Gait analysis in neurological populations: Progression in the use of wearables.

Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.

Susac Syndrome: Clinical characteristics, diagnostic findings and treatment in 19 cases.

Susac's Syndrome (SS), which was first described in 1979, is a rare and presumably autoimmune disorder characterized by encephalopathy, hearing loss, and visual disturbance resulting from branch retinal artery occlusion (BRAO). This study reports 19 SS patients' clinical characteristics, MRI features, CSF analysis, treatment strategies and outcomes. At initial presentation, only three of 19 patients demonstrated the complete clinical triad. Clinic presentation varied from isolated hemiparesis to the full triad (encephalopathy, hearing loss and visual disturbances). Corpus callosum (CC) involvement was noted in the MRI of 18 patients (97%) and BRAO was detected in 17 (95%) patients. All patients were treated with intravenous methylprednisolone after the initial assessment. This case series is presented to emphasize the differences in clinical presentation of SS and the importance of MRI and FFA in diagnosis.

The efficacy of ozone therapy in neonatal rats with hypoxic ischemic brain injury.

OBJECTIVES: This study is aimed to determine the effect of ozone therapy in neonatal rats with experimentally induced hypoxic ischemic brain injury (HIBI). METHODS: The study included 7-d-old male Wistar rats that were randomized to the sham, control, ozone 1, and ozone 2 groups. All rats except those in the sham group were kept in a hypoxia chamber, and then the rats in the control group were given 0.5 mL of saline. Those in the ozone 1 group were given ozone 1 mg kg-1 intraperitoneally, and those in the ozone 2 group were given ozone 2 mg kg-1 intraperitoneally. RESULTS: There were significantly fewer apoptotic neurons in the right hemispheres of the rats in the ozone 1 and ozone 2 groups than in the control group (p < 0.001 and p < 0.001, respectively). There were significantly fewer apoptotic neurons in the right hemispheres of the rats in the ozone 2 group than in the ozone 1 group (p < 0.001). Morris Water Maze (MWM) test results were similar in the ozone 2 and sham groups. CONCLUSIONS: The present study's findings show that ozone therapy reduced neuronal apoptosis and improved cognitive function in neonatal rats with experimentally induced HIBI (Tab. 2, Ref. 30).

Evaluation of the plasma microRNA levels in stage 3 premature retinopathy with plus disease: preliminary study.

PurposeIn the present study, we aimed to investigate the changes in plasma microRNA (miRNA) levels in premature infants diagnosed with premature retinopathy (ROP).Patients and methodsIn order to investigate the relationship of miRNAs with ROP, 13 premature infants admitted to Mersin University, Medical School, Department of Ophthalmology and diagnosed with ROP stage 3 with plus disease between January 2014-January 2015 were included in the study. Control group consisted of 15 premature infants with no ROP. The plasma miRNA levels were evaluated using high-throughput quantitative real-time PCR.ResultsThe results of study demonstrated that the expression level of miR-23a and miR-200b-3p was significantly upregulated in patients with ROP when compared with the control group (P<0.05). The expression level of miR-27b-3p and miR-214-3p was significantly downregulated in patients (P<0.05). In addition, expression of 17 miRNA (miR-410-3p, miR-17-5p, miR-451a, miR-31-5p, miR-132-3p, miR-183-5p, miR-184, miR-222-3p, miR-296-5p, miR-200a-3p, miR-328-3p,miR-96-5p, miR-199a-5p, miR-99a-5p, miR-106a-5p, miR-125b-5p, miR-155-5p) had upregulated or downregulated, but not statistically significantly different when compared with the control group.ConclusionsOur results suggest that plasma miRNA levels may alter in ROP and, some miRNAs might have an effect in the physiopathology of this disease. These molecules may have an important therapeutic role in patients who are unresponsive to anti-vascular endothelial growth factor therapy. However, further studies must be conducted for possible effects of miRNAs in vascular disorders of eye such as ROP. Moreover to define the relationship of these molecules with the disease more clearly, a multicenter study including more patients is necessary.

Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study.

OBJECTIVES: This is the first study evaluating the predictive value of myocardial performance on arrhythmia and mortality via tissue-Doppler and microvolt T-wave alternans in infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia-rewarming. METHODS: The study included 23 term newborns having criteria for hypoxic-ischemic encephalopathy, and 12 controls. Tissue-Doppler imaging and T-wave alternans were performed in the first six hours after birth in patients from both groups and after hypothermia-rewarming treatment on the fifth day. RESULTS: The basal T-wave alternans values were higher in patients in lead aVF(p < 0.001) which also correlated with existing acidemia (r = 0.517; p = 0.012). Basal T-wave alternans and post­treatment values of patients were compared in leads V1 (p < 0.001) and aVF (p < 0.001); a significant decrease was found on the fifth day. Moreover, right ventricle diastolic diameter and estimated systolic pulmonary artery pressure of patients in the first 6 hours were higher (p = 0.03, p < 0.001, respectively). Although, the ejection fraction of patients did not decrease, basal values of left and right ventricular systolic and diastolic functions were lower initially, and increased significantly after treatment. CONCLUSION: The global cardiac functions and myocardial performance of newborns with hypoxic-ischemia might be improved with therapeutic hypothermia which can be determined by using T-wave alternans and tissue-Doppler measurements. However, further studies are needed to assess whether these measurements are prognostic in determining the myocardial dysfunction and arrhythmias (Tab. 2, Fig. 3, Ref. 26).

Is levetiracetam neuroprotective in neonatal rats with hypoxic ischemic brain injury?

BACKGROUND: The aim of this study was to determine if levetiracetam (LEV) is neuroprotective in neonatal rats with hypoxic-ischemic brain injury (HIBI). METHODS: The study included 7-d-old male Wistar rats that were randomly divided into the LEV400, LEV800, control, and sham groups. All the rats, except those in the sham group, underwent ligation of the carotid artery and were then kept in a hypoxic chamber containing 8% oxygen for 2 h. At the end of the hypoxic period the rats in the control group were administered saline solution 0.5 mL, the rats in the LEV400 group were administered LEV 400 mg.kg-1, and rats in the LEV800 group were administered LEV 800 mg.kg-1 via the intraperitoneal route. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) method was used to evaluate neuronal apoptosis in the rats. The Morris Water Maze (MWM) test was performed at age 14 weeks in order to evaluate cognitive function. RESULTS: The number of apoptotic neurons in the right hemispheres was significantly lower in the sham, LEV400, and LEV800 groups than in the control group (p < 0.001, p < 0.001, and p < 0.001, respectively). In addition, the number of apoptotic neurons in the right hemispheres was significantly lower in the LEV800 group than in the LEV400 group (p = 0.001). Platform finding time (PFT) during MWM testing was significantly shorter in the sham and LEV800 groups on d 4 than on d 1 (p = 0.001 and p = 0.006, respectively); however, PFT did not significantly change between d 1 and d 4 in the control or LEV400 groups (p = 0.91 and p = 0.096, respectively). CONCLUSION: Based on the present findings, LEV exhibited a dose-dependent neuroprotective effect in neonatal rats with HIBI (Ref. 27).

Increased platelet count in severe peritoneal endometriosis.

OBJECTIVE: Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis. MATERIALS AND METHODS: Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosis were divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student's t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni. RESULTS: PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011). CONCLUSION: Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

Surgical outcome of bronchiectasis in children: long term results of 60 cases.

BACKGROUND: Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis. METHODS: We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome. RESULTS: There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method. CONCLUSIONS: Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

An Investigation of the Relationship between the eNOS Gene Polymorphism and Diagnosed Migraine.

We investigated the phenotype-genotype association of the following endothelial nitric oxide synthase (eNOS) gene polymorphisms, rs743506, rs2070744, rs1799983, rs180079, rs3918226, rs207468799 and rs148554851, in patients suffering from migraine living in Edirne, Turkey. A total of 175 individuals, who had been diagnosed with migraine between April 2013 and December 2013, at the Neurology Department, Trakya University Medical Faculty, Edirne, Turkey, and 125 healthy controls were recruited. The above gene polymorphisms were analyzed from genomic DNA in both patient and control groups, using the pyro-sequencing method. The eNOS rs1799983 TT genotype frequency in migraine patients who had a headache duration of longer than 24 hours was statistically significantly higher than in patients who had migraine attacks that lasted under 24 hours (p = 0.047). In terms of the AGGTGGA haplotype, the severity of headache was statistically significant, and was found to be severe in 61.0% (p = 0.0001). Also in terms of the AGGTGGA haplotype, the duration of headache was statistically significant, and was >24 hours in 56.0% of patients (p = 0.008). In our study, there was no significant genotypephenotype relationship between eNOS rs743506, rs2070744, rs1799983, rs180079, rs3918226, rs207468799 and rs148554851 gene polymorphisms and migraine patients with and without aura living in Edirne, Turkey. The AGGTGGA haplotype constitutes a risk in terms of the severity and the duration of headaches in patients with migraine. This risk is significantly higher in patients with migraine with aura than patients with migraine without aura.

Evaluation of serum transforming growth factor ß1 and C-reactive protein levels in migraine patients.

BACKGROUND AND PURPOSE: Migraine is a frequent form of head-ache. Although many mechanisms describing onset of migraine with and without visual aura have been suggested, the aetiology of migraine headaches is still not clear. Neurogenic inflammation may play a key role in the development of migraine headaches. We evaluated the discriminative power of serum levels of C-reactive protein (CRP) and transforming growth factor beta 1 (TGF-ß1) in patients who presented to our clinic with migraine headaches with or without visual aura. MATERIAL AND METHODS: We designed a prospective case-control study of 51 patients with migraine (27 with migraine with aura and 24 with migraine without aura; all had headache) and compared them with 27 healthy subjects during the study period. Demographic and clinical characteristics recorded were age, sex, marital status, occupation, characteristics of headache, laboratory values, and serum CRP and TGF-ß1 levels. Statistical analyses used Student t-test, the χ2 test, and ANOVA followed by the post-hoc Bonferroni test for multiple comparisons. Receiver operator characteristic (ROC)-curve analysis for CRP and TGF-ß1 was also conducted. RESULTS: There was no difference between the groups in terms of demographic characteristics, marital status, and socioeconomic status. Statistically, white blood cell levels, serum glucose levels, triglyceride levels, high-density lipoprotein levels, and serum CRP and TGF-ß1 were significantly higher in patients with migraine (p < 0.05). The ROC curve results in this study identified that CRP and TGF-ß1 may discriminate patients who have different types of migraine headache. CONCLUSIONS: This study suggests that serum CRP and TGF-ß1 levels may be diagnostic factors to differentiate migraine patients with and without aura. These findings show that neurogenic inflammation may have a role in the aetiology of migraines.

The predictors of poor outcomes in patients with femoral artery injuries.

PURPOSE: This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries. PATIENTS AND METHODS: The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded. RESULTS: Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively. CONCLUSIONS: The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma.

BACKGROUND AND OBJECTIVE: In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy. PATIENTS: A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010. RESULTS: Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months. CONCLUSIONS: The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

Clinico-epidemiological study of caustic substance ingestion accidents in children in Anatolia: the DROOL score as a new prognostic tool.

BACKGROUND: To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study. METHODS: We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (> or = 21 days) dilatation patients who were referred for OBD by other hospitals. RESULTS: In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < or = 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients. CONCLUSIONS: Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> or = 21 days). OBD can then also be started earlier in these patients.

Risk factors for maternal mortality in eclampsia: analysis of 167 eclamptic cases.

BACKGROUND: The aim of this study was to evaluate risk factors associated with maternal mortality in patients with eclampsia. METHODS: The probable risk factors of maternal mortality including maternal age, length of hospital stay, gestational age, systolic and diastolic blood pressures; hematocrit, hemoglobin, platelet count, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase were determined from patients' charts and Odds ratios (OR) of these factors were detected using by logistic regression analysis. RESULTS: According to logistic regression model, AST [OR, (95% Confidence Interval, CI): 7.39 (2.71-20.13)]; ALT [6.45 (2.42-17.16)]; postpartum diastolic blood pressure [4.58 (1.80-11.62)]; hematocrit [3.52 (1.86-6.65)]; hemoglobin [2.67 (2.01-3.55)] were found to be significant risk factors for maternal mortality. CONCLUSIONS: In eclamptic patients, close monitoring of particular laboratory values and blood pressure, and early intervention to alterations of certain variables will provide possibility for prevention against potential complications and subsequently decreasing mortality.

Outcomes of pregnancies in women with parity ten or more: a case control study.

PURPOSE: To determine the outcomes of pregnancies in women with parity ten and more. MATERIALS AND METHODS: We designed this study in a government hospital in rural Turkey. Pregnant women with parity of ten or more (n=126) were evaluated and compared with pregnant women with parity lower than ten (n=90). The risk factors recorded were maternal age, parity, gestational age (weeks), delivery mode, fetal birth weight and Apgar scores. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, U.S.A.). RESULTS: During the study period, a total of 12,551 deliveries were delivered at the current clinic. One hundred and twenty-six mothers were delivered with parity ten or more with a ratio of 1.01%. There was a statistically significant difference between the study and control group by means of maternal age, parity, fetal birth weight and 1- and 5-min Apgar scores (p < 0.05). There was no difference in delivery mode between the groups. CONCLUSION: According to this study, pregnant women with parity ten or more showed no adverse clinical characteristics when compared with pregnant women with parity lower than ten.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study.

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85 percent; interassay variation: 3.45-8.22 percent) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH4, and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95 percent confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH4 were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Comparison of responses to Ovsynch between Holstein-Friesian and Swedish Red cows.

The Ovsynch protocol was designed to synchronize ovulation, thereby allowing timed artificial insemination (TAI) of all cows without detection of estrus. However, the effectiveness of Ovsynch in different breeds of dairy cows has not been previously compared. The aim of this study was to compare the response to Ovsynch in cycling lactating Holstein-Friesian (HF) and Swedish Red (SR) dairy cows. A total of 495 cyclic cows (n=347 HF, n=148 SR) were housed together and treated with Ovsynch (GnRH-7 d-PGF2α-56 h-GnRH-16 to 18 h-TAI). Ovulatory responses, synchronization rate, maximal follicle size at the time of AI, and percentage of pregnant cows per AI (P/AI at 31 and 62 d after AI) were compared between breeds. Ultrasonography was performed during Ovsynch at first GnRH, PGF2α, at time of AI, and 7 d after AI. Ovulatory response and synchronization rate were similar in HF versus SR cows (60.2 vs. 62.2%; 88.4 vs. 88.5%, respectively). Cows that ovulated to the first GnRH of Ovsynch had smaller follicle size at AI (15.9±0.1 vs. 16.4±0.2 mm). Maximal follicle size at AI was greater for HF (16.4±2.2 mm) than SR (15.5±2.3 mm) cows. The P/AI was greater for SR than HF cows at the 62-d pregnancy diagnosis (56.1 vs. 46.1%). In addition, pregnancy loss between 31 and 62 d of pregnancy was greater in HF (10.1%) than SR (3.5%) cows. Fertility was less in HF cows during the hot season (57.7 in cold vs. 38.1% in the hot season), whereas such a decrease was not observed in SR (60.0 in cold vs. 53.5% in the hot season) cows. Thus, although the GnRH treatments of Ovsynch were equally effective in SR and HF cows, pregnancy outcomes (P/AI at d 62 and pregnancy survival) were greater in SR than HF cows, and P/AI in SR cows was not compromised during the hot season as was found for HF cows.

Management of non-traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases.

AIM: Acute limb ischemia (ALI) is one of the most potentially devastating but treatable diseases, resulting from a sudden obstruction in the arterial flow. The aim of this study was to examine the outcome of thromboembolectomy, and to determine the risk factors associated with limb loss and mortality in ALI. METHODS: A retrospective chart review of 270 patients on whom thromboembolectomy was performed between September 2002 and December 2009 due to ALI. Of these, 146 (54.1%) were men and mean age was 64.3. RESULTS: Etiology was embolic in 63.3% of cases. Late thromboembolectomy after 72 hours was performed in 57.8% of patients. On admission 38.9% of patients had grade IIb ischemia; grade III ischemia was present in 9.6% of patients. Failure of first thromboembolectomy developed in 21.1% of patients and bypass surgery was performed on 25.2% of patients. Amputation and mortality rates were 7.4% and 8.5% respectively. Binary logistic regression analysis revealed that risk factors of limb loss were thromboembolectomy failure, high ischemic stage, high level of plasma creatinine kinase and compartment syndrome on admission and predictors of mortality were congestive heart failure, ischemic heart disease, reperfusion injury and longer ischemic time. CONCLUSION: In ALI, thromboembolectomy is highly protective against amputation, as well as mortality, even in delayed cases with more than one week in the clinical absence of tissue necrosis. At least, it provides partial limb salvage. In addition, patients must be given a chance for limb salvage in the case of stage 3 ischemia, too.

Evaluation of adolescent pregnancies: 10-year experience of a hospital in rural Turkey.

PURPOSE: To evaluate the characteristics of adolescent pregnancies admitted to our clinic. MATERIALS AND METHODS: This retrospective and descriptive study was performed at Ergani State Hospital from January 2000 to December 2010. This is an outpatient gynecology and obstetrics at government hospital in Southern Eastern Region of Turkey. A total of 15,210 pregnancies were delivered during the study period, of whom 711 of them were adolescent pregnancies. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: During the study period, of the total of 15,210 deliveries 711 (4.6%) were adolescent pregnancies (age range 14-19 years). The mean age (95% CI) of the patients was 17.90 +/-1.12 (17.82-17.98) years old. Most of the patients were nulliparous (n = 559, 78.60%). Mean gestational weeks, fetal birth weight and fetal birth length and 95% CI values were as follows: 37.11 +/- 2.53 (36.93-37.30), 3045.73 +/- 51.70 (3007.65-3083.79) and 48.68 +/- 2.31 (48.51-48.85), respectively. Six hundred and twenty (87.20%) of the patients delivered spontaneously by the vaginal route, while 91 (12.80%) were delivered by cesarean section. Although the age range of the patients was not wide, there was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length (p < .01). CONCLUSION: According to this study, the ratio of adolescent pregnancies was found to be 4.6% which was lower than other regions of Turkey. The majority of the patients were nulliparous and most delivered spontaneously by the vaginal route. There was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length.