Peripheral and central smell regions in patients with stroke: an MRI evaluation.

OBJECTIVES: We aimed to determine how odor pathways in the stroke were affected. Measurements were performed by magnetic resonance imaging (MRI). METHODS: Cranial MRI images of 82 adult patients were included. Group 1 was consisted of 41 patients with stroke. The control group (Group 2) was consisted of 41 patients without stroke. In both groups, peripheral (OB volume and olfactory sulcus (OS) depth) and central smell areas (insular gyrus area and corpus amygdala area) were measured by MRI. RESULTS: Peripheral and central smell regions were smaller in the stroke group compared to the control group, whereas right and left side measurements were not different. There were positive correlations between measurements of the peripheral and central smell regions. In older patients with stroke, left OB volume and bilateral OS depths, bilateral insular gyrus areas and bilateral corpus amygdala areas decreased. As the duration of stroke increased, left OB volume decreased. In males with stroke, left OB volume was lower than the females with stroke. Linear regression analysis (backward) showed that in longer stroke duration, OB-volume_R increased and OB volume_L decreased. In older patients, corpus amygdala area_R decreased. In females, OB volume_L increased. CONCLUSION: Both central and peripheral odor pathways were affected, and left OB in the peripheral odor pathways was even more affected in case of longer duration of the stroke. Changes in central and peripheral olfactory pathways in patients with stroke may not be aimed at neuroplasticity and repair, but rather may be a reflection of inflammation and degenerative changes in stroke.

Changes in Peripheral Olfactory Pathways in Rheumatoid Arthritis.

OBJECTIVES: We investigated olfactory bulb (OB) volumes and olfactory sulcus (OS) depths in patients with rheumatoid arthritis (RA). METHODS: In this retrospective study, cranial magnetic resonance images of 68 adult patients were included. Group 1 consisted of 34 adult patients with RA. The control group (group 2) consisted of 34 adult patients without RA. In both groups, peripheral odor pathways (OB volumes and OS depths) were measured by magnetic resonance imaging. RESULTS: Our results showed that the OB volumes of the RA group were significantly lower than those in the control group bilaterally (P < 0.05). In each of the RA and control groups, the OS depth of the right side was found to be significantly higher than those on the left side (P < 0.05). On the left side, OS depth values of RA patients who used biological agents were significantly higher than those RA patients who did not use biological agents (P < 0.05). Correlation tests showed that there were positive correlations between OB volumes and OS depths bilaterally. In older patients with RA, bilateral OS depth values were decreased (P < 0.05). CONCLUSIONS: Our study has shown that the peripheral olfactory pathways in patients with RA can be affected to a degree that is reflected in anatomical measurements. The use of biological agents contributes to the protection of odor functions to a certain extent. The importance of evaluating the sense of smell in patients with RA clinically and radiologically should be emphasized.

Patients with rheumatoid arthritis and osteoarthritis in terms of sex hormone receptors and histopathological comparison of features.

OBJECTIVES: This study aims to investigate the relationship between estrogen receptors (ERs) and progesterone receptors (PRs) and histopathological findings in synovial tissue in rheumatoid arthritis (RA) and osteoarthritis (OA) patients. PATIENTS AND METHODS: Synovial tissue samples obtained from synovial surgery from 30 RA (10 males, 20 females) and 92 OA (27 males, 65 females) patients with median age of 59 (range, 50 to 67) years were analyzed retrospectively between January 2010 and January 2019. The relationship between histopathological features and hormone receptor presence was analyzed. RESULTS: There was a meaningful relationship between histopathological parameters and RA and OA (p=0.01). The sex hormone receptor's presence was significantly higher in females with RA (p=0.01). Additionally, in the RA group, there was a remarkable relationship between ER and focal aggregates of lymphocytes (p=0.01), perivascular infiltrates of lymphocytes (p=0.03), and diffuse infiltrates of lymphocytes (p=0.01). In the OA group, a significant relationship was observed between PR and subchondral inflammation (p=0.01). In multivariate analysis, it was observed that ER was an independent risk factor for focal aggregates of lymphocytes in RA group (odds ratio [OR]=1.51 [1.02-2.25], p=0.04). Besides, PR was found to be an independent risk factor for subchondral inflammation in OA group (OR=3.90 [1.28-11.80], p=0.02). CONCLUSION: The presence of the sex hormone receptor in the synovium may change histopathological features and affect the clinical course.

End-To-End Computerized Diagnosis of Spondylolisthesis Using Only Lumbar X-rays.

Lumbar spondylolisthesis (LS) is the anterior shift of one of the lower vertebrae about the subjacent vertebrae. There are several symptoms to define LS, and these symptoms are not detected in the early stages of LS. This leads to disease progress further without being identified. Thus, advanced treatment mechanisms are required to implement for diagnosing LS, which is crucial in terms of early diagnosis, rehabilitation, and treatment planning. Herein, a transfer learning-based CNN model is developed that uses only lumbar X-rays. The model was trained with 1922 images, and 187 images were used for validation. Later, the model was tested with 598 images. During training, the model extracts the region of interests (ROIs) via Yolov3, and then the ROIs are split into training and validation sets. Later, the ROIs are fed into the fine-tuned MobileNet CNN to accomplish the training. However, during testing, the images enter the model, and then they are classified as spondylolisthesis or normal. The end-to-end transfer learning-based CNN model reached the test accuracy of 99%, whereas the test sensitivity was 98% and the test specificity 99%. The performance results are encouraging and state that the model can be used in outpatient clinics where any experts are not present.

Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction.

OBJECTIVES: This study aims to investigate the effect of chiropractic manipulative treatment on sacroiliac joint dysfunction (SIJD) and its relationship to oxidative stress (OXS) parameters. PATIENTS AND METHODS: Thirty-three patients diagnosed with SIJD (20 males, 13 females; mean age 36.3±9.7 years; range, 18 to 60 years) and 30 healthy volunteers (20 males, 10 females; mean age 36.4±12.2 years; range, 20 to 57 years) were included in this cross-sectional, case-control study conducted between February 2017 and September 2017. Manipulation was applied to the patients once a week for a duration of four weeks. The patients were evaluated at pre-treatment and one month after treatment with visual analog scale, SIJD test, and total thiol, native thiol, disulphide, and ischemia-modified albumin (IMA) as OXS indicators. RESULTS: Prior to treatment, we demonstrated that serum native thiol (µmol/L) and total thiol (µmol/L) levels in the patient group were lower compared to control subjects (p=0.03 and p=0.02, respectively). Serum IMA levels were higher in the patient group (p=0.01). There was no change in OXS parameters after manipulative treatment in the patient group. CONCLUSION: Manipulation is useful in SIJD. Thiol/disulphide homeostasis and serum IMA levels may be used to measure the OXS in patients with SIJD.

The relationship of serum vitamin D receptor levels with disease activity and clinical parameters in patients with ankylosing spondylitis.

OBJECTIVES: The aim of this study was to investigate the relationship between serum vitamin D receptor (SVDR) levels and disease activity parameters in patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: Between July 2016 and January 2017, a total of 62 patients (51 males, 11 females; mean age 36.5±12.8 years; range, 23 to 49 years) with AS and 32 healthy volunteers (25 males, 7 females; mean age 41.57±13.6 years; range, 26 to 48 years) were included in the study. The SVDR levels were measured using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels were recorded. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were used to assess disease activity. RESULTS: Although there was no significant difference between the patient and control groups (p=0.66), SVDR levels were significantly elevated in patients with active AS (BASDAI score ≥4) (p=0.01). The SVDR levels significantly increased in AS patients with peripheral joint involvement and enthesitis (p=0.01, p=0.05, respectively). The SVDR levels significantly elevated in patients treated with non-steroidal anti- inflammatory drugs, compared to those treated with biological agents and control group (p=0.01, p=0.03, respectively). The SVDR levels were positively correlated with the BASDAI, CRP and ESR in the patient group (p=0.01, r=0.751; p=0.01, r=0.75; p=0.01, r=0.81, respectively). CONCLUSION: Our study results suggest that serum SVDR levels are associated with the disease activity and clinical parameters in patients with AS. Based on these findings, SVDR level may be used as a marker of disease activity in AS.

Evaluation of tendinosis of the long head of the biceps tendon by strain and shear wave elastography.

AIM: To investigate strain (SE) and shear wave elastography (SWE) characteristics of the long head of the biceps tendon (LHBT) tendinosis in comparison with magnetic resonance imaging (MRI) findings. MATERIAL AND METHODS: Twenty patients with a MRI diagnosis of tendinosis and twenty healthy subjects with normal LHBT in MRI were prospectively examined by SE and SWE. SE color mapping was divided into four types in accordance with elasticity designs: type I predominantly blue (hardest tissue), type II predominantly blue-green (hard tissue), type III predominantly green (intermediate tissue), type IV predominantly green-yellow-red (soft tissue). Quantitative measurements of LHBT hardness with SWE were analyzed in kilopascals (kPa). RESULTS: In the tendinosis group SE types in transverse scan were I in 24% of tendons, II in 50%, III in 25%, and in longitudinal scan I in 15%, II in 75%, and III in 10%. In the control group SE types in transversescan were II in 10% of tendons, III in 55%, IV in 35%, and in longitudinal scan II in 10%, III in 55%, and IV in 35%. SWE values in transverse scan were 38.32±7.2 kPa in the tendinosis group and 18.6±3.1 kPa in the control groupand in longitudinal scan 39.42±7.4 kPa in the tendinosis group, and 20.62±4.6 in the control group. There was a statistically significant difference in terms of elasticity patterns between the tendinosis and control groups (p<0.001). The receiver operating characteristic curve analysis was perfect and a cut-off value of tranverse 25.8 kPa and longitudinal, 24.6 kPa shear values had very high sensitivity and specificity for tendinosis. CONCLUSION: SE and SWE may be useful diagnostic tools for LHBT tendinosis when considering usability, cost effectiveness, and patient preference compared to MRI.

Evaluation of the Brachial Plexus With Shear Wave Elastography After Radiotherapy for Breast Cancer.

OBJECTIVES: The aim of this study was to analyze the elasticity characteristics of the brachial plexus by shear wave elastography (SWE) in patients receiving radiation therapy (RT) for breast cancer and to compare them with their contralateral brachial plexus to evaluate whether elasticity properties can be used as supporting findings for the early diagnosis of brachial plexus involvement in patients receiving RT. METHODS: A prospective analysis with electromyography and SWE was performed on 23 brachial plexuses of patients receiving RT for breast cancer and their contralateral brachial plexuses. An electromyographic device was used for nerve conduction studies. Evaluations were done by the same investigator, and superficial electrodes were used in the recordings. A quantitative analysis of the brachial plexus with SWE was performed, with values in kilopascals on a color scale ranging from 0 (red, soft) to 150 (dark blue, hard) kPa. RESULTS: Mean SWE values ± SD were 51.0 ± 14.0 kPa for the ipsilateral brachial plexuses of patients receiving RT and 18.0 ± 4.2 kPa for the contralateral brachial plexuses. Statistically significant differences were observed between the groups in the analysis of SWE values (P < .001). No significant correlation was found between the nerve conduction parameters and elastographic values (P > .05). CONCLUSIONS: Shear wave elastography showed that the brachial plexuses of patients receiving RT were stiffer than the unaffected brachial plexuses. Brachial plexus stiffening may be associated with fibrotic processes.