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Öğe Assessment of mean platelet volume (MPV) in primary hyperparathyroidism: Effects of successful parathyroidectomy on MPV levels(Institute of Experimental Endocrinology ueenregu@kramare.savba.sk, 2014) Yilmaz, HakkiObjective. A determinant of platelet function - mean platelet volume (MPV), is newly emerging risk factor for atherothrombosis. The aim of this study is to evaluate MPV in patients with primary hyperparathyroidism (PHPT) before parathyroidectomy (PTX) and six months after successful PTX in a retrospective study. Methods. We analyzed the changes in serum biochemical, parathyroid hormone (PTH) and MPV before and six months after PTX in 66 patients with PHPT and 44 healthy controls, age- and sex-matched. Results. Sixty-six patients (18 men, 48 women) with mean age 53.8±12.7 years were analyzed. MPV was significantly higher in the patients with PHPT before PTX than in the same group after PTX (9.26±1.20 fl vs. 7.99±0.80 fl, p<0.0001). MPV levels were positively correlated with PTH (r=0.888, p<0.0001), calcium (r=0.292, p=0.017) in the preoperative phase. Postoperative (after 6 months) MPV showed a significant positive correlation with postoperative PTH (r=0.381, p=0.002) and calcium levels (r=0.324, p=0.008). Conclusions. These results suggest that subjects with PHPT lead to have increased platelet activation. © 2015 Elsevier B.V., All rights reserved.Öğe Association between Red Blood Cell Distribution Width and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography(Korean Soc Cardiology, 2015) Gurel, Ozgul Malcok; Demircelik, Muhammed Bora; Bilgic, Mukadder Ayse; Yilmaz, Hakki; Yilmaz, Omer Caglar; Cakmak, Muzaffer; Eryonucu, BeyhanBackground and Objectives: The red blood cell distribution width (RDW) has been found to be associated with cardiovascular morbidity and mortality. The objective of this study was to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary heart disease (CHD). Subjects and Methods: A total of 527 consecutive patients with a low to intermediate risk for CHD but without obvious disease were enrolled in this study. The study subjects underwent coronary computerized tomography angiography and CACS was calculated. The patients were divided into two groups based on CACS: Group I (CACS <= 100) and Group II (CACS>100). The two groups were compared in terms of classic CHD risk factors and haematological parameters, particularly the RDW. Results: Group I patients were younger than Group II patients. The Framingham risk score (FRS) in patients of Group II was significantly higher than that in patients of Group I. Group II patients had significantly elevated levels of haemoglobin, RDW, neutrophil count, and neutrophil/lymphocyte ratio compared with Group I patients. CACS was correlated with age, RDW, and ejection fraction. In the multivariate analysis, age, RDW, and FRS were independent predictors of CACS. Using the receiver-operating characteristic curve analysis, a RDW value of 13.05% was identified as the best cut-off for predicting the severity of CACS (>100) (area under the curve=0.706). Conclusion: We found that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD.Öğe Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients(Taylor & Francis Ltd, 2015) Yilmaz, Hakki; Cakmak, Muzaffer; Inan, Osman; Darcin, Tahir; Aktas, Aynur; Gurel, Ozgul Malcok; Bilgic, Mukadder AyseAim: Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients. Materials and methods: The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA. Results: Hypertensive patients (n=263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n=55). Univariate analysis showed that AASI was positively associated with age (r=0.212, p< 0.001) body mass index (r=0.412, p<0.001), pulse pressure (r=0.350, p<0.001), plasma sEPCR (r=0.894, p<0.001), 24-h heart rate (r=0.176, p=0.001) and inversely related to high-density lipoprotein (HDL) (r=-0.293, p<0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI. Conclusion: We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.Öğe CA 125 levels and left ventricular function in patients with end-stage renal disease on maintenance hemodialysis(Taylor & Francis Ltd, 2014) Yilmaz, Hakki; Gurel, Ozgul Malcok; Celik, Huseyin Tugrul; Sahiner, Enes; Yildirim, Mehmet Erol; Bilgic, Mukadder Ayse; Bavbek, NuketPurpose: The aim of this study was to analyze associations between serum cancer antigen 125 (CA 125) levels and left ventricular (LV) function in patients with end-stage renal disease on maintenance hemodialysis (HD). Methods: CA 125 levels, pro-brain natriuretic peptide (pro-BNP) and biochemical parameters were measured, and echocardiography was performed for 110 patients and 47 healthy controls. Results: The mean CA 125 level in patients, 38.78 +/- 35.48 U/mL, was significantly higher than that found in healthy controls (9.20 +/- 4.55 U/mL; p = 0.003). Patients with elevated CA 125 levels (n = 40) had significantly lower levels of albumin and reduced relative wall thickness, LV ejection fraction (EF) and fractional shortening but significantly higher levels of pro-BNP and a greater left ventricular end-diastolic diameter (LVEDd) and -systolic diameter (LVESd). CA 125 levels were positively correlated with pro-BNP (r = 0.596, p<0.05) and C-reactive protein (CRP) levels (r = 0.439, p<0.05), as well as LVEDd (r = 0.599, p<0.001), LVESd (r = 0.750, p<0.001) and LV mass index (r = 0.378, p<0.05). In contrast, serum CA 125 levels were negatively correlated with albumin (r = -0.513, p<0.05) and hemoglobin (r = -0.475, p<0.05) as well as the EF (r = -0.878, p<0.0001). A depressed EF (beta = -1.121, p<0.0001) and increased CRP levels (beta = 0.247, p = 0.035) were independent predictors of high CA 125 levels in the whole group in the multivariate-model. Conclusions: Our study is the first to demonstrate an association between serum CA 125 levels and LV systolic dysfunction via inflammation in patients on maintenance HD.Öğe Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis?(Informa Healthcare, 2015) Yilmaz, Hakki; Cakmak, Muzaffer; Inan, Osman; Darcin, Tahir; Akcay, AliAim: Neutrophil-lymphocyte ratio (NLR) is an easily calculated, sensitive, and accurate marker for prognosis and diagnosing sepsis, cardiovascular disease and cancer. As sepsis and septic shock are main causes of acute kidney injury (AKI) intensive care unit (ICU), we investigated whether NLR is an early predictor of AKI in patients with severe sepsis. We compared NLR's predictive power with that of other inflammation-related variables. Methods: Between December 2011 and November 2013, we enrolled 118 consecutive cases with severe sepsis admitted to ICU in this retrospective study. Levels of C-reactive protein (CRP), NLR, and white blood cell count (WBC) were recorded on admission and patients' renal function was monitored for seven consecutive days. Results: The rate of AKI occurrence 7 days after enrollment was 57.6%. NLR levels were higher in the AKI group (Group 1) than in the non-AKI group (Group 2) on the day of ICU admission (p<0.001). AKI development was independently associated with NLR, Acute Physiology and Chronic Health Evaluation II (APACHE II) and duration of invasive mechanical ventilation (MV) in multivariate logistic regression analysis. The area under the receiver-operating characteristic (ROC) curve of NLR for predicting AKI was 0.986, which was superior to WBC and CRP (p<0.05). The cut-off value of 10.15 for NLR had the highest validity for predicting AKI in patients with severe sepsis. The sensitivity, specificity, negative-predictive value (NPV), and positive-predictive value (PPV), for this cut-off value was 90.2%, 92.9%, 90.4%, and 92.7%, respectively. Conclusion: NLR is superior to CRP, and WBC for predicting the development of AKI in patients with severe sepsis.Öğe Can Serum Gdf-15 be Associated with Functional Iron Deficiency in Hemodialysis Patients?(Springer India, 2016) Yilmaz, Hakki; Cakmak, Muzaffer; Darcin, Tahir; Inan, Osman; Bilgic, Mukadder Ayse; Bavbek, Nuket; Akcay, AliFunctional iron deficiency (FID) incidence is gradually increasing in hemodialysis (HD) patients. Recently, high levels of GDF-15 supressed the iron regulatory protein hepcidin and GDF-15 expression increased in iron-deficient patients. The relationship between FID, GDF-15, and hepcidin is currently unknown. The present study aimed to evaluate the association between GDF-15, hepcidin, and FID in chronic HD patients. Serum GDF-15 and hepcidin concentrations were measured in 105 HD patients and 40 controls. FID is defined as serum ferritin > 800 ng/mL, TSAT < 25 %, Hb levels < 11 g/dL, and reticulocyte haemoglobin content (CHr) < 29 pg. Serum GDF-15 and hepcidin levels were increased significantly in HD patients with FID, compared to HD patients without anemia and controls. GDF-15 correlated with ferritin, hepcidin, and CRP in the entire cohort. GDF-15 was related to ferritin and CRP in HD patients with FID. GDF-15 is better diagnostic marker than hepcidin for detection of FID [AUC = 0.982 (0.013) versus AUC = 0.921 (0.027); P = 0.0324]. GDF-15 appears to be a promising tool for detection of FID. High levels of ferritin and CRP correlated with GDF-15. Our results support GDF-15 as a new mediator of FID via hepcidin, chronic inflammation, or unknown pathways.Öğe Circulating irisin levels reflect visceral adiposity in non-diabetic patients undergoing hemodialysis(Taylor & Francis Ltd, 2016) Yilmaz, Hakki; Cakmak, Muzaffer; Darcin, Tahir; Inan, Osman; Sahiner, Enes; Demir, Canan; Aktas, AynurBackground: Recent evidence suggests that increased visceral adiposity is a strong independent risk factor for cardiovascular death and all-cause mortality in hemodialysis (HD) patients. Irisin, which is a novel myokine, can play critical roles in diabetes and adiposity. The purpose of our study was to investigate whether serum irisin levels are associated with body mass index, waist circumference (WC), and total fat mass in non-diabetic patients undergoing maintenance HD.Methods: This cross-sectional study included 108 non-diabetic HD patients and 40 age- and sex-matched apparently healthy subjects. Serum irisin concentrations were determined using an enzyme-linked immunosorbent assay. Body fat composition (TBF-410 Tanita Body Composition Analyzer) was measured and calculated.Results: Serum irisin levels did not differ between HD patients and the healthy controls (523.50 +/- 229.32 vs. 511.28 +/- 259.74, p=0.782). Serum irisin levels were associated with age (r=0.314; p=0.006), HOMA-IR (r=0.472; p=0.003), WC (r=0.862; p<0.001), and total fat mass (r=0.614; p<0.001). In multivariate regression analysis, WC (=1.240, p<0.001) and total fat mass (=0.792, p=0.015) were the variables that were significantly associated with irisin concentrations (R-2=0.684, p<0.001) after adjusting for confounding factors (age and HOMA-IR). Conclusions: These results suggest that serum irisin levels are related to visceral adiposity in non-diabetic HD patients.Öğe Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients(Informa Healthcare, 2014) Bavbek, Nuket; Yilmaz, Hakki; Erdemli, Haci Kemal; Selcuki, Yusuf; Duranay, Murat; Akcay, AliAim: We aimed to investigate the QT dispersion and corrected QT (QTc) dispersion which are suggested as the signals of ventricular arrhythmias, in patients on maintenance CAPD and to evaluate the correlation between iron stores and these electrocardiographic parameters. Materials and method: Fifty-eight patients on maintenance CAPD and 19 healthy age- and sex-matched adults without cardiac disease were included. The PD patients were divided into two groups according to whether their computerized measurements of QTc dispersion were longer than 65 ms. Results: Although QT interval was statistically significantly shorter in control group (34 +/- 28 vs. 43 +/- 34 ms; p<0.05), there was no significant difference in regards to the QTc, QT dispersion and QTc dispersion between two groups. PD patients with QTc dispersion longer than 65 ms had higher levels of serum ferritin (p = 0.038) and transferrin saturation (TSAT; p = 0.022) than the others. QTc dispersion were positively correlated with ferritin (r = 0.469, p<0.01) and TSAT (r = 0.430, p<0.01) in CAPD patients. Conclusion: Although prolonged QTc, QT dispersion and QTc dispersion were suggested as the markers of ventricular arrhythmias we did not find any significant difference in regards to these parameters between control patients and CAPD patients. But the high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.Öğe Galectin-3 as a new biomarker of diastolic dysfunction in hemodialysis patients(Urban & Vogel, 2015) Gurel, Ozgul Malcok; Yilmaz, Hakki; Celik, Tugrul H.; Cakmak, Muzaffer; Namuslu, Mehmet; Bilgic, Ayse M.; Bavbek, NuketGalectin-3 (gal-3) is an emerging prognostic biomarker in heart failure (HF). Clinical and experimental studies suggest that gal-3 is an important mediator of HF. Here we aimed to examine the relationship between gal-3 and diastolic dysfunction in patients undergoing maintenance hemodialysis (HD). We examined the relationship between plasma gal-3 levels and left ventricular diastolic function. Plasma gal-3 was measured in 87 subjects with chronic HD and in 45 healthy controls using biochemical evaluations. Conventional echocardiography and pulsed tissue Doppler assessment were performed in all patients. Left ventricular diastolic dysfunction (LVDD) was defined as E' < 8 cm/s. The E/E' ratio was used as the main determinant of LVDD grade. The mean gal-3 concentrations were: 16.05 ng/ml (13.89-19.75) in healthy controls; 14.54 ng/ml (10.85-17.65) in HD patients with normal diastolic function; and 23.30 ng/ml (20.12-26.87) in HD patients with LVDD (p < 0.01). Plasma gal-3 levels correlated with E/E' (r = 0.933, p < 0.01), left atrial volume index (r = 0.713, p < 0.01), and E' (r = -0.685, p < 0.01). ROC analysis showed that the best gal-3 cut-off point for the diagnosis of LVDD was 20.12 ng/ml with a sensitivity of 67.6 % and specificity of 84.6 % (AUC = 0.803). We suggest that gal-3 may be a promising biomarker for the detection of LVDD in HD patients.Öğe Is Kidney Injury Molecule 1 a Valuable Tool for the Early Diagnosis of Contrast-Induced Nephropathy?(Bmj Publishing Group, 2015) Akdeniz, Derya; Celik, Huseyin Tugrul; Kazanci, Fatmanur; Yilmaz, Hakki; Yalcin, Serkan; Bilgic, Mukadder Ayse; Ruzgaresen, NuketAim/Scope Contrast-induced nephropathy (CIN) is a common complication of diagnostic/therapeutic procedures. Serum creatinine levels are sensitive but often lead to diagnostic delays in acute kidney injury and potential misclassification of actual injury status. Kidney injury molecule (KIM-1) is a novel early marker of acute kidney injury. The aim of our study was to evaluate the KIM-1 levels in patients with CIN. We performed a single-center, nested case-control study. Materials and Methods Three thousand two hundred patients who had undergone coronary angiography were included in the study. Thirty-two patients were diagnosed with CIN. Twenty patients who had undergone coronary angiography but did not have CIN were evaluated as a control group (n = 20). The diagnosis of CIN was performed according to the KDIGO 2012 Acute Kidney Injury Guideline criteria. Urinary KIM-1 levels were measured by enzyme-linked immunosorbent assay before as well as on the 6th and 48th hours of contrast exposure. Serum creatinine levels were measured before as well as on the 24th and 48th hours after angiographic procedure. Results We demonstrated that KIM-1 levels increased in the patients with CIN significantly on the sixth hour when compared with the baseline (P < 0.01; median levels, 0.27 and 0.70 mg/dL) but not in the controls (P = 0.107). The precontrast and 48th-hour KIM-1 levels were median ones and were also significantly different (P = 0.001, the median levels were 0.27 and 0.60 mg/dL, respectively). Conclusions Because creatinine is a sensitive but a late marker of CIN, KIM-1 may be used for early diagnosis and early initiation of treatment and may reduce risk for morbidity.Öğe Is vitamin D supplementation a new hope for the therapy of the septic shock?(2013) Yilmaz, Hakki; Şahiner, Enes Seyda; Darçın, Tahir; Çelik, Hüseyin Tuğrul; Bilgiç, Mukadder Ayşe; Akçay, Ali T.Vitamin D is mainly known for its traditional role in the bone mineralization and calcium homeostasis. Recent studies have shown that vitamin D receptors (VDR) are present in almost all the tissues and cells in the human body. In addition, several studies have revealed that vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. In addition, septic patients have decreased vitamin D binding-protein (DBP) levels which further exacerbate the vitamin D deficiency. The role of vitamin D treatment in sepsis syndrome has been evaluated in animal model of sepsis where 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] administration was associated with improved blood coagulation parameters in sepsis associated with a disseminated intravascular coagulation. Vitamin D treatment in vitro has also been demonstrated to modulate levels of the systemic inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-?) and interleukin 6 (IL-6), as well as inhibit the lipopolysaccharide (LPS)-induced activation and vasodilation of vascular endothelium. Vitamin D may enhance the induction of the antimicrobial peptides, cathelicidin and b-defensin, which have been described on mucosal and epithelial surfaces acting as the body's first line of defense against viral and bacterial pathogens. Vitamin D supplementation may divert attention from relatively simple, natural, and low-costmethods of preventing severe sepsis and septic shock. Further prospective, randomized and controlled clinical trials of adjunctive vitamin D therapy in patients who are vitamin D deficient are needed in the management of human sepsis syndrome. © 2014 Elsevier B.V., All rights reserved.; MEDLINE® is the source for the MeSH terms of this document.Öğe Melatonin protects kidney against apoptosis induced by acute unilateral ureteral obstruction in rats(Polish Urological Assoc, 2016) Yildirim, Mehmet Erol; Badem, Huseyin; Cakmak, Muzaffer; Yilmaz, Hakki; Kosem, Bahadir; Karatas, Omer Faruk; Bayrak, ReyhanIntroduction To investigate whether there was a protective effect of melatonin on apoptotic mechanisms after an acute unilateral obstruction of the kidney. Material and methods A total of 25 rats consisting of five groups were used in the study, designated as follows: Group 1: control, Group 2: sham, Group 3: unilateral ureteral obstruction treated with only saline, Group 4: unilateral ureteral obstruction treated with melatonin immediately, and Group 5: unilateral obstruction treated with melatonin one day after obstruction. Melatonin was administered as a 10 mg/kg dose intraperitoneally. The kidneys were evaluated according to the apoptotic index and Ki-67 scores. Results Comparison of all obstruction groups (Group 3, 4, and 5), revealed that the apoptotic index was significantly higher in Groups 1 and 2. Despite melatonin reduced apoptotic mechanisms in Groups 4 and 5, there was no significant difference between Groups 4 and 5 in terms of the reduction of apoptosis. However, the reduction of apoptosis in the melatonin treated group did not decrease to the level of Groups 1 and 2. Conclusions Despite melatonin administration, which significantly reduces the apoptotic index occurring after acute unilateral ureteral obstruction, the present study did not observe a return to normal renal histology in the obstruction groups.Öğe Neutrophil-Lymphocyte Ratio (NLR) Could Be Better Predictor than C-reactive Protein (CRP) for Liver Fibrosis in Non-alcoholic Steatohepatitis(NASH)(Assoc Clinical Scientists, 2015) Yilmaz, Hakki; Yalcin, Kadir Serkan; Namuslu, Mehmet; Celik, Huseyin Tugrul; Sozen, Meral; Inan, Osman; Nadir, IsilayBackground-Aim. Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease worldwide. The aims of this study were to assess Neutrophil-Lymphocyte Ratio (NLR) and C-reactive protein (CRP), and their association with liver histology in patients with non-alcoholic steatohepatitis (NASH), chronic hepatitis B (HBV), and hepatitis C (HCV). Material-Methods. We studied 38 consecutive patients with biopsy-proven NASH, 19 patients with HCV, 45 patients with HBV, and 35 healthy controls who were similar for age and gender. The stage of fibrosis was measured using a 6-point scale. Results. NLR was significantly higher in NASH patients compared to controls, HBV, and HCV patients (p<0.001, p<0.001, and p<0.001, respectively). NLR was positively associated with NAFLD activity scores (r=0.861, p<0.001). NLR was associated with hepatocyte ballooning degeneration (r=0.426, p=0.024), lobular inflammation(r=0.694, p<0.001), steatosis(r=0.498, p=0.007), and fibrosis stage(r=0.892, p<0.001) in NASH patients. Univariate and multivariate analyses showed that NLR was significantly associated with liver fibrosis and NAS (beta=0.631, p<0.001 for liver fibrosis; beta=0.753, p<0.001 for NAS in the multivariate model); however, CRP had no association with liver fibrosis and NAS. Conclusion. NLR is a promising and inexpensive inflammation marker that correlates with histological grade and fibrosis stage in NASH patients.Öğe Neutrophil-lymphocyte ratio may be superior to C-reactive protein for predicting the occurrence of postmenopausal osteoporosis(Institute of Experimental Endocrinology ueenregu@kramare.savba.sk, 2014) Yilmaz, Hakki; Uyfun, M.; Yılmaz, Tuğba S.; Namuslu, Mehmet; Inan, Osman; Taskin, A.; Çakmak, MuzafferObjective: Recent studies revealed that inflammation plays a critical role in bone remodeling and the pathogenesis of postmenopausal osteoporosis, a major health concern. Neutrophil-lymphocyte ratio (NLR) is a cost-effective marker of inflammation that has been linked with several diseases. This study aimed to compare NLR and C-reactive protein (CRP) levels in osteopenic, osteoporotic, and control subjects and to assess the correlation between NLR levels, CRP, and bone mineral density (BMD) in postmenopausal women. Methods: In this cross-sectional study, the relationship between NLR, CRP, and BMD in 438 women was investigated using uni- and multivariate analyses. BMD (g/cm²) was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), CRP, glucose/lipid metabolism, and established risk factors were determined. Results: In the osteoporotic group, NLR and CRP levels were found to be elevated as compared to the osteopenic and control groups (NLR: 4.68 ± 0.72, 3.17 ± 0.43, 2.01 ± 0.54; CRP: 12.3 ± 4.1, 4.1 ± 2.7, 3.2 ± 2.1, respectively). A negative correlation was present between NLR and the lumbar spine (L2-L4) and femoral neck BMD after adjusting other risk factors. There was no correlation between CRP levels and BMD after adjusting other risk factors. NLR was significantly associated with L2-L4 BMD (ß = -0.653, p<0.001) and femoral neck BMD (ß = -0.178, p<0.001), but CRP level had no association with BMD in a multivariate model. Conclusions: Our data indicate that NLR may be a better predictor than CRP for occurrence of osteoporosis in postmenopausal women. © 2015 Elsevier B.V., All rights reserved.Öğe Relationship between late arteriovenous fistula (AVF) stenosis and neutrophil-lymphocyte ratio (NLR) in chronic hemodialysis patients(Taylor & Francis Ltd, 2014) Yilmaz, Hakki; Bozkurt, Alper; Cakmak, Muzaffer; Celik, Huseyin Tugrul; Bilgic, Mukadder Ayse; Bavbek, Nuket; Akcay, AliObjectives: Primary cause of late arteriovenous fistula (AVF) dysfunction is venous stenosis as result of neointimal hyperplasia. The mechanism of AVF stenosis is not exactly understood. But inflammation is a contributing factor for development of AVF stenosis. Neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, and it was investigated in many diseases. The aim of this study was to investigate the relationship between NLR and AVF stenosis in chronic hemodialysis patients. Materials and methods: Of 593 patients applied to the department of interventional radiology between January 2011 and November 2012, a total of 108 patients meeting the appropriate criteria were included in this study. All patients were assessed with Color Doppler ultrasonography and then digital subtraction angiography was used for the patients with abnormal results. Sixty-four patients were classified as patients with AVF stenosis (group 1) and 44 patients without AVF stenosis (group 2). Routine biochemical and complete blood count values measured six months ago were recorded for all patients. Results: Mean NLR (3.47 +/- 0.46 vs. 2.27 +/- 0.22; p < 0.001) was higher in group 1 compared to group 2, whereas high-density lipoprotein (HDL; 31.8 +/- 12.6 mg/dL vs. 51.5 +/- 11.9 mg/dL; p < 0.001) was lower in group 1. NLR level was correlated with degree of AVF stenosis (r = 0.625; p < 0.01). Receiver operating characteristic curve analysis showed that NLR (optimal-cut-off = 2.70) was a useful parameter in prediction of AVF stenosis (AUC = 0.893, sensitivity = 98.4% and specificity = 75%; p < 0.001). NLR level and HDL530 mg/dL in logistic regression analysis are independent predictors of AVF stenosis. Conclusions: For hemodialysis patients with increased level of NLR and decreased level of HDL, regular monitoring with regard to the development of AVF stenosis may be beneficial. Our study suggests that the mechanism of AVF stenosis might have similarities to that of atherosclerosis.Öğe Relationship of late arteriovenous fistula stenosis with soluble E-selectin and soluble EPCR in chronic hemodialysis patients with arteriovenous fistula(Springer, 2015) Bilgic, Mukadder Ayse; Yilmaz, Hakki; Bozkurt, Alper; Celik, Huseyin Tugrul; Bilgic, Ismail Celal; Gurel, Ozgul Malcok; Kirbas, IsmailVascular access dysfunction caused by stenosis is a major complication for hemodialysis (HD) patients. However, physiopathology of late arteriovenous fistula (AVF) stenosis is still under investigation. The aim of the present study was to evaluate the association between plasma soluble EPCR (sEPCR) with serum soluble E-selectin (sE-selectin) concentration and late AVF stenosis in HD patients. Plasma sEPCR and serum sE-selectin concentrations were measured in 94 HD patients. Using these data, we studied the association of sEPCR and sE-selectin with the presence and degree of AVF stenosis using ultrasonography and fistulogram. Fifty-one patients have AVF stenosis, and the others (n = 43) have patent AVF. The degree of AVF stenosis was correlated with serum sE-selectin levels (r = 0.351, p = 0.01), but not sEPCR (r = 0.075, p = 0.702). The median level of sE-selectin was statistically higher in the group of AVF stenosis than in the group of patent AVF [463.2 pg/ml (275.4-671.4) vs. 162.5 pg/ml (96.7-285.3), p = 0.001]. Increased sE-selectin levels [OR (OR) = 6.356, p = 0.015] and high levels of LDL (OR = 4.321, p = 0.044) were independent predictors of late AVF stenosis in the multivariate model. sE-selectin and the LDL were the most important predictors of late AVF stenosis. In addition, sE-selectin correlated with the degree of AVF stenosis. We suggested that atherosclerosis might be contributing factor for development of late AVF stenosis.Öğe Role of interlekin-35 as a biomarker in patients with newly diagnosed hashimoto’s thyroiditis(Institute of Experimental Endocrinology macvetrev@fvm.ukim.edu.mk, 2016) Yilmaz, Hakki; Çakmak, Muzaffer; Ceydilek, Bilge; Demir, Canan; Aktas, AynurObjective. Interleukin-35 (IL-35), an interleukin-12 (IL-12) cytokine family member, is shown to be a potent immunosuppressive and anti-inflammatory cytokine. Inducible regulatory T cells (Tregs) produce IL-35 that mediates the immune inhibitory function of Tregs. Growing evidence revealed that upregulation of IL-35 expression may play a critical role in the prevention of autoimmune diseases in various experimental autoimmunity models and vice versa. Hashimoto’s thyroiditis (HT) is considered to be a Treg cell-related autoimmune disease with loss of self-tolerance. Methods. One hundred-twenty eight subjects, newly diagnosed hypothyroid HT patients [56 overt (Group 1), 72 subclinical hypothyroid (Group 2)] and 38 healthy controls (Group 3) were enrolled in the study. The levels of serum IL-35 were determined by enzyme-linked immunosor-bent assay (ELISA). Results. Serum IL-35 levels were lower in the HT group when compared with subclinical HT group [304.5 (834.6) pg/ml vs. 636.1 (1542.0) pg/ml, p=0.004] and control cases [304.5 (834.6) pg/ml vs. 1064.7 (2526.8) pg/ml, p<0.001]. Serum IL-35 levels were inversely associated with thyroid stimulating hormone (TSH; rs=–0.396, p<0.001) and anti-thyroid peroxidase antibodies (TPOAb; rs=–0.571, p<0.001) in whole group. Serum IL-35 were negatively associated with TSH (rs=–0.264, p=0.003) and TPOAb (rs=–0.735, p<0.001) in patients with Hashimoto’s thyroiditis (Group 1 + Group 2). Conclusion. The results suggest that IL-35 may play a role in the pathogenesis of HT. © 2020 Elsevier B.V., All rights reserved.Öğe Serum galectin-3 levels were associated with proteinuria in patients with Familial Mediterranean Fever(Springer, 2015) Yilmaz, Hakki; Inan, Osman; Darcin, Tahir; Bilgic, Mukadder Ayse; Akcay, AliThe most common and pernicious complication of Familial Mediterranean fever (FMF) is renal amyloidosis, usually affecting the kidneys, leading to end-stage renal failure. FMF-related renal amyloidosis needed to be diagnosed early. Optimal colchicine dose is effective in preventing and reversing renal amyloidosis. Galectin-3, profibrotic mediator, has regulatory functions in inflammation, fibrosis and tumorigenesis. Galectin-3 is a strong prognostic marker for heart failure. Galectin-3 plays role in diabetic nephropathy and chronic kidney disease. The aim of the study is to investigate whether galectin-3 is related to proteinuria and amyloidosis in FMF. Seventy-five FMF patients who have no exclusion criteria and healthy controls (n = 36) were included. Serum galectin-3 was measured and morning spot urine was collected for determination of the protein/creatinine ratio (PCR). Serum Galectin-3 levels were significantly higher in FMF patients than the control group [969.66 (3825) pg/mL vs. 238 (921) pg/mL, respectively; P < 0.001]. We classified into two groups: Group1 (n = 48) had FMF patients with proteniuria, Group2 (n = 27) had FMF patients without proteinuria. Group1 had higher levels of galectin-3 than Group2 [1106(3812) pg/mL vs. 867.3(1433) pg/mL, P < 0.001]. Galectin-3 levels were correlated with PCR in whole group and FMF group (r = 0.785, P < 0.001 and r = 0.803, P < 0.001). In ROC curve, best cutoff value = 581.50 pg/mL was used to detect proteinuria (sensitivity = 91.7 %, specificity = 71.4 %, AUC = 0.879) and optimal cutoff value = 1458.00 pg/mL was an indicator of nephrotic-range proteinuric (sensitivity = 100 %, specificity = 92.1 %, AUC = 0.983). Galectin-3 is associated with proteinuria and renal amyloidosis in FMF. Galectin-3 may play role in pathogenesis of amyloidosis.Öğe Serum levels of endocan correlate with the presence and severity of pre-eclampsia(Taylor & Francis Inc, 2016) Cakmak, Muzaffer; Yilmaz, Hakki; Baglar, Esra; Darcin, Tahir; Inan, Osman; Aktas, Aynur; Celik, Huseyin TugrulBackground: Endocan, a cysteine-rich dermatan sulfate proteoglycan expressed by endothelial cells, is seemed to be a new biomarker for endothelial dysfunction. Pre-eclampsia (PE) is characterized by the new onset of hypertension, proteinuria after 20 weeks of gestation, placental vascular remodeling, systemic vascular inflammation and endothelial dysfunction. The aim of this study was to investigate the relationship of PE and its severity with serum endocan levels. Methods: A cross-sectional study was performed. Serum was collected from women with PE and normotensive controls. Serum endocan and tumor necrosis factor alpha (TNF-alpha) concentrations were measured by a specific enzyme linked immunosorbent assay. Results: Patients with PE had significantly higher median (interquartile range) endocan and mean TNF-alpha concentrations than controls [20.04 (12.26) ng/mL vs 15.55 (6.19) ng/mL, p < 0.001 for endocan; 26.49 +/- 12.14 pg/mL vs 14.62 +/- 5.61 pg/mL, p < 0.001 for TNF-alpha; respectively]. Serum endocan concentrations were positively correlated with systolic blood pressure (r = 0.618, p < 0.001), diastolic blood pressure (r = 0.608, p < 0.001), the amount of 24-h proteinuria (r = 0.786, p < 0.001) and TNF-alpha (r = 0.474, p < 0.001) in women with PE. In subgroup analysis, patients with severe PE had significantly higher endocan concentrations than those with mild PE. Receiver operating characteristic analysis of endocan was used to identify the patients with PE and also discriminating between mild and severe PE. Conclusion: Serum endocan concentrations were significantly elevated in women with PE versus normotensive controls, and concentrations seem to be associated with the severity of the disease.Öğe Subclinical hypothyroidism in combination with vitamin D deficiency increases the risk of impaired left ventricular diastolic function(Institute of Experimental Endocrinology peter.golla@degruyter.com, 2015) Yilmaz, Hakki; Çakmak, Muzaffer; Darçın, Tahir; Inan, Osman; Gürel, Özgül Malçok; Bilgiç, Mukadder Ayşe; Bavbek, NüketObjective. Subclinical hypothyroidism and vitamin D deficiency are common. The diastolic function of patients with both subclinical hypothyroidism and vitamin D deficiency remains unknown. This study aimed to investigate diastolic dysfunction in patients with both subclinical hypothyroidism and vitamin D deficiency. Subjects and Methods. This study included 254 patients. All patients underwent standard Doppler echocardiography. Patients who had risk factors for diastolic dysfunction or had used L-thyroxine and vitamin D within the previous 3 months were excluded. Vitamin D deficiency was defined as a 25-OH-vitamin D level lower than 20 ng/ml, and vitamin D sufficiency was defined as a 25-OHvitamin D level ?30 ng/ml. Subclinical hypothyroidism was defined as a TSH level of 4.5-10 mU/l when the free T4 concentration was normal. Results. The patients were divided into 4 groups. Group 1 (n=71) included patients with subclinical hypothyroidism and vitamin D deficiency; Group 2 (n=66) included patients with subclinical hypothyroidism and vitamin D sufficiency; Group 3 (n=65) included euthyroid patients with vitamin D deficiency; and Group 4 (n=52) included euthyroid patients with vitamin D sufficiency. LAVI (31.3±3.2, 28.7±3.0, 28.4±3.4, and 27.9±3.9; p<0.001) and E/E’ values (11.2±2.7, 8.9±2.7, 9.1±2.9, 8.8±2.5; p<0.001) were significantly higher in Group 1 than in Groups 2, 3 and 4. E’ values were significantly lower in Group 1 than in Groups 2, 3 and 4. Conclusion. The coexistence of subclinical hypothyroidism with vitamin D deficiency can lead to further deterioration in the LV diastolic function via the regulation of intracellular calcium and induction of inflammatory activity. Therefore, close follow-up of the diastolic functions of these patients could be beneficial. © 2018 Elsevier B.V., All rights reserved.
