CIN was observed in 20.5% of patients. Advanced age, male gender, elevated creatinine, uric acid and phosphate levels, and low glomerular filtration rate were correlated with the development of CIN. Correlation analysis also showed a significant association between the ALP level and the development of CIN (126.1 ± 144.9 vs. 97.2 ± 46.9, p = 0.004). Univariate regression analysis also showed the impact of ALP on the development of CIN (OR 1.004, 95% CI 1.001–1.007, p = 0.02). Conclusions: Our outcomes indicate a possible active role of ALP in the mechanism of CIN. An elevated ALP level may predict the development of CIN.

Tear tumor necrosis factor alpha (TNF-α), transforming growth factor beta 1 (TGF-β₁), and epidermal growth factor (EGF) levels were determined in patients with inactive trachoma, and a possible relation between these cytokines and conjunctival cicatrization severity was investigated. Forty-four patients with inactive trachoma who were admitted to the Department of Ophthalmology at the Harran University, Sanliurfa, Turkey, were included in this study. The control group consisted of 20 age- and sex-matched healthy subjects. The levels of cytokines in tears were measured by ELISA. Tear samples were collected from the conjunctival cul-de-sac by means of blunted-tip glass capillary tubes. Eyes with inactive trachoma were classified into three subgroups with respect to conjunctiva cicatrization: mild, moderate, and severe. In 44 patients with inactive trachoma, conjunctival cicatrization was found, including mild (n = 15), moderate (n = 16), and severe (n = 13) cases. In patients with inactive trachoma, decreases in tear EGF (p = 0.000) concentrations and increases in tear TGF-β₁ (p = 0.006) and TNF-α (p = 0.046) levels with respect to the control group were found to be concordant with conjunctival cicatrization severity. Statistically significant correlations in tear TNF-α (p = 0.018), TGF-β₁ (p = 0.007), and EGF (p = 0.043) levels were found between mild and severe cicatrization groups. TNF-α and TGF-β₁ have been implicated in the fibrogenic process. Elevated tear levels of inflammatory/fibrogenic cytokines may play an important role in scar formation in trachoma. It is possible that decreased tear levels of EGF, which may be important for the maintenance of corneal epithelial integrity, are related to fibrosis in the lacrimal gland ductules.

We present the first case report of coronary-carotid artery collateral formation in Takayasu's arteritis. There was a vasculitic involvement of both subclavian and carotid arteries with critical stenosis; cerebral perfusion was supported with collaterals arising from the mesenteric arteries and coronary artery.

Serum ALP is a widely avaliable unfavourable prognostic parameter in coronary heart disease. Elevated ALP levels were associated with inadequate CCC, which supports the previously reported literature concerning the negative prognostic value of ALP levels in cardiovascular settings.

).Most patients with subclavian steal syndrome usually present with angina pectoris, and secondary myocardial infarction is rarely reported.1,2 Herein, we present a case of coronary bypass graft in which a left anterior descending artery (LAD)-left internal mammary artery (LIMA) graft was applied to supply the left arm due to complete left subclavian artery (LSCA) occlusion. The patient was hospitalized with a diagnosis of unstable angina. The assessed cardiac markers were above the cutoff points.A 75-year-old male patient presented with unstable angina. He had undergone three-vessel coronary bypass surgery 9 years ago. Cardiac markers were increased, including creatine kinase MB and troponin-I (51.5 U/L and 1.64 ng/mL, respectively). Coronary angiography revealed the patent venous grafts anastomosed to the right coronary and circumflex artery and also a patent LIMA graft anastomosed to the middle LAD. However, there was retrograde flow through the LIMA and the left arm was supplied by retrograde flow from the LAD (►Fig. 1B), since the LSCA was totally occluded from the osteal segment (►Fig. 1A). The patient did not show any claudication of the left arm nor symptoms related to posterior cerebral circulation. There was a systolic blood pressure discrepancy of 30 mm Hg between the upper extremities. The asymptomatic clinical picture may be explained by the sufficient retrograde flow to the left arm, which can trigger myocardial infarction in the distal LAD territory. The EuroSCORE of the patient was calculated to be 14. We preferred interventional therapy initially. Graft stent implantation to the LAD and elective bypass surgery to the SCA was scheduled.Coronary-SCA steal syndrome is an uncommon phenomenon in which the coronary flow is diverted into the SCA through the patent LIMA conduit due to critical subclavian stenosis.3 The prevalence of significant LSCA stenosis in patients referred for coronary bypass operation has been reported to be 0.2 to 6.8%. Most patients usually present with angina pectoris, and secondary myocardial infarction is rarely reported. 1,2 Treatment strategies vary according to the clinical picture, includes a medical follow-up, and interventional approaches involving the SCA or LAD itself. Initially, a percutaneous intervention of either SCA or LAD can be preferred. Successful interventions to the SCA in similar clinical settings have also been reported. 4 However, percutaneous intervention of chronic total occlusion of the SCA is still obscure. In our case, the SCA was totally occluded from the osteal segment and the occluded segment was relatively long. Therefore, we preferred the safer approach (i.e., percutaneous intervention of the LAD with graft stent deployment and subsequent surgical therapy for the SCA if necessary); however, the patient declined interventional treatment and followed up with medical therapy. Keywords► steal syndrome ► subclavian stenosis ► acute coronary syndrome AbstractCoronary-subclavian artery (SCA) steal syndrome is an uncommon phenomenon in which coronary ...