Serum FGF-23 and klotho levels in patients with systemic sclerosis and its relationship with carotid intima media thickness

Aim: Systemic sclerosis (SSc) is an uncommon connective tissue disease characterized by skin fibrosis. Fibrosis of internal organs such as the lungs and heart is also involved in SSc via complex pathophysiological mechanisms. Increased serum fibroblast growth factor (FGF-23) is related to cardiac hypertrophy and fibrosis in chronic kidney disease. We investigated the likely role of FGF-23 and Klotho in SSc and their link with carotid intima-media thickness (CIMT) in these patients. Material and Methods: A total of 86 participants (43 SSc patients between 18 and 65 years old and 43 healthy volunteers) were included in the study. We recorded patients' demographic data, clinical features, and biochemical and hormonal parameters. A radiologist performed the ultrasonographic examination of CIMT. The chi-square test and Fisher's exact test were utilized for comparisons of categorical variables. Results: In SSc patients, the FGF-23 level was significantly higher. According to our subgroup analysis, the patients with interstitial lung disease (ILD) had significantly higher FGF-23 levels than patients without ILD (p=0.031). However, the levels of alpha-klotho were similar between the two groups. The mean CIMT in SSc patients was significantly higher than in the control group (0.62 +/- 0.11 vs. 0.49 +/- 0.10, mm; p0.001). There were no correlations between FGF-23 (p=0.086, r=0.265), alpha-klotho (p=0.820, r=0.036), FGF23/alpha-klotho (p=0.90, r=0.019), and CIMT in SSc patients. Discussion: FGF-23 can play a culprit role in the pathogenesis of SSc. It was not related to CIMT as a predictor of atherosclerosis. It can predict lung involvement and disease prognosis.Scientific Research Projects Unit [2021TIPF009]The study was financed by the Scientific Research Projects Unit (Project No: 2021TIPF009)

Comparison of Multiparametric and Fast MRI Protocols in Detecting Clinically Significant Prostate Cancer and a Detailed Cost Analysis

Background Due to the long acquisition time and high cost of multiparametric magnetic resonance imaging (mpMRI), biparametric and, more recently, fast prostate magnetic resonance imaging (fpMRI) protocols have been described. However, there is insufficient data about the diagnostic performance and cost of fpMRI. Purpose To compare the diagnostic performances and cost analysis of fpMRI and mpMRI in clinically significant prostate cancer (csPCA). Study Type Retrospective. Population A total of 103 patients (63 had csPCA) with a mean age of 66.83 (+/- 7.22) years were included. Field Strength/Sequence A 1.5-T; T1- and T2-weighted turbo spin-echo imaging (T1WI and T2WI), echo-planar diffusion-weighted images, and dynamic contrast-enhanced T1W imaging. Assessment Three readers independently evaluated the fpMRI and mpMRI images in different sessions blinded to all patient information. Diagnostic performances of fpMRI and mpMRI were evaluated. Kappa coefficient (kappa) was used to determine the interreader and intrareader agreement. A detailed cost analysis was performed for each protocol. Statistical Tests Receiver operating characteristics analysis, area under the curve (AUC), and kappa test were used. Diagnostic performance parameters were also calculated. Results Of the 63 malignant index lesions (csPCA), 53/63 of those (84.1%) originated from the peripheral zone and 10/63 lesions (15.9%) originated from the transition zone. The AUC values for fpMRI were 0.878 for reader 1, 0.937 for reader 2, and 0.855 for reader 3. For mpMRI, the AUC values were 0.893 for reader 1, 0.94 for reader 2, and 0.862 for reader 3. Inter and intrareader agreements were moderate to substantial (kappa range, 0.5-0.79). The total cost per examination was calculated as euro12.39 and euro30.10 for fpMRI and mpMRI, respectively. Data Conclusions Fast MRI protocol has similar diagnostic performance with mpMRI in detecting csPCA, and fpMRI can be considered an alternative protocol that could create a lower financial burden on health-care systems. Level of Evidence 4 Technical Efficacy Stage