To the Editor: We read with great interest the article entitled “Low levels of serum uric acid increase the risk of low bone mineral density in young male patients with ankylosing spondylitis1”. Thanks to Kang and colleagues for their valuable investigation in which they concluded that lower serum uric acid (SUA) levels were associated with lower bone mineral density in young male patients with ankylosing spondylitis and that … Address correspondence to Dr. T. Dogan, Department of Internal Medicine, Gulhane Military Medical Academy, Ankara, Turkey. E-mail: dr_tolgadogan94{at}yahoo.com

Mitochondrial respiratory chains consist of approximately 100 structural proteins. Thirteen of these structural proteins are encoded by mitochondrial DNA (mtDNA), and the others by nuclear DNA (nDNA). Mutation in any of the mitochondrial structural-protein related genes, regardless of whether they are in the nDNA or mtDNA, might cause mitochondrial disorders. In the recent past, new nuclear genes required for assembly, maintenance, and translation of respiratory chain proteins have been found. Mutation in these genes might also cause mitochondrial disorders (MD). NFU1 gene is one of such genes and has a role in the assembly of iron-sulfur cluster (ISC). ISCs are included in a variety of metalloproteins, such as the ferredoxins, as well as in enzymatic reactions and have been first identified in the oxidation-reduction reactions of mitochondrial electron transport. It is important to be aware of NFU1 gene mutations that may cause severe mitochondrial respiratory chain defects, mitochondrial encephalomyopathies and death, early in life.

Although psychiatric advance directives give service users control over their care, very few studies exist on the content of PADs. This paper aims to contribute to this evidence base by presenting the content of psychiatric advance directives in India.Participants were 75 clients seeking outpatient care at a mental health services organisation in Tamil Nadu, India, who agreed to draft a PAD.Most clients were comfortable with appointing a representative (usually a family member) to make decisions on their behalf during a period of decisional incapacity or relapse, were willing to accept admission to the hospital/clinic and take medication if required, wanted to have a trusted person to discuss their mental health problems. No client used the opportunity to outright refuse treatment.This study highlights an important first step in improving the quality of mental health care by documenting user preferences for care in India. More in-depth research is needed to elicit rich descriptions of experiences of care and user-centred understanding of rights.

To the Editor: We read with great interest the article by FowlerBrown et al on the mediating effect of leptin on the relationship between body weight and knee osteoarthritis (OA) in older adults (1). The authors reported that almost half of the association between elevated body mass index (BMI) and knee OA could be explained by the inflammatory adipokine leptin. We thank the authors for their valuable research; however, we have some comments. Leptin has key roles in the regulation of energy balance, metabolism, body weight, and endocrine function (2). Previous studies have revealed that some diseases, such as chronic liver diseases, major depression, cardiovascular disease, diabetes mellitus, hypertension, Helicobacter pylori infection, and several inflammatory diseases (such as rheumatoid arthritis and systemic lupus erythematosus) could affect serum leptin levels (3,4). The authors did not mention the above diseases, and this omission could have influenced the findings of the study. In addition to confounding diseases, it has been suggested that some types of antidepressants, antipsychotics, glucocorticoids, antihypertensive drugs, and statins affect serum leptin levels (5,6). Also, dietary supplements, such as linoleic acid, zinc, vitamin A, vitamin D, vitamin E, and -3 fatty acid, could affect plasma leptin levels (7,8). Bailey et al found that 49% of the US population reported supplement use (9). With this in mind, the authors should define whether the participants used these kinds of drugs and dietary supplements. It is known that serum leptin levels are higher in women than men (10). Fowler-Brown and colleagues indicated a statistically significant difference between groups, which were based on BMI, in terms of sex. This difference could affect leptin levels directly. Therefore, sex, as a confounding factor for measurement of leptin, should be taken into account while classifying the study groups in order to obtain a robust study group. In conclusion, although this study contributes valuable information, an explanation of these concerns will certainly provide a clearer picture when interpreting leptin levels among participants.

In a recent issue of Annals of Neurosciences, we read with great interest the article by Kasarpalkar and colleagues entitled "Brain-Derived Neurotrophic Factor in children with Autism Spectrum Disorder" in which the investigators reported that the protective effect of brain derived neurotrophic factor (BDNF) due to relatively higher levels in mild phenotypes of autism compared to severe autism and its possible diagnostic role in autism spectrum disorders. 1However, we think that some points should be discussed.

We have read with great interest the published article by Karppelin et al. entitled with “Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP”. 1 Karppelin M. Siljander T. Aittoniemi J. Hurme M. Huttunen R. Huhtala H. et al. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP. J Infect. 2014; https://doi.org/10.1016/j.jinf.2014.11.002 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar They have evaluated the predictive value of pentraxin 3 (PTX3) and C-reactive protein (CRP) upon recurrence of cellulitis then they have concluded that both biomarkers in the acute phase of acute cellulitis did not predict further recurrences. However, there are some points that need to be clarified. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRPJournal of InfectionVol. 70Issue 5PreviewTo identify risk factors for recurrence of cellulitis, and to assess the predictive value of pentraxin 3 (PTX3) and C-reactive protein (CRP) measured at baseline. Full-Text PDF Response to Agilli and AydinJournal of InfectionVol. 70Issue 5PreviewWe thank Alonso and Aydin for their comments on our study of the risk of recurrent cellulitis and the role of pentraxin 3 and C-reactive protein.1 Full-Text PDF

Spinal tuberculosis is a chronic destructive disease with long-term morbidity. Patients are usually young especially from a poor socioeconomic background. Destruction of the intervertebral disk space and the adjacent vertebral bodies is the characteristic lesion. The dorsal spine is the most affected region with multi-level noncontiguous involvement being detected more frequently. Patients usually present with chronic back pain associated with spinal tenderness, paraplegia, spinal deformities, as well as with constitutional symptoms. Magnetic resonance imaging has proved to be more sensitive and specific for its diagnosis, but availability and affordability of this investigation remain a problem in developing countries. Anti-tuberculous drug therapy has revolutionized the treatment of this debilitating disease. Surgery is still required in selected cases especially with evolving neurological deficit, progressive deformity, intractable pain and lack of response to drug therapy. With early diagnosis and effective treatment, prognosis is generally good.Materials/Methods: After getting permission from the clinical governance department, We collected the retrospective data of 305 patients with diagnosed spinal tuberculosis, who underwent surgical intervention.There was no significant difference in incidence among males and females. Housewives were the most affected. Lower dorsal spinal was the commonest site involved but our study didn't confirm the incidence of multi-level disease process. Anterior decompression along with Cage fixation was most frequently performed procedure.Despite the availability of highly effective antituberculous drugs, advanced surgical procedure, the spinal tuberculosis still maintains its demographic profile. There has been no change in characteristics of spinal presentation of this chronic debilitating disease. Patients continue to suffer the same way as they were suffering decades ago.

We read with great interest the article by Gajewska and colleagues in which the investigators reported that the concentration of brain-derived neurotrophic factor (BDNF) did not differ in the participants, regardless of sex, age, obesity, or the declared physical activity1. However, we think there are some points that should be mentioned as contributory factors. Previous studies showed that several diseases such as bipolar disease, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, atherosclerosis, Alzheimer’s disease, Parkinson’s disease, epilepsy, major depression, schizophrenia, colorectal cancer, atopic diseases (allergic rhinitis, atopic dermatitis) and lower respiratory tract infection could affect BDNF levels2,3. Beside of above diseases, clopidogrel, aspirin, anti tumor necrosis factor alpha drugs, antidepressants, and statins could alter BDNF levels4,5. Also, dietary supplements such as zinc, vitamin B, vitamin E, vitamin A, omega-3 fatty acids, ginkgo biloba extracts and folic acid can influence BDNF levels6,7. In this regard, without defining these contributing factors, interpreting the results is problematic. BDNF levels were found to fluctuate during menstrual cycle. In luteal phase, BDNF levels were shown to be higher than follicular phase8. Also, Begliuomini et al9 suggested that BDNF levels were lower in women with amenorrhea or menopause than that of fertile women. Maffioletti and colleagues suggested that serum preparation procedure is highly important issue to provide robust methodology10. Due to being stored in platelets, BDNF level is highly affected from duration of the clotting process. They recommended the minimum clotting duration for a correct serum BDNF dosage as 1 hour. In this study, the authors did not define sampling time, clotting period or women’s menstrual status, which could cause falsely higher or lower serum BDNF levels. Therefore, standardization of methodology is essential for measurement of serum BDNF. In conclusion, clarifying these concerns will certainly provide a clearer picture when interpreting serum BDNF levels among participants.

Dear Editor, We read with great interest the article by Rumora and colleagues entitled “Paraoxonase 1 activity in patients with chronic obstructive pulmonary disease,” in which the investigators reported that patients with chronic obstructive pulmonary disease had signifi cantly lower paraoxonase-1 (PON-1) activity compared to the healthy subjects (1). However, we think that some points should be discussed. PON-1 hydrolyzes organophosphate substrate paraoxon and aromatic esters, such as phenylacetate and has been shown to inhibit LDL oxidation. Previous studies showed that certain diseases such as psoriasis, chronic renal failure, infl ammatory bowel diseases, hypertension, Parkinson’s disease, Alzheimer disease, vascular dementia, chronic liver disease, systemic lupus erythematosus, hyperlipidemia and acute phase response status could aff ect serum PON-1 activity (2, 3). However, the authors expressed several diseases such as infective and infl ammatory diseases as exclusion criteria; it would be better if they applied simple laboratory tests such as routine biochemistry tests, complete blood count, thyroid function tests, erythrocyte sedimentation rate and C reactive protein to provide robust data about study groups. Another contributing factor for PON-1 activity is medicine use. It is known that just lipid lowering drugs, aspirin, dexametazon, fenofi brate, phenobarbital, and hormone replacement therapy could aff ect PON-1 activity (4). In addition, dietary supplements such as vitamin E, vitamin C, zinc, iron, and fl avonoids can alter PON-1 activity (5). It is known that women have higher PON-1 activity than men. In this study, control and patient groups did not match in terms of gender. Th erefore, the fi nding of the study as higher mean PON-1 activity in control group than patients may have arisen from this non-uniform distribution of participants. Namely, we think that it is essential to provide ageand sex-matched control group for this study. In conclusion, although this study contributes valuable information to the medical literature, clarifying these concerns will certainly provide a clearer picture while interpreting PON-1 activity among participants.

This study examined the research status and development process of FU Qingzhu's Obstetrics and Gynecology (Fu Qing Zhu Nv Ke,《傅青主女科》, FQZNK) in the past 40 years with bibliometrics and visual analysis.Retrieved all related literature in the research field of FQZNK from the domestic and foreign databases: China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Web of Science (WOS) core database, including Science Citation Index Expanded (SCIE), Social Sciences Citation Index (SSCI), and Arts & Humanities Citation Index (A&HCI). The search range was from January 1, 1980 to March 10, 2021. In addition, bibliometrics and CiteSpace 5.7.R2 software were used to analyze literature types, published journals, cited literature, the number of author publications, co-author networks, co-institution networks, keyword co-occurrence networks, keyword clusters, and keyword bursts.A total of 678 valid records were included in the final dataset. Literature types, high publication journals, highly cited literature, high-yield institutions, high-yield research teams, and high-productivity scholars in this research field were found through bibliometrics. Literature types can be divided into four categories, among which 451 are theoretical studies on academic thoughts of FQZNK, accounting for 66.5% of the included journals. The Journal of Shanxi Traditional Chinese Medicine had the largest volume of published articles (61), accounting for 9.0% of the total number of the included journals. The most cited literature was ZHOU Mingxin's article "Using the quantitative method to discuss author's authenticity and formula characteristics of FU Qingzhu's Obstetrics and Gynecology", which was cited 94 times. Hunan University of Chinese Medicine, the institution with the most publications, published 45 articles, and YOU Zhaoling, the most published author, published 33 articles. Moreover, it was found that most high-yield researchers came from high-yield institutions and that Hunan University of Chinese Medicine had the most research on FQZNK. Keyword co-occurrence analysis revealed that the keyword "FQZNK" had the highest frequency (597 times) and the highest centrality (1.00). Keyword cluster analysis used the Log-Likelihood Ratio (LLR) algorithm to form eleven important clusters: #0 treatment aiming at its root causes, #1 gynecopathy, #2 Siwu Decoction (四物汤), #3 FU Qingzhu, #4 post-partum, #5 infertility, #6 dysmenorrhea, #7 sterility, #8 coordinate the heart and kidney, #9 Danggui Buxue Decoction (当归补血汤), and #10 treatment. It was found that the prescriptions of FQZNK were studied mainly before 2000, the theoretical studies were mainly conducted before 2010, and its clinical application was mainly explored from 2010 until now. Diseases such as dysmenorrhea, morbid vaginal discharge, infertility, metrorrhagia, and polycystic ovarian syndrome (PCOS) have recently become popular topics in this field.The current study provides more scientific, accurate, and comprehensive scientific support for further research and development of traditional Chinese medicine (TCM) in FQZNK. With this foundation, people can use burst detection to ascertain the current hotspots in research, get their development trends, and forecast future research directions. In addition, infertility, morbid vaginal discharge, flooding, and PCOS treatments based on TCM syndrome differentiation are currently popular research topics for FQZNK.