Endocan and Non-Dipping Circadian Pattern in Newly Diagnosed Essential Hypertension

BACKGROUND AND OBJECTIVES: Non-dipper hypertension is frequently accompanied by endothelial dysfunction and activation. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. This study aims to investigate the association between circadian blood pressure (BP) pattern and plasma endocan levels together with high-sensitivity C-reactive protein (hsCRP) in patients with newly diagnosed untreated hypertension. SUBJECTS AND METHODS: Twenty-four hour ambulatory blood pressure monitoring was recorded in 35 dipper, 35 non-dipper hypertensives and 35 healthy controls. Endocan levels were measured by enzyme-linked immunosorbent assay. Serum levels of hsCRP were also recorded. RESULTS: Despite similar daytime and 24-hour average BP values between dippers and non-dippers, statistically significant high nocturnal BP was accompanied by a non-dipping pattern (Systolic BP: 132±9 vs. 147±11 mmHg; Distolic BP: 80±7 vs. 91±9 mmHg, respectively, p<0.001 for both). Non-dipper patients demonstrated higher endocan levels compared to dippers and normotensives (367 (193-844) pg/mL, 254 (182-512) pg/mL and 237 (141-314) pg/ml, respectively, p<0.001). HsCRP levels were significantly higher in non-dippers than the other groups (p=0.013). In a multivariate logistic regression analysis, endocan (p=0.021) and hsCRP (p=0.044) were independently associated with a non-dipping pattern. CONCLUSION: Elevated endocan levels were found in non-dipper groups. Endocan and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that elevated levels of endocan in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to the possible future role of endocan in selection of hypertensive patients at higher risk or target organ damage.

Proximal tibial osteotomy in medial compartment osteoarthritis: how high is high?

Proximal tibial osteotomy [PTO], which can be performed using various techniques, is a common procedure for the treatment of medial compartment osteoarthritis of the knee. Changes in the biomechanics of knee may cause problems in the long term, depending on the technique that was performed. Whichever technique is used, the level at which the osteotomy is performed is a significant factor in any changes in biomechanics and for potential problems in future surgery. The relationship between the techniques applied and the names used throughout its progression is investigated in this review, which briefly evaluates the historical improvement of PTO applied in the treatment of knee osteoarthritis. Denomination defined by the first practitioners of different osteotomies that were used in the treatment of knee osteoarthritis and identified under different names were investigated in the literature. Compatibilty of technique defined by using the word "high" and different techniques were evaluated. The contribution of alteration in surgical techniques on nomenclature has lead to standard usage with time. The term "high", which has been used for longer than four decades, does not cover all of these techniques. Nomenclature of osteotomies performed for the treatment of medial compartment osteoarthritis would therefore be more appropriate, if it were used in such a way as to define the actual level of osteotomy. We believe that osteotomies performed distal to the tibial tubercle must be definedas 'upper tibial' or 'proximial tibial' instead of 'high', or related osteotomy level and method must be clearly stated in each individual case