A kynurenine pathway enzyme aminocarboxymuconate-semialdehyde decarboxylase may be involved in treatment-resistant depression, and baseline inflammation status of patients predicts treatment response: a pilot study.

The kynurenine pathway (KP) and inflammation are substantial in depression pathogenesis. Although there is a crosstalk between the KP, inflammation, and neurotrophic factors, few studies examine these topics together. Novel medications may be developed by clarifying dysregulations related to inflammation, KP, and neurotrophic factors in treatment-resistant depression (TRD). We aimed to evaluate the serum levels of KP metabolites, proinflammatory biomarkers, and brain-derived neurotrophic factor (BDNF) in healthy controls (HC) and the patients with TRD whose followed up with three different treatments. Moreover, the effect of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) on biomarkers was investigated. Study groups comprised a total of 30 unipolar TRD patients consisting of three separate patient groups (ECT = 8, rTMS = 10, pharmacotherapy = 12), and 9 HC. The decision to administer only pharmacotherapy or ECT/rTMS besides pharmacotherapy was given independently of this research by psychiatrists. Blood samples and symptom scores were obtained three times for patients. At baseline, quinolinic acid (QUIN) was higher in the patients with TRD compared to HC, whereas picolinic acid (PIC), PIC/QUIN, and PIC/3-hydroxykynurenine were lower. Baseline interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) were higher in nonresponders and non-remitters. ECT had an acute effect on cytokines. In the rTMS group, tumor necrosis factor-α (TNF-α) decreased in time. PIC, QUIN, and aminocarboxymuconate-semialdehyde decarboxylase (ACMSD) enzyme may play a role in TRD pathogenesis, and have diagnostic potential. rTMS and ECT have modulatory effects on low-grade inflammation seen in TRD. Baseline inflammation severity is predictive in terms of response and remission in depression.

Evaluation of Advanced Oxidation Protein Products (AOPP) and Superoxide Dismutase (SOD) Tissue Levels in Patients with Nasal Polyps.

The aim of this study is to eveluate levels of advanced oxidation protein products (AOPP) which are thought to increase in the polyp tissue and superoxide dismutase (SOD), an antioxidant enzyme, with using specthrophotometry in polyp tissue and healthy mucosa. 30 nasal polyp patients without inflammatory disease except for nasal polyposis were included in the study. The control group consisted of 18 patients who did not have allergy, asthma, inflammatory and granulomatous disease and planned surgery due to septum deviation and concha hypertrophy. AOPP and SOD tissue levels were measured by spectrophotometry in polyp tissue specimens taken from patients with nasal polyps and concha samples taken from patients in the control group. The mean AOPP tissue level of patients in the nasal polyposis group was statistically significantly higher than the control group. (p < 0.05). The mean SOD activity level was significantly lower in the nasal polyposis group than the control group. (p < 0.05) As a result of this study, high AOPP levels in polyp tissue and low SOD levels in polyp tissue compared to healthy nasal mucosa, oxidative stress plays an important role in nasal polyp development.

The relationship between long-term statin usage and myocardial injury related to percutaneous coronary interventions evaluated by high-sensitivity troponins.

OBJECTIVE: Myocardial injury related to percutaneous coronary interventions (PCI) might adversely affect the prognosis of patients with coronary artery disease. Our study aimed to investigate the effects of long-term statin usage on myocardial injury related to elective PCI. METHODS: In our study, total 102 patients were included and evaluated in 3 groups based on the statin usage before PCI, "potent statin" group (n=26), "weak statin" group (n=23), and "statin free" group (n=53). The occurrence of the procedural complications was identified (n=31). The myocardial injury was determined by serial high-sensitivity troponin T (hsTnT) testing at 0th, 2nd, 4th, and 12th hour of the procedure. RESULTS: The increase in hsTnT values in the 2nd and 4th hour was significantly lower in the potent statin group than in the other 2 groups (p=0.008 and p=0.009, respectively). In patients with procedural complications, the increase in hsTnT levels at the 2nd, 4th, and 12th hour were also lower in the potent statin group (p=0.032, p=0.019, and p=0.006, respectively). Also, in patients with procedural complications, hsTnT levels exceeding the myocardial infarction limit at the 4th and 12th hour were lower in the potent statin group (p=0.039 and p=0.006, respectively). CONCLUSION: These results show that elective PCI related myocardial injury was less frequent in patients who were using high-dose statins. This result was more pronounced in patients who developed complications during the procedure.

Contribution of the laboratory to a diagnosis process by sequential reflective testing: Paraprotein interference on a direct bilirubin assay.

Errors in laboratory medicine occur in the preanalytical, analytical, and postanalytical phases. The errors are mostly detected in the preanalytical period. However, analytical errors are still an important source of error, despite their frequency is reduced significantly in years thanks to developments in laboratories. In this case, an analytical error was noticed during the verification of a patient's results. The direct bilirubin of a 66-year-old male patient admitted to the emergency department was higher than the total bilirubin. The patient's symptoms were fatigue and dyspnoea. Albumin and haemoglobin (Hb) concentrations of the patient were significantly low. After considering the patient's demographics and laboratory results, the laboratory specialist suspected a paraproteinemia interference. Total protein was performed as a reflective test. The albumin/globulin ratio was reversed. Thereafter, serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) were performed as another reflective tests, respectively. SPEP and IFE results were in favour of monoclonal gammopathy. The patient was directed to a haematologist, underwent a bone marrow biopsy, and the result was reported as Waldenstrom's macroglobulinemia with plasma cell differentiation expressing IgM-Kappa. The patient went on a chemotherapy protocol, and his condition has been improved in subsequent months. Detection of analytical errors is of great importance, like in our case, and may be used as a tool to identify patients who have not yet been diagnosed. The laboratory specialist must dominate the entire process of each test in the laboratory, be aware of the limitations of tests, and turn these disadvantages into advantages when necessary.

Intrastromal versus subconjunctival anti-VEGF agents for treatment of corneal neovascularization: a rabbit study.

OBJECTIVE: To determine whether subconjunctival or intrastromal administration of anti-VEGF agents is more effective on suture-induced corneal neovascularization (CoNV) in rabbits. METHODS: CoNV was induced in 48 eyes of 24 New Zealand white rabbits by using an 8/0 silk suture. On the 7th day after suturing, the rabbits were divided into four treatment groups as follows: six rabbits received subconjunctival bevacizumab (group 1), six rabbits received subconjunctival aflibercept (group 2), six rabbits received intrastromal bevacizumab (group 3) and six rabbits received intrastromal aflibercept (group 4). On the 7th and 14th days after suturing, the CoNV area was calculated by standardised analysis of photographs using the Image-J program. On the 14th day after suturing, all rabbits were sacrificed and then corneal tissue was harvested for the analysis of vascular endothelial growth factor (VEGF)-A, VEGF-B and placental growth factor (PIGF) levels. RESULTS: On the 7th day after suturing, CoNV areas were 17.10 ± 2.98, 18.88 ± 3.78, 17.36 ± 4.52, 18.57 ± 4.16 and 17.31 ± 2.81 mm2 in the groups 1-4 and control group, respectively. On the 7th day after intervention and removal of suture, CoNV areas were 4.85 ± 1.99, 6.66 ± 1.73, 2.83 ± 1.08, 2.63 ± 1.16 and 11.93 ± 2.64 mm2 in the group 1-4 and control group, respectively. CoNV area was reduced by 88.1% and 82.5% in eyes receiving intrastromal aflibercept and bevacizumab, respectively (both p < 0.001), and by 64.5% and 69.9% in eyes receiving subconjunctival aflibercept and bevacizumab, respectively (both p = 0.001). CONCLUSION: Intrastromal anti-VEGF therapy regressed CoNV more effectively than subconjunctival therapy regardless of the type of anti-VEGF agent.

Evaluation of oxidative stress in pseudo-exfoliative glaucoma patients treated with and without topical coenzyme Q10 and vitamin E.

PURPOSE:: To evaluate the levels of oxidative stress markers such as superoxide dismutase and malondialdehyde in eyes with pseudo-exfoliative glaucoma treated with and without topical coenzyme Q10 (CQ10) and vitamin E (Coqun drop). METHODS:: This prospective, randomized clinical study was conducted on 64 eyes of 64 patients. All patients underwent phacoemulsification and intraocular lens implantation surgery. Aqueous humor samples were aspirated from the anterior chamber at the beginning of cataract surgery. The pseudo-exfoliative glaucoma + Coqun group received topical Coqun (100 mg CQ10, 500 mg Vitamin E TPGS) twice daily for 1 month preoperatively, while the pseudo-exfoliative glaucoma group consisted of pseudo-exfoliative glaucoma cases who had not taken Coqun. Pseudo-exfoliation syndrome cases formed the pseudo-exfoliation syndrome group. The main outcomes were the superoxide dismutase and malondialdehyde levels of aqueous humor in both groups. RESULTS:: The mean aqueous humor superoxide dismutase level was significantly higher in the pseudo-exfoliative glaucoma group than in pseudo-exfoliative glaucoma + Coqun and pseudo-exfoliation syndrome groups (p < 0.001, p = 0.004, respectively). Also, the mean aqueous humor superoxide dismutase level was significantly lower in the pseudo-exfoliation syndrome group than in pseudo-exfoliative glaucoma + Coqun group (p = 0.009). The mean malondialdehyde levels showed no significant difference between the groups (p > 0.05 for all). CONCLUSION:: Our study showed lower aqueous humor level of superoxide dismutase in pseudo-exfoliation syndrome patients compared to pseudo-exfoliative glaucoma patients. Significantly lower superoxide dismutase level was observed in pseudo-exfoliative glaucoma patients who received topical Coqun compared to pseudo-exfoliative glaucoma patients without Coqun treatment. No significant change was observed on the malondialdehyde level during 1-month follow-up period.