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Objectives: This study aims to investigate the usability and reliability of our new axis in a three-dimensional modelling work and demonstrate if it is a reproducible method for anteversion measurement that sufficiently correlates with other computed tomography (CT)-derived gold standards including transepicondylar axis (TEA) and posterior condylar axis (PCA). Patients and methods: Three-dimensional solid models were derived from left femoral CT data of 100 participants (50 males, 50 females; mean age 57 years: range, 21 to 86). The newly proposed popliteal surface axis (PSA) was compared with TEA and PCA in terms of anteversion measurement on these solid models. Results: Popliteal surface axis was found as a reproducible reference axis in our study as it could be measured in 99% of our sample. The mean value of PSA based anteversion was (-) 1.8 degrees which was 10.7 degrees and 4.4 degrees for PCA and TEA, respectively. Popliteal surface axis was perfectly correlated with PCA and TEA for anteversion measurements (p

Microcephalic primordial dwarfism (MPD) is a group of autosomal recessive inherited single-gene disorders with intrauterine and postnatal global growth failure. Seckel syndrome is the most common form of the MPD. Ten genes are known with Seckel syndrome. Using genome-wide SNP genotyping and homozygosity mapping we mapped a Seckel syndrome gene to chromosomal region 4q28.1-q28.3 in a Turkish family. Direct sequencing of PLK4 (polo-like kinase 4) revealed a homozygous splicing acceptor site transition (c.31-3 A>G) that results in a premature translation termination (p.[=,Asp11Profs*14]) causing deletion of all known functional domains of the protein. PLK4 is a master regulator of centriole biogenesis and its deficiency has recently been associated with Seckel syndrome. However, the role of PLK4 in genomic stability and the DNA damage response is unclear. Evaluation of the PLK4-Seckel fibroblasts obtained from patient revealed the expected impaired centriole biogenesis, disrupted mitotic morphology, G 2 /M delay, and extended cell doubling time. Analysis of the PLK4-Seckel cells indicated that PLK4 is also essential for genomic stability and DNA damage response. These findings provide mechanistic insight into the pathogenesis of the severe growth failure associated with PLK4-deficiency. © 2017 European Society of Human Genetics All rights reserved.

Summary: This study explores the effect of supervised back extensor strength training on spinal pain, back extensor muscle strength, trunk-arm endurance, kyphosis, functional mobility, and quality of life (QoL) among sixty postmenopausal women with vertebral osteoporotic fractures. Purpose: To compare the effects of a 6-week supervised or home-based program of back-strengthening exercise on spinal pain, back extensor strength, trunk-arm endurance, kyphosis, functional mobility, and QoL in osteoporotic postmenopausal women with vertebral fractures. Methods: The study was designed as a randomized controlled clinical trial. Sixty osteoporotic postmenopausal women with vertebral fracture (mean age 60.3 ± 9.3 years) were included in the study. Subjects were randomly assigned into three groups (supervised program, home-based program, or control), each consisting of 20 subjects. The subjects underwent the 6-week exercise program which included strengthening exercise for the back extensor muscles. They performed three sets of 8, 10, or 12 repetitions for each of the exercises, biweekly ascending, three times per week. Spinal pain, back extensor strength, trunk and arm endurance, kyphosis, functional mobility, and QoL were measured at baseline and at the end of the exercise program. Results: Statistically significant improvements were demonstrated on spinal pain, muscle strength and endurance, functional mobility, and QoL for the supervised exercise program compared with control and home-based exercise groups (p < 0.01). Home-based exercise program did not provide a significant improvement compared with the control group except for mobility parameters of QoL. Conclusions: Six-week supervised back extensor strengthening training is superior to home-based program in terms of spinal pain, back extensor muscle strength, trunk endurance, functional mobility, and QoL for postmenopausal osteoporotic women with vertebral fractures. © 2019, International Osteoporosis Foundation and National Osteoporosis Foundation.

We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd

Aims: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. Materials and methods: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. Results: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p

Background: In this study, the authors aimed to compare the effects that a medium- and long-chain triglyceride (MCT/LCT) fat infusion and a fish oil-based (ω-3) fat infusion for parenteral nutrition (PN) had on systemic inflammation, cytokine response, and hepatic steatosis in mixed intensive care unit (ICU) patients. Methods: This was a single-center, placebo-controlled, randomized clinical trial in a university hospital. Four patient groups, including systemic inflammatory response syndrome (SIRS) and sepsis patients, were assigned to receive PN employing the MCT/LCT fat infusion or the fish oil-based fat infusion over 7 days. Blood biochemistry and liver steatosis were evaluated. Results: Twenty sepsis and 20 SIRS patients were included in this study. There was no statistically significant difference in terms of biochemical values and Acute Physiology and Chronic Health Evaluation II scores between the different feeding groups. Sepsis groups who received MCT/LCT revealed higher grades of liver steatosis by ultrasound on days 7 and 10 (P

We report on a patient with partial monosomy 6p and partial trisomy 12q identified by fluorescent in situ hybridization (FISH) and array-based comparative genomic hybridization (aCGH). She had a complex phenotype characterized by mental retardation (MR), psychomotor developmental delay, speech disorder, hypertelorism, eye anomalies, hearing loss, low-set malformed ears, thin upper lip, heart defect, clinodactyly, pes valgus, and skeletal anomalies. There is phenotypic overlap between our case and Mutchinick syndrome. This is the first report of a combined partial monosomy 6p and partial trisomy 12q due to an unbalanced translocation between subtelomeric regions of these chromosomes.

To evaluate the clinical effectiveness of wrist splint usage arranged by determining the optimal position on which the median nerve is compressed the least through sonographic examination for patients with carpal tunnel syndrome (CTS). This study was a prospective, clinical trial with a 6-week follow-up. Twenty-four patients diagnosed clinically and electromyographically with CTS were included in the study. A total of 37 wrists were studied on. When the patients were grouped according to the optimal position, Group I comprising 16 (43.24%) wrists was at 15 degree flexion, Group II comprising 12 (32.43%) wrists was neutral, Group III comprising 6 (16.22%) wrists was at 15° extension and Group IV comprising 3 (8.11%) wrists was at 30° extension configurations. Groups I, II and III were included in clinical follow-up. Symptom severity score (SSS), functional status score (FSS), Grip strength and Pinch strength were used for the clinical follow-up and evaluation of the patients. When pre- and post-treatment were compared, a statistically significant recovery was detected in all three groups in respect to SSS (Group I P < 0.01, Group II P < 0.05, Group III P < 0.05). A statistically significant recovery was detected for FSS only in Group I (P < 0.05) and for Grip strength in Group II (P < 0.05). When the groups were compared among themselves, no statistically significant difference was detected for any of the parameters (P > 0.05). In this study, by sonographic examination of the patients included in the study with CTS, we saw that the optimal position on which the median nerve is compressed the least varies depending on the individual and we determined that this position was 15° flexion most frequently for our patients. We also observed that in clinical follow-up of wrist splint usage arranged on custom optimal position results in significant recovery. © 2010 Springer-Verlag.

Introduction Aging and the decline of ovarian hormonal secretion during menopause may alter libido, and sexual response and functioning. The effects of hormone replacement therapy (HRT) on the genital vascular hemodynamics have been widely studied. However, there is a lack of knowledge about the effect of HRT on basal clitoral blood flow. Aim The aims of this study were to measure clitoral artery blood flow and to determine whether HRT has a significant effect in clitoral artery blood flow in postmenopausal women. Methods Doppler sonography of clitoral arteries was performed in 25 postmenopausal women aged 51.3 ± 4.5 years who had been using a continuous combined HRT (0.625 mg of conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate, in 1 tablet daily) for 2.0 ± 1.1 years, and the clitoral artery peak systolic velocity, resistance index (RI), and pulsatility index (PI) were measured. Thirty‐five postmenopausal women aged 50.0 ± 4.2 years who had not used HRT served as a control group. Main Outcome Measures Assessment of clitoral blood flow with color Doppler ultrasonography by measuring the peak systolic velocity, RI, and PI. Results Clitoral artery circulation was easily detectable by the color Doppler sonography. The clitoral artery peak systolic velocities were significantly higher in postmenopausal women taking HRT compared with the control group (11.8 ± 5.2 cm/second vs. 15.0 ± 5.4 cm/second, P = 0.025). Conclusion HRT improves blood flow to the clitoris. A clitoral blood flow evaluation may be proposed as a potential tool to assess the impact of HRT on the genital tissues and to investigate female sexual response disorders in postmenopausal women. Alatas E, Yagci B, Oztekin O, and Sabir N. Effect of hormone replacement therapy on clitoral artery blood flow in healthy postmenopausal women. J Sex Med 2008;5:2367–2373.

The objective is to investigate the effect of obesity and hepatosteatosis on the Doppler waveform pattern of the hepatic veins. B-mode and duplex Doppler sonography of the liver and the right hepatic vein was performed in 102 obese subjects and 84 healthy volunteers. The severity of fatty infiltration was graded as mild, moderate and severe. The flow pattern of the right hepatic vein was classified as triphasic, biphasic and monophasic. The Doppler flow pattern in the right hepatic vein was triphasic in 56 (55%), biphasic in 27 (26%) and monophasic in 19 (19%) obese patients, whereas it was triphasic in 83 (99%) and biphasic in 1 (1%) control subject, achieving a statistical significance (Mann-Whitney U-test, P

Purpose. We evaluated the potential application of sonography to monitor alterations in abdominal fat thickness in obese women before and after dieting. Methods. This study included 40 obese women (mean age, 42.2 ± 9.4 years; mean body mass index [BMI], 36.0 ± 5.9 kg/m2) who underwent a 3-month low-calorie diet. Height, weight, waist circumference (WC), and hip circumference (HC) were measured. BMI and waist-to-hip ratio (WHR) were calculated. Abdominal subcutaneous (S) and intra-abdominal preperitoneal (P) fat were measured at their maximum (max) and minimum (min) thickness sites using a 7.5-MHz linear-array probe. Intra-abdominal visceral (V) fat was measured using a 3.5-MHz convex-array probe. Measurements were taken before and after caloric restriction. Results. The mean weight was reduced from 88.6 ± 17.1 kg to 83.0 ± 15.9 kg (p < 0.0001). The mean changes in Smin (r = 0.376, p = 0.017), Smax (r = 0.508, (p = 0.001), Pmin (r = 0.439, p = 0.005), and V (r = 0.365, p = 0.022) fat thicknesses were positively correlated with change in weight; the change in Pmax fat thickness showed the best and most significant correlation (r = 0.591, p < 0.0001). BMI (r = 0.969, p < 0.0001), WC (r = 0.510, p = 0.001), and HC (r = 0.422, p = 0.007) changes were also positively correlated with weight change, but the WHR change (r = 0.019, p > 0.05) was not. Conclusions. All the abdominal fat layers, particularly the intra-abdominal P fat, will decrease in response to loss of body fat by dieting. Sonography seems to be useful in monitoring small variations in the thicknesses of abdominal S and intra-abdominal P and V fat. © 2002 Wiley Periodicals, Inc.

Purpose: This study has two objectives: (1) using ultrasound (US) as a tool for measuring subcutaneous (S) and intra-abdominal; preperitoneal (P) and visceral (V) fat thickness. (2) Assessing the relationship between selected anthropometrical variables and US-measured S, P and V fat also evaluating the contribution of abdominal fat accumulation in development of liver steatosis. Methods and materials: Sixty-eight obese patients (aged 43.9±9.3 years) and 40 non-obese subjects (aged 34.03±9.0 years) were recruited to this study. Height, weight (W), waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. A linear-array probe (7.5 MHz) was used to measure S and P. A convex-array probe (3.5 MHz) was used for measuring V and assessing liver fatty infiltration. Results: In 45 (66%) patients, there were diffuse liver fatty changes. Liver steatosis showed significant correlation with V (r=0.57), P (r=0.38) and S (r=0.37). It also correlated with W (r=0.52), BMI (r=0.6), WC (r=0.45) (P

Objectives: To examine and compare the effects of massage and matrix rhythm therapy in young women on the peripheral blood circulation. Design: Randomized, double-blind, controlled trial. Setting: Pamukkale University in Denizli, Turkey. Patients: Fifteen healthy women age 19-23 years. Intervention: Matrix rhythm therapy was applied to the left lower extremity for a single 30-minute session. At least 1 week later, massage was applied to the left lower extremity for 30 minutes in a single session. The same physiotherapist applied both sessions. Outcome measures: The blood velocity (cm/s), artery diameter (mm), and blood flow (ml/min) of the popliteal and the posterior tibial arteries were measured with color Doppler ultrasonography. All images were evaluated by the same radiologist. Results: After matrix rhythm therapy and massage application, blood velocity, artery diameter, and blood flow in arteries increased. However, matrix rhythm therapy caused a more prominent increase in the amount of blood flow in the popliteal and in the posterior tibial artery than did massage. After matrix rhythm therapy application, the average increases in the blood flow rates in the popliteal and the posterior tibial arteries were 25.29%±16.55% and 34.33%±15.66%, respectively; after the massage, the increases were 17.84%±17.23% and 16.07%±10.28%, respectively. Conclusion: Matrix rhythm therapy and massage increased peripheral blood flow in young women. Matrix rhythm therapy method resulted in more prominent increases. © Mary Ann Liebert, Inc.

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Background The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women. Methods One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-α, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis. Results There was a positive correlation between serum IL-6 and TNF-α ( r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) ( r = .43; p = .0001), waist circumference ( r = .41; p = .0001), and visceral fat layer ( r = .33; p = .0001) measurements and HOMA-IR index ( r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed ( r = .320; p = .0001). TNF-α was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters. Conclusions There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-α levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.

Ankylosing spondylitis (AS) primarily affects the spine and axial skeleton. Major extra‐articular manifestations include cardiovascular and pulmonary involvement, uveitis, enteric mucosal lesions, ...

Behcet’s disease is a multisystemic inflammatory disorder [1]. Parenchymal (65– 81%) and vascular (19–27.5%) forms were defined for neurological involvement [1, 2]. Sinus thrombosis and intracranial hypertension are the most common examples of the vascular form [1]. It is very uncommon that these two forms of the disease occur in the same individual [1]. In this report we present a case with neuro-Behcet’s disease (n-BD) that had signs of both clinical forms contemporaneously including aseptic meningitis, venous sinus thrombosis, intracranial hypertension and a callosal lesion. A 27-year-old male patient presented with headache, papilloedema and neck stiffness. In cranial MRI, superior sagittal sinus thrombosis, prominent meningeal contrast enhancement (figure 1) and a lesion of 1 cm in diameter located in the splenium of the corpus callosum enhancing with gadolinium on T1W and hyperintense on T2W (figure 2a) were seen. CSF pressure was measured as 600 cmH2O; a high lymphocyte count and an increased level of protein were detected. A ten year history of recurrent oral aphthus, genital ulcerations and positive pathergy test directed to Behcet’s disease. Methylprednisolone, azathioprine, acetazolamide were used. Symptoms and signs resolved completely in one year. Follow up MRI revealed complete recanalisation of the thrombosis and disappearance of the callosal lesion (figure 2b). This case shows that major clinical forms can be seen in the same patient synchronically in n-BD. Isolated hyperintense white matter lesion located in the splenium of the corpus callosum is another interesting point of the case. In the literature only one n-BD case with similar callosal involvement was found [3]. We saw reversible callosal lesions in multiple sclerosis and its variants and but in this patient a detailed history and CSF immunological analysis were not consistent with neither of them. Correspondence: Dr. Levent Sinan Bir Pamukkale Universitesi Tip Fakultesi Hastanesi Noroloji Anabilim Dali Kat 1 B105Kinikli 20070 Denizli Turkey E-Mail: sbir@pamukkale.edu.tr

Objective. The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. Methods. Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. Results. Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P

Objective: To investigate the relation between intra-abdominal fat distribution and metabolic disorders in nonobese patients with the polycystic ovary syndrome (PCOS). Design: Prospective case-control study. Setting: University-based hospital. Patient(s): Thirty nonobese patients with PCOS and 30 lean women with regular menstrual cycles (controls). All participants had a body mass index < 25kg/m2. Main Outcome Measure(s): Subcutaneous and intra-abdominal visceral and preperitoneal fat thicknesses were assessed by ultrasonography. Glucose tolerance and insulin sensitivity were evaluated by standard 75-g oral glucose tolerance test and area-under-the-curve analysis. Serum hormones and lipid profile were measured. Result(s): The mean preperitoneal and visceral fat thicknesses were significantly greater in nonobese patients with PCOS. Subcutaneous fat mass was similar between the PCOS and control groups. Nonobese patients with PCOS had glucose intolerance, hyperinsulinemia, and dyslipidemia, manifested by high serum levels of triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels and low serum low-density lipoprotein (LDL) levels. No correlation existed between subcutaneous fat thickness and the metabolic variables in nonobese patients with PCOS. However, serum triglyceride levels correlated with visceral fat and preperitoneal fat thickness. The mean HDL level correlated negatively with visceral fat and preperitoneal fat thickness. The area under the curve for insulin and mean fasting insulin levels correlated positively with visceral fat thickness. In multiple regression analysis, visceral fat thickness contributed significantly to high serum triglyceride and fasting insulin levels. Conclusion(s): Intra-abdominal preperitoneal and visceral fat accumulation may contribute to the development of glucose and lipid metabolism disorders in nonobese patients with PCOS. © 2003 by American Society for Reproductive Medicine.

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The aim of this study was to assess whether magnetic resonance imaging could predict the outcome of attempted vaginal delivery in a group of pregnant women whose parturition had to be induced by oxytocin. The signal intensity and morphology alterations in the cervix of 21 full-term pregnant women were analyzed before the induction of parturition. T2-weighted gradient echo sequences were utilized and signal intensity in the cervix was measured from the anterior and posterior lips of the cervix. An index indicating the brightness range of the cervix was formulated to overcome the effects of the individual intensity changes. Imaging features including the signal intensity and the evidence of effacement were correlated with the actual type of delivery performed. Images were also assessed visually by two independent radiologists. Statistical analysis of brightness indexes that were considered to have a predictive value as an indicator for possible delivery was not significant. However, visually assessed signal intensity of the cervix correlated strongly with the type of delivery. Effacement itself was the most reliable parameter in predicting the progress of the delivery. In conclusion, MR imaging seems to be useful for predicting normal parturition in full-term pregnant women who need oxytocin induction. However, the presence of effacement seems to be a more reliable and practical parameter that will be preferred in that prediction.

This study investigated the effectiveness of magnetic resonance imaging (MRI) with rectal administration of the enteral contrast agent gadolinium diethylene triamine pentaacetic acid (Gd-DTPA) in the diagnosis of recurrent perianal fistulae, assessing the number, anatomical extent, location, and signal intensities of various lesions. Fistulas were examined by MRI before and after rectal administration of Gd-DTPA in 50 patients (excluding fistulas due to inflammatory bowel disease). Surgical findings were compared with both pre- and postcontrast T1-weighted, T2-weighted, and short T1 inversion recovery (STIR) sequences. Of the 68 fistulous tracts detected surgically, precontrast imaging identified 16 by T1-weighted images (hypointense), 27 by T2-weighted images (hyperintense or iso- to weakly hyperintense), and 54 by STIR. Postcontrast imaging identified 29 by T1-weighted images, 58 by T2-weighted, and 54 by STIR. MRI with rectal administration of Gd-DTPA thus facilitates determination of fistula tracts, which are better resolved by precontrast STIR than by either precontrast T1- or T2-weighted images. Postcontrast T2-weighted images were substantially superior to T1-weighted. Both non-contrast STIR and postcontrast T2-weighted sequences were adequate for classifying fistulas in ano, but in complex recurrent anal fistula post-contrast T2-weighted images were more helpful.