STEAP4 and HIF-1α gene expressions in visceral and subcutaneous adipose tissue of the morbidly obese patients.

AIM AND BACKGROUND: Obesity is a multifactorial disease in which environmental and genetic factors play an integrated role. Determining such target genes will help to elucidate the mechanisms underlying complex diseases such as obesity and diabetes which are usually seen together. Present study investigates the expression levels of STEAP4 and HIF-1α in visceral and subcutaneous adipose tissue. PATIENTS AND METHODS: 30(6M) morbidly obese patients undergoing bariatric surgery were included in the study. The patients were grouped according to the BMI as Group I (BMI <50kg/m(2)) and Group II (BMI ≥50kg/m(2)). Samples from visceral (omentum) and subcutaneous adipose tissues were obtained from each patient and real-time PCR (qPCR) was carried out for STEAP4 and HIF-1α gene expressions. Correlations between expression levels and clinical parameters were analyzed. RESULTS: Mean age of the patients recruited to the study was 37.4 (18-64) years. Mean BMI was 46 (36-60) kg/m(2). STEAP4 expression in visceral adipose tissue was significantly higher than subcutaneous tissue. Visceral STEAP4 expression was also found to be reduced with increased BMI. It was also lower in patients with HbA1C over 6. Furthermore, expression of subcutaneous and visceral HIF-1α was significantly higher in Group II. There was a significant correlation between BMI, glycosylated hemoglobin, STEAP4 and HIF-1α gene expression. CONCLUSIONS: Obesity and related disease are linked with the fact that there is a low grade inflammation in the adipose tissue of the obese individuals. Counter-regulatory processes such as STEAP4 protein family are overwhelmed by the proinflammatory stimuli. HIF-1α expression is increased due to tissue hypoxia and pro-inflammatory stimuli in the obese individuals, which results in increased visceral STEAP4 expressions.

The association of elevated mean platelet volume with the outcome of acute mesenteric ischemia.

Mesenteric ischemia is a life-threatening vascular emergency with high mortality rates. Mean platelet volume (MPV) has been shown to be closely related to platelet activation. We investigated whether MPV was associated with outcome of acute mesenteric ischemia (AMI). Sixty-one patients who were operated for AMI were retrospectively evaluated. Patients were divided into two groups: survivors and nonsurvivors, according to the outcome, and the two groups were compared in terms of MPV levels and other prognostic factors. Urea, creatinine, alkaline phosphatase, amylase, gamma-glutamyl transferase and MPV levels were significantly higher in nonsurvivors, when compared to that of survivors. In addition, hypertension, atherosclerotic heart diseases and rhythm disorders were statistically significant risk factors for mortality. AMI is an uncommon but highly lethal surgical emergency. Our results indicate that an elevated MPV is associated with a worse outcome in patients with AMI.

Evaluation of liver injury in a tertiary hospital: a retrospective study.

BACKGROUND: Liver is the most frequently injured intraabdominal organ following abdominal trauma. Liver injury in polytraumatized patients can vary from minor contusions to major lacerations and is associated with morbidity and mortality. The objective of this study was to evaluate the outcome of liver injury in polytraumatized patients. METHODS: Only surgically treated 82 patients with liver injury over an eight year period (2005-2013) were included in this study and analyzed retrospectively. Data collected included demographics, laboratory findings, intraoperative findings, operative management, and outcome. The patients were divided into two groups and the mortality and survival data were compared. RESULTS: The overall mortality rate was 18.3% (15 of 82 patients). 34 (41.5%) patients had blunt, forty-eight (48.5%) had penetrating trauma. There were multiple traumas in forty-seven (57%) patients. Forty-seven (57%) patients had total of seventy one coexisting intraabdominal injuries. Forty-six (56.1%) patients had stable and thirty-six (43.9%) had unstable hemodynamics on admission. In mortality group AST, ALT, LDH, APTT, PT, INR, and creatinine levels were high, fibrinogen levels and platelet counts were low on admission. CONCLUSION: Hemodynamic instability, coexisting musculoskeletal and chest injury, high APTT, PT, INR, AST, ALT, LDH levels, and low fibrinogen levels and platelet counts on admission should be considered as predictive factors for mortality.

Predictive value of liver transaminases levels in abdominal trauma.

INTRODUCTION: We aimed to evaluate whether hepatic transaminase levels could predict the presence and severity of liver injury following abdominal trauma. METHODS: We performed a retrospective analysis of 75 surgically treated patients and 21 non-surgically treated patients with liver injury who were managed between 2004 and 2012. We retrieved demographic, laboratory, radiologic, and intraoperative data, as well as surgical procedures and the outcome from the patients' medical records. We compared the findings between patients divided into 2 groups according to the severity of liver injury: group 1, including patients with Grade 1 or 2 liver injuries; and group 2, including patients with grade 3 to 5 liver injury. RESULTS: There were 87 (90.6%) males and 9 (9.4%) females. The mean age was 34 years (range, 17-90 years). The overall mortality rate was 14.6% (n = 14). The injury was blunt in 83 patients (86.5%) and penetrating in 13 patients (13.5%). There were multiple traumas in 60 patients (62.5%). Overall, 43 patients (44.8%) had a total of 61 coexisting intraabdominal injuries. The circulating aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase (LDH) levels were significantly higher in group 2 than in group 1. CONCLUSIONS: In patients with abdominal trauma, abnormal hepatic transaminase and LDH levels are associated with liver injury. Alanine aminotransferase ≤76 U/L, aspartate aminotransferase <130 U/L, and LDH ≤410 U/L are predictive of low-grade liver injury, and patients with serum liver levels below these levels can be managed conservatively.

Prospective evaluation of crural repair with and without double-sided mesh reinforcement.

BACKGROUND: Laparoscopic Nissen fundoplication is gold standard treatment for gastroesophageal reflux disease. We examined the results of laparoscopic Nissen fundoplication with or without double-sided polypropylene mesh. PATIENTS AND METHODS: Sixty patients were prospectively evaluated. Primer cruroraphy and primer cruroraphy with mesh were performed in 31 and 29 patients, respectively. The Gastrointestinal Quality of Life Index (GIQLI) was used for assessment of the patient satisfaction preoperatively and postoperatively at 12 months. RESULTS: Sixty patients were included in the study, with a mean age of 42 years. There was no difference between the 2 groups with respect to age, sex, and duration of symptoms. GIQLI showed an equal improvement, and there were no differences in the quality of life in both the groups. All patients' endoscopic findings were normal at first year. CONCLUSIONS: Laparoscopic Nissen fundoplication appears to prevent reflux and its symptoms and create better quality of life. Double-sided polypropylene mesh for repair may result in better quality of life.