Examination of 3D sella turcica models in three species of ruminants.

Sella turcica is an important anatomical structure that contains the pituitary gland. Changes observed on the sella turcica facilitate the identification of diseases such as Down syndrome, Seckel syndrome and tuberculum sellae meningioma in humans. Therefore, studies in this region are critical for a better understanding of sella turcica. The crania of six adult male tuj sheep, five adult male hair goats and five adult male gazelles were used in the study. Cross-sectional images of the cranium were captured using computed tomography. Cross-sectional images were used to model the sella turcica region in 3D, and the region was analysed morphologically and morphometrically. It was observed in the study that fossa hypophysialis, dorsum sella and processus clinoideus caudalis were clearly observed on the sella turcica. The processus clinoideus caudalis in some animals was not split into two. In morphometric analysis, the sella turcica length and sella turcica height (rostral border) parameters were statistically significant between the groups (p < 0.05). Consequently, this study morphological and morphometric examinations were carried out on the sella turcica of different ruminant species, and the differences between the groups were discussed. This study is expected to contribute to the very limited number of related studies, taxonomy and clinical studies in this field.

Comparison of craniometric measurements of New Zealand rabbit (Oryctolagus cuniculus L.) using three-dimensional scanner with digital calliper measurements: A methodological study.

As technology has developed in recent years, the use of three-dimensional (3D) scanners and printers has become widespread in the medical field. However, since this field is new, all kinds of methodological and experimental related studies gain importance. This study aimed to identify the differences between the calliper measurements by determining the craniometric data on the models constructed by scanning the crania of New Zealand Rabbits (Oryctolagus cuniculus L.), preferred as experimental animals, with a three-dimensional scanner. Therefore, a total of 12 New Zealand rabbits including 6 females and 6 males were used. After the crania that comprised the study material were macerated, they were subjected to 3D scanning. After the scanning process was completed, they were craniometrically measured both on the scanned models and by using a digital calliper. Analysis of the craniometric data of the 3D scanner showed that there was a difference between sexes at the level of p < 0.05 in widest length between the external acoustic meatus (WLBEAM), skull width and Foramen magnum height (FMH) parameters and cranial index data, and at the level of p < 0.001 in the largest nasal width (LNW) parameter. A statistical difference was found between sexes in frontal length, WLBEAM, LNW and FMH parameters and cranial index values in craniometric data collected with the digital calliper (p < 0.05). Consequently, the data collected in this study were found to be close to each other in both methods, suggesting that the 3D scanner may be used in morphometric studies.

Morphometric analysis of the skull of Hamdani sheep via Three-Dimensional modelling.

The aim of the present study was to determine the craniometric characteristics of the crania of Hamdani sheep, one of local breeds of Turkey, by using computed tomography (CT). In the study, 13 (six female and seven male) skulls were used. After CT images of the skulls were taken, their three-dimensional models were created by MIMICS 20.1 (The Materialise Group, Leuven, Belgium) program. Thirty-eight craniometric measurements were taken over the models created and nine indices were calculated by using these measurements. All the characteristics examined were expressed as mean ± SE. In the study, statistically significant differences were found between females and males in terms of greatest neurocranium breadth, facial breadth, greatest palatal breadth (p < 0.05) and height of the foramen magnum (p < 0.01) parameters. No statistically significant difference was observed between the sexes in the calculated index values (p > 0.05). In conclusion, it is thought that the findings obtained from the study will contribute to the zooarchaeology and sheep taxonomy of Mesopotamian region.

Investigating metacarpi of Hamdani sheep via different measurement and modelling methods: A methodological study.

The aim of the study was to perform the morphometric analyses on metacarpi of Hamdani sheep via different measurement methods and to compare the methods. Thus, metacarpal bones of 15 females and 15 males were used in the study. Measurements were taken from the measurement points determined on metacarpus via four methods, and their statistical analyses were performed. When both male and female metacarpal bones were examined in the De parameter in the comparison with the methods, it was observed that the four measurement methods were different from one another (p < 0.01). When DEM and DEL measurement parameters were examined in male metacarpus, the highest value was measured in ImageJ and the smallest value was measured in 3D Slicer software; however, it was found that the statistical difference was not significant when compared numerically (p > 0.05). As a result, while it was observed that the measurements made by using digital calliper measurements, photometric analysis, and 3D software were similar in some of the parameters but there was no statistically significant difference; whereas, Statistical difference was detected in some parameters.

Nephrolithiasis during the first 6 months of life in exclusively breastfed infants.

BACKGROUND: We investigated etiology and prognosis of infantile nephrolithiasis, including whether lithogenic and anti-lithogenic content of breast milk affects its formation. METHODS: Thirty infants with nephrolithiasis and 30 healthy infants exclusively breastfed for the first 6 months of life were included in this prospective cohort case-control study. At entry, age, sex, and timing of birth of patients and controls were recorded. All patients were diagnosed and followed up periodically using ultrasonography. All infants received oral vitamin D (400 units/day). Lithogenic (calcium, oxalate, uric acid, phosphate) and anti-lithogenic (citrate, magnesium) components of maternal milk, serum calcium, phosphate, magnesium, 25-hydroxy vitamin D and parathormone, as well as spot urine calcium, uric acid, cystine, oxalate, magnesium, citrate/creatinine ratio, and calcium/citrate ratio were compared. RESULTS: Mean follow-up period was 56.1 ± 6.8 months. There was no difference concerning lithogenic and anti-lithogenic content of breast milk. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels (49.1 ± 19 vs. 26.7 ± 4 ng/ml, p < 0.001) were significantly higher and parathormone level significantly lower in patients. Random urine calcium/creatinine and calcium/citrate ratios were significantly higher in patient group (0.63 ± 0.40 vs. 0.42 ± 0.10 and 0.62 ± 0.12 vs. 0.41 ± 0.25 mg/mg, respectively, p < 0.01). Three patients were lost to follow-up after the first year. At last follow-up, calculi disappeared in 25/27 remaining patients without interventions or therapy. CONCLUSIONS: Breast milk does not have an etiologic effect in infantile nephrolithiasis. Higher serum vitamin D levels may have roles in development of lower levels of PTH and higher levels of serum and urine calcium, leading to stone formation. The prognosis for infantile stones is excellent. Graphical abstract.

An unusual complication of endotracheal intubation: ingestion of a bulb in a premature neonate.

Endotracheal intubation is a common daily procedure used for sustaining life in premature and term neonates in the neonatal intensive care unit. This procedure can be associated with some iatrogenic complications. One of these complications is ingesting a laryngoscope light bulb, and it is an extremely rare complication in neonates. The consequences of ingestion or aspiration may be serious and life-threatening. Herein, a male premature neonate, ingested a laryngoscope light bulb during endotracheal intubation because of surfactant replacement therapy, is reported. This case re-affirms the importance of checking the integrity of equipment before intubation effort.

Evaluation of Free Breathing Versus Breath Hold Diffusion Weighted Imaging in Terms Apparent Diffusion Coefficient (ADC) and Signal-to-Noise Ratio (SNR) Values for Solid Abdominal Organs.

BACKGROUND: Our aim was to compare the apparent diffusion coefficient (ADC) values of normal abdominal parenchymal organs and signal-to-noise ratio (SNR) measurements in the same patients with breath hold (BH) and free breathing (FB) diffusion weighted imaging (DWI). MATERIAL/METHODS: Forty-eight patients underwent both BH and FB DWI. Spherical region of interest (ROI) was placed on the right hepatic lobe, spleen, pancreas, and renal cortices. ADC values were calculated for each organ on each sequence using an automated software. Image noise, defined as the standard deviation (SD) of the signal intensities in the most artifact-free area of the image background was measured by placing the largest possible ROI on either the left or the right side of the body outside the object in the recorded field of view. SNR was calculated using the formula: SNR=signal intensity (SI)(organ)/standard deviation (SD)(noise). RESULTS: There were no statistically significant differences in ADC values of the abdominal organs between BH and FB DWI sequences (p>0.05). There were statistically significant differences between SNR values of organs on BH and FB DWIs. SNRs were found to be better on FB DWI than BH DWI (p<0.001). CONCLUSIONS: Free breathing DWI technique reduces image noise and increases SNR for abdominal examinations. Free breathing technique is therefore preferable to BH DWI in the evaluation of abdominal organs by DWI.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula.

PURPOSE: The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. METHOD: The cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery. RESULTS: Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. CONCLUSION: In palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

Effect of Erythropoietin and Stem Cells on Traumatic Brain Injury.

OBJECTIVE: To investigate the healing effects of erythropoietin (EPO) and stem cells (SCs) in traumatic brain injury (TBI). METHODS: Twenty-nine Wistar albino rats were used and separated into the following groups: control (C), EPO, SC, and SC+EPO. Group C received a TBI only, with no treatment. In the EPO group, 1000 U/kg EPO was given intraperitoneally at 30 minutes after TBI. In SC group, immediately after formation of TBI, 3 × 10,000 CD34(+) stem cells were injected into the affected area. In the SC+EPO group, half an hour after TBI and the injection of stem cells, 1000 U/kg EPO was injected. Before and after injury, trauma coordination performance was measured by the rotarod and inclined plane tests. RESULTS: Seven weeks after trauma, rat brains were examined by radiology and histology. Rotarod performance test did not change remarkably, even after the injury. Compared with group C, the SC+EPO group was found to have significant differences in the inclined plane test results. CONCLUSIONS: Separately given, SCs and EPO have a positive effect on TBI, and our findings suggest that their coadministration is even more powerful.

Investigation of Biomechanical Characteristics of Intact Supraspinatus Tendons in Subacromial Impingement Syndrome: A Cross-sectional Study with Real-time Sonoelastography.

OBJECTIVE: The aim of this work was to evaluate the real-time sonoelastography (RTSE) in the assessment of the supraspinatus tendon in patients with subacromial impingement syndrome (SIS). METHODS: Twenty-five patients with unilateral shoulder pain that was diagnosed as SIS according to magnetic resonance imaging findings were included in the study. Healthy shoulders of the patients comprised the control group. Bilateral shoulder RTSE examinations were performed by a radiologist who was blinded to the involved side of the participants. The RTSE images were recorded and assessed by 2 radiologists individually 1 month later. American Shoulder and Elbow Surgery shoulder index, Quick Disabilities of Arm Shoulder and Hand Questionnaire, and Constant scores were applied to evaluate the disability and functional status. The correlation between strain ratio and functional scores were investigated. RESULTS: Of the 25 participants, 9 (36%) were men and 16 (64%) were women. The RTSE findings were pathologic in tendons of 23 patients (92%) with SIS. The strain ratio was significantly higher in the affected shoulders (P < 0.001). The interobserver agreement was good for image analysis. There was no significant correlation between strain ratio and functional scores. CONCLUSION: Structural changes in the supraspinatus tendon can be demonstrated with RTSE in patients with SIS.

Streptomyces sp. TEM 33 possesses high lipolytic activity in solid-state fermentation in comparison with submerged fermentation.

Solid-state fermentation (SSF) is a bioprocess that doesn't need an excess of free water, and it offers potential benefits for microbial cultivation for bioprocesses and product development. In comparing the antibiotic production, few detailed reports could be found with lipolytic enzyme production by Streptomycetes in SSF. Taking this knowledge into consideration, we prefer to purify Actinomycetes species as a new source for lipase production. The lipase-producing strain Streptomyces sp. TEM 33 was isolated from soil and lipase production was managed by solid-state fermentation (SSF) in comparison with submerged fermentation (SmF). Bioprocess-affecting factors like initial moisture content, incubation time, and various carbon and nitrogen additives and the other enzymes secreted into the media were optimized. Lipase activity was measured as 1.74 ± 0.0005 U/g dry substrate (gds) by the p-nitrophenylpalmitate (pNPP) method on day 6 of fermentation with 71.43% final substrate moisture content. In order to understand the metabolic priority in SSF, cellulase and xylanase activity of Streptomyces sp. TEM33 was also measured. The microorganism degrades the wheat bran to its usable form by excreting cellulases and xylanases; then it secretes the lipase that is necessary for degrading the oil in the medium.

Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis.

The objective of this study was to investigate the role of real-time sonoelastography (RTSE) in patients with lateral epicondylitis (LE) and whether it is associated with clinical parameters. Seventeen patients with unilateral LE were enrolled in the study. The healthy elbows of the participants constituted the control group. Using B-mode ultrasound, color Doppler ultrasound, and RTSE, we prospectively examined 34 common extensor tendon elbows of 17 patients. Both color scales and strain ratio were used for evaluating RTSE images. Two radiologists evaluated the RTSE images separately. Elbow pain was scored on a 100-mm visual analog scale (VAS). Symptom duration and the presence of nocturnal pain were questioned. Quick disabilities of arm shoulder and hand (DASH) Questionnaire was applied to assess the pain, function, and disability. Nottingham health profile (NHP) was used to determine and quantify perceived health problems. Both color scales and strain ratios of the affected tendon portions were significantly different from that of healthy tendons (p < 0.001). There was no significant association between NHP, VAS, Quick DASH scores, and color scales and strain ratio. Strain ratio of the medial portion of the affected tendon was significantly correlated with symptom duration (rho = -0.61 p = 0.010) and nocturnal pain (rho = 0.522 p = 0.031). Interobserver agreement was substantial for color scales (κ = 0.74, p = 0.001) and strain ratio (ICC = 0.61, p = 0.031). RTSE may facilitate differentiation between healthy and affected elbows as a feasible and practical supplementary method with substantial interobserver agreement. RTSE was superior to B-mode ultrasound and color Doppler ultrasound in discriminating tendons with LE. Strain ratio of the medial portion of the tendon is associated moderately with nocturnal pain and symptom duration. No other associations were present between RTSE findings and clinical or functional parameters.

The prognostic role of prenatal MRI volumetric assessment in fetuses with isolated ventriculomegaly.

In this prospective study, we aimed to establish the value of volumetric assessment by prenatal brain MRI in determining the prognosis of fetuses with isolated VM. A total of 23 fetuses with isolated VM were included in the study. Supratentorial cerebral parenchyma volume (PV) and ventricular volume (VV) were measured, and supratentorial ventricular/parenchymal volume (VV/PV) ratios were calculated. Pregnancy and postnatal neurodevelopmental outcomes up to two years of age were obtained and correlated with the volumetric measurements. VV was found to be strongly and positively correlated with ventricular dimension. There was a statistically significant difference between the VV/ PV ratios of the good and poor prognosis groups into which the cases had been categorized. The fetuses with a poor prognosis had a significantly higher VV/PV ratio. Volumetric parenchymal and ventricular measurements obtained by fetal brain MRI may contribute to future clinical studies concerning the evaluation of fetuses with VM and provide an important indicator in cases where management dilemmas arise.

A Hemophagocytic Lymphohistiocytosis Case with Newly Defined UNC13D (c.175G>C; p.Ala59Pro) Mutation and a Rare Complication.

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immunocompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.

Monoarticular hip involvement in pseudogout.

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout.