Podwyższony poziom greliny w stanie przedrzucawkowym: czy grelina jest przyjacielem czy wrogiem?

Objectives: To investigate maternal serum ghrelin levels in pregnancies complicated by preeclampsia and to explore the relationship between ghrelin level and disease severity. Materials and methods: This case-control study included 40 healthy pregnant women, 42 women with mild preeclampsia, and 40 women with severe preeclampsia. The groups were matched in terms of maternal and gestational age and body mass index. Serum ghrelin levels were measured via enzyme immunoassay. Results: Serum ghrelin levels were significantly higher in women with mild and severe preeclampsia than in healthy controls (p < 0.001). Although serum ghrelin levels were somewhat higher in the severe compared to the mild preeclampsia group, the difference was not statistically significant (p > 0.05). In the control group, no significant correlation was observed between ghrelin level and any other parameter, but in the preeclampsia group, serum ghrelin levels were negatively correlated with uterine artery Doppler index values and both systolic and diastolic blood pressure (all p-values < 0.05). Multivariate stepwise linear regression analysis revealed that systolic blood pressure (β = 0.493, p = 0.023) was independently associated with serum ghrelin level. Conclusion: Elevated blood ghrelin levels were correlated with disease severity in pregnancies complicated by preeclampsia.Cel pracy: Ocena poziomu greliny w surowicy kobiet w ciąży powikłanej stanem przedrzucawkowym i określenie związku między poziomem greliny a ciężkością choroby. Materiał i metoda: Do badania włączono 40 zdrowych kobiet w ciąży, 42 z łagodnym stanem przedrzucawkowym i 40 z ciężkim stanem przedrzucawkowym. Grupy były dobrane pod względem wieku ciążowego, wieku matek i wskaźnika masy ciała. Poziom greliny w surowicy był mierzony metodą immunoenzymatyczną. Wyniki: Poziom greliny w surowicy był istotnie wyższy u kobiet z łagodnym i ciężkim stanem przedrzucawkowym niż w grupie kontrolnej (p < 0,001). Chociaż poziom greliny w surowicy był wyższy w grupie z ciężkim stanem przedrzucawkowym niż w grupie z łagodnym stanem przedrzucawkowym, to ta różnica nie była istotna statystycznie (p > 0,05). W grupie kontrolnej nie obserwowano żadnych istotnych związków pomiędzy poziomem greliny a jakimkolwiek innym parametrem, ale w grupie ze stanem przedrzucawkowym poziom greliny w surowicy był ujemnie skorelowany z indeksami przepływów Dopplera w tętnicy macicznej oraz ciśnieniem krwi skurczowym i rozkurczowym (all p-values < 0,05). Wieloczynnikowa analiza regresji liniowej wykazała, że skurczowe ciśnienie krwi było niezależnym czynnikiem związanym z poziomem greliny w surowicy (β = 0,493, p = 0,023). Wnioski: Podwyższony poziom greliny we krwi był związany z ciężkością choroby w ciążach powikłanych stanem przedrzucawkowym

Türkiye’de akciğer kanseri hastalarında uyku bozuklukları

WOS:000455820300004PubMed ID: 30683024Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was toanalyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. Materials and Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. Results: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. Conclusion: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.Giriş: Uyku kalitesinin, kanser semptomlarının şiddetiyle ilişkili olduğu bilinmektedir. Bu çalışmada, Türkiye’de akciğer kanseri hastalarında uyku ile ilişkili sorunların prevalansı ve kanser semptomlarının insomnia üzerine etkisinin araştırılması amaçlandı. Materyal ve Metod: Türkiye’de 26 merkezin katılımıyla gerçekleştirilen, akciğer kanserli olguların dahil edildiği çok merkezli bir çalışma olan ASPECT çalışması verileri, bu hastalarda görülen uyku sorunları, insomni ve bunların kanser semptomları ile ilişkisi yönüyle yeniden değerlendirildi. Hastaların demografik özellikleri ve hastalıkları hakkında bilgi, hasta ile yüz yüze görüşülerek ve hastane kayıtları aracılığıyla derlendi. Uykuyu başlatma ve sürdürme zorluğu (DIMS) ile gündüz artmış uyku hali veya yorgunluk tanımlayan olgular insomni olarak değerlendirildi. Gündüz uyku hali, yorgunluk ve akciğer kanseri semptomları Edmonton Semptom Değerlendirme Skalası kullanılarak kaydedildi. Bulgular: Katılan 1245 olgunun, %48.4’ünde DIMS, %60.8’inde gündüz uyku hali ve %82.1’inde yorgunluk mevcuttu. Insomni prevalansı %44.7 olarak bulundu. Kadın cinsiyet, evre 3-4 hastalık, metastatik hastalık, komorbid hastalıklar ve kilo kaybı 5 kg olan olgularda insomnia oranı anlamlı olarak daha yüksekti. Diğer yandan insomnisi olan hastalarda ağrı, bulantı, dispne ve anksiyete semptomları anlamlı düzeyde yüksek bulundu. Multivariate lojistik regresyon analizi, orta ileri şiddetli ağrısı ve dispnesi olan, ayrıca ciddi anksiyetesi olan hastalarda insomni sıklığının 2-3 kat fazla olduğunu ortaya koydu. Sonuç: Çalışmamız, kanser semptomları ile uyku kalitesi arasında yakın bir ilişki olduğunu ortaya koymuştur. Bu nedenle, akciğer kanserli hastalarda kaliteli bir uyku için, kanser semptomların yeterince kontrol edilmesi gereklidir

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study

Objective: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. Methods: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. Results: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). Conclusion: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium