Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus.

AIM: We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice. METHODS: We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP. RESULTS: The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP. CONCLUSION: Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.

A novel screening test for colon cancer: Talin-1.

OBJECTIVE: Cell adhesion and angiogenesis within the extracellular matrix involve special signaling molecules, such as integrins and the actin binding protein Talin-1. The aim of this study was to investigate and describe the expression of Talin-1 for the early detection of colon cancer. PATIENTS AND METHODS: Blood serum samples were collected from 50 healthy volunteers and from 90 patients with colon cancer. Using an enzyme-linked immunosorbent assay (ELISA), all 140 samples were analyzed. RESULTS: Preoperative levels of Talin-1 in the serum were significantly higher in patients with colon cancer (p < 0.001). No significant correlation was found between preoperative levels of Talin-1 in the serum and the age and gender of the patients (p < 0.05). However, a significant correlation was found between Talin-1 levels and the tumor grade, TNM stage, and lymph node metastasis (p < 0.001). CONCLUSIONS: Talin-1 may play a role in the reinforcement of cell proliferation, cell adhesion, and angiogenesis in colon cancer. Thus, the Talin-1 protein activity may be a novel biomarker to detect colon cancer in humans.

The relationship between serum tumor-associated trypsin inhibitor levels and clinicopathological parameters in patients with gastric cancer.

BACKGROUND: Tumor-associated trypsin inhibitor (TATI) is expressed with trypsinogen in tumors. We studied the clinical-pathologic association and significance of preoperative serum levels of TATI in gastric cancer patients. PATIENTS AND METHODS: Pre-treatment serum levels of TATI in patients with gastric cancer and healthy controls were analyzed by a specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Statistically significant differences were found in serum TATI levels between patients with gastric cancer and healthy controls (p < 0.0001). There was a significant relationship between the serum levels of TATI and clinicopathological parameters. However, serum levels of TATI were significantly higher in patients with an advanced T stage (T3) (p < 0.001), lymph node metastasis (p < 0.001) and an advanced TNM stage (stage III or IV; p < 0.001). CONCLUSIONS: Our study suggests that TATI may be used to identify potentially high-risk groups of upper gastric carcinoma. Elevated level of TATI was associated with progressive disease or advanced stage.

Evaluation of the effects of hyperbaric oxygen treatment and enoxaparin on left colon anastomosis. An experimental study.

BACKGROUND: Surgical interventions on left colon lead to high morbidity. The problems in wound healing are the main cause of this morbidity. Hypoxia retards wound healing and hyperbaric oxygen treatment (HBOT) has an anti-hypoxic effect. MATERIALS AND METHODS: In this experimental study we divided eighty Wistar albino rats into eight groups and numbered between 1 and 8. Normal (non-ischemic) and ischemic left colon anastomosis were performed in the first and second four groups respectively. HBOT and subcutaneous enoxaparin were applied to the groups separately and in combination for four days, except the control groups. (Group-1 and Group-5). We measured anastomotic bursting pressures and performed pathological examinations besides electron microscopic study in one sample from each group after sacrificing the rats on the fourth day. RESULTS: There were no statistically significant differences in bursting pressures when we compared Group-1 with other non-ischemic groups, and Group-5 with Group-6, but there were statistically significant differences when we compared Group-5 with Group-7 and 8. In pathological examination, there were no statistically significant differences between the groups concerning necrosis, epithelization, granulation tissue formation and collagen deposition. Statistically significant differences were found in the scores of neovascularization when we compared Group-1 with Group-3 and 4, and Group-5 with Group-8. Electron microscopic evaluation revealed a prominent increase both in neovascularization and collagen fibers in the samples taken from the groups received enoxaparine and hyperbaric oxygen treatment in combination. CONCLUSIONS: These findings suggest that HBOT increases neovascularization and bursting pressures in ischemic colon anastomosis in contrast with enoxaparin.

Human neutrophil peptides 1, 2 and 3 (HNP 1-3): elevated serum levels in colorectal cancer and novel marker of lymphatic and hepatic metastasis.

OBJECTIVE: Biological levels of localized colon tumors are needed for the diagnosis and prevention of colon cancer. Numerous biomarker studies are produced currently through research. We investigated some peptides with the aim of identifying biomarkers for colorectal cancer and lymphatic and hepatic metastasis. MATERIALS AND METHODS: A total of 100 patients with histologically proven colorectal cancer and 60 normal volunteers were included in this study. Preoperative serum was collected for analysis. Human neutrophil peptides levels (HNP) were assayed by solid phase RIA (Radio Immun Assay) based on monoclonal antibodies. RESULTS: The HNP-1, -2 and -3-also known as α-defensin-1, -2 and -3-are present in elevated concentrations in the plasma from colorectal cancer patients. CONCLUSION: Preoperative high plasma HNP 1-3 levels are associated with colorectal cancer. The HNP 1-3 levels may procure information on patients with lymph node or hepatic metastasis.

The relationship among acute-phase responce proteins, cytokines, and hormones in various gastrointestinal cancer types patients with cachectic.

BACKGROUND: Acute-phase response proteins (APRPs), cytokines, and hormones have been claimed to be an independent, important factor of cancers. We suggest that in gastrointestinal system cancers, changes in APRP, cytokines, and hormones are associated. METHODS: C-reactive protein (CRP), albumin, interleukin 1α (IL-1α), IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), midkine, vascular endothelial growth factor-A(VEGF-A), VEGF-C, VEGF receptor 1 (VEGFR1), leptin, adiponectin, and ghrelin serum levels are studied in 148 gastrointestinal system cancer types and 40 healthy controls. RESULTS: We found statistically significant differences and correlations between groups. We found significantly higher serum CRP, IL-1α, IL-1ß, IL-6, IL-8, IL-10, TNF-α, VEGF-A, VEGF-C, VEGFR1, and leptin concentrations in patients with esophageal, gastric, pancreas, colon, and rectum cancers than controls (p < 0.001, p < 0.0001). But, we found lower levels of the serum albumin, midkine, adiponectin, and ghrelin in patients with esophageal, gastric, pancreas, colon, and rectum cancers compared to control subjects (p < 0.05, p < 0.001). CONCLUSIONS: Cachexia in gastrointestinal system cancer types is associated with changes in APRP, cytokines, and hormone concentrations. This may be reflected between the outcomes in malignancies and the biomarkers.

Serum thymidine kinase is associated with gastric adenocarcinoma.

Thymidine kinase (TK) plays an essential role in the processing of thymidine within the cell and therefore it is an important marker of proliferation, particularly in tumor cells. The aim of our study was to determine the diagnostic and prognostic importance of TK measurement in gastric adenocarcinoma. The serum level of TK was measured in 72 patients with gastric adenocarcinoma. Serum levels of TK were significantly elevated in gastric adenocarcinoma in comparison with healthy individuals. Also, we have found that there are significant variations in TK serum concentrations when measured that correlate with important variations in clinico-pathological features and prognostic significance (Tab. 2, Ref. 16).

Serum des-gamma-carboxyprothrombin in patients with pancreatic head adenocarcinoma.

The total des-gamma-carboxyprothrombin (DCP) produced in pancreatic adenocarcinoma and the correlation between the tissue DCP and serum DCP levels has been examined. Fifty patients with resectable pancreatic head cancer were examined regarding both the tissue and serum levels of DCP. The mean tissue DCP in the cancer tissue, non-cancer tissue, the serum levels in patients, and the serum levels in controls was 190.500 mAU/ml mg protein, 32.000 mAU/ml mg protein, and 46.000 mAU, and 10.000 mAU, respectively. The elevation of tissue and serum levels of DCP in pancreatic adenocarcinoma patients is a very useful marker for pancreatic adnocarcinoma and should be used without any other tumor marker (Tab. 2, Ref. 15).

Circulating levels of VEGF family and their receptors in hepatocellular carcinoma.

To analyze the serum levels and prognostic significance of vascular endothelial growth factor (VEGF) family (VEGF-A, -C and -D) and their receptors (VEGFR-1 and -2) in patients with hepatocellular carcinoma. The serum levels of VEGF family members were measured in 56 control subjects and 68 patients with hepatocellular carcinoma using an enzyme-linked immunosorbent assay (ELISA). These measurements were correlated with clinic pathological features. The serum levels of VEGF-A and its receptor, VEGFR-1, were significantly higher in patients with hepatocellular carcinoma than in controls (p < 0.001). There was no significant difference in serum levels of VEGF-C and VEGFR-2 between patients and controls. VEGF-A levels were associated with advanced tumor stage and presence of metastases. VEGFR-1 was associated with metastases, advanced overall stage, tumor differentiation. VEGFR-2 levels were associated with poor tumor differentiation. Serum VEGF levels are significantly in the same cohort of patients with variable clinic pathological features and prognostic values. The measurement of VEGF-A and its VEGFR-1 levels in sera may reflect the development of tumor, metastasis and angiogenesis (Tab. 2, Ref. 20).

Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure.

Morning headache is accepted as part of clinical findings of obstructive sleep apnoea syndrome (OSAS). The prevalence of morning headache is at variable levels from 18% to 74% in patients with OSAS. However, there is controversy over the association of morning headache and OSAS. We studied morning headache prevalence and characteristics in 101 controls with apnoea-hypnoea index (AHI) < 5 and 462 OSAS patients with AHI > or = 5. Morning headache was reported by only nine (8.9%) subjects in a control group compared with 156 (33.6%) of OSAS patients (P < 0.01). Morning headache prevalence was significantly higher in severe and moderate OSAS groups. AHI was significantly higher in OSAS patients with morning headache compared with patients without morning headaches. Oxygen saturation nadir during rapid eye movement and non-rapid eye movement sleep as well as mean oxygen saturation value during total sleep time were also found to be significantly lower in morning headache group. However, none of the sleep parameters was found to be determinants of morning headache. Morning headache was more frequently reported by patients of female gender and with primary headache history. Morning headache was totally resolved in 90% of patients treated with nasal continuous positive airway pressure. The history of OSAS should be considered in the differential diagnosis of morning headache.