Arbitration in International Commercial Agreements: The Noose Draws Tighter

WOS: 000298822100014PubMed ID: 22166511This study aimed to examine fibroblast growth factor-19 (FGF-19) in type 2 diabetic (T2DM) patients with metabolic syndrome (MetS) and to evaluate the relationship between FGF-19 and other cardiovascular risk factors, such as atherogenic index of plasma (AIP) and hsCRP. 26 T2DM patients with MetS and 12 healthy controls were enrolled in the study. Serum FGF-19 levels were measured by sandwich ELISA, and compared with other cardiovascular risk factors; lipid profile, AIP, glucose, HbA1c, and hsCRP. AIP was calculated as log (TG/HDL-c). The median (1-3.quartile) FGF-19 levels in T2DM patients with MetS and healthy controls were 122.90 (108.63-237.60) pg/ml and 293.45 (153.64-370.31) pg/ml, respectively (P=0.003). Patients were also grouped by body mass index (BMI) = 30 kg/m(2) (n=13) with median (1-3.quartile) FGF-19 values 168.70 (113.54-275.77) pg/mL and 115.89 (97.94-200.40) pg/mL, respectively (P=0.007). Significant negative correlations were found between FGF-19 and BMI, triglyceride, log (TG/HDL-c), hsCRP, and HbA1c (r=-0.526, P=0.001; r=-0.327, P=0.05; r=-0.312, P=0.05; r=-0.435, P=0.006; r=-0.357, P=0.028, respectively). We showed that FGF-19 levels are low in T2DM patients with MerS. The negative relationship between FGF-19 and several known cardiovascular risk factors such as TG, log (TG/HDL-c), hsCRP and HbA1c in diabetic patients with MetS suggests that FGF-19 can be used as a contributing marker

Effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice

WOS: 000287226600011PubMed ID: 20690079PURPOSE We assessed the effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice using the estimated glomerular filtration rate (eGFR) and evaluated the factors associated with renal dysfunction. MATERIALS AND METHODS Between July 2007 and September 2009, 108 consecutive patients (69 men 39 women; median age, 59 years; range, 29-87 years) with obstructive jaundice (20 benign, 88 malignant) that were unsuitable for endoscopic retrograde cholangiopancreticography were evaluated at admission and at follow-up exams five and thirty days after percutaneous transhepatic biliary drainage. Two patients with suspected contrast-induced nephropathy were excluded. Renal function was assessed by measuring levels of urea, creatinine and electrolytes and evaluating the modification of diet in the renal disease formula for eGFR. RESULTS eGFR was <60 mL/min/1.73 m(2) before percutaneous transhepatic biliary drainage in 27 patients (25%) and increased significantly 30 days after percutaneous transhepatic biliary drainage (P = 0.008). In the malignant external drainage subgroup, there was a significant increase in eGFR on the fifth day after percutaneous transhepatic biliary drainage (P = 0.038). The procedure-related mortality rate was zero. Nine malignant patients (8.49%) died within thirty days due to underlying diseases. On the fifth day, eGFR was significantly lower in these patients than in surviving patients (P = 0.049), and bilirubin levels were significantly higher before the intervention than in surviving patients (P = 0.04). Multiple logistic regression analysis showed that serum direct bilirubin is a significant predictor of renal function (P. 0.049). CONCLUSION Obstructive jaundice is associated with renal dysfunction, and serum direct bilirubin is a significant predictor of renal function. Percutaneous transhepatic biliary drainage improves renal function and is crucial for prognosis of obstructive jaundice

Prognostic Utility of Serum Neopterin in Obstructive Jaundice Secondary to Malignant Lesions Treated by Percutaneous Transhepatic Biliary Drainage

WOS: 000319956100018PubMed ID: 23707094Purpose: To perform biochemical profiles before and after percutaneous transhepatic biliary drainage (PTBD) and investigate the potential utility of measuring C-reactive protein (CRP); circulating cytokines, and neopterin, a marker Of cell-mediated immunity, to predict outcomes of patients with obstructive jaundice. Materials and Methods: In a prospective study, 47 patients with obstructive jaundice secondary to malignant lesions were evaluated before, at the fifth hour after, and on the fifth day after PTBD for neopterin, nitrate, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, CRP levels, and liver function. Results: Neopterin levels on day 5 after PTBD were significantly higher than the levels before treatment bent and at the fifth hour. However, nitrate, cytokine, white blood cell, albumin, and creatinine levels were not significantly different. On the fifth day after PTBD, CRP levels were significantly higher and total bilirubin, direct bilirubin, alkaline phosphatase, aspartate transaminase, and alanine transaminase values were lower than the before-treatment values. Seven patients (15%) died within 30 days after drainage. On the fifth day after PTBD, neopterin, IL-6, IL-10, and creatinine levels were significantly higher and albumin levels were lower in the early mortality group. The performance characteristics of neopterin and creatinine were statistically significant in predicting mortality. Conclusions: Neopterin levels increased after PTBD, indicating cellular immune activation. The nonsignificant change in cytokine levels may be related to low enduring release in malignancy. The extremely elevated level a of neopterin and creatinine after PTBD might serve as harbingers of early death in patients with cholestasis secondary to malignant lesions.Ege University Scientific Research Projects DirectorshipEge UniversityThis study is supported by Ege University Scientific Research Projects Directorship

Serum N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) levels in hyperthyroidism and hypothyroidism

WOS: 000252185000001PubMed ID: 18271501Natriuretic peptides represent a novel diagnostic tool in the assessment of heart failure. N-terminal-pro-B-type natriuretic peptide (NT-proBNP), a member of the natriuretic peptid family, is produced and released from cardiac ventricles. Changes in cardiac functions are observed in thyroid dysfunctions. The aim of this study was to assess the changes in serum NT-proBNP levels and to evaluate impact of thyroid hormones on serum NT-proBNP in patients with hyperthyroidism and hypothyroidism. Serum NT-proBNP levels were measured in 21 patients with hyperthyroidism and in 24 patients with hypothyroidism and compared with 20 healthy control subjects. Patients without cardiac disease were included into the study as well. Serum NT-proBNP levels were measured by electrochemiluminescence immunoassay. Serum NT-proBNP levels were higher in hyperthyroid patients than in hypothyroid patients and in control subjects, with mean values of 239.03 +/- 47.33, 45.97 +/- 13.48, 55.57 +/- 13.01 pg/ml, respectively (p < 0.0001). Serum NT-proBNP and thyroid hormones were correlated in all patients. Moreover, there was a significant positive correlation between serum NT-proBNP and serum free T4 (FT4) levels (r = 0,549, p = 0.012) in hyperthyroidic patients. Multiple regression analyses demonstrated that increasing FT4 was independently associated with a high serum NT-proBNP levels, whereas heart rate was not in hyperthyroid patients. Serum NT-proBNP levels are higher in the hyperthyroid state as compared with the hypothyroid and euthyroid state. Thyroid dysfunction affects serum NT-proBNP levels, possibly influencing the secretion of the peptide. Therefore, thyroid function has to be considered when evaluating high serum NT-proBNP levels in patients without cardiac dysfunction

The detection of left ventricular diastolic dysfunction in hypertensive patients: Performance of N-terminal probrain natriuretic peptide

WOS: 000281280000002PubMed ID: 20070249Aim. Diastolic dysfunction (DD) results in increased cardiovascular risk in hypertensives. We studied the performance of N-terminal probrain natriuretic peptide (NT-proBNP) in detecting DD. Materials and methods. 241 hypertensive patients admitted to cardiology polyclinics were included in this study. They were grouped according to the presence of DD. Group 1: Essential hypertensive patients without DD (n=119); group 2: essential hypertensive patients with DD (n=122). All underwent trans-thoracic echocardiography for the evaluation of transvalvular flow, morphology, left ventricular wall motion abnormalities and ejection fraction. NT-proBNP levels were measured by an electrochemiluminescence immunoassay. Results. The systolic blood pressure (BP) (mean +/- SD) was 140 +/- 12 mmHg in group 1 and 144 +/- 16 mmHg in group 2 (p=0.049), the diastolic BP (mean +/- SD) was 88 +/- 10 mmHg in group 1 and 90 +/- 14 mmHg in group 2 (p=0.043). The median (1st-3rd quartile) NT-proBNP level in group 2 was significantly higher than group 1 [121.05 (61.03-207.66) and 31.17 (17.07-54.09) pg/ml, respectively (p<0.001)]. In the receiver operating characteristics analysis, the area under the curve was 0.862 (95% CI 0.816-0.908). At the cut-off of 45 pg/ml, sensitivity was 86.9%, specificity was 62.4%, and at the cut-off 65 pg/ml, sensitivity was 74.6%, specificity was 83.8%. Conclusion. Plasma NT-proBNP levels may be useful for identifying patients with DD and it is conceivable to use a cut-off level 65 pg/ml as a "rule in" test

Pleural fluid neopterin levels in tuberculous pleurisy

WOS: 000248465100008PubMed ID: 17531216Objectives: Neopterin is produced by stimulated macrophages under the influence of gamma interferon of lymphocyte origin. It is regarded as a biochemical marker of cell-mediated immune response. This study was designed to assess the diagnostic value of pleural fluid neopterin levels in tuberculous pleurisy in comparison with adenosine deaminase activity. Design and methods: Pleural fluid adenosine deaminase (ADA) activity and neopterin levels were measured in 16 patients with tuberculous pleurisy (TP) and 19 patients with malignant pleurisy (MP). ADA activity was determined by a colorimetric method, whereas neopterin levels were determined by a reversed-phase liquid chromatography technique. All values were given as median (min-max). Results: The mean age was 45.43 +/- 20.39 years in the TP group and 60.42 +/- 11.02 years in the MP group (p = 0.026). The median pleural fluid ADA activity was 51.75 U/L (3.50-62.40 U/L) in the TP group and was 2.30 U/L (1-8.20 U/L) in the MP group. The difference was statistically significant (p < 0.001). The median pleural fluid neopterin levels were 13.15 nmol/L (1.86-59.50 nmol/L) and 2.44 nmol/L (0.92-27.60 nmol/L) in the TP group and the NIP group, respectively (p 0.021). In order to evaluate the diagnostic value of pleural fluid neopterin concentrations, receiver-operating-characteristic curve analysis was performed. Conclusion: Pleural fluid neopterin concentration is significantly higher in TP when compared to MP, however when compared, its clinical use as a diagnostic marker is not valuable as ADA. (c) 2007 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved

Impact of renal function or folate status on altered plasma homocysteine levels in hypothyroidism

WOS: 000236535900016PubMed ID: 16543681Hyperhomocysteinemia is an independent risk factor for coronary, peripheral and cerebrovascular diseases. Moderately elevated total homocysteine (tHcy) levels have been reported in patients with overt hypothyroidism. Plasma tHcy concentration is affected by several physiological factors and is elevated tinder conditions of impaired folate and cobalamin status and in renal failure. The aim of this Study was to assess plasma tHcy concentrations and to evaluate the role of potential determinants of plasma tHcy levels in hypothyroid patients. Fasting plasma tHcy, serum homocysteine-related vitamins folate and vitamin B-12, serum cystatin C (CysC) and creatinine, were determined in 22 hypothyroid patients and compared with 25 healthy control subjects. Creatinine clearance (CCr) was calculated using the Cockroft-Gault formula. Plasma tHcy levels were determined by HPLC with fluorescence detection and serum CysC by automated particle enhanced immunoturbidimetry. Plasma tHcy, creatinine levels were significantly higher, and serum CysC levels, and creatinine clearance values were lower in hypothyroid patients than in control subjects. Folate levels were lower in hypothyroidic group compared to the control group. There were no differences in vitamin 13, levels between hypothyroid and control groups. Positive correlation was noted between tHcy and creatinine levels in hypothyroid patients (r = 0.596); however, an inverse correlation was found between tHcy and folate levels (r = -0.705) in hypothyroid patients. In conclusion, tHcy was increased in hypothyroidism, and this increase was more strongly associated with changes in serum folate than in serum creatinine and CysC, suggesting an altered folate status