and p=0.002, respectively) and control groups (p<0.001, both). Although there was no correlation between SA and NO (p>0.05), serum SA levels were significantly correlated with CRP in diabetic foot group (p<0.001). Conclusion: We suggest that SA could be related to acute phase response in patients with diabetic foot ulcer. Elevated serum SA and NO levels may be indicators of oxidative stress-induced vascular damage. Özet Amaç: Bu çalışma, diyabetik ayak ülseri olan hastalarda serum sialik asit (SA) düzeylerinin nitrik oksit (NO) ve C-reaktif protein (CRP) ile ilişkisini belirlemeyi amaçladı. Metod: Bu çalışma, toplam 56 tip 2 diyabetik hasta (27 diyabetik ayak ulserli ve 29 ayak ülseri olmayan) ve 22 sağlıklı gönüllüyü kapsadı. Serum SA, NO ve CRP duzeyleri sırasıyla spektrofotometrik ve nefelometrik metodlarla ölçüldü. Bulgular: Serum SA düzeyleri, diyabetik ayak grubunda diyabet grubundan daha yüksekti (p<0.05). CRP ve NO düzeyleri, diyabetik ayak grubunda diyabet (p<0.001 ve p=0.002, sırasıyla) ve kontrol grupları (p<0.001, her ikisinde) ile karşılaştırıldığında anlamlı olarak daha yüksek bulundu. Diyabetik ayak grubunda, SA ve NO arasında korelasyon olmamasına rağmen (p>0.05), serum SA düzeyleri CRP ile anlamlı olarak koreleydi (p<0.001). Sonuç: Diyabetik ayak ülseri olan hastalarda, SA’nın akut faz cevabıyla ilişkili olduğunu ileri sürebiliriz. Artmış serum SA ve NO düzeyleri oksidatif stresin neden olduğu vasküler hasarın göstergeleri olabilir.