The effect of hepatitis C virus infection on insulin resistance in chronic haemodialysis patients

PURPOSE: To investigate the contribution of HCV infection to insulin resistance in chronic haemodialysis patients. MATERIALS AND METHODS: The study was performed with 55 patients who were on regular haemodialysis therapy three times per week. Of the 55 patients, 34 (20 females and 14 males with an average age of 40.9 years) were anti-HCV (+) and were defined as the HCV (+) group. The remaining 21 patients (8 females and 11 males with an average age of 50 years) were negative for HCV and other viral markers and were defined as the HCV (-) group. BMI of all patients were below 27. Insulin resistance (IR) was calculated according to the HOMA formula and patients were called HOMA-IR (+) if their HOMA scores were higher than 2.5. All of the HOMA-IR (+) patients in both groups were called the HOMA-IR (+) subgroup. None of the patients had a history of drug use or any diseases that were related to insulin resistance except uremia. In both groups and the healthy control group, insulin and glucose levels were studied at three different venous serum samples taken at 5- minute intervals after 12 hours of fasting. Other individual variables were studied at venous serum samples taken after 12 hours of fasting. RESULTS: HOMA scores were (3)2.5 in 22 of 34 HCV (+) patients (64.7%) and 7 of 21HCV (-) patients (33.33%) (p=0.024). Insulin levels of HCV (+) group (13.32 +/- 9.44mIU/mL) were significantly higher than HCV (-) (9.07 +/- 7.39mIU/mL) and the control groups (6.40 +/- 4.94mIU/ mL) (p=0.039 and p=0.021 respectively). HCV (+) patients were younger (40.94 +/- 17.06 and 52.62 +/- 20.64 years, respectively) and had longer dialysis duration (7.18 +/- 3.61 and 2.91 +/- 2.69 years, respectively). Significant positive correlations of HOMA score with insulin (r=0.934, p=0.000) and fasting glucose levels (r=0.379, p=0.043) were found in the HOMA- IR (+) subgroup. Also, a significant positive correlation was found between ALT and insulin levels in the HOMA IR (+) subgroup. C-peptide levels of both HCV (+) and (-) groups were significantly higher than the control group (p < 0.001). There were not any significant correlations between HOMA score and some of the other individual variables including levels of triglyceride, ferritin, ALT, iPTH and Mg in any of the groups. CONCLUSION: In chronic haemodialysis patients; HCV infection is related to a high prevalence of insulin resistance, higher insulin and glucose levels.     

Reconstruction of congenital and acquired columellar defects: clinical review of 38 patients

ABSTRACT: Reconstruction of columella presents certain difficulties and includes reconstruction of the cartilaginous strut and the overlying skin to obtain good results. We conducted a retrospective clinical review of 38 patients presenting with congenital and acquired columellar defects. Anatomic characteristics to be considered were defined and a classification method is proposed to more fully describe columellar defects. The columellar defects of the patients were classified into three groups as follows: type I, skin defect of columella and absence of medial crura of lower lateral cartilage; type II, type II + partial absence of caudal part of septal cartilage; and type III, complex defect of columella accompanying with the other nasal subunit defects. The patients chosen in this study were designed to describe a common approach for the choice of the reconstruction method that provides excellent aesthetic result while minimizing the extent of the surgery and maximizing patient acceptance.     

Platelet function testing during 5-day storage of single and random donor plateletpheresis.

Platelet concentrates are routinely manufactured from whole blood by differential centrifugation (random donor platelets-RDP) or by plateletpheresis (single donor platelets-SDP). These platelet concentrates have a storage period of 5 days and many different approaches exist to measure the condition of platelets during their storage. In this study, platelet aggregation testing using adenosine diphosphate (ADP) and collagen and flow cytometric platelet activation analysis using CD41 FITC and CD62 PE before and after ADP was performed on days 1, 3 and 5 of storage of platelet preparations. Thirty three RDPs, stored in Baxter and Kansuk blood bags and 18 SDPs stored in Fresenius blood bags were evaluated. In RDPs and in SDPs; ADP and collagen induced PA responses were decreased significantly on the 3rd and 5th days compared to 1st day. CD62 positive platelet percentage after ADP were decreased significantly on the 3rd and 5th days compared to the 1st day in Kansuk((R)) bags. Flow cytometric analysis revealed minor changes in CD41 expression after ADP on the 3rd day compared to 1st day and on the 5th day compared to 3rd day. Differences in CD62 positive platelet percentage were not significant between the RDPs and SDPs. Our results suggest that: (1) ADP and collagen induced PA responses decrease both in RDPs and SDPs during storage. (2) Flow cytometric analysis does not show major significant changes in platelet activation after ADP during storage. (3) Continous shaking on the agitator does not cause a significant change in CD62 positive platelet percentage during storage. (4) Platelet aggregation responses in RDPs stored in Baxter((R)) and Kansuk((R)) blood bags do not differ during storage.     

Verbal working memory impairments following traumatic brain injury: an fNIRS investigation

The construct of working memory and its reliance on dorsolateral prefrontal cortex (DLPFC) have been the focus of many studies in healthy subjects and in clinical populations. However, transfer of knowledge gained from cognitive science studies to clinical applications can be a challenging goal. This scarce cross-dissemination may be partially due to the use of ‘tools’ that are limited in their ability to generate meaningful information about impairments in clinical groups. To this end, this paper investigates the use of functional near-infrared spectroscopy (fNIRS), which offers unique opportunities for recording neuroactivation. Specifically, we examine measures of the DLPFC hemodynamic response during a working memory task in adults with traumatic brain injury (TBI) and healthy controls. Analysis of hemodynamic measures showed significant differences between the two groups, even without differences in behavioral performance. Additional subtle disparities were linked to levels of performance in TBI and healthy subjects. fNIRS hemodynamic measures may therefore provide novel information to existing theories and knowledge of the working memory construct. Future studies may further define these subtle differences captured by fNIRS to help identify which components affect inter-individual variations in performance and could play a contributing role in the choice and planning of neurorehabilitation interventions targeting working memory.     

Increased Laterality of the Thalamus in Children and Adolescents with Asperger's Disorder: An MRI and Proton Spectroscopy Study

Objective

Thalamic abnormalities have been reported in people with pervasive developmental disorders (PDD) including Asperger''s Disorder (ASP). The aim of the present study was to compare the volume and volume fraction of the thalamus and the metabolite concentrations in children and adolescents with ASP using the magnetic resonance imaging and proton magnetic resonance spectroscopy. Additionally, the relationships between thalamic abnormalities and clinical features were examined.

Methods

Volume and volume fractional and metabolic measurements of bilateral thalamus were collected from 15 boys with ASP with a total IQ over 70 (age range 7-18 years, mean age 11.6±3.79 years), and 15 healthy controls matching age, sex and IQ. The thalamic volumes, hemisphere volumes and total brain volumes (TBV) were estimated using the stereological methods on magnetic resonance images. Chemical metabolites of thalamus were evaluated by ¹H spectroscopy.

Results

No differences in thalamic volumes, volume fractions and metabolites were observed between the groups. There were significant correlation between thalamic volume and total brain volume in both groups. The ASP group showed a significant left-minus-right thalamus difference as well as a significantly greater laterality index. In addition, a significant correlation between the laterality index and Autism Behavior Checklist language scores was observed.

Conclusion

Findings from this investigation point to a significant increase in laterality of the thalamus and a relationship with language problems in individuals with ASP. Our findings suggest that thalamic abnormalities may be related to mild language problems observed in ASP.     

NF‐κB activation mediates LPS‐or zymosan‐induced hypotension and inflammation reversed by BAY61‐3606, a selective Syk inhibitor,in rat models of septic and non‐septic shock

We have previously demonstrated that the activation of the spleen tyrosine kinase (Syk)/inhibitory‐κB (IκB)‐α/nuclear factor‐κB (NF‐κB) p65 signalling pathway contributes to hypotension and inflammatory response in a rat models of zymosan (ZYM)‐induced non‐septic shock. The purpose of this study was to further examine the possible mechanism underlying the effect of inhibition of Syk by BAY61‐3606 via NF‐κB activity at the level of nuclear translocation regarding the production of vasodilator and proinflammatory mediators in lipopolysaccharide (LPS) (septic)‐ and ZYM (non‐septic)‐induced shock. Administration of LPS (10 mg/kg, ip) or ZYM (500 mg/kg, ip) to male Wistar rats decreased mean arterial pressure and increased heart rate that was associated with an increase in the activities of cyclooxygenase and nitric oxide synthase, tumour necrosis factor‐α, and interleukin‐8 levels, and NF‐κB activation and nuclear translocation in sera and/or cardiovascular and renal tissues. BAY61‐3606 (3 mg/kg, ip), the selective Syk inhibitor, given 1 hour after LPS‐ or ZYM injection reversed all the above‐mentioned effects. These results suggest that Syk contributes to the LPS‐ or ZYM‐induced hypotension and inflammation associated with transactivation of NF‐κB in septic and non‐septic shock.     

The relationship of Prohepcidin levels with anemia and inflammatory markers in non-diabetic uremic patients: a controlled study

Introduction: Hepcidin, a small peptide hormone synthesized in the liver, plays central role in regulation of iron metabolism. Hepcidin generation in chronic kidney disease (CKD) is dependent on iron status, anemia, inflammation, and hypoxia and erythropoietin levels. In our study, the relationship between Prohepcidin levels and inflammation and iron indices in non-diabetic uremic patients was investigated. Methods: This study has a cross-sectional design which includes four groups: Non-diabetic 21 patients with stage 4 CKD (predialysis), 20 hemodialysis (HD) and 21 peritoneal dialysis (PD) patients and 17 healthy volunteers as the control group. Complete blood count, iron, total iron binding capacity (TIBC), ferritin, high-sensitive C-reactive protein (hsCRP), fibrinogen, parathyroid hormone, interleukin (IL)-6 and Prohepcidin levels were recorded. Results: Serum Prohepcidin levels in the predialysis, HD, PD and the control groups were 119.6?±?45.1?ng/mL, 140.2?±?41.8?ng/mL, 148.2?±?35.0?ng/mL and 93.8?±?21.9?ng/mL, respectively (p?r?=?0.345, p?=?0.002), creatinine (r?=?0.465, p?r?=?0.253, p?=?0.025), hsCRP (r?=?0.275, p?=?0.019), duration of dialysis treatment (r?=?0.443, p?r?=?0.467, p?r?=?0.615, p?r?=??0.286, p?r?=??0.573, p?r?=??0.473, p?r?=??0.351, p?=?0.002) and hematocrit (r?=??0.342, p?=?0.002) levels. Discussion: Prohepcidin levels increase with deepening anemia and show positive correlation with inflammatory markers. Therapeutic interventions regarding Prohepcidin action on inflammatory status may play a role in the treatment of anemia due to inflammation. Functional iron deficiency is frequent in uremic patients. It may be beneficial to measure Prohepcidin level together with ferritin among these patients.     

Allergic contact dermatitis from Laurus nobilis oil induced by massage

Non-occupational contact allergy to Laurus nobilis (laurel) oil is considered rare. Herein, we report a case of allergic contact dermatitis after a massage with a mixture of olive oil and L. nobilis oil. Patch testing showed (+++) reactions to laurel oil and (++) to the mixture of olive oil and laurel oil.