Czynnik wzrostu fibroblastów 21 i jego związek z wrażliwością na insulinę u krewnych pierwszego stopnia chorych na cukrzycę typu 2

  Introduction: Fibroblast growth factor 21 (FGF 21) has been suggested as a predictor for the development of type 2 diabetes mellitus (T2DM). Material and methods: We aimed to determine FGF 21 levels in normoglycaemic (Group 1) and prediabetic (Group 2) first-degree relatives (FDR) of patients with T2DM in comparison with normoglycaemic subjects without a history of T2DM in their FDR (Group 3). Results: There was a significant difference between Group 1, 2, and 3 with respect to plasma FGF 21 concentrations (143.3 ± 93.8, 221.9 ± ± 171.7 and 121.2 ± 119.8 pg/mL, respectively, p = 0.01). FGF 21 levels were significantly increased in prediabetic FDR of patients with T2DM compared to normoglycaemic subjects without a history of T2DM in their FDR (p = 0.02). FGF 21 levels did not differ between normoglycaemic FDR of patients with T2DM and normoglycaemic subjects without a history of T2DM in their FDR (p > 0.05). In the whole group, FGF 21 correlated positively with age (r = 0.31, p = 0.003), BMI (r = 0.38, p < 0.001), systolic blood pressure (r = 0.38, p = 0.001), diastolic blood pressure (r = 0.26, p = 0.02), fasting blood glucose (r = 0.24, p = 0.02), HOMA-IR (r = 0.23, p = 0.03), AUC glucose (r = 0.35, p = 0.001), and AUC insulin (r = 0.32, p = 0.003) and negatively with HDL cholesterol (r = –0.24, p = 0.02) and Matsuda ISI (r = –0.33, p = 0.002). In the regression analysis, BMI was the most predictive factor for FGF 21 levels (beta = 0.41, r2 = 0.17, p < 0.001). Conclusions: We showed that FGF 21 concentrations are increased in prediabetic FDR of patients with T2DM and that there is a significant association between FGF 21 and obesity and insulin sensitivity. (Endokrynol Pol 2016; 67 (3): 260–264)    Wstęp: Sugerowano, że stężenie czynnika wzrostu fibroblastów 21 (FGF 21) jest czynnikiem predykcyjnym rozwoju cukrzycy typu 2 (T2DM). Materiał i metody: Celem badania było ustalenie stężenia FGF 21 u osób z normoglikemią (grupa 1) i ze stanem przedcukrzycowym (grupa 2) będących krewnymi pierwszego stopnia (FDR) chorych na T2DM w porównaniu z osobami z normoglikemią z ujemnym wywiadem rodzinnym w kierunku T2DM (grupa 3). Wyniki: Stwierdzono istotne różnice między grupami 1, 2 i 3 pod względem stężenia FGF 21 w osoczu (odpowiednio 143,3 ± 93,8; 221,9 ± 171,7 i 121,2 ± 119,8 pg/ml; p = 0,01). Stężenia FGF 21 były istotnie wyższe w grupie krewnych pierwszego stopnia chorych na T2DM ze stanem przedcukrzycowym niż u osób z normoglikemią bez dodatniego wywiadu rodzinnego w kierunku T2DM (p = 0,02). Stężenia FGF 21 nie różniły się istotnie między krewnymi pierwszego stopnia chorych na T2DM z normoglikemią a osobami z normoglikemią bez T2DM u krewnych pierwszego stopnia (p > 0,05). W całej badanej grupie stwierdzono dodatnią korelację między stężeniem FGF 21 a wiekiem (r = 0,31; p = 0,003), BMI (r = 0,38; p < 0,001), skurczowym ciśnieniem tętniczym (r = 0,38; p = 0,001), rozkurczowym ciśnieniem tętniczym (r = 0,26; p = 0,02), glikemią na czczo (r = 0,24; p = 0,02), wskaźnikiem HOMA-IR (r = 0,23; p = 0,03), AUC glukozy (r = 0,35; p = 0,001), AUC insuliny (r = 0,32; p = 0,003) oraz ujemną korelację ze stężeniem cholesterolu frakcji HDL (r = –0,24; p = 0,02) i wskaźnikiem ISI według Matsudy (r = –0,33; p = 0,002). W analizie regresji najsilniejszym czynnikiem prognostycznym stężenia FGF 21 był wskaźnik BMI (beta = 0,41; r2 = 0,17; p < 0,001). Wnioski: Podsumowując, autorzy wykazali, że stężenia FGF 21 są zwiększone u krewnych pierwszego stopnia chorych na T2DM ze stanem przedcukrzycowym i że istnieje silny związek między stężeniem FGF 21 a otyłością i wrażliwością na insulinę. (Endokrynol Pol 2016; 67 (3): 260–264)

Detecting the interferences in adrenocorticotropic hormone measurement - three cases reinforcing the efficiency of the complementary clinical and laboratory audit

Highlights Comparing test results to clinical data enhances the identification of interferences Misinterpretation of ACTH as a result of interference may lead to unnecessary testing Despite the interference, ACTH concentration can be in the reference interval Accurate measurement of adrenocorticotropic hormone (ACTH) is crucial in the evaluation of pituitary and adrenal disorders. Although great progress has been achieved in ACTH measurement with immunometric assays, interference may occur and adversely affect the clinical management. The report contributes to compiling the evidence on the clinical challenges with the management of the interferences in the ACTH measurement by presenting three cases: two with clinically overt hypercortisolism and discrepant ACTH concentrations within the reference interval; the third case describes the falsely elevated ACTH in a patient with secondary adrenal insufficiency. In all patients, the results obtained with the two immunometric platforms, chemiluminescence (CLIA) immunoassay (Siemens, Immulite) and electrochemiluminescence (ECLIA) immunoassay (Roche, Cobas), were discordant. Serial dilution of plasma samples revealed nonlinearity. After polyethylene glycol (PEG) precipitation recoveries were less than 22%, 26%, and 3%, respectively, supporting interference. Moreover, a decrease in ACTH concentration after incubation in a heterophile antibody-blocking tube was observed in the second case. In the first case, misinterpretation of ACTH led to inferior petrosal sinus sampling (IPSS), whereas timely detection of assay interference prevented further investigations in other cases. Increasing awareness regarding ACTH interference and comprehensive approach in evaluation could allow timely detection, helping to prevent unnecessary testing and perplexing clinical outcomes

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Consequences of hypoxia-reoxygenation phenomena in patients with obstructive sleep apnea syndrome

Background and Objectives : Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by numerous episodes of absence of respiratory flow during sleep, which can be followed by a decrease in SaO2 , which is rapidly normalized when ventilation resumes. We hypothesize that this hypoxia-reoxygenation phenomena may affect the generation of vascular endothelial growth factor (VEGF), erythropoietin (EPO), endothelin-1 (ENDO-1), and inducible nitric oxide synthase (iNOS). Design and Setting : Prospective, patients referred to sleep disorders center. Patients and Methods : The presence and severity of OSAS were determined using the standard overnight polysomnography. Diagnosis of OSAS was made when the apnea-hypopnea index (AHI) was ≥15, independent of the appearance of symptoms. Serum levels of VEGF, EPO, ENDO-1, and nitrite-nitrate were measured after overnight fasting in 69 patients with OSAS and in 17 healthy control subjects. Serum levels of VEGF and nitrite-nitrate were measured again after 12 weeks of treatment with continuous positive airway pressure (CPAP) in OSAS patients. Results : Serum VEGF levels were found to be significantly higher and nitrite-nitrate levels were found to be significantly lower in OSAS patients than in controls (P=.003, .008, respectively), but no differences in EPO and ENDO-1 levels were found between the groups. We demonstrated that in OSAS patients, the serum VEGF levels were decreased and nitrate levels were increased after 12 weeks of CPAP treatment (P=.001, .002, respectively). Conclusion : According to our data, it is likely that hypoxia-reoxygenation phenomena affect the VEGF and nitrite-nitrate levels, which may be pathogenic factors in generating cardiovascular complications in OSAS

Comparisons of the effects of the sevoflurane and propofol on acute ischemia reperfusion and DNA damages in rabbits

Abstract Background and objectives: The aim of this study was to compare the effects of sevoflurane and propofol anesthesia on oxidative DNA damage that occurs in low-extremity ischemia and is caused by tourniquet application. Methods: Fourteen New Zealand rabbits were randomly allocated into two equal groups. Group S (n = 7) received sevoflurane (2.5-4 percent) inhalation and Group P (n = 7) received a propofol infusion (1-2 mg·kg-1·min-1), after which a pneumatic tourniquet was placed on the right lower extremity. Blood samples were collected prior to tourniquet placement (baseline), 120 min after ischemia, 15 min after ischemia and 120 minutes (min) after ischemia. Malondialdehyde (MDA) levels were analyzed to determine lipid peroxidation, and single cell gel electrophoresis (SCGE) was used to determine DNA damage. Results: At 15 min after ischemia, the MDA levels in Group P (8.15 ± 2.61 µM) were higher than baseline (6.26 ± 3.19 µM, p = 0.026) and Group S (4.98 ± 0.77 µM, p = 0.01). DNA damage was similar in both groups, although DNA damage was higher than baseline (tail moment 0.63 ± 0.27, tail intensity 3.76 ± 1.26) in Group P at the 15th minute of reperfusion (tail moment 1.05 ± 0.45, p = 0.06; tail intensity 5.33 ± 1.56, p = 0.01). The increase in tail moment and tail intensity returned to normal levels in both groups 2 hours after the termination of ischemia. Conclusion: Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet

Studying the serum ghrelin levels of the elite athletes and sedentary controls fasting at the time of Ramadan

The Ghrelin is produced primarily by enteroendocrine cells in the gastric mucosa, and increases gastric emptying in normal subjects. The purpose of this study is to determine the differences in the Ghrelin level during different times along the day, and to assess the differences between the athletes and sedentary at the end of Ramadan fasting period of one month. The results indicated that there were no significant difference among the Ghrelin levels of athletes and sedentary during different times through the day (p>0.05). Significant differences were observed between pre- and post-tests mean Ghrelin scores of subjects (p<0.05) without making a separation as an athlete and sedentary. Also, the results indicated no significant difference between repeated Ghrelin measurements of athletes and sedentary (p>0.05). A significant and positive relationship was found in the middle level at the percentages of BMI and body fat of both groups. Moreover, there were significant differences among BMI scores (p<0.01) and body fat % (p<0.05) of the athletes and sedentary. Consequently, fasting during Ramadan did not cause any differentiation on the serum Ghrelin level of athletes and sedentary, but without group differentiation there was significant increase from the initial measurement to the last measurement of the serum Ghrelin level. There was a significant and positive relationship at middle level between BMI and body fat % of both groups of athletes and sedentary. There was a significant relationship, on the other hand, between BMI and repeated Ghrelin measurements of subjects.The Ghrelin is produced primarily by enteroendocrine cells in the gastric mucosa, and increases gastric emptying in normal subjects. The purpose of this study is to determine the differences in the Ghrelin level during different times along the day, and to assess the differences between the athletes and sedentary at the end of Ramadan fasting period of one month. The results indicated that there were no significant difference among the Ghrelin levels of athletes and sedentary during different times through the day (p>0.05). Significant differences were observed between pre- and post-tests mean Ghrelin scores of subjects (p<0.05) without making a separation as an athlete and sedentary. Also, the results indicated no significant difference between repeated Ghrelin measurements of athletes and sedentary (p>0.05). A significant and positive relationship was found in the middle level at the percentages of BMI and body fat of both groups. Moreover, there were significant differences among BMI scores (p<0.01) and body fat % (p<0.05) of the athletes and sedentary. Consequently, fasting during Ramadan did not cause any differentiation on the serum Ghrelin level of athletes and sedentary, but without group differentiation there was significant increase from the initial measurement to the last measurement of the serum Ghrelin level. There was a significant and positive relationship at middle level between BMI and body fat % of both groups of athletes and sedentary. There was a significant relationship, on the other hand, between BMI and repeated Ghrelin measurements of subjects

Comparisons of the effects of the sevoflurane and propofol on acute ischemia reperfusion and DNA damages in rabbits

Abstract Background and objectives: The aim of this study was to compare the effects of sevoflurane and propofol anesthesia on oxidative DNA damage that occurs in low-extremity ischemia and is caused by tourniquet application. Methods: Fourteen New Zealand rabbits were randomly allocated into two equal groups. Group S (n = 7) received sevoflurane (2.5-4 percent) inhalation and Group P (n = 7) received a propofol infusion (1-2 mg·kg-1·min-1), after which a pneumatic tourniquet was placed on the right lower extremity. Blood samples were collected prior to tourniquet placement (baseline), 120 min after ischemia, 15 min after ischemia and 120 minutes (min) after ischemia. Malondialdehyde (MDA) levels were analyzed to determine lipid peroxidation, and single cell gel electrophoresis (SCGE) was used to determine DNA damage. Results: At 15 min after ischemia, the MDA levels in Group P (8.15 ± 2.61 µM) were higher than baseline (6.26 ± 3.19 µM, p = 0.026) and Group S (4.98 ± 0.77 µM, p = 0.01). DNA damage was similar in both groups, although DNA damage was higher than baseline (tail moment 0.63 ± 0.27, tail intensity 3.76 ± 1.26) in Group P at the 15th minute of reperfusion (tail moment 1.05 ± 0.45, p = 0.06; tail intensity 5.33 ± 1.56, p = 0.01). The increase in tail moment and tail intensity returned to normal levels in both groups 2 hours after the termination of ischemia. Conclusion: Given that oxidative stress and genotoxic effect disappear in the late stages of reperfusion, we conclude that neither sevoflurane nor propofol can be considered superior to the other in anesthesia practices for extremity surgeries involving the use of a tourniquet

The analysis of hormones and enzymes extracted from endocrine glands of the neck region in deaths due to hanging

WOS: 000253560000011PubMed ID: 19749617Our study was designed to determine whether the hormone and enzyme levels that we have mentioned in serum specimens can be used in postmortem examinations of the cases of hanging or not. Our research includes the postmortem results of the thyroid tissue pathologic examinations, serum levels of triiodothyronine (fT3), thyroxine (fT4), thyrotropin (TSH), thyroglobulin, parathormone (PTH), calcitonin, and amylase in cases of death due to hanging. The mean of fT3 and thyroglobulin levels were higher in hanging cases than those of sudden death cases. This difference was statistically significant (P < 0.05). In our study, we obtained data demonstrating that high postmortem levels of free T3 and thyroglobulin may be indicators of vital reaction in hanging cases. In such cases of death, it seems that applying pressure on the neck region where the thyroid gland is located causes the leakage of thyroglobulin as well as fT3, the active form of the thyroid hormone