Sema Genc

Relationship Between Visceral Adipose Tissue and Adiponectin, Inflammatory Markers and Thyroid Hormones in Obese Males with Hepatosteatosis and Insulin Resistance

BACKGROUND AND AIMS In our detailed analysis of the recent academic publications, we have not found sufficient evidence regarding the changes of metabolism that occur in cases of insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the changes in various biomarkers of obese patients by taking into consideration the IR and NAFLD, which occur increasingly together. METHODS Obese male patients included in the study (n = 315) were divided into three groups. Group I was determined as mild pathology (n = 129; HOMA-IR ≥2.5 and grade 0 or HOMA-IR <2.5 and grade 1-2 hepatosteatosis), group II as moderate pathology (n = 145; HOMA-IR ≥2.5 and grade 1-2 or HOMA-IR <4 and grade 3 hepatosteatosis) and group III as severe pathology (n = 41; HOMA-IR ≥4 and grade 3 hepatosteatosis). Waist circumference (WC), percent body fat (%BF), visceral adipose tissue (VAT), subcutaneous abdominal fat tissue (SCAT), thyroid volume (Tvol), thyroid hormones, insulin, adiponectin, fibrinogen and ultrasensitive C-reactive protein (us-CRP) were measured in all patients. RESULTS A negative correlation between adiponectin and HOMA-IR was found (r = -0.4226; p <0.001). In addition, there were significant differences among all three groups with respect to VAT (p <0.01). Moreover total-triiodo-L-thyronine (TT3) and free-triiodo-L-thyronine (fT3) levels were observed first to decrease in group II compared to group I and then to increase in group III (p <0.001). Fibrinogen and us-CRP levels in group III were significantly higher (p <0.001). CONCLUSIONS TT3 and fT3 levels as well as adiponectin, fibrinogen and us-CRP levels may be affected by the relationship between IR and NAFLD in obese patients. Moreover, increased VAT is a more important risk factor than WC, %BF and BMI, with respect to IR and NAFLD.

The effect of COX-2 inhibitor, nimesulide, on angiogenetic factors in primary endometrial carcinoma cell culture

Angiogenesis, the development of new blood vessels from preexisting capillaries, is essential for the development, growth and advancement of solid tumours. Angiogenesis is enhanced by prostaglandins (PGs) that are synthesised by the catalysis of cyclooxygenases (COX-1 and COX-2) from arachidonic acid. COX-2 is upregulated in a variety of malignancies and favours the growth of malignant cells by stimulating proliferation and angiogenesis. The aim of this study is to investigate the angiogenetic process by determining the levels of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1 and interleukin (IL)-8 in endometrial cancer cells and to study the effect of nimesulide, a selective COX-2 inhibitor, on these mediators using cell culture. Endometrial tissue specimens were obtained from subjects with endometrial cancer and intramural leiomyoma. Cells were incubated with either 10 or 50 μM nimesulide for 24 h. VEGF, MCP-1 and IL-8 concentrations were determined by sandwich quantitative enzyme immunoassay (ELISA). VEGF concentration was significantly higher in cancer cells than normal endometrial cells. VEGF was decreased with 10 μM nimesulide in cancer cells whereas it remained unaltered in normal cells. Both MCP-1 and IL-8 concentrations were lower in cancer cells than normal cells. MCP-1 levels were decreased with both doses of nimesulide in normal cells, whereas IL-8 levels were significantly affected only by 50 μM of nimesulide. These results suggest that COX-2 inhibitors may be effective in the treatment of endometrial cancer via suppression of angiogenesis.

Nutritional risk in hospitalized patients: impact of nutritional status on serum prealbumin

OBJETIVO: Falha no reconhecimento e acompanhamento do estado nutricional e a razao mais importante da desnutricao em pacientes hospitalizados. Este estudo objetivou avaliar o estado nutricional dos pacientes e comparar os resultados com os niveis sericos de pre-albumina. METODOS: Foram incluidos 97 pacientes no estudo, internados consecutivamente. O risco de desnutricao foi avaliado de acordo com dados antropometricos e com a Avaliacao Subjetiva Global e Triagem de Risco Nutricional 2002. Os estados nutricionais dos pacientes foram comparados com suas idades, sexo, indice de massa corporal, historico medico, perda de peso e analises bioquimicas, incluindo pre-albumina e tempo de permanencia hospitalar. RESULTADOS: De acordo com o Triagem de Risco Nutricional 2002, 57% dos pacientes estavam desnutridos ou em risco de desnutricao, apresentando boa correlacao com o Avaliacao Subjetiva Global (p<0,001, r=0,700). A analise multivariada mostrou correlacoes positivas entre desnutricao e idade, perda de peso, malignidade e proteina reativa-C (p=0,046, p=0,001, p=0,04 e p=0,002). Um escore ³3 no Triagem de Risco Nutricional 2002 foi associado a internacao prolongada (p<0,001). Houve correlacao entre pre-albumina serica e o estado nutricional, independente do numero de doencas cronicas e biomarcadores de inflamacao (p=0,01). A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e valor diagnostico da pre-albumina na avaliacao do risco de desnutricao foram de 94%, 32%, 0,67, 0,78 e 69, respectivamente. Apos sete dias de suporte nutricional, o risco de desnutricao caiu em 12% (p<0,001) e os niveis sericos de pre-albumina aumentaram em 20% (p=0,003). CONCLUSAO: Ao inves de refletir o estado nutricional global do paciente, niveis sericos baixos de sericos de pre-albumina podem ser vistos como um sinal de maior risco de desnutricao, exigindo uma avaliacao nutricional mais extensa. A analise serica de pre-albumina pode ser usada para o monitoramento de pacientes recebendo suporte nutricional.

Cystatin-C and creatinine as indices of glomerular filtration rate in the immediate follow-up of renal transplant patients.

Serum cystatin-C (cys-C), creatinine (Cr), C-reactive protein (CRP) and amyloid A have been shown to provide useful information for renal function following transplantation. In this study, we wanted to evaluate the impact of these parameters as markers of the glomerular filtration rate (GFR) on the third and seventh days of the post-transplantation period. Cys-C was determined by the particle-enhanced immunoturbidimetric assay, and serum amyloid A (SAA) by the sandwich-enzyme immunoassay kit. Cr and CRP concentrations were measured by the Cobas Integra 400 autoanalyser. The patients (n=35) were followed with daily repetitive measurements of serum Cr and urine output per hour, and with Doppler ultrasonography against the risk of rejection. Statistical evaluations were made using the ANOVA and Pearson’s test. Serum cys-C and Cr levels on both the 3rd and 7th days after transplantation were lower than those of pretransplantation values (P<0.001). The Cr/cys-C ratio was decreased on the 3rd day of the post-transplantation period, and kept declining on the 7th day. This ratio was high only in the patient with an acute rejection episode. None of the patients with high pretransplant CRP levels had a rejection episode during a six-month follow-up. SAA concentrations were found to be higher than the pretransplant values in the early post-transplant period. Cys-C had good sensitivity to estimate the renal function in the very early period of transplantation, but its value as a marker of GFR was decreased at the end of first week. As none of the 34 patients had a rejection episode, the observed rise in SAA and CRP levels is not specific to rejection.

The Decreased CD4+CD25+ FoxP3+ T Cells in Nonstimulated Allergic Rhinitis Patients Sensitized to House Dust Mites

Objective. Regulatory (CD4+CD25+) T cells have been shown to play an important role in the development of allergic diseases. This study aims to investigate CD4+CD25+ T cells, Forkhead box P3 (FoxP3+ cells), and T-helper 1/T-helper 2 (Th1/Th2) cytokines in newly diagnosed allergic rhinitis (AR) patients. Methods. Altogether, 10 subjects with AR and 12 age-matched nonallergic healthy subjects were included in this study. CD4+CD25+ T cells, FoxP3+ T cells in peripheral blood mononuclear cells (PBMCs) were evaluated by flow cytometry, and the Th1/Th2 cytokine levels were determined by cytometric bead array immunoassay in both PBMC supernatants and nasal lavage fluids. Results. The percentage of CD4+CD25+ T cells were significantly higher, whereas the percentage of FoxP3+ cells were lower in AR patients compared with healthy subjects. In PBMC culture supernatants, interleukin-10 (IL-10) levels were significantly lower (p = .012), whereas IL-4, IL-5, and tumor necrosis factor-α (TNF-α) levels in nasal lavage fluids were higher in AR patients compared with healthy subjects (p = .026, p = .015, p = .03, respectively). Conclusions. Our findings indicate that decrease in CD4+CD25+FoxP3+ T cell fraction and diminished levels of IL-10 are noteworthy without allergen stimulation in house dust mite AR patients.

The Presence of Prolidase Activity in Amniotic Fluid and Its Evaluation as a Maturity Test

Prolidase (EC: 3.4.13.9) catalyses the hydrolysis of the peptide bond involving the imino nitrogen of proline or hydroxyproline. Because of the high proportion of imino acids in collagen, this enzyme plays an important role in its degradation. Since collagen turnover rate is expected to be high during fetal growth, the level of prolidase activity may reflect the degree of fetal maturation. In this study, amniotic fluid prolidase I activity was measured in term and preterm pregnancies. Lecithin concentration, which has been widely used for predicting fetal lung maturity, was also measured. Prolidase I activity was positively correlated with lecithin levels (n = 30; r = 0.42; p < 0.02), and also with birth weight of the babies (n = 30; r = 0.52; p < 0.01) in the term-mature group. Dysmature babies had significantly lower prolidase I activity in the amniotic fluid which was thought to be indicative of growth retardation.

Evaluation of turbidimetric inhibition immunoassay (TINIA) and HPLC methods for glycated haemoglobin determination.

Various factors may affect the accuracy of hemoglobin (Hb) A1c measurements that are widely used to monitor glycemic control in diabetic patients. This study was aimed to compare the values of HbA1c obtained by two different methods, Roche Tina‐quant second and thirdgeneration HbA1c assays based on the turbidimetric inhibition immunoassay (TINIA), and high‐performance liquid chromatography (HPLC) cation‐exchange method used by Arkray Adams HA‐8160 analyzer.

Enhanced nerve growth factor expression by mast cells does not differ significantly between idiopathic and allergic rhinitis

BACKGROUND The role of neurotrophins in allergic rhinitis (AR) has been well studied, but it has not been evaluated in idiopathic rhinitis (IR). OBJECTIVE We aimed to evaluate the nasal β-nerve growth factor (β-NGF) expressions of mast cells in patients with AR and IR. METHODS Seventeen patients with house dust mites-induced persistent moderate/severe allergic rhinitis (mean age: 29.7 ± 11.96), 14 patients with idiopathic rhinitis (mean age, 29.3 ± 10.62), and 16 healthy controls (29.9 ± 11.57) were included in the study. Nasal biopsy specimens were taken from the posterior part of the inferior turbinate from all of the study subjects. Nasal β-nerve growth factor and its receptors, pan-neurotrophin receptor p75, and tyrosine kinase A (trkA) were assessed with an immunofluorescence assay. Mast cells were determined by both an immunofluorescence assay and immunohistochemistry as tryptase-positive cells. RESULTS The β-NGF, trkA, and p75 receptor counts were significantly higher in AR and IR patients than in the control group (P < .001, for each), but they were not different between AR and IR patients. Similarly, the ratio of β-NGF+ mast cells/total mast cells and the ratio of β-NGF+ mast cells/total β-NGF+ cells in AR and IR patients was found to be elevated when compared with the control group (P < .001, P < .001, P < .001, and P = .046, respectively); furthermore, the 2 ratios were not statistically different between the 2 patient groups. CONCLUSION The increase in β-NGF-expressing mast cells does not differ between idiopathic and allergic rhinitis. Therefore, we propose that mast cells do play a role in the pathogenesis of IR as important as in that of AR.

A Comparison of hs-CRP Levels in New Diabetes Groups Diagnosed Based on FPG, 2-hPG, or HbA1c Criteria

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) have been used to diagnose new-onset diabetes mellitus (DM) in order to simplify the diagnostic tests compared with the 2-hour oral glucose tolerance test (OGTT; 2-hPG). We aimed to identify optimal cut-off points of high sensitive C-reactive protein (hs-CRP) in new-onset DM people based on FPG, 2-hPG, or HbA1c methods. Data derived from recent population-based survey in Turkey (TURDEP-II). The study included 26,499 adult people (63% women, response rate 85%). The mean serum concentration of hs-CRP in women was higher than in men (p < 0.001). The people with new-onset DM based on HbA1c had higher mean hs-CRP level than FPG based and 2-hPG based DM cases. In HbA1c, 2-hPG, and FPG based new-onset DM people, cut-off levels of hs-CRP in women were 2.9, 2.1, and 2.5 mg/L [27.5, 19.7, and 23.5 nmol/L] and corresponding values in men were 2.0, 1.8, and 1.8 mg/L (19.0, 16.9, and 16.9 nmol/L), respectively (sensitivity 60–65% and specificity 54–64%). Our results revealed that hs-CRP may not further strengthen the diagnosis of new-onset DM. Nevertheless, the highest hs-CRP level observed in new-onset DM people diagnosed with HbA1c criterion supports the general assumption that this method might recognize people in more advanced diabetic stage compared with other diagnostic methods.

The Association of Glycemic Markers with Plasma Adipocytokine Levels inWomen with Gestational Diabetes

Introduction: Alterations in the synthesis of cytokines have been demonstrated in gestational diabetes (GDM), but the association of cytokines with short- and long-term glycemic markers has not been defined clearly. In this study, the variations in the plasma levels of visfatin, TNF-α, IL-1β, IL-6, and IL-10 were investigated and theirassociations with glycemic markers -HbA1C, fructosamine, 1,5-anhydro-D-glucitol (1,5-AG), and continuous glucose monitoring system (CGMS) parameters were evaluated. Material and methods: 33 pregnant women with GDM, and 20 pregnant women without any maternal and fetal disorder were comprised in the study. Three of the 33 women diagnosed with GDM required insulin therapy were excluded from the study. The visfatin, TNF-α, IL-1β, IL-6 and IL-10 and 1,5-AG were determined by ELISA. HbA1C% and fructosamine were also evaluated. Continuous glucose monitoring system (CGMS) was applied to the women with GDM. Results: Serum IL-6 and IL-1β levels were significantly high in GDM compared to controls (p=0.039, and p=0.04, respectively). An increase in TNF-α level by approximately 33% did not reach significant level. No significant interactions between BMI and cytokines were found. Visfatin levels were correlated with 1,5 AG (r=0.557, p=0.001) and TNF-α concentration was correlated with HbA1C (r=0.341, p=0.050). IL-1β was associated with both MAD% and average glucose which are indices of CGMS (p=0.004 and p=0.008). Conclusions: Increased IL-6, IL-1β, and TNF-α, and their correlation with short- or longterm glycemic markers present an evidence for the roles of these cytokines and visfatin on carbohydrate metabolism in the course of gestational process and gives a priority to proinflammatory cytokine profile in gestational diabetes.