Analysis of YKL‐40 Acute‐Phase Protein and Interleukin‐6 Levels in Periodontal Disease

Background: YKL‐40, a new acute‐phase protein, is shown to be elevated in inflammatory diseases, such as rheumatoid arthritis, type 2 diabetes mellitus, and coronary artery diseases. However, there is no data indicating a relationship between YKL‐40 and periodontal disease. Interleukin‐6 (IL‐6) is the major regulator of acute‐phase protein synthesis and one of the most studied inflammatory markers in periodontal disease. The purpose of the present study is to evaluate YKL‐40 and IL‐6 levels in gingival crevicular fluid (GCF) and serum of patients with periodontal disease and healthy individuals. Methods: Periodontally healthy individuals (n = 15), patients with gingivitis (n = 15), and patients with severe chronic periodontitis (CP) (n = 15) without any systemic disease were included in the study. Clinical measurements were recorded; GCF and blood samples were obtained from each participant. GCF and serum YKL‐40 and IL‐6 levels were analyzed by enzyme‐linked immunosorbent assay. Statistical analysis was performed by parametric and non‐parametric tests. Results: Total amounts of YKL‐40 and IL‐6 in GCF as well as serum YKL‐40 and IL‐6 levels were significantly higher in patients with gingivitis and CP compared with healthy controls (P <0.01). YKL‐40 levels in GCF and serum as well as serum IL‐6 levels were significantly higher in patients with CP compared with patients with gingivitis (P <0.01). Conclusions: YKL‐40 levels in GCF as well as serum YKL‐40 and IL‐6 levels increased from gingivitis to periodontitis. Within the limits of the present study, the YKL‐40 molecule might be a potential novel inflammatory marker of periodontal disease.     

Extent of coronary collateral vessel decrease with advanced age

OBJECTIVE: Animal experiments show that angiogenesis, responsible for the development of collaterals, impairs with increasing age. We retrospectively investigated the relationship between the extent of coronary collaterals and age in patients who had total occlusion in at least one of their epicardial coronary arteries. METHODS AND RESULTS: The records of 2160 consecutive patients who had undegone coronary angiography were examined. The coronary collaterals of the 720 patients who had total occlusion in at least one epicardial artery were evaluated according to the Rentrop scoring system. The patients were divided into four groups according to age: age < 50 years (group 1), > or = 50 years and < 60 years (group 2), > or = 60 years and < 70 years (group 3) and > 70 years (group 4). A Rentrop score of 1 to 3 was accepted as a reliable measure of presence of coronary collaterals. The gender distribution was statistically comparable among the groups. The percentage of the coronary collaterals was as follows: 67% in group 1, 47% in group 2, 48% in group 3 and 28% in group 4. The extent of coronary collaterals was significantly lower in group 4 compared with group 1 (p < 0.01). CONCLUSION: The extent of coronary collaterals seems to decrease significantly with advanced age.     

The only effects of recombinant follicle-stimulating hormone for ovulation induction in the pre-implantation period of rats

Objective The aim of this study was to evaluate the changes in follicular development, serum hormonal levels, and endometrium in the pre-implantation period of rats by using recombinant FSH (rFSH) without human chorionic gonadotropin (hCG). Methods Thirty female rats were studied in six groups of five specimens. Two groups determined as controls (groups 1 and 2). Two groups received constant doses of rFSH (groups 3 and 4) and other two decreasing doses (groups 5 and 6). One of the paired groups was mated. Uterus, ovaries, and blood samples were taken from non-mated groups (groups 1, 3, and 5) at the proestrus period and from mated groups (groups 2, 4, and 6) in the pre-implantation period. Results In non-mated groups antral follicles and corpus luteum periodicum and in mated groups antral follicles, corpus luteum periodicum, and corpus luteum graviditatis were increased in rFSH groups, especially in decreasing dose groups. Estradiol (E₂) levels were increased and progesterone (P)/E₂ ratio was significantly decreased in decreasing dose groups. Endometrium surface epithelium was columnar, irregular, and folded in rFSH groups. Endometrium glandular epithelium was cuboidal in all groups. In decreasing dose groups endometrial stroma was smooth and fibroblastic. Mitotic indices of endometrium surface, glandular epithelium, and stroma were significantly decreased in rFSH groups. Primary follicles and P levels showed no change. Conclusion It seems likely that decreasing doses of rFSH might be used in order to improve follicular development, although it has negative effects with E2 on endometrium in the pre-implantation period of rats.     

Tombstoning ST-Elevation Myocardial Infarction

Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.Despite the presence of a few reports on tombstoning ST elevation, there is no report which reviews STEMI demonstrating this electrocardiographic pattern.     

Peritoneal Carcinoembryonic Antigen Level for Predicting Locoregional and Distant Spread of Gastric Cancer

Purpose Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer. Methods We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent. Results Twenty-one (30%) patients had sCEA levels >10 ng/ml, whereas 25 patients (35.7%) had pCEA levels >10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent. Conclusion Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.     

Role conflict, role ambiguity, and burnout in nurses and physicians at a university hospital in Turkey

In many countries currently, health-care professionals experience burnout in their professional life. This study explored the relationship between burnout, and role conflict and role ambiguity in nurses and physicians at a university hospital in Turkey. The data were collected by questionnaires that included sociodemographic variables, Maslach's Burnout Inventory (MBI), and Rizzo's Role Conflict and Role Ambiguity Scales. Two hundred and fifty one health-care professionals (170 physicians and 81 nurses) responded to the survey. There was a strong positive correlation between the MBI and Rizzo's Role Conflict and Role Ambiguity Scales. The nurses showed significantly higher levels of role conflict, role ambiguity, and burnout compared to the physicians. A multiple regression analysis showed that role conflict and role ambiguity might help to explain the higher level of burnout experienced by the nurses compared to the physicians. Future research is needed to develop preventive measures for the burnout of health-care professionals.     

Secondhand management of "spaghetti wrist": do not hesitate to explore

"Spaghetti wrist" consists of the severance of at least three structures, of which one is the median nerve or the ulnar nerve, and it is one of the most devastating injuries of the hand. Close follow-up and appropriate rehabilitation are mandatory for management; however, this is not easy in patients whose previous treatment was accomplished elsewhere. The authors explored 28 patients with spaghetti wrist injuries who were previously operated. The study included those with areas of the hand, innervated by the injured nerve, that were partially or completely anesthetic. Limited sensorial return was also uniform and partial anesthetic sites were usually limited to only a finger or either side of a finger. When explored, six nerves had a normal appearance and 18 nerves had neuroma-in-continuity on their repair sites. The median nerves of the remaining five patients had been repaired not to their original proximal or distal stumps, but to adjacent tendons. A nerve tissue bridge from the proximal to the distal stump developed in all these patients. The authors conclude that hand surgeons should explore the previous repair sites if they have any suspicions regarding the technique performed and the success of previous management of spaghetti wrist. Any partial sensorial return to a limited area may be the result of axonal secondary pathways; thus, early exploration during the critical period can protect these patients from paralyzing sequelae of the injured nerves.     

Free temporoparietal fascial flaps and full-thickness skin grafts in aesthetic restoration of the nose

Free tissue transfers have been rapidly replacing distant flaps for use in nasal reconstruction. The temporoparietal fascial flap is a thin, broad, pliable, and well-vascularized flap. It can be used to drape over the cartilaginous and bony framework of the nasal skeleton and nourish the underlying primary cartilage grafts as well as the overlying full-thickness skin graft. The thin contour of the flap is aesthetically superior to thicker skin flaps and eliminates the need for secondary defatting or touch-up procedures. A large, single sheet of full-thickness skin graft, harvested from the supraclavicular region, can be applied over the fascial flap in the same session and provide a quite acceptable color match. The authors present a case whose alar margins and atrophic nasal skin were restored in one session by primary conchal cartilage grafts, a free temporoparietal fascial flap, and a full-thickness supraclavicular skin graft.