Pathophysiology and Prevention of Heart Disease in Diabetes Mellitus

Diabetes mellitus (DM) has become a public health problem worldwide, and it has large implications for cardiovascular disease (CVD). In this article, we discuss the etiology and pathophysiology of CVD in DM including the effects of abnormal glucose homeostasis, genetic factors, epigenetics, apoptosis, common pathophysiological mechanisms shared by both DM and CVD, and contributions of other comorbidities. We then cover the pathogenesis of both atherosclerotic disease and cardiomyopathy in relation to DM. Finally, we discuss the prevention of heart disease in DM with a focus on hypertension and dyslipidemia management, weight loss, lifestyle changes, antiplatelet therapy, and glycemic control.     

A comparative study of focal medium-depth chemical peel versus cryosurgery for the treatment of solar lentigo

Recently, focal chemical peels with trichloroacetic acid (TCA) have been introduced for the treatment of pigmentary disorders to minimize the side effects such as pain or scarring associated with medium-to-deep chemical peeling. This is a controlled, prospective study to compare the efficacy of a focal medium-depth chemical peel regimen using 70% glycolic acid and 35% TCA with cryosurgery, in the treatment of solar lentigines of the hands. Twenty-five patients were treated with either focal medium-depth chemical peel or cryosurgery, which was randomly assigned to the left or right hand. Clinical improvement was graded by the three blinded investigators 2-months after the treatment. In the focal medium-depth chemical peel treated side, clearing was achieved in four out of 23 patients (17.4%) compared with five out of 23 patients (21.7%) in the cryosurgery treated side. Statistically, the difference between the clinical improvement of solar lentigines with chemical peel and cryosurgery was not significant, according to chi-square test (p = 0.940). However, we suggest that treatment of the solar lentigines with a focal medium-depth chemical peel may be clinically superior to treatment with cryosurgery, due to the paucity of side effects, such as hypopigmentation and pain, associated with the chemical peel regimen.     

Simplified PGD of common determinants of haemoglobin Bart’s hydrops fetalis syndrome using multiplex-microsatellite PCR

The high incidence of double-gene deletions in α-thalassaemia increases the risk of having pregnancies with homozygous α⁰-thalassaemia, the cause of the lethal haemoglobin (Hb) Bart’s hydrops fetalis syndrome. Preimplantation genetic diagnosis (PGD) has played an important role in preventing such cases. However, the current gap-PCR based PGD protocol for deletional α-thalassaemia requires specific primer design for each specific deletion. A universal PGD assay applicable to all common deletional determinants of Hb Bart’s hydrops fetalis syndrome has been developed. Microsatellite markers 16PTEL05 and 16PTEL06 within the α-globin gene cluster were co-amplified with a third microsatellite marker outside the affected region in a multiplex-PCR reaction and analysed by capillary electrophoresis. Eight informed couples at risk of having Hb Bart’s hydrops fetalis were recruited in this study and all patients underwent standard procedures associated with IVF. A total of 47 embryos were analysed. Three pregnancies were achieved from three couples, with the births of two healthy babies and one ongoing pregnancy. This work has successfully adapted an earlier protocol and developed a simple and reliable single-cell assay applicable to PGD of Hb Bart’s hydrops fetalis syndrome regardless of type of deletion.Alpha-thalassaemia is one of the most common inheritable disorders worldwide. It is a blood disorder that, in its lethal form caused by deletion of all four copies of the α-globin gene, results in the demise of the affected fetus, a condition referred to as haemoglobin (Hb) Bart’s hydrops fetalis syndrome. Preimplantation genetic diagnosis (PGD) has played an important role in preventing such cases. Current PGD protocols for deletional α-thalassaemia utilize a strategy called gap-PCR, which requires the different assays for different deletion types. We have developed a universal PGD assay applicable to all common deletional determinants of Hb Bart’s hydrops fetalis syndrome based on microsatellite marker analysis. Eight informed couples at risk of having Hb Bart’s hydrops fetalis were recruited in this study and all patients underwent standard procedures associated with IVF. Forty-five embryos were analysed in total. Three pregnancies were achieved from three couples, with the births of two healthy babies and one pregnancy still ongoing. We have successfully adapted our earlier protocol and developed a simple and reliable single cell assay applicable to PGD of Hb Bart’s hydrops fetalis syndrome regardless of the type of deletion.     

Best predictors of survival outcome after tertiary cytoreduction in patients with recurrent platinum-sensitive epithelial ovarian cancer

Objective

To evaluate the efficacy of tertiary cytoreduction (TCR) on survival and to determine prognostic factors which may influence surgical and survival outcome.

Study design

Twenty-three consecutive patients who had recurrent platinum-sensitive epithelial ovarian cancer and underwent TCR between January 1999 and January 2011 were evaluated. Factors which impact on TCR outcome and survival were determined by statistical analysis.

Results

TCR was optimal (< 1 cm residual tumor) in 15 of the 23 patients (65.2%) and suboptimal in 8 patients (34.8%). None of the clinicopathologic factors was associated with TCR outcome. On the contrary, TCR outcome (optimal vs suboptimal) was independently associated with survival in univariate analysis (P = 0.018).

Conclusion

There is not a good predictor of TCR outcome but TCR seems to be beneficial for patients in whom optimal surgery can be achieved. Therefore, preoperative assessment of patients and weighing the potential survival benefit against potential surgical risks are very important for patient selection.     

In vitro measurement of ejaculation latency time (ELT) and the effects of vardenafil on ELT on lifelong premature ejaculators: placebo-controlled,double-blind,cross-over laboratory setting

Objective  

The aim of this study is to measure the ejaculation latency time (ELT) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation (PE) in a laboratory setting.     

A 48 year old patient with bilateral spontaneous hemothorax-difficulties in evaluation-case report

Spontaneous hemothorax (SH) is a rare disease manifestation and most of the data about SH consist of case reports and case series. Bilateral SH is much more rare entity. Hemothorax is an unusual complication of ruptured thoracic aortic dissection (AoD) and occurs usually on the left hemithorax. It is often difficult to diagnose AoD preclinically due to its many possible symptoms. We present a case of bilateral SH due to ruptured acute aortic dissection in a patient with no pre-existing risk factors for AoD. Differential diagnoses of spontaneous hemothorax and difficulties in AoD evaluation are also discussed in this report.     

The role of UGT1A1 promoter polymorphism and exon-1 mutations in neonatal jaundice

Objective: In the present study, we investigated the effects of promoter polymorphism and an exon-1 mutation (G71R) in the UGT1A1 gene in neonates with unexplained hyperbilirubinemia and direct Coombs-negative [DC(–)] ABO incompatibility.

Methods: Two-hundred term neonates in their first week of life and without additional icterogenic factors were included in the study. Neonates with a serum total bilirubin (STB) level ≥17?mg/dL constituted the hyperbilirubinemia group (n?=?100), while the control group comprised healthy neonates with a STB level <12.9?mg/dL (n?=?100). The cases were further subdivided into unexplained hyperbilirubinemia (n?=?50), ABO(+) hyperbilirubinemia (n?=?50), ABO(–) control (n?=?50), and ABO(+) control (n?=?50) groups on the basis of the presence or absence of DC(–) ABO incompatibility. DNA was isolated from peripheral blood and amplified by PCR, and UGT1A1 gene promoter and exon-1 were sequenced to verify sequence alterations.

Results: The frequency of TA6/6, TA6/7, TA7/7, and GGA/GGA, GGA/AGA, AGA/AGA genotypes was found to be 63.5%, 21%, 15.5%, and 91.5%, 8%, 0.5%, respectively. While both heterozygous and homozygous TA7 polymorphism increased risk of hyperbilirubinemia in the ABO(+) hyperbilirubinemia group (heterozygous OR 16.76, 95% CI:3.52-79.70, p?p?=?0.002), only heterozygous TA7 polymorphism increased jaundice risk (OR 5.08 95% CI:76-14.65, p?=?0.003) in unexplained hyperbilirubinemia. But, the coexistence of G71R mutation and promoter polymorphism or G71R mutation and DC(–) ABO incompatibility did not increase the severity of hyperbilirubinemia (p?>?0.05).

Conclusions: UGT1A1 gene promoter polymorphism and G71R mutation are possible risk factors for Turkish neonates with DC(–) ABO incompatibility and unexplained hyperbilirubinemia.