Evaluation of the importance of immunological profile for pemphigus vulgaris in the light of necessity to modify compensation theory

According to the “desmoglein compensation theory,” anti-Dsg1 and anti-Dsg3 profiles are crucial for the clinical outcome of pemphigus vulgaris. However, recent studies have highlighted several cases with an incompatibility between the antibody profile and clinical manifestation. Data of 37 patients who had been diagnosed pemphigus vulgaris in our Department between January 2014-June 2016 were retrieved from our clinical database. Patients with ABSIS skin involvement scores, oral mucosa extent and severity scores, anti-Dsg1 and Dsg3 antibody profile were included in this retrospective study. Patients with discordance between clinical manifestations and immunological profile were considered as atypical clinical phenotype. Patients with missing data were excluded. In all 37 patients, Dsg1 and Dsg3 antibody titers at the baseline did not correlate with the concurrent ABSIS scores. At follow up, we detected statistically significant correlations between anti Dsg-1 profile and ABSIS skin involvement scores (p=0.006; r=0.588) and between anti-Dsg3 and ABSIS mucosal extent and severity scores (p=0.058; r=0.431). After treatment, the reduction of Dsg-1 antibody titers was statistically significant in remittent patients (p=0.027). We did not detect statistically significant reduction of Dsg-3 antibodies. Four subjects had incompatible antibody profile and clinical activity. Discordance between phenotype-antibody profile and clinical activity-Dsg titers support the idea that non-Dsg antigens may also be the target for pemphigus autoimmunity. </p

Evaluation of atrial electromechanical conduction delay in case of hemodynamically insignificant rheumatic heart disease: A tissue Doppler study

Background: Atrial electromechanical delay (AEMD) that reflects delayed conduction may show us the clinical reflection of pathological changes in the atria. The main objective of the present study is to investigate AEMD in patients who had previous rheumatic carditis but without hemodynamically significant valvular disease. Methods: A total of 40 patients, previously diagnosed as rheumatic carditis but without significant valvular stenosis/regurgitation and atrial enlargement; and 39 age- and-sex matched controls were enrolled for the present study. Parameters of AEMD (lateral mitral annulus electromechanical delay, septal mitral annulus electromechanical delay and lateral tricuspid annulus electromechanical delay) were measured with tissue Doppler echocardiography and left intra-atrial and inter-atrial conduction times were calculated accordingly. A 24h ambulatory Holter monitoring was used in both groups to detect atrial fibrillation episodes and quantify atrial extrasystoles. Results: Parameters of AEMD, including left intra-atrial and inter-atrial conduction times of subjects in the study group were longer compared to the control group (23.7 ± 7.0 vs. 18.3 ± 6.2). Conclusions: Increased AEMD is observed in patients with previous rheumatic carditis and no significant valvular stenosis/regurgitation and atrial enlargement, which may partly explain the increased incidence of atrial fibrillation observed in these patients

Serum Galectin-3 Level Predicts Early Recurrence Following Successful Direct-Current Cardioversion In Persistent Atrial Fibrillation Patients

Objective: Atrial structural remodeling has been suggested to contribute to atrial fibrillation (AF) recurrence following direct-current cardioversion (DCCV). The role of several inflammatory and extracellular matrix turnover markers in AF recurrence following DCCV has been investigated. However, data on the impact of galectin-3, which is known to play a role in various fibrotic conditions, including cardiac fibrosis are lacking. The aim of this study was to demonstrate the predictive role of serum galectin-3 levels in AF recurrence following successful DCCV. Methods: A total of 90 persistent AF patients who were scheduled for DCCV were prospectively enrolled. Serum samples were assayed to determine pre-DCCV galectin-3 levels using the enzyme-linked immunosorbent assay method. Patients were followed up for 3 months for AF recurrence. Results: Of 90 persistent AF patients (mean age: 55.33 +/- 7.94 years; 53.33% male) who underwent successful DCCV, 28 (31.11%) experienced early AF recurrence within 3 months. Patients with AF recurrence had a greater left atrial volume index (LAVI) (33.35 +/- 2.45 mL/m(2) vs. 29.21 +/- 3.08 mL/m(2); p<0.001) and serum galectin-3 levels were higher (0.88 ng/mL [min-max: 0.52-1.32] vs. 0.60 ng/mL [min-max: 0.38-0.91]; p<0.001). In multivariate analysis, the number of DCCV attempts (hazard ratio [HR]: 1.879, 95% confidence interval [CI]: 1.052-3.355; p=0.033), LAVI (HR: 1.180, 95% CI: 1.028-1.354; p=0.018), and serum galectin-3 level (HR: 11.933, 95% CI: 1.220-116.701; p=0.033) were found to be independently associated with early AF recurrence following successful DCCV. Conclusion: Circulating levels of galectin-3 may have an association with early AF recurrence following DCCV.WoSScopu

Association Of Red Cell Distribution Width With Characteristics Of Coronary Atherosclerotic Plaques As Detected By Computed Tomography Angiography

Objective: To evaluate the relationship between red blood cell distribution width (RDW) and the severity/morphology of coronary atherosclerotic plaques (CAPs). Methods: We retrospectively analyzed 572 patients without a history of coronary artery disease (CAD) in whom dual-source 64-slice computed tomography angiography (CTA) was performed due to the suspicion of CAD. Results: Critical CAPs were detected in 26.9% of subjects. The RDW value was higher in patients with critical CAPs than in those without (13.63 +/- 1.28 vs. 14.31 +/- 1.58, p<0.001). Patients with any type of CAP regardless of the morphology or severity revealed enhanced RDW levels compared with those with normal coronary arteries (p<0.001). In the multinomial logistic regression analysis, RDW was found as an independent predictor for the presence of severe CAP (odds ratio (OR): 1.40, 95% confidence interval (CI): 1.20-1.63, p<0.001). RDW was also found to be associated with the presence of non-calcified plaque (OR: 1.30, 95% CI: 1.08-1.57, p=0.006) and mixed plaque morphologies (OR: 1.47, 95% CI: 1.19-1.81, p<0.001) after adjusted for other variables. Conclusion: Our findings suggested that RDW as a simple, available and inexpensive biomarker was significantly associated with both the severity and vulnerable morphology of CAPs in patients undergoing coronary CTA.Wo

Tsunami Waves in Izmit Bay

Based on eyewitness reports and run-up and inundation measurements, the tsunami generated after the Kocaeli earthquake had a period shorter than a minute and arrived a few minutes after the earthquake on the northern coasts and about a minute after on the southern coasts. The sea receded first along northern and southern coastlines of Izmit Bay. This information provides valuable information on the generation mechanism of the tsunami waves, for it implies that there was a large subsidence near and/or at the shoreline, possibly caused by a stepover between two strands of the strike-slip fault system. The fairly consistent reports of approximately one-minute wave periods rule out bay oscillations as the source of the flooding and indicate that regions of subsidence may have been localized (Alpar 1999; Guneysu 1999). Tsunami waves may have also been generated by sediment slumping within the bay, in addition to tectonic subsidence. Local peaks in tsunami run-up along the northern and southern shorelines of the middle basin hint that these slumps may have generated waves near Degirmendere. The Kocaeli earthquake generated only small tsunami waves that caused no extensive damage to coastal structures. The tsunami hit close to highly populated areas, however. This is a cause of substantial concern, as there are hundreds of houses, hotels, and cafés within tens of meters of the coastline. Future earthquake hazard mitigation programs in Izmit Bay and the Sea of Marmara need to consider the hazards of tsunami waves, which may result from coseismic seafloor motion, underwater landslides, slumps, and subsidence

Clinical Significance of HER2 Overexpression in Gastric and Gastroesophageal Junction Cancers

In this study, we investigated the rate of human epidermal growth factor receptor 2 (HER2) overexpression in gastric (GC) and gastroesophageal junction cancers (GEJCs) and the relationship with HER2 expression and clinical, pathological parameters and prognosis