Background/Objectives: Behçet’s disease (BD) is a chronic multisystem inflammatory disorder in which vascular involvement represents a major cause of morbidity and mortality. However, the molecular mechanisms underlying vascular involvement remain poorly understood. Lipidomics offers a powerful approach to investigate disease-associated metabolic alterations at the lipid level. Methods: Plasma lipidomic profiles were analyzed in 48 patients with BD, including 18 with vascular involvement, and 40 age- and sex-matched healthy controls. Lipids were extracted using a chloroform–methanol-based protocol and analyzed by LC-qTOF-MS. Data processing and lipid annotation were performed using MS-DIAL. Multivariate and univariate statistical analyses, together with class-based KEGG pathway mapping, were applied to evaluate lipidomic alterations. Results: Principal component analysis demonstrated a clear separation between BD patients and healthy controls, indicating extensive lipidomic remodeling. BD was associated with significant alterations in phosphatidylcholines, sphingomyelins, diacylglycerols, and triacylglycerols, reflecting coordinated changes in membrane structure, lipid-mediated signaling, and energy metabolism. Pathway analysis further supported the involvement of glycerophospholipid, glycerolipid, and phosphatidylinositol-related metabolic pathways. Comparison between BD patients with and without vascular involvement revealed no major global lipidomic shift; however, specific lipid species showed consistent alterations. Two phosphatidylcholine species (PC 33:2 and ether-linked PC 31:4e) were decreased, whereas one triacylglycerol species (TAG 58:2) was increased in patients with vascular involvement. Conclusions: These findings suggest that BD is characterized by coordinated lipidomic reprogramming involving membrane remodeling, inflammatory signaling, and metabolic adaptation. Vascular involvement appears to be associated with subtle, lipid-specific alterations rather than a global lipidomic shift, highlighting potential molecular features of disease progression.

PURPOSE:Obstructive sleep apnea is associated with intermittent hypoxia and oxidative stress. Whether oxidative and antioxidant biomarkers differ between rapid eye movement-related and non-rapid eye movement-related phenotypes remains unclear. We compared circulating melatonin and oxidative stress markers across sleep-stage phenotypes and disease severity categories. METHODS:In this prospective case-control study, 165 participants (34 controls, 31 rapid eye movement-related obstructive sleep apnea, 100 non-rapid eye movement-related obstructive sleep apnea) underwent overnight polysomnography. Serum melatonin, 8-hydroxy-2'-deoxyguanosine, total oxidant status, and total antioxidant status were measured using enzyme-linked immunosorbent assay and colorimetric methods. The oxidative stress index was calculated as the ratio of total oxidant status to total antioxidant status multiplied by 100. Group comparisons were performed using nonparametric tests with appropriate post-hoc analyses. Additional analyses adjusted for age, body mass index, and sex using rank-transformed analysis of covariance. Correlations were evaluated using Spearman analysis with correction for multiple testing and formally compared between groups. RESULTS:In unadjusted analyses, melatonin and 8-hydroxy-2'-deoxyguanosine levels were lower in obstructive sleep apnea, particularly in non-rapid eye movement-related and moderate disease. However, these differences were no longer statistically significant after adjustment for body mass index and sex. Total oxidant status, total antioxidant status, and oxidative stress index did not differ significantly between groups. Descriptive differences in correlation patterns were observed, but formal comparison showed no statistically significant between-phenotype differences. CONCLUSION:Circulating redox biomarkers in obstructive sleep apnea show modest differences that appear largely influenced by body mass index and sex. These findings should be considered exploratory and hypothesis-generating rather than evidence of phenotype-specific biological mechanisms.

OBJECTIVE:Short-chain fatty acids (SCFAs) are produced when the microbiota in the large intestine cause fermentation of dietary carbohydrates and fibers. These fatty acids constitute the primary energy source of colon mucosa cells and have a protective effect in patients suffering from inflammatory bowel disease (IBD). This study aimed to compare the SCFA levels in the stools of patients with IBD and healthy controls. METHOD:Healthy controls and patients with IBD aged 18 and over were included in the study. Stool samples from all patients and healthy controls were collected, and stool acetic acid, propionic acid, and butyric acid levels were measured using a gas chromatography-mass spectrometry measurement method. RESULTS:In this study, 64 participants were divided into two groups: 34 were in IBD (Crohn disease and ulcerative colitis) and 30 were in healthy control group. When fecal SCFA concentrations of IBD and healthy control groups were compared, a statistically significant difference was observed between them. When the fecal SCFA concentrations of Crohn's disease and ulcerative colitis patients in the IBD group were compared, however, no statistically significant difference was observed between them. Furthermore, when the participants' diet type (carbohydrate-based, vegetable-protein-based and mixed diet) and the number of meals were compared with fecal SCFA concentrations, no statistically significant difference was observed between them. CONCLUSION:In general, fecal SCFA levels in patients with IBD were lower than those in healthy controls. Moreover, diet type and the number of meals had no effect on stool SCFA levels in patients with IBD and healthy individuals.

Objectives Investigation of inherited metabolic disorders in autism spectrum disorder (ASD) is a matter of debate. X-linked creatine transporter deficiency is among the metabolic disorders which may present predominantly with features of ASD and intellectual disability. Here, we aimed to screen for creatine transporter deficiency in boys with ASD at a university hospital in Turkey.Methods Random urine samples were collected from males with ASD (age 3-18 years); urine creatinine, creatine and guanidinoacetate levels were determined by liquid chromatography - tandem mass spectrometry. Demographic and clinical data were obtained via history and physical examination. The primary outcome was the diagnosis of creatine transporter deficiency (elevated urinary creatine:creatinine ratio). The diagnosis of guanidinoacetate methyltransferase deficiency and the parameters associated with the creatine metabolites were secondary outcomes.Results Forty seven boys were enrolled, 21.3 and 19.1 % of whom had gross motor delay or paroxysmal abnormalities. 55.3 and 51.1 % patients had low urine creatine and guanidinoacetate levels, respectively, and no cases of creatine transporter deficiency or guanidinoacetate methyltransferase deficiency were identified. Age at ASD diagnosis, age at speech onset, otic or ocular dysmorphic features and psychotropic medications were weakly associated with creatine metabolites.Conclusions We found no evidence to support routine screening of boys with ASD for creatine transporter deficiency, but the small number of participants is a limitation. Associates of urinary creatine metabolites were not considered to be clinically significant. High proportion of patients with low creatine and guanidinoacetate levels may be due to nutritional issues, and requires further study.

Objective:Epilepsy is one of the most common neurological diseases in the pediatric population. Orexins are excitatory peptides and associated with energy homeostasis, eating and drinking behaviors, sleep regulation, sleep-wake periods, analgesia, and cognitive activities such as attention, learning, and memory. The aim of this study was to reveal the relationship between plasma orexin levels and seizures in pediatric epilepsy patients with seizures, epilepsy patients in remission, and healthy control group with similar demographic characteristics. Material and methods:The study was conducted between December 2021 and December 2022 in the Department of Pediatric Neurology of a tertiary hospital. 30 epilepsy patients who had a seizure in the last 24 h, 30 epilepsy patients in remission, and 17 healthy controls were included in the study. The Human Orexin-A Enzyme-Linked Immunosorbent Assay Kit was used to measure serum orexin-A level. In the ERG and CG, blood samples were obtained during routine controls. Results:No statistically significant difference was found between serum orexin levels of acute seizure group (ASG), epilepsy in remission group (ERG), and control group (CG). In the ASG, no significant difference was found when orexin levels were compared according to the time of blood sampling after seizure (0-8 h, 8-16 h, 16-24 h). In patients with seizures, the orexin levels of patients with focal seizures were compared with those of patients with generalized seizures. There was no statistically significant difference between the groups. Patients with seizures were evaluated according to electroencephalography (EEG) and cranial magnetic resonance imaging (MRI) findings, and no statistically significant difference was found between orexin levels between the groups. Conclusion:Our study is the first to evaluate orexin levels in children with epilepsy. Further research is needed to evaluate the role of orexins in the pathophysiology of epilepsy. With the clear relationship between orexin and epilepsy, antiorexinergic drugs can be used in the treatment of epilepsy.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting brain functions in which qualitative and quantitative problems in communication and behavior are accompanied by restricted interest and repetitive behaviors. There is no laboratory method, or a special test used to diagnose ASD. Here we aimed to report the analysis of the urinary metabolic signatures of ASD patients and healthy subjects to compare the significant changes in the main components of metabolic pathways.Method: A total of 85 male subjects, 42 patients and 43 controls, aged 3-18 years, were included in the study. Urine organic acid levels were analyzed by both GC-MS and LC-MS/MS and the results were recorded. The results obtained were statistically evaluated between the patient and control groups. Results: Certain metabolites involved in branched-chain amino acid metabolism, aromatic amino acid metabolism, tricarboxylic acid cycle, and glycolysis metabolites were found to be significantly reduced in the patient group compared to controls.Conclusions: Our study is the first in the literature in terms of evaluating both GC-MS and LC-MS/ MS together and revealing the general map of metabolism. In addition to revealing some new metabolites in ASD patients, it is also important in terms of summarizing which main pathways these metabolites play a role in. Today, with the widespread use of devices that measure with high sensitivity and provide the opportunity to evaluate many analytes at the same time, it will be possible to reveal the pathology of diseases more accurately such as ASD whose etiopathogenesis has not been fully revealed.

BACKGROUND:Behçet's disease is a systemic, inflammatory disease affecting multiple organs. Vascular involvement is the main cause of morbidity and mortality in Behçet's disease patients. Though clinically well-defined, there is limited information related to disease pathogenesis and vascular incidence in this patient group. The aim of this study is to investigate the unique metabolic signatures of Behçet's disease patients with vascular involvement. METHODS:Metabolomic profiling was performed on serum samples of 48 Behçet's disease patients (18 with vascular involvement) and 40 healthy controls using gas chromatography-mass spectrometrybased untargeted metabolomics analysis. Multivariate and univariate statistical analyses were performed to find altered metabolites and pathways. RESULTS:Untargeted metabolomics results showed that a total of 168 metabolites were identified. The comparison between the groups of Behçet's disease, vascular involvement in Behçet's disease, and the healthy control group showed that altered amino acid and oxidative stress pathways, especially with glutathione synthesis, could be an important stage for developing Behçet's disease. CONCLUSION:In the present work, the untargeted metabolomics approach provided new molecular insights for a better understanding of Behçet's disease pathogenesis and also developing vascular involvement in Behçet's disease at the metabolite level. The results showed that vascular involvement in Behçet's disease could be highly linked with amino acid metabolism and also the antioxidant system, and these disease-related pathways could be evaluated with further experiments for diagnosis and prognosis of Behçet's disease and also for vascular involvement in Behçet's disease.

Objective: COVID-19 is a disease caused by SARS-COV-2 and early diagnosis and classification of the COVID-19 are critical for the better prognosis. This study aimed to combine laboratory data of COVID-19 patients with Computed Tomography Segmentation-Volume Analysis (CT-SVA). Thus, we hope to contribute to the early diagnosis and classification of the disease. Methods: Patients were divided into two groups according to disease severity as mild/moderate (n=41) and severe/critical (n=42). Some laboratory parameters were recorded and evaluated together with CT-SVA. Results: The results of the study have shown that sodium, C-reactive protein, D-dimer, ferritin, fibrinogen, interleukin 6, procalcitonin, white blood cells, neutrophil, neutrophil-lymphocyte ratio values were significantly higher at first admission in the severe/critical diseased group (p<0.05), while albumin, lymphocyte, and venous blood pH values were significantly lower (p<0.05). CT-SVA results have shown negative correlation with albumin, while having a positive correlation with C-reactive protein, D-dimer, ferritin, fibrinogen, interleukin 6 and procalcitonin. The results of the performed Receiver Operating Characteristics analysis revealed that CT-SVA has a cut-off value of 15.92 with a sensitivity of 87.1% and a specificity of 80.0% in predicting disease severity. Binary logistic regression model has included CT-SVA, D-dimer, ferritin, interleukin 6, and neutrophil-lymphocyte ratio. The model correctly classified 88.1% of cases. CT-SVA, D-dimer, ferritin, interleukin 6, and neutrophil-lymphocyte ratio were detected to be the independent predictors of disease severity. Conclusion: Evaluation of laboratory parameters together with CT-SVA results will help identification of cases with a poor prognosis and accelerate intervention.

BACKGROUND:Behçet's disease (BD) is a chronic inflammatory vasculitis affecting multiple organs. Uveitis is frequently seen in patients with BD, especially in Turkish population.OBJECTIVES:To investigate vascular endothelial growth factor (VEGF) gene polymorphisms along with the levels of VEGF and VEGF receptors in patients with Behçet's uveitis (BU).MATERIAL AND METHODS:Fifty-five BD-associated uveitis patients and 30 ageand sex-matched controls were included in this case-control study. The genotypes of the single nucleotide poymorphisms (SNPs): rs2010963 (+405G), rs3025039 (+936T) and rs699947 (-2598A) of the VEGF-A gene were determined using real-time polymerase chain reaction (RT-PCR) and serum levels of VEGF and VEGF receptors were measured using enzyme-linked immunosorbent assay (ELISA).RESULTS:No associations of the VEGF gene polymorphisms were observed in BD uveitis patients, but arthritis was present in 53.3% of patients not possessing CT genotype in C3025039→T polymorphism (p = 0.024). Although there were no statistically significant differences in serum VEGF-A, VEGF-C and soluble vascular endothelial growth factor receptor-3 (sVEGFR-3) levels (p < 0.05), serum vascular endothelial growth factor receptor-1 (VEGFR-1) and sVEGFR-3 levels were significantly higher in the BD group (p < 0.001 and p = 0.001, respectively). In addition, VEGF-C/soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) ratio was significantly higher (p < 0.001), while VEGF-A/VEGFR-1 and VEGF-C/sVEGFR-3 ratios were significantly lower (p < 0.001 and p = 0.033, respectively) in BD patients compared to controls. Also, VEGF-C/sVEGFR-3 (p = 0.024, r = 0.37) and VEGF-C/sVEGFR-2 (p = 0.020, r = 0.38) ratios were positively correlated with disease duration.CONCLUSIONS:The significant changes in sVEGFR-3 levels and VEGF-C/sVEGFR-3 ratio has shown that lymphangiogenesis processes might take place in the pathogenesis of BD uveitis, and these parameters can be important indicators of evaluation of BD patients with uveitis together with disease duration.

Background/aim: Increased bone turnover is a hallmark of hyperthyroidism. The underlying factors of how thyroid hormones affect bone cells are still under the spotlight. Previous studies indicated serum osteoprotegerin (OPG), receptor activator of NF-kB ligand (RANKL), and interleukin-6 (IL-6) as mediators of the effect of thyroid hormones on bone metabolism. Ultimately, the present research aimed to examine the association of IL-6 with OPG and RANKL in patients with hyperthyroidism. Materials and methods: We carried out this study with 39 newly diagnosed and untreated Graves' patients and 43 healthy controls. In addition to routine tests, we measured serum OPG, RANKL, and IL-6 levels. Results: Mean age and sex distribution were similar in both groups. The hyperthyroid group had significantly higher OPG (p = 0.002) and IL-6 (p < 0.001) levels, but RANKL levels were significantly lower in this group (p < 0.001). We found OPG not to correlate with free T4 and T3, while it had a moderate and negative correlation with thyrotropin (TSH) (r = -0.372, p = 0.001). IL-6 had no correlation with OPG but positively correlated with free T4 (r = 0.445, p < 0.001) and free T3 (r = 0.326, p = 0.035). It also negatively correlated with RANKL (r = -0.247, p = 0.033). Conclusion: Maintaining skeletal development and integrity is partially regulated by a normal balance of thyroid hormones. We concluded that increases in serum OPG and IL-6 levels accompanied hyperthyroidism. However, excessive levels of the hormones might cause drops in serum RANKL levels. Our results suggested that OPG, RANKL, and IL-6 might be involved in the cross-talking among immunity, thyroid function, and bone metabolism in the case of hyperthyroidism.

Objective: The cytokine storm presented in the hyperimmune response is related to poor prognosis in people with COVID-19. Interleukin-6 (IL-6) is one of the most prominent cytokines, especially on mucosal surfaces during infection, causing the cytokine storm. Polyunsaturated fatty acids (PUFAs) are the precursors of eicosanoids, which play critical roles in immune regulation and inflammation. The balance between omega-3 and omega-6 levels in the cell membrane has a critical role in regulating the equilibrium between proinflammatory and antiinflammatory processes and inducing IL-6 production. The present study focused on inflammatory and antiinflammatory mechanisms in COVID-19 over PUFAs and on relating their levelswith disease prognosis and severity. Methods: A total of 106 participants were included in the study. They were divided into three groups according to IL-6 level- 1: <35 pg/mL, 2: between 35 and 300 pg/mL, and 3: >300 pg/mL. Erythrocyte membrane PUFA compositions were analyzed by group. Results: Levels of gamma-linolenic acid and omega-6/omega-3 ratios were significantly increased in all comparison groups (P < 0.05). Total omega-6 and the ratio of arachidonic acid to eicosopentaenoic acid showed a statistically significant difference only between groups 1 and 3 (P < 0.05). There was a moderately negative correlation between total omega-3 and IL-6 and procalcitonin. There were positive correlations with omega-6/omega-3 ratio inflammatory markers, and the total omega-6 index also showed a moderately positive correlation with IL-6, procalcitonin, and D-dimer levels. Conclusions: The ratio of arachidonic acid to eicosopentaenoic acid, and omega-3 PUFAs, can be systemic signs of poor prognosis, increased lung damage, and high mortality in COVID-19, together with IL-6. (c) 2021 Published by Elsevier Inc.

Objectives: The present study aims to evaluate the relationship between Behcet's uveitis and lymphangiogenesis by determining levels of Vascular endothelial growth factor-C (VEGF-C, its receptors sVEGFR-2, sVEGFR-3 and lymphangiogenesis markers podoplanin (PDPN) and lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1), and C-type lectin domain family 1 member B (CLEC2). Materials and methods: 55 patients with BD uveitis and 31 healthy control subjects were enrolled in the study. Results: sVEGFR-2, sVEGFR-3, VEGF-C/sVEGFR-2 ratio, PDPN and LYVE-1 levels were higher in the patient group. A positive correlation was found between LYVE-1 and hsCRP levels. PDPN had a strong predictive value for progression with a cut-off value of 2 pg/mL, with 69% sensitivity and 68% specificity (p = 0.001). Conclusion: LYVE-1 and PDPN can be good representatives of the ongoing inflammatory processes in BD uveitis and point out that the disease can be related to lymphangiogenesis.

Abstract The authors have requested that this preprint be removed from Research Square.

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients. Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively. Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29–9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29–27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31–12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively). Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease.

Objective: The dependence between gingival crevicular fluid (GCF) of Interleukin-34 (IL-34) level and Receptor activator of nuclear factor -kB ligand/ osteoprotegerin (RANKL/OPG) ratio in the severity of periodontitis might reveal an unknown pathway of diseases with bone destruction. There is no study about the evaluation of IL-34 levels together with GCF RANKL and OPG levels in periodontitis patients before and after non-surgical periodontal treatment (NSPT). The objectives of this research were to investigate changes in the levels and relative ratios of IL-34, OPG, and RANKL in the GCF of patients with periodontitis before and after NSPT. Materials and Methods: 20 healthy participants (CTRL), 20 patients with stage 3-grade B periodontitis and 20 with stage 3-grade C periodontitis were recruited. GCF and clinical periodontal recordings were investigated at the baseline and 6 weeks after NSPT. Enzyme-linked immunosorbent assay (ELISA) were used for quantifying of GCF IL-34, RANKL and OPG levels and their relative ratios were calculated. Results: Greater values for GCF IL-34 and RANKL levels were found in the both of periodontitis groups than in CTRL group at baseline, whereas GCF OPG levels were statistically lower at baseline (P < 0.05). GCF IL-34 and RANKL levels decreased in the 6th week after NSPT in the both periodontitis groups, while the concentration OPG levels statistically increased (P < 0.05). Significantly positive correlations among the IL-34 with RANKL, sampled-site clinical attachment level (CAL), and gingival index (GI), whereas negative correlation with OPG were reported (P < 0.05). Conclusions: GCF IL-34 levels was high in patients with periodontitis and decreased after NSPT and its levels showed positive correlations with RANKL/OPG ratio levels CAL and GI. Determining of IL-34 levels together with RANKL/OPG ratio in GCF may therefore be valuable in detecting high risk individuals with periodontitis patients.

Immunoglobulin A vasculitis (IgAV) is classified as a leukocytoclastic vasculitis characterized by immune deposits in endothelial walls of small vessels causing vascular endothelial injury. The aim of the present study is to evaluate levels of vascular endothelial growth factor‐A (VEGF‐A) and VEGF receptor‐1 (VEGFR‐1) levels in adult IgAV patients.

Objective: Fat-soluble vitamins (A, D, E and K) are isoprene derived apolar molecules. While deficiencies of these vitamins have been associated with various diseases such as type 2 diabetes and cancer, high doses of Vitamin A and D can cause toxic effects. Accurate detection of serum levels of these vitamins have critical importance. In this study, it is aimed to develop and validate a sensitive and specific Liquid Chromatography Tandem Mass Spectrometry (LC-MS / MS) method that allows simultaneous analysis of fat-soluble vitamins. Materials and Methods: Serum samples were deproteinized with methanol and chromatographic separation of analyzes were performed by LC-MS/MS system (Agilent Technologies 6420 Triple Quadrapole LC-MS), Agilent Pursuit PFP column (100 mm x 3.0 mm; 3.0 mu m), in gradient mode using Mobile phase A (milli-Q + 0.1 % formic acid) and Mobile phase B (Methanol + 0.1 % formic acid). Ion scan was performed in MRM (multiple reaction monitoring) mode with positive ion selectivity in ESI ion source. Results: The retention times were 6.93 min, 6.94 min and 9.34 min while concentrations were linear in the ranges between 10 -150 ng/mL, 3 - 90 mu g/dL and 6 - 90 mu g/mL for 25-hydroxy vitamin D-3 (25 - OHD3), Vitamin A and Vitamin E, respectively. Inter-day Coefficient Variation (CV%) values for Vitamin A, Vitamin E and 25 - OHD3 were; 9.08 %, 9.85 % and 3.07 % and intra-day CV% values were; 2.98 %, 5.05 % and 5.01 %. LOD and LOQ results were 2.11 mu g/dL and 3.50 mu g/dL for Vitamin A; 1.71 mu g/mL and 2.45 mu g/mL for Vitamin E; 1.47 ng/mL and 2.50 ng/mL for 25 - OHD3, respectively. Conclusion: In this study, a LC-MS/MS method that can analyze fat soluble vitamins in 13 min was developed and validated. This method will be useful for clinical purposes by replacing low specificity immunoassay methods and High Performance Liquid Chromatography (HPLC) methods that can not allow simultaneous analysis.

Background:We aimed to improve the accuracy and reliability of our test results by calculating the measurement uncertainty (MU) and reference change value (RCV) for routine biochemical parameters. Materials and Methods:For the MU estimation, 23 different routine biochemistry parameters were included in the study.For the RCV calculation of the tests, Fraser and logarithmic transformation formulas were used.The MUs were compared to the total allowable error recommendations defined by the CLIA and Westgard.Results: When the estimated MU results of our laboratory were compared with the international limits, it was found that albumin, amylase, alanine transaminase, total bilirubin, direct bilirubin, blood urea nitrogen, calcium, creatinine kinase, chlorine, creatinine, glucose, potassium, lactate dehydrogenase, lipase, magnesium, sodium, total protein, phosphorus, C-reactive protein (CRP), aspartate transaminase, β-human chorionic gonadotropin, creatine kinase (CK)-MB (mass) and troponin-I test results were compatible with CLIA'88 limits, but the MU results of albumin, calcium, chlorine, magnesium, sodium and total protein were not compatible with Westgard limits.The RCV results, using Fraser approach, of CRP, CK, direct bilirubin, total bilirubin, lipase and troponin I-tests showed a wide range because of the high biological variations.The RCV's calculated limit value for CRP in the decreasing direction exceeded 100%, which makes it impossible to use.However, when RCV was recalculated with logarithmic conversion formula, more usable results were obtained. Conclusion:Each laboratory should calculate MU values to bring the reliability of test results close to international limits.Logarithmic transformation formulas should be used in the RCVs calculation of tests with high biological variation, such as CRP.In addition, MU and RCV should be given with the test results to improve diagnostic accuracy.

Aims: Medulloblastoma is very rare and accounts for only 1% of intracranial tumors in adults.There are limited treatment options for adult medulloblastoma patients who have relapsed or refractory disease.We aimed to show real-life data on health outcomes in adult patients with recurrent or refractory medulloblastoma patients who received autologous hematopoietic stem cell transplantation (AHSCT). Methods:We analyzed the data of 15 patients who underwent AHSCT after ifosfamide, carboplatin, and etoposide (ICE) as high-dose chemotherapy (HDCT) regimen for relapsed or refractory medulloblastoma from 2010 to 2020.Overall response rate (ORR), overall survival (OS) and progression-free survival (PFS) of the patients were evaluated.Results: Fifteen patients were observed in this study.The mean age of the study group was 27.9±8.1 years and 53.3% of the patients were female (n=8).ORR was 100%.The median OS and PFS were 24 months [95% confidence interval (CI): 11.4-36.5]and 13 months (95% CI: 10.2-15.8),respectively.One-year OS and PFS rates were 77% and 55.2%, respectively.Five-year OS rate was 82.5%. Conclusions:AHSCT with ICE as HDCT regimen is a safe and effective treatment option for relapsed or refractory adult medulloblastoma patients with an acceptable ORR, OS and PFS time.

Obstructive sleep apnea (OSA) is a disorder characterized by recurrent episodes of obstruction of the upper respiratory tract during sleep often accompanied by oxygen desaturations. Antioxidant defense mechanisms are important to prevent OSA-associated diseases and decrease mortality. We aimed to determine the levels of selenium and vitamins A, C, and E in patients with OSA but without any comorbidities and compare the results with a control group, theorizing that the findings may be helpful to understand the antioxidant mechanisms in the pathogenesis of OSA and associated diseases. We designed a case-control study with 146 subjects. Subjects were categorized into four groups by apnea-hypopnea index (AHI) scores: control (n = 32; AHI < 5), mild OSA (n = 32; 5 ≤ AHI < 15), moderate OSA (n = 34; 15 ≤ AHI < 30), and severe OSA (n = 48; AHI ≥ 30) groups. Serum levels of selenium were measured by atomic absorption spectrometer. Vitamin A, C, and E levels were measured by high-performance liquid chromatography and ultraviolet (HPLC-UV) detector. After adjusting for age, BMI, and gender, serum selenium and vitamin A levels were found to be higher in patients with OSA compared with controls (ANCOVA, p < 0.008, and p = 0.014 respectively), and levels of these markers increased with the severity of the disease. AHI was positively correlated with selenium (r = 0.289; p < 0.001), and vitamin A levels (r = 0.276; p < 0.001). These results demonstrated that antioxidant response with increased vitamin A, and selenium concentrations, may be important defense mechanisms in patients with OSA patients who do not have other comorbidities. Antioxidant nutrients or supplements may be implemented as a complementary treatment of OSA to support antioxidant defense.