Cardiothoracic ratio and left ventricular ejection fraction relationship: A meta-analysis study.

OBJECTIVES: To determine the overall effect size, identify the study with the strongest effect size, and examine the age group with the strongest relationships between the variables. METHODS: In this study, a meta-analytical analysis was carried out by bringing together 13 studies from around the world examining the statistical relationships between cardiothoracic ratio (CTR) and left ventricular ejection fraction (LVEF). Thus, it is hoped that the results will contribute to studies on the relationships between CTR and LVEF and bring a holistic view to these relationships. To determine CTR, studies were identified through a review of the literature, and those that reported a correlation between the variables under investigation were included in the analysis process. The date range of this study 01.11.2022-15.01.2023. RESULTS: According to the findings, when all the results were analysed together, the mean effect size for CTR and LVEF correlation was found to be r=-0.12. When all studies were considered separately, generally small negative correlations were observed between CTR and LVEF. It is possible to say that there is no publication bias in the studies. CONCLUSION: This study is a meta-analytic study combining 13 studies examining the statistical relationships between CTR and LVEF. The results of this study are expected to make a valuable contribution to the field of research on the relationship between CTR and LVEF, providing a more comprehensive understanding of these associations. PROSPERO Reg. No.: 392207.

Comparative effects of radial and focused extracorporeal shock wave therapies in coccydynia.

Objectives: This study was conducted to compare the effects of radial and focused extracorporeal shock wave therapy (ESWT) in patients with coccydynia. Patients and methods: In this prospective randomized double-blind study conducted between March 2021 and October 2021, 60 patients with coccydynia (50 males, 10 females; mean age: 35.9±12.0 years, range 18 to 65 years) were randomized into three groups (n=20) according to different wave types of ESWT: focused, radial, and sham. The Visual Analog Scale (VAS) was used for pain assessment, and the Oswestry Disability Index (ODI) was used for functional assessment in all patients before the treatment (baseline), after the completion of four sessions of treatment (fourth week), one month after the end of the treatment (eighth week), and three months after the end of the treatment (16th week). Results: The mean body mass index of the participants was 26.2±3.0. Compared to baseline, the VAS scores at four weeks were reduced only in the radial ESWT group (p<0.05). Compared to baseline, the VAS and ODI scores at eight and 16 weeks were significantly reduced in both the focused and radial ESWT groups (p<0.05 for all). The radial ESWT group was significantly superior to the focused ESWT group in the comparisons between the groups at four weeks in the VAS values and at 16 weeks in the ODI scores (p<0.05 for all). Conclusion: Radial and focused ESWT are both effective in treating coccydynia compared to sham ESWT. However, radial ESWT may be more effective in the treatment of coccydynia.

Evaluation of the relationship between abdominal fat distribution and osteoporotic vertebral compression fracture with MRI.

OBJECTIVE: This study was carried out to investigate the effects of abdominal subcutaneous adiposity and visceral adiposity on osteoporotic compression fractures. MATERIAL AND METHODS: The study group consisted of a total of 152 individuals aged 50-80 years; 76 were included in the vertebral fracture group and 76 in the healthy control group, whose bone mineral density was calculated. In order to determine the distribution of abdominal fat in both groups, four different measurements, i.e., sagittal abdominal diameter (SAD), abdominal diameter (AD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST), were made using lumbar magnetic resonance imaging (MRI). The visceral fat ratio (VFR) was also calculated based on these measurements. RESULTS: There was a significant difference between the patient and control groups in VST and DST values, both when gender distribution was and was not taken into account (p < 0.006 for all cases). There was no significant difference between the patient and control groups in SAD and AS values, both when only female patients were considered, and gender distribution was not taken into account (p > 0.25 for all cases). On the other hand, in the analysis, when only male patients were considered, the SAD and AD values of the patient group were found to be significantly lower than those of the control group (p = 0.046 and p = 0.048, respectively). CONCLUSION: In conclusion, the study findings indicated that high SAD values in the male gender and high VST and DST values in both genders were associated with low lumbar vertebral fracture risk.

Evaluation of the Differences in the MRI Findings Related to Primary and Secondary Adhesive Capsulitis.

Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6 mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.

Residual Dizziness in Elderly Patients after Benign Paroxysmal Positional Vertigo.

INTRODUCTION: The aim of this study was to compare the effects of Brandt-Daroff (BD) exercise and shopping exercise (SE) on the resolution of residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) following a successful modified Epley canalith repositioning maneuver (CRP). METHODS: This single-blind, randomized clinical trial included patients with posterior semicircular canal type of BPPV. Following the modified Epley maneuver, patients that experienced RD were randomly assigned to 3 groups: (i) BD, (ii) SE, and (iii) control groups. Primary outcomes were quantified using the Dizziness Handicap Inventory (DHI). RESULTS: Following CRP, 240 (63%) participants experienced RD. All these patients were followed up weekly for RD. After the resolution of RD, patients were followed up monthly for recurrence. Mean time to recovery was 16.4 ± 10 (range, 5-49) days in the BD group, 11.5 ± 4.6 (range, 6-32) days in the SE group, and 23.4 ± 16.8 (range, 6-89) days in the control group. The SE group recovered significantly faster than the BD and control groups (p < 0.001). Baseline emotional DHI (E-DHI) scores were significantly correlated with the duration of pre-CRP symptoms (p < 0.001). Correlation analysis indicated that patients with obesity and diabetes mellitus (DM) recovered later than patients without these comorbidities. CONCLUSION: We found that RD improved significantly in the SE group compared to the BD and control groups. Additionally, a significant relationship was established between RD and high anxiety levels and DM, and obesity had a negative impact on the resolution of RD.

Morphometric and volumetric analysis of the cervical spinal cord and vertebral canal using computed tomography images in normal Van cats.

This study was performed on Van cats to determine the volumetric, morphometric and surface area measurement values of their cervical spinal cords (SC) and vertebral canals (CC) and the ratios between their dimensions using computed tomography (CT) images. The study also aims to reveal any biometric differences in these values between the two sexes. Spinal cord and vertebral canal CT images of 16 healthy adult Van cats (8 males and 8 females) were used in the study. First, three measurement points were selected for each vertebra on their cranial, medial and caudal sections along the sagittal axis. Next, the morphometric values were obtained using the transversal images of these measurement points. The surface areas for the SC and CC were calculated using the stereological planimetry method. The Cavalieri's principle was then used to calculate the relevant anatomic structure volumes. The obtained values were then statistically analysed. SC and CC were found to be larger in males in general, while 'SC cranial/CC cranial' and 'SC medial/CC medial' dimensions and volume ratios were found to be larger in female cats on average. Bodyweight and age values were found to have a negative correlation with SC and CC ratio, but the correlation was statistically insignificant. All SC and CC surface area and volume measurements were found to be higher in male cats (p < .05). We believe the results obtained by this study will provide valuable insight into veterinary clinicians in evaluating pathological lesions in the cervical spinal cord and vertebral canal CT scans.

Combined treatment of sinapic acid and ellagic acid attenuates hyperglycemia in streptozotocin-induced diabetic rats.

In the present study, we aimed to investigate the effect of individual and combined treatment of sinapic acid (SA) and ellagic acid (EA) in streptozotocin (STZ)-induced diabetic rats. Rats were divided into eight groups (n = 7): Normal Control, Diabetic Control, Diabetic + Sinapic Acid, Diabetic + Ellagic Acid, Diabetic + Sinapic Acid + Ellagic Acid, Sinapic Acid, Ellagic Acid and Sinapic Acid + Ellagic Acid. Diabetic groups were injected with a single dose of 50 mg/kg STZ intraperitoneally. Rats received 20 mg/kg/day SA and 50 mg/kg/day EA intragastrically for 28 days. The numerical density of immunopositive ß-cells and volume density of pancreatic islets were calculated. Additionally, glucose and insulin levels in serum, MDA, GSH, and CAT levels of pancreatic tissue were measured. While serum glucose levels increased, serum insulin levels decreased in STZ-induced diabetic rats. But these changes in glucose and insulin were restored by individual and combined treatments of SA and EA. Also, individual and combined treatments of SA and EA increased insulin expression of ß-cells in STZ-induced diabetic rats. Moreover, these compounds improved deteriorating oxidative stress parameters in STZ-induced diabetic rats. Our study indicates that SA and EA, especially their combined treatments, can be used as an antihyperglycemic agent in diabetes.

Relationship Between Proliferative Breast Lesions and Breast Cancer Risk Factors.

OBJECTIVE: The prognosis of breast cancer (BC) is determined directly based on the stage of disease at the time of diagnosis. Proliferative breast lesions (PBLs) are an important risk factor for BC development. The risk of developing BC varies according to the presence of extent of proliferation in the breast lesions. We aimed to investigate the effect of BC risk factors on the PBLs in this study. MATERIALS AND METHODS: Patients who visited the surgical clinic of the university during the past 6 years who presented with PBLs with or without atypia by fine/core needle aspiration biopsy were included in this study. The relationship between PBLs and BC risk factors such as the age, mass size, Body Mass index (BMI), smoking, sports activity, BC family history, the use of hormone replacement therapy, number of pregnancies, and the duration of breastfeeding were compared. RESULTS: A total of 74 (96.1%) of all patients were women and three were men. The median age of the patients was 38 (range: 19-74) years; the cut-off value of age was 35.5 years. The mean age of patients with PBL-with atypia (PBL-WA) was higher (p=0.005) in the malignant group based on the final pathology and radiological imaging features (for both, p<0.001). The mean size of the mass was large at 2.53±1.33 (1-6) cm; and the cut-off value of the tumor size was 2.5 cm. The mean size was greater in the PBL-WA patients (p=0.171) in the malignant group based on the final pathology and radiological characteristic (respectively, p=0.004 and p=0.016). The mean BMI was 26.8±4.4 kg/m2 (18.8-35.1) and the cut-off value was 25.4 kg/m2. BMI was greater in the PBL-WA group and in the malignant group based on the final pathology (respectively, p=0.002 and p=0.001). Smoking was positive in 66.2% (n=51) of the patients, and it was high in the PBL-WA patients (p=0.001). The percentage of patients with no sports activity was 63.6% (n=49), while it was 20.8% (n=16) for those with once a week sports activity and 15.6% (n=12) for those with twice a week activity. There was family history of BC in 16.9% (n=13) of all patients. The number of positive cases of family history of BC was greater in the malignant group (p=0.001). Hormone replacement therapy was recorded in 11.7% (n=9) of the patients. The mean numbers of pregnancies (2.1±2.4) and breastfeeding duration (32.5±37.4 months) were low in the benign groups due to the relatively lower average age of the patients. CONCLUSION: Based on our analysis, age is an extremely important aspect for assessing PBLs. The age of the patient was statistically significantly greater in the patients with malignant lesions in all groups. The factors lesion size, BMI, smoking habit, and BC family history were also more frequent in the malignant groups. The rate of sports activity was lower in the malignant groups. Thus, it is necessary to evaluate patients individually when evaluating PBLs. It is recommended to evaluate PBLs together with BC risk factors for the better understanding.

Evaluation of the effects of different treatment modalities on angiogenesis in heart failure patients with reduced/mid-range ejection fraction via VEGF and sVEGFR-1.

OBJECTIVES: To investigate the clinical significance of VEGF, sVEGFR-1 in heart failure reduced ejection fraction (HFrEF) and heart failure mid-range ejection fraction (HFmrEF) patients. Methods: A total of 104 people consisting of HFrEF and HFmrEF patients (n=54) and healthy (n=50) subjects were included in this comparative cross-sectional study. The study took place in Gulhane Training and Research Hospital, Ankara, Turkey, between  2011 and 2013. Serum VEGF, sVEGFR-1, plasma pro-BNP analysis and transthoracic echocardiography were performed.  Results: The average sVEGFR-1 level of the HFrEF and HFmrEF patients was significantly higher than the control group (0.185±0.122; 0.141±0.120; p=0.013). The average sVEGFR-1 level of the HFrEF and HFmrEF patients using beta-blocker was significantly higher than the HFrEF and HFmrEF patients not using it (p=0.015). There was a significant and positive correlation between sVEGFR-1 and N-terminal pro-brain natriuretic peptide (pro-BNP)  levels in the group with HF (r=0.211, p=0.044). Conclusion: It increases awareness about the role of sVEGFR-1 in HFrEF anf HFmrEF patients and the need for further studies. Beta-blocker may have a negative effect on angiogenesis in HFrEF and HFmrEF via increasing sVEGFR-1 levels. Additionally, Pro-BNP may contribute to inhibiting angiogenesis by increasing sVEGFR-1 levels and sVEGFR-1 may be an important biomarker in HFrEF and HFmrEF.

Is Maternal Blood Procalcitonin Level a Reliable Predictor for Early Onset Neonatal Sepsis in Preterm Premature Rupture of Membranes?

BACKGROUND: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies. METHODS: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted. RESULTS: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV. CONCLUSION: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS.

Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography.

AIM: The aim of this research was to study and compare placental elasticity with acoustic radiation force impulse (ARFI) elastography in pre-eclamptic and normal pregnancies. METHODS: A total of 107 singleton pregnancies in the third trimester (38 healthy control subjects, 34 patients with gestational hypertension, and 35 pre-eclampsia patients) were included in the study. ARFI elastography was used to determine the placental elasticity in the three predetermined regions of the placenta (the fetal edge, maternal edge, and central part of the placenta). The obstetrical data regarding grayscale and Doppler ultrasonography and perinatal outcomes were reviewed. A mean placental shear wave velocity cut-off value that predicts the presence of pre-eclampsia was determined. RESULTS: The shear wave elasticity values in the pre-eclampsia group in all three regions were significantly higher than in the gestational hypertension and healthy control groups (P = 0.001). The most significant difference was found in the peripheral edge of the placenta from the fetal surface in the pre-eclampsia group (P = 0.001). CONCLUSION: The stiffness of the placenta determined by the ARFI technique is significantly higher in pre-eclampsia patients. ARFI elastography of the placenta might be used as a non-invasive and easy method in the diagnosis and evaluation of pre-eclampsia as a supplement to the already existing methods.

Removal of epulis fissuratum by Er,Cr:YSGG laser in comparison with the conventional method.

OBJECTIVE: The present study aimed to compare clinical outcomes during the recovery period after soft tissue surgery performed by an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with those after surgery with the conventional method, in which a scalpel was used. METHODS: A total of 44 epulis fissuratum removal surgeries were performed in 30 healthy volunteers using either an Er,Cr:YSGG laser (laser group) or a scalpel (conventional group), with the same number of lesions in each group. Both groups were controlled postoperatively on days 2, 7, 14, and 30. The visual analog scale (VAS) pain scores of the patients and healing, erythema, and suppuration in the surgical area were recorded with scores between 0 and 3. Total wound surface was measured by a ruler according to the Bates-Jensen Wound Assessment Tool. RESULTS: The results of the present study demonstrated that there were no significant differences between the conventional group using analgesic and the laser group in terms of the VAS scores (p = 0.744) and edema (p = 0.206). Evaluation of wound surface revealed healing without any problem as of the 2nd day at a rate of 82% in the laser group and 59% in the conventional group. CONCLUSIONS: In conclusion, Er,Cr:YSGG laser was superior to scalpel regarding clinical outcomes, and led to a difference in the use of analgesic and local anesthetic.