Cardiovascular responses of exercises performed within the extreme exercise domain.

Stroke volume (SV), heart rate (HR) and arterio-venous O2 difference (a-vO2diff) responses to heavy and severe-intensity exercise have been well documented; however, there is a lack of information on the SV, HR and a v-O2diff responses of work rates within extreme exercise domain. The aim of this study was, therefore, to focus on central and peripheral components of VO2 responses to exercises performed within the heavy, severe and extreme exercise domain. Eight well-trained male cyclists participated in this study. Maximal O2 consumption (VO2max) and corresponding work rate (P@VO2max) were determined by multisession constant work rate exercises. Cardiovascular responses to exercises were evaluated by nitrous-oxide rebreathing method with work rates from 40 % to 160 % of P@VO2max, VO2max corresponded to 324+/-39.4 W; however, maximal SV responses occurred at 205+/-54.3 W (p<0.01). Maximal cardiac output (Q), HR, and a vO2diff responses were revealed by the P@VO2max. VO2 response to exercise significantly decreased from severe-intense exercises to the first work rate of extreme exercise domain due to significant decreases in Q, SV, and HR responses (p<0.05), except a v-O2diff (p>0.05). Moreover, non-significant decreases in Q, SV, and a v-O2diff were evaluated as response to increase in work rate belonging to extreme work rates (p>0.05), except the HR (p<0.05). Work rates within the lower district of the extreme exercise domain have an important potential to improve peripheral component of VO2, while the P@VO2max seems the most appropriate intensity for aerobic endurance development as it maximizes the central component of VO2max.

The role of oxidative stress parameters in the differential diagnosis of malignant and benign ascites.

OBJECTIVE: Ascites is the pathological fluid accumulation in the peritoneal cavity and there are mainly two reasons for its etiology. These are malignant diseases such as hepatoma or pancreas cancer and benign diseases such as liver cirrhosis and heart failure. In this study, we investigated the diagnostic utility of arylesterase (ARES), paraoxonase (PON), stimulated paraoxonase (SPON), catalase (CAT) and myeloperoxidase (MPO) in the differential diagnosis of malignant and benign ascites. PATIENTS AND METHODS: This study was conducted between February and September 2016. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking, and drinking alcohol were excluded from the study. RESULTS: The study population consisted of 60 patients: 36 had benign (60%) and 24 had malignant (40%) ascites. The mean age of the patients was 63.3 years. MPO levels (14.2 vs. 4.2; p=0.028) were found to be higher and PON (2.6 vs. 4.5; p<0.001), SPON (10.7 vs. 23.9; p<0.001), ARES (615.7 vs. 823.5, p<0.001) and CAT (13.3 vs. 36.8; p=0.044) were found to be lower in malignant patients compared to benign patients. There was a positive correlation between PON, SPON, and ARES levels, and a negative correlation between MPO levels and SPON, ARES, and CAT levels. MPO levels showed superior diagnostic performance compared to ARES and CAT levels (p<0.05) for predicting malignancy but showed no diagnostic superiority compared to PON and SPON levels (p>0.05). CONCLUSIONS: PON, SPON, ARES, CAT, and MPO can be used with high sensitivity and specificity in the differential diagnosis of malignant and benign ascites.

Effects of infliximab against carbon tetrachloride-induced intestinal injury via lipid peroxidation and apoptosis.

Carbon tetrachloride (CCL4) is often employed in the production of chlorofluorocarbons, petroleum refining, oil and rubber processing, and laboratory applications. Oral, subcutaneous, and inhalation exposure to CCL4 in animal studies have been shown to be capable of leading to various types of cancer (benign and malignant, liver, breast, and adrenal gland tumors). The present study also evaluated the protective role of infliximab (INF) against the deleterious effects of CCL4 on the intestinal system. Twenty-four male Sprague-Dawley rats were randomly assigned into three groups, control (n = 8), CCL4 (n = 8), and CCL4 + INF (n = 8). The control group received 1 mL isotonic saline solution only via intraperitoneal (i.p.) injection. The CCL4 group received a single i.p. dose of 2 mL/kg CCL4. The CCL4 + INF group received a single i.p. dose of 7 mg/kg INF followed 24 h later by a single dose of 2 mL/kg CCL4. All rats were euthanized 2 days following drug administration. CCL4 group samples also exhibited diffuse loss of enterocytes, vascular congestion, neutrophil infiltration, an extension of the subepithelial space and significant epithelial lifting along the length of the villi with a few denuded villous tips. In addition, CCL4 treatment increased intestinal malondialdehyde (MDA) level and caspase-3 positivity. On the other hand, INF decreased MDA levels, caspase-3 positivity, and loss of villous. Our findings suggest that CCL4 appears to exert a highly deleterious effect on the intestinal mucosa. On the other hand, INF is effective in preventing this CCL4-induced intestinal injury by reducing oxidative stress and apoptosis.

Roles of adiponectin and leptin as diagnostic markers in pancreatic cancer.

NTRODUCTION: Obesity is one of the most serious public health problem worldwide. Adipose tissue synthetize and secrete many growth factors and several cytokines known as adipokines. Studies demonstrated changes in the levels of these adipokines in many types of cancer associated with obesity. In this study, we aimed to evaluate the possible relationship between adiponectin and leptin levels with pancreas cancer and disease stage, representative of Turkish population. MATERIALS AND METHODS: The study was conducted between April 2012 - November 2013. Study included 46 patients - 46 control subjects, who had pancreatic carcinoma. Results between the patients and the control group and relationship between the disease stage and results were evaluated. RESULTS: The comparison of preoperative adiponectin and leptin levels of the study group with the levels of the control group showed that there was no correlation with adiponectin and pancreas cancer. In contrast, leptin levels in the study group were significantly lower than in the control group. There was no correlation between the disease stage and adiponectin and leptin levels. CONCLUSION: There was a significant correlation between low leptin levels and pancreatic cancer, while adiponectin had no correlation. Differential diagnosis of pancreas cancer can be made by evaluating low leptin levels with elevated tumor markers (Tab. 3, Ref. 17).

Interplay between 15-lipoxygenase-1 and metastasis-associated antigen 1 in the metastatic potential of colorectal cancer.

OBJECTIVES: Metastasis-associated antigen 1 (MTA1) is implicated in metastasis while 15-lipoxygenase-1 (15-LOX-1) reduces cell motility, when re-expressed in colorectal cancer (CRC). We aimed to understand any potential interplay between MTA1 and 15-LOX-1 in CRC metastasis. MATERIALS AND METHODS: ALOX15 and MTA1 expression in tumour and normal samples were analysed from TCGA RNA-seq data, microarray data sets and a human CRC cDNA array. Western blots, chromatin immunoprecipitation (ChIP), luciferase assays and electrophoretic mobility shift assays (EMSA) were carried out in HT-29 and LoVo cells re-expressing 15-LOX-1 to determine NF- κB activity at the MTA1 promoter. Functional assays in cells ectopically expressing either 15-LOX-1, MTA-1 or both, were carried out to determine adhesion and cell motility. RESULTS: Significantly higher expression of MTA1 was observed in tumours compared to normal tissues; MTA1 overexpression resulted in reduced adhesion in CRC cell lines. Re-expression of 15-LOX-1 in the CRC cell lines reduced expression of endogenous MTA1, corroborated by negative correlation between the two genes in two independent human CRC microarray data sets, with greater significance in specific subsets of patients. DNA binding and transcriptional activity of NF-κB at the MTA1 promoter was significantly lower in cells re-expressing 15-LOX-1. Functionally, the same cells had reduced motility, which was rescued when they overexpressed MTA1, and further corroborated by expressions of E-cadherin and vimentin. CONCLUSIONS: Expression of MTA1 and 15-LOX-1 negatively correlated in specific subsets of CRC. Mechanistically, this is at least in part through reduced recruitment of NF-κB to the MTA1 promoter.

Expression of cyclin A, cyclin E and p27 in normal, hyperplastic and frankly malignant endometrial samples.

Cellular growth is under the control of certain molecules such as cyclins and cyclin dependent kinases. Dysregulation of these proteins disrupt cell cycle and may trigger malignant transformation. Cyclins and kinase inhibitors also play essential roles in endometrial cellular proliferation. But the exact roles of these mediators in the disease process is not clear. We evaluated expression of cyclin A, cyclin E and p27 in normal, hyperplastic and malignant endometrial samples assuming different expression patterns in physiological and pathological processes. A total of 75 patients with histopathological diagnosis of normal proliferative, hyperplastic or malignant endometrial samples were evaluated with different cellular proliferation markers, cyclin A, cyclin E and p27. For cyclin E, endometrial cancer samples had higher rate of immunoreactivity than normal proliferative and hyperplastic endometrial samples. Staining properties for cyclin A were comparable for three groups. However, p27 immunoreactivity decreased progressively as lesions progress from proliferative benign endometrium to frank carcinoma. Further large-scale studies with clinical follow-up will reveal the exact role of cyclins on endometrial carcinogenesis.

Prognostic factors determining survival in patients with node positive differentiated thyroid cancer: a retrospective cross-sectional study.

OBJECTIVE: The prognostic factors for the disease-free status and overall survival among patients who had differentiated thyroid cancer with cervical lymph node metastasis were evaluated to develop a better understanding of the possible effects of lymph node metastasis on the disease process. DESIGN: The data from 101 patients who underwent modified radical neck dissection to determine the presence of cervical node positive differentiated thyroid cancer was evaluated and disease-free survival and overall survival rates were calculated. Prognostic factors predicting these survival rates were evaluated. SETTING: This research took place between July of 1994 and December of 2006 in the Department of General Surgery at Ankara Oncology Training and Research Hospital. PARTICIPANTS: One hundred and one patients underwent a modified radical neck dissection after the cervical nodes were assessed as positive for the presence of cancer. MAIN OUTCOME MEASURES: Ten-year disease-free survival and overall survival rates were measured. RESULTS: We calculated the 10-year disease-free survival rate at 67.3% and the overall survival rate at 86.1%. Age, thyroidal extracapsular invasion, vascular invasion, metastasis, age, completeness of resection, size score and TNM staging were found to be relevant to disease-free survival and overall survival in both the univariate and the multivariate analyses. While the age, metastasis, extent of disease score was relevant to disease-free survival and overall survival in the univariate analysis, this association is not found in the multivariate analysis. The histological type of the tumour was not predictive of disease-free survival, but the follicular type was closely related to the prognosis for overall survival. CONCLUSION: Cervical node metastasis in thyroid carcinoma slightly reduces overall survival. Prognostic factors can help identify high-risk patients and point towards an adequate therapeutic approach.

Removal of intra-abdominal mislocated intrauterine devices by laparoscopy.

This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena(®) (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.

Exercise with vibration dumb-bell enhances neuromuscular excitability measured using TMS.

AIM: The purpose of the study was to examine the effects of exercise without vibration and exercise with vibration (27 Hz) on the cortical silent period (CSP) and cortical motor threshold (CMT) measured using transcranial magnetic stimulation (TMS). METHODS: In 22 university athletes, a circular coil attached to a TMS stimulator was applied over the contralateral motor cortex of the target forearm. Resting cortical motor thresholds for dominant and non-dominant extremities were measured for each participant. Then, 15 biceps curls (15 flexion and 15 extension movements) were performed with the dominant arm using a single vibration dumbbell with the vibration turned off. On a different day, the same biceps curl protocol was performed with the dumbbell vibrating at 27 Hz (2 mm amplitude). A supra-threshold TMS stimulus (1.5x CMT) was delivered while participants were voluntarily contracting the flexor digitorum sublimus muscle (30% MVC grip strength) to determine cortical silent periods before and after each upper extremity exercise protocol. Cortical motor thresholds were measured at rest and after the vibration exercise protocol. RESULTS: All subjects completed the study protocol as designed. After TMS, the CSP in the dominant (exercised) extremities increased after exercise without vibration from a resting (pre-exercise) mean of 57.3 ms to 70.4 ms (P<0.05) and after exercise with vibration, the CSP decreased to a mean of 49.4 ms (P<0.02). The CSP in the non-dominant (unexercised) extremities decreased from resting values of 75.6 ms to 69.3 ms (P=0.935) after the exercise-only protocol and decreased to 49.4 ms (P<0.01) after the vibration exercise protocol. The cortical motor threshold in exercised extremities decreased from a resting mean of 41.4 µV to a postvibration exercise mean of 38.6 µV (P<0.01). In non-exercised extremities, the CMT also decreased, from mean of 43.5 µV to 39.9 µV after the vibration-exercise (P<0.01). CONCLUSION: Vibration exercise enhances bilateral corticospinal excitability, as demonstrated by a shortened cortical silent period and lower cortical motor threshold in both exercised and non-exercised extremities.

Repeated in vitro fertilization failure and its relation with thrombophilia.

BACKGROUND: The objective of this study was to determine the prevalence of some thrombophilic factors and its relation to in vitro fertilization (IVF)-embryo transfer failure in women who had had three or more previously failed IVF-embryo transfer cycles. METHODS: The study group included 51 consecutive women with three or more previously failed IVF-embryo transfer cycles (group 1). The control group included 50 women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of factor V Leiden, prothrombin (G20210A), and methylenetetrahydrofolate reductase (C677T) mutations. RESULTS: A similar prevalence of factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase mutations was found in both groups. At least one inherited thrombophilic factor was detected in 62.7% of women with repeated IVF failure and in 53.9% of women in group 2. No association between repeated IVF failure and these thrombophilic factors was found statistically. CONCLUSION: These data suggest that factor V Leiden, methylenetetrahydrofolate reductase and prothrombin gene mutation do not have a significant role in IVF-embryo transfer implantation failure.

The treatment of 65 women with imperforate hymen by a central incision and application of Foley catheter.

OBJECTIVE: To determine the surgical outcome of 65 women with imperforate hymen treated with a central surgical incision and insertion of a Foley catheter. DESIGN: A prospective study. SETTING: The study was carried out at Department of Obstetrics and Gynecology, Faculty of Meram Medicine, Selcuk University, between 1 January 1996 and 30 June 2006. POPULATION: A total of 65 women diagnosed as imperforate hymen. METHODS: A central oval incision was performed to imperforate hymenal membrane, then 16F Foley catheter was protruded and the balloon was insufflated. Catheter was removed after 2 weeks duration. Estrogen cream was prescribed to all women for application onto hymenal structure for 2 weeks. MAIN OUTCOME MEASURES: Efficacy of procedure in treatment of imperforate hymen, preserving hymenal structural integrity that is accepted as important for virginity in some societies. RESULTS: After the procedure, hymenal orifice created remained open and intact in all women except two women. Closure of artificially created hymenal orifice in these two women was believed to be related to inappropriate administration of estrogen cream. Subsequent treatment with local estrogen treatment results in the hymenal orifice remaining opened in these two women. CONCLUSIONS: We have previously reported the technique in 2002, but now we are able to demonstrate results of our technique in an expanded number of women. This technique is less invasive than other methods and prevents many social problems related to virginity by preventing destruction of the integrity of the hymenal structure and providing an annular-intact hymenal ring.

Contraceptive efficacy and side effects of Implanon.

OBJECTIVE: To determine the efficacy and side effects of Implanon used for long-term contraception. MATERIAL AND METHOD: Prospective study of 80 patients who used Implanon for long-term contraception between January 2004 and January 2006. Side effects, efficacy and removals were recorded. RESULTS: Amenorrhoea, infrequent bleeding and frequent bleeding were reported by 33 (41.25%), 19 (23.75%) and 14 patients (17.5%), respectively. Non-menstrual side effects comprised breast tenderness in 15 patients (18.75%), acne in eight (10%), headache and dizziness in three (3.75%); depressive mood disorders, pelvic pain and loss of libido were mentioned each by two of the women (2.5%). During the study period, Implanon was removed from 20 participants. No problem was encountered during its placement or removal. CONCLUSION: Patients considering use of Implanon must be carefully selected and informed about its expected side effects before placement.

ACE I/D gene polymorphism and aerobic endurance development in response to training in a non-elite female cohort.

AIM: The aim of this study was to investigate the association between ACE gene polymorphism and short- and medium-duration aerobic endurance performance improvements in response to the same training regimen in a non-elite female cohort. METHODS: Fifty-five female non-elite Caucasian Turkish athletes trained to enhance running speeds corresponding to 70% and 90% of heart rate reserve (V-HRR70 and V-HRR90 respectively) 30 min running speed performance (V-30min) 3 times per week, for 6 weeks. ACE gene polymorphisms studied by PCR analysis. RESULTS: The distribution of genotypes in the whole cohort was 21.8%, 41.8%, 36.4% for II (n=12), ID (n=23) and DD (n=20), respectively. Subjects with ACE II genotype had significantly higher improvements in V-30min and V-HRR70 than the ACE DD group (P<0.05). However, in HRR90 ACE DD genotype had a better performance enhancement in running speed than others (P<0.05). Endurance improvements in the V-HRR70 and in the V-30min showed a linear trend as II>ID>DD (P<0.05 and P<0.01, respectively) while a linear trend as DD>ID>II (P<0.01) observed in V-HRR90. CONCLUSION: ACE II genotype may related with better improvements in medium duration aerobic endurance performance whilst ACE DD genotype seems to be more advantageous in performance enhancement in shorter duration and higher intensity endurance activities.

Cumulative effects of conjugated linoleic acid and exercise on endurance development, body composition, serum leptin and insulin levels.

AIM: The aim of this study was to evaluate the accruing effects of conjugated linoleic acid (CLA) supplementation and aerobic exercise (Ex) on body composition and serum lipid profile in humans. METHODS: Forty-four healthy female young subjects were divided ExCLA, CLA, Ex and control (C) groups. The groups of CLA and ExCLA were supplemented with 3.6 g/d CLA whilst ExCLA and Ex groups were exercised for 30 min(-1.)3 days(-1.)week(-1) for 6 weeks. RESULTS: After the study period, fat ratio, fat mass, waist and hip girths were reduced in all experimental groups and fat-free mass induced in ExCLA and CLA groups and body weight was reduced in the CLA group when compared to baseline levels. These alterations were significantly different than those of controls with the highest variations were observed in the ExCLA. There was no change in serum leptin, apo-AI, apo-B, total cholesterol, HDL, LDL, free fatty acid, and triglyceride levels. Serum glucose concentrations of ExCLA and CLA groups and insulin level of ExCLA group decreased significantly as compared to baseline levels with only serum glucose reduction of both groups were significantly different than those of controls (P<0.05). Endurance performance significantly increased in ExCLA and Ex groups (P<0.01) but did not vary in the CLA and controls. CONCLUSIONS: It was shown that both CLA and exercise were effective in improvement of body composition and these effects were cumulated when they have been used together. CLA supplementation alone or with exercise seems effective on serum glucose and insulin concentrations but ineffective on endurance performance.

The prevalence of familial Mediterranean fever in the Turkish province of Denizli: a field study with a zero patient design.

OBJECTIVE: This study had two aims: (1) to investigate the prevalence of familial Mediterranean fever (FMF) and Behçet's disease (BD) in school students in Denizli, a province in western Turkey; and (2) to determine whether the previously suggested "zero patient design" was reliable for use in a prevalence survey. METHODS: The field survey was performed in two stages. In the first stage 7,389 students (3,847 females and 3,542 males) were asked to fill out a questionnaire in the classroom. In the questionnaire, filtering questions for FMF (the presence of recurrent attacks of fever accompanying abdominal pain, joint pain/swelling, and/or chest pain) and BD (presence of aphthous stomatatis) were asked. The second stage consisted of two parts. In the first, 3225 questionnaires were completed by 1778 female and 1447 male students calculated according to the zero patient design, who were selected randomly from among 7389 students for evaluation. Students with any suspicion of FMF and Behçet's disease were called to the hospital for detailed investigation. In the second step the remaining students were evaluated. RESULTS: Out of 3225 children questioned in the first step, 156 claimed recurrent abdominal pain and/or chest pain, and/or joint pain/swelling with accompanying fever, which might suggest the presence of FMF However, this diagnosis was excluded after further clinical evaluation. In the second step 152 students were called for detailed investigation: 2 patients, one 10 years and the other 12 years old, were diagnosed as having FMF. None were diagnosed to have Behçet's disease. CONCLUSION: The prevalence of FMF in Turkey in general is about 0.093%. The prevalence rate found in this survey was lower (0.027%) which may be due to the historic background of the region. This is the first study that has shown that the "zero patient design" can be used in an epidemiological survey.

Nonrelated living-donor kidney transplantation: medical and ethical aspects.

Several patients with end-stage renal disease went to Bombay for renal transplantation from nonrelated living donors and then returned to Turkey for posttransplantation follow-up. The aims of this study are to evaluate the long-term results of renal transplantation from nonrelated living donors in Turkish patients with end-stage renal disease and to discuss the ethical and social aspects of nonrelated kidney donation. One hundred and twenty-seven patients (89 males, 38 females; mean age 38.1, range 17-63 years) were investigated retrospectively. None of the patients went to Bombay on our advice. All transplantations were performed between 1991 and 1995. The mean follow-up period after transplantation was 34.2 (range 1-68) months. Graft survival rates were 85, 83, and 57% after 3 months and 1 and 5 years, respectively. Patient survival rates were 94, 93, and 92% after 3 months and 1 and 5 years, respectively. Seven patients died within the first 3 months after the transplantation. Surgical problems, infections, acute rejection, ciclosporin nephrotoxicity, and hepatic problems were common complications. We conclude that medical and surgical complications occur frequently in paid kidney transplantation, but most of these complications can be prevented by adequate preoperative management, and precautionary measures should be taken to prevent commercialization of renal transplantation before the spread of emotionally related living kidney donation.

A new needle suspension procedure for genuine stress incontinence and anterior vaginal wall prolapse.

A new suspension method was developed for the correction of anterior vaginal wall relaxation and genuine stress incontinence. This procedure suspends the anterior vaginal wall to the anterior rectus fascia, and in doing so gives support to the bladder neck, anterior vaginal wall and vaginal apex. The procedure is performed at the time of vaginal hysterectomy or correction of anterior vaginal wall relaxation. The authors present their experience with this technique in 31 patients.