Increased serum citrullinated histone H3 levels in COVID-19 patients with acute ischemic stroke = Akut ischaemiás stroke-ban szenvedő Covid-19-betegek körében megnő a szérum citrullinált hiszton H3-szintje

Prevalence of acute ische­mic stroke (AIS) is increased in patients with coronavirus disease 2019 (COVID-19). A proposed hypothesis is increased virus-induced propensity to hypercoagulation resulting in arterial thrombosis. Our aim was to provide evidence regarding the involvement of neutrophil extracellular trap (NET) formation (NETosis) in COVID-19 related AIS. Twenty-six consecutively enrolled COVID-19+ pneumonia patients with AIS, 32 COVID-19+ pneumonia patients without AIS and 24 AIS patients without COVID-19 infection were included to the study. Clinical characteristics of recruited patients were collected. Serum levels of citrullinated histone H3 (H3Cit; a factor of NETosis), IL-8 and C5a (mediators associated with NETosis) were measured by ELISA (enzyme-linked immunosorbent assay). H3Cit levels were significantly higher in COVID-19+ AIS patients, whereas all study groups showed comparable IL-8 and C5a levels. There were no significant differences among etiological subgroups of AIS patients with or without COVID-19. AIS patients with COVID-19 showed relatively increased white blood cell, lymphocyte, neutrophil, D-dimer, C-reactive protein and procalcitonin levels than control groups. H3Cit levels did not correlate with clinical/prognostic features and inflammation parameters. H3Cit and IL-8 levels were correlated in COVID-19 patients without stroke but not in COVID-19 positive or negative AIS patients. Increased levels of inflammation parameters and H3Cit in COVID-19 related AIS suggest that NETosis may cause susceptibility to arterial thrombosis. However, H3Cit levels do not correlate with clinical severity measures and inflammation parameters diminishing the prognostic biomarker value of NETosis factors. Moreover, the link between IL-8 and NETosis appears to be abolished in AIS

Cerebrospinal Fluid Level of Phosphorylated Neurofilament Heavy Chain is Higher in Converting Clinically Isolated Syndrome and Correlates with CAMP Response Element‑Binding Protein Concentration

Introduction: Prevision of conversion from clinically isolated syndrome (CIS) tomultiple sclerosis (MS) is required to avoid unnecessary use of immunomodulatingagents and to recognize patients with high disease activity. Our aim was toevaluate the value of phosphorylated neurofilament heavy chain (pNFH, a markerfor neuroaxonal degeneration) and Cyclic adenosine monophosphate responseelement‑binding protein (cAMP response element‑binding protein [CREB], amarker for neuroregeneration) levels in the prediction of conversion from CIS toMS. Methods: Twenty‑three consecutively recruited treatment‑naïve CIS patientswere followed for 36 months. pNFH and CREB levels were measured in the firstepisode cerebrospinal fluid (CSF) and the serum of 12 converting (CIS‑MS) and11 nonconverting CIS patients (CIS‑CIS) by enzyme‑linked immunosorbent assay.Results: Baseline CSF but not serum samples of CIS‑CIS patients displayedsignificantly lower pNFH levels compared to patients with CIS‑MS. The analysisof receiver operating characteristic curve presented a high specificity for theprediction of MS conversion for the CSF pNFH cut‑off level of 730.9 pg/ml. CSFpNFH levels significantly correlated with serum and CSF CREB levels. Higherbaseline CSF pNFH and CREB levels were associated with more rapid progressionto MS or increased disability scores. Conclusion: CSF pNFH measurement maypotentially determine MS patients with unfavorable clinical progression after thefirst attack. pNFH and CREB appear to be increased in parallel in CSF of CISpatients with higher disease activity. These results suggest that neurofilaments arenot only indicators of axonal degeneration but also partly a marker of neuronaldifferentiation and new axon regeneration mediated by CREB signaling pathway

Perspective of Turkish Medicine Students on Cancer, Cancer Treatments, Palliative Care, and Oncologists (ARES Study): a Study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913-2921, 2014; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15-iii28, 2012). It is crucial to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840-841, 2005). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words "cancer" and "oncologist" meant for the students. The participant students were analyzed in two study groups; "group 1" (n = 1.255) were phases I and II students that had never attended an oncology lesson, and "group 2" (n = 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of p < 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (p = 0.00025), they believed that early diagnosis was never possible (p = 0.042), all people with a diagnosis of cancer would certainly die (p = 0.044), and chemotherapy was not successful in a metastatic disease (p = 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (p = 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2; p = 0.097), and cancer was reminding them of "death" (54% in group 1 and 48% in group 2; p = 0.102). This study suggested that oncology education was useful for the students' understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country