Prospective Assessment of Glucocorticoid Toxicity in Rheumatology Practice: A Focus on the Glucocorticoid Toxicity Index.

OBJECTIVE: The glucocorticoid toxicity index (GTI) is developed to measure glucocorticoid (GC)-related morbidity over time. This study aimed to assess GC-toxicity in patients at a rheumatology outpatient clinic by using the GTI and to identify the factors that interfere with the GTI. METHODS: This prospective study included patients with inflammatory arthritis (IA), connective tissue disease, and vasculitis who were newly prescribed GC-treatment (GC-naive) or have been still on GC-treatment for ≤2 years (GC-experienced). Patient demographics and disease characteristics, aggregate improvement score (GTI-AIS), cumulative worsening score (GTI-CWS), and cumulative GC-doses were recorded at baseline, 3rd month, and 6th month. Generalized estimating equations (GEE) were used to evaluate the GTI scores and associated factors including cumulative GC-doses. RESULTS: The study included 156 (48.7% GC-naive) patients with a mean age of 49.1 ± 17.1 years. More than half of the patients in both groups had a diagnosis of vasculitis. A higher cumulative GC-dose was found to be associated with higher GTI-scores in both groups (p< 0.001). In the GC-naive group, patients with vasculitis showed higher GTI-scores than IA patients (p< 0.001); there was also a significant increase in the GTI-CWS at the 6th month compared with the 3rd month. In the GC-experienced group, GTI-AIS and GTI-CWS were significantly different at 3rd and 6th month (p< 0.05). CONCLUSION: It was shown that GTI scores were associated with cumulative GC-doses and vasculitis patients in the GC-naive patients had higher GTI scores than inflammatory arthritis. The GTI allows individualized assessment and management of adverse effects experienced by patients as a result of GC treatment.

Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke.

INTRODUCTION: Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment. METHODS: Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods. RESULTS: The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions. CONCLUSIONS: We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices.

Biomarker detection using corrected degree of domesticity in hybrid social network feature selection for improving classifier performance.

BACKGROUND: Dimension reduction, especially feature selection, is an important step in improving classification performance for high-dimensional data. Particularly in cancer research, when reducing the number of features, i.e., genes, it is important to select the most informative features/potential biomarkers that could affect the diagnostic accuracy. Therefore, researchers continuously try to explore more efficient ways to reduce the large number of features/genes to a small but informative subset before the classification task. Hybrid methods have been extensively investigated for this purpose, and research to find the optimal approach is ongoing. Social network analysis is used as a part of a hybrid method, although there are several issues that have arisen when using social network tools, such as using a single environment for computing, constructing an adjacency matrix or computing network measures. Therefore, in our study, we apply a hybrid feature selection method consisting of several machine learning algorithms in addition to social network analysis with our proposed network metric, called the corrected degree of domesticity, in a single environment, R, to improve the support vector machine classifier's performance. In addition, we evaluate and compare the performances of several combinations used in the different steps of the method with a simulation experiment. RESULTS: The proposed method improves the classifier's performance compared to using the whole feature set in all the cases we investigate. Additionally, in terms of the area under the receiver operating characteristic (ROC) curve, our approach improves classification performance compared to several approaches in the literature. CONCLUSION: When using the corrected degree of domesticity as a network degree centrality measure, it is important to use our correction to compare nodes/features with no connection outside of their community since it provides a more accurate ranking among the features. Due to the nature of the hybrid method, which includes social network analysis, it is necessary to investigate possible combinations to provide an optimal solution for the microarray data used in the research.

Fit of High-Translucency Zirconia Fixed Dental Prostheses Using Two Different Intraoral Scanners.

PURPOSE: To assess the marginal and internal fit of monolithic zirconia fixed dental prostheses (FDPs) comparing two different intraoral scanners (IOSs) and assessment methods. MATERIALS AND METHODS: A maxillary typodont with three prepared teeth allowed fabrication of five-unit high-translucency monolithic zirconia FDPs. The typodont was scanned with two IOSs: Cerec Omnicam and 3Shape TRIOS 3. In total, 30 FDPs were milled from presintered high-translucency zirconia blocks. Dual-scan and silicone replica assessments were used to determine marginal and internal gaps. RESULTS: A statistical significance was observed for marginal gaps (3Shape [74.27 ± 10.4 µm] and Cerec [86.45 ± 14.3 µm]) and for internal gaps (3Shape [126.12 ± 12.7 µm] and Cerec [112.38 ± 17.2 µm]). CONCLUSIONS: The outcomes of this study showed that the 3Shape TRIOS 3 produced a better overall marginal fit, while the Cerec Omnicam created a better internal fit. Additionally, a greater overall marginal and internal gap was noted with the silicone replica method over the dual-scan method.

Do cervical stabilization exercises change the effects of conventional exercises in patients with Parkinson's disease?

OBJECTIVES: The aim of this study was to examine whether cervical stabilization exercises (CSEs) change the effects of conventional exercises (CEs) in patients with PD. METHODS: Twenty-five patients with PD were randomized into two groups. While the experimental group (EG) received CSEs in addition to CEs, the control group (CG) received only CEs. Both programs lasted 8 weeks. Eighteen participants were able to complete the study. The outcomes were the changes in posture, cervical joint position sense (JPS), balance assessment, 10-m walking tests (10MWT), and the Timed Up & Go (TUG) test. RESULTS: At the end of the study, significant improvement was observed in both groups in terms of trunk rotation angle and pelvic asymmetry, the time parameter of TUG, and the 10MWT (p < 0.05). In the EG, greater improvement was detected in the Berg Balance Scale, static posturography, postural alignment, JPS, and the cadence parameter of TUG (p < 0.05). DISCUSSION: CEs and CSEs could improve walking speed and posture in patients with PD, but if CSEs are added to CEs, greater improvements could be achieved in JPS and postural control.(Clinical Trials ID: NCT03854747).

Early Postoperative Adjuvant Radiotherapy Versus Active Monitoring After Gross Total Resection for Atypical Meningiomas: Factors Associated with Early Recurrence.

AIM: To investigate the predictors of recurrence after gross total resection (GTR) that require early adjuvant radiotherapy upfront rather than at initial recurrence of atypical meningiomas (AMs). MATERIAL AND METHODS: A retrospective study of gross totally resected AMs was conducted in a tertiary care center within ten years. The clinical, radiological, and pathological parameters were analyzed statistically, and the factors associated with recurrence after GTR were determined with univariate analysis. RESULTS: Among 23 AMs with GTR, 34.8% showed recurrence in a median follow-up of 40 months after the surgery. Preoperative tumor volume, tumor location in the skull base or tentorium, and lack of progesterone expression were associated with the higher recurrence rate. AMs with a preoperative volume of 27.5 cm³ were the most significant risk factor for the recurrence (a 9.3-fold increase) than those with < 27.5 cm < sup > 3 < /sup > (66.7% vs. 14.3%, respectively). CONCLUSION: Patients diagnosed with larger AMs ( > 27.5 cm < sup > 3 < /sup > ) might have higher recurrence rates after GTR and, therefore, would benefit from early adjuvant radiotherapy without waiting for a recurrence. AMs located in the skull base or tentorium and AMs having no progesterone expression might also be potential predictors for recurrence.

Effects of Two Exercise Regimes on Patients with Chiari Malformation Type 1: a Randomized Controlled Trial.

This study aims to measure the effects of two different exercise programs on neck pain, proprioception, balance, coordination, posture, and quality of life in patients with Chiari malformation (CM) type 1. Sixteen patients were randomized to two different exercise programs: a tailored exercise protocol for CM (TEP-CM) and cervical spinal stabilization exercises (CSSE). Both exercise programs were implemented by a physiotherapist 3 days a week for 6 weeks. The primary outcome was Neck Disability Index. Secondary outcomes were visual analogue scale for pain, joint position sense error measurement, Berg Balance Scale, Time Up and Go Test, International Coordination Ataxia Rating Scale, PostureScreen Mobile, and Short Form-36. Assessments were done immediately before and after the intervention programs. Both groups showed significant improvement in Neck Disability Index, and some secondary outcome measures (P < 0.05). However, there were no statistical differences in post-intervention changes between the groups (P > 0.05). This is the first study to examine the effects of different exercise programs on symptoms in patients with CM type 1. Our preliminary findings indicate that exercise programs can improve pain, balance, proprioception, posture, coordination, and quality of life in CM type 1. Therefore, exercise should be considered safe, beneficial, and low-cost treatment option for CM type 1 patients without surgical indications.

Assessment of Mucosa-Associated Epithelial Chemokine, Thymus-Expressed Chemokine, Periostin and Zonulin Levels in Infants With Atopic Dermatitis.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease. Skin and gut are the organs that first encounter antigens and environmental triggers. The mechanisms behind the relation between skin and gut immune responses in AD have not been identified yet. Aims and Objectives: To investigate mucosa-associated epithelial chemokine (MEC/CCL28), thymus-expressed chemokine (TECK/CCL25), periostin and zonulin levels in infants with AD. Materials and Methods: Children under one year old participated in the study. We used a propensity matching score. We included 39 infants who had active AD lesions at the time of evaluation. Serum MEC/CCL28, TECK/CCL25, periostin and zonulin levels were measured. Results: We examined age and sex matched 39 infants with AD and 39 healthy infants. Median value of zonulin was lower in infants with AD [49.2 (27.1-71.8) ng/mL] compared to healthy controls [58.5 (27.3-80.8) ng/mL] (P < 0.001). Infants with zonulin levels ≤55.15 ng/mL had 11.64 times more risk of developing AD than the infants with zonulin levels >55.15 ng/mL. Infants whose MEC/CCL28 levels were ≥8.3 ng/mL had 5.83 times more risk of developing AD than the infants with MEC levels <8.3 ng/mL. Duration of AD and SCORAD index score did not show correlation with MEC/CCL28, TECK/CCL25, periostin and zonulin levels. Conclusion: Low zonulin levels and high MEC/CCL28 levels in infants may show an increased association with AD.

Cephalometric Mandibular Dimensions in Growing Turkish Children: Trends of Change, Sex-Specific Differences, and Comparisons with Published Norms.

OBJECTIVE: The aims of this study were to investigate cephalometric mandibular dimensions in growing Anatolian Turkish children and to identify the periods of rapid growth for boys and girls. Furthermore, the secondary aim was to compare obtained values with published standards in the literature. METHODS: A total of 528 pretreatment lateral cephalometric radiographs, grouped according to age and sex, were analyzed. Effective mandibular length, ramus height, and corpus lengths were comparatively evaluated within age groups for boys and girls and between sexes for the same age group. Data acquired from this study were compared with American, Canadian, Chinese, and European norms. Growth curves for mandible were constructed for each sex group. RESULTS: Effective mandibular length was almost always significantly longer in boys, except for 9- and 12-year-age groups. Effective mandibular length in girls increased significantly between ages 8 and 10, 10 and 12, and 11 and 13 years, while in boys between ages 8 and 10, 9 and 11, and 13 and 15 years. Turkish girls had significantly shorter effective mandibular lengths than American girls at age 14. No significant difference was found between Turkish and Chinese girls and boys. Turkish girls and boys had significantly shorter corpus lengths from their Norwegian counterparts at age 12. CONCLUSION: Except for 9- and 12-year-age groups, effective mandibular length was almost always significantly longer in boys compared to the girls. It is suggested to use norm values from more recently conducted studies and which are representative of the studied population. Growth curves can be used to predict the approximate mandibular dimensions at a particular age.

Intensive physiotherapy versus home-based exercise and custom-made orthotic insoles in patients with plantar fasciitis: Pilot study.

BACKGROUND: This prospective pilot study assessed the feasibility of comparing intensive physiotherapy group (IPG), home-based exercise (HBEG) group, and insole group (IG) to find the most effective treatment program for plantar fasciitis. METHODS: Thirty-nine individuals with plantar fasciitis were selected to participate in this pilot study. The patients were randomly divided into 3 groups, as IPG (manual interventions, exercise, insoles), HBEG (exercise, insoles), and IG (insoles). The feasibility details including percentage of the enrollment and adherence to the groups were recorded. Pain was measured with a visual analog scale, and dorsiflexion range of motion (DROM), foot function, and health-related quality of life were evaluated at the baseline and week 6. One-way ANOVA analysis and Kruskal Wallis test were used to determine the differences of the percentage change of the parameters. RESULTS: Pain and functional evaluation results showed improvements clinically in all of groups and quality of life results were similar for all groups. There was no difference between the groups after 6 weeks of treatment (P > 0.05). CONCLUSIONS: The 3 treatment programs were found clinically applicable with high patient adherence. According to the data all intervention types were found moderately effective for pain and function. Insoles could be an option applied alone or with other treatments, and manual techniques gave better results in patients with limited ankle dorsiflexion. Although the results should be interpreted with caution because of the small sample size, these results were found promising and feasible to conduct a future RCT. CLINICAL TRIAL REGISTRATION NUMBER: RCT 06144834.

Assessment of dental anxiety levels among dental emergency patients during the COVID­19 pandemic through the Modified Dental Anxiety Scale.

BACKGROUND: Coronavirus disease 2019 (COVID­19) continues to affect dental emergency services worldwide. Dental anxiety (DA) is described as a common and distressing problem in terms of oral health maintenance. OBJECTIVES: The present study aimed to evaluate DA levels as well as the COVID­19 fear and perception of control (COVID­19 FPC) in patients attending dental emergency clinics during the COVID­19 pandemic. MATERIAL AND METHODS: Sociodemographic, dental and medical data was obtained from the participants. A face-to-face questionnaire with questions referring to the reasons for the emergency dental visit, the visual pain scale, the Modified Dental Anxiety Scale (MDAS), and the COVID­19 Fear and Perception of Control Scale (COVID­19 FPCS) as well as additional questions concerning bruxism and a previous diagnosis of anxiety/panic attacks or depression was administered. The χ2 test was used to analyze the data. RESULTS: A total of 1,439 patients were included in the study. The most common reason for the dental visit was pain (47.5%). The prevalence of DA was 5.1% (74/1,439). A significant association was found between DA and gender (p = 0.020). The incidence of severe pain was higher in patients with DA than in those without DA (p = 0.002). No significant differences in the MDAS scores were found between patients with and without a chronic disease (p = 0.804), with regard to the educational status (p = 0.364), or between the age groups (p = 0.600). The prevalence of a 'strongly agree' response to all questions in COVID­19 FPCS was higher in patients with DA as compared to those without DA. CONCLUSIONS: Females and patients with severe pain were more likely to exhibit DA. In general, patients with DA strongly agreed with the statements of COVID­19 FPCS, which may indicate a correlation between the 2 scales.

The musculoskeletal problems and psychosocial status of teachers giving online education during the COVID-19 pandemic and preventive telerehabilitation for musculoskeletal problems.

BACKGROUND: Musculoskeletal and psychosocial problems have tended to increase during the COVID-19 pandemic. OBJECTIVE: To evaluate the changes in musculoskeletal problems and psychosocial status of teachers during the COVID-19 pandemic due to online education and to investigate the effects of preventive telerehabilitation applications for musculoskeletal problems. METHODS: Forty teachers who conducted online education during the pandemic volunteered to participate in the study. All assessments were performed via online methods. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), ProFitMap-Neck questionnaire, Oswestry Disability Index (ODI), and Upper Extremity Functional Index (UEFI) were used to evaluate musculoskeletal problems; the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to evaluate anxiety and depression, respectively; and the Work-Life Balance Scale (WLBS) was used to evaluate how well individuals achieve this balance. Information about before online education, during online education, and after training was obtained with the assessments. After the first assessment, telerehabilitation, which involved presentations and brochures, was applied to 18 participants willing to participate in the training. RESULTS: The ProFitMap, UEFI, and WLBS scores during the online education decreased significantly, while the scores of the CMDQ, ODI, BDI, and BAI during the online education increased significantly compared to the pre-online education scores (p < 0.05). In addition, the total CMDQ, ProFitMap, and ODI scores improved significantly after the training (p < 0.05). CONCLUSION: Musculoskeletal and psychosocial problems increased in teachers during online education. Preventive telerehabilitation methods will be beneficial for individuals who do not have access to face-to-face physiotherapy.

Added Value of CT Pelvic Bone Unfolding Software to Radiologist Performance in Detecting Osteoblastic Pelvic Bone Lesions in Patients With Prostate Cancer.

PURPOSE: To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer. METHODS: A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package "CT Bone Unfolding." Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference. RESULTS: In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method (P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy (P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold (P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936). CONCLUSIONS: The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

A novel technique for prediction of preterm birth: fetal nasal flow Doppler.

OBJECTIVES: Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. METHODS: This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). RESULTS: Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24 h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48 h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24 h (0.98±0.2 vs. 1.25±0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) <1.25 detects 94.6% of patients who will eventually deliver in the first 24 h after admission. CONCLUSIONS: Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.

Use of the 50-g glucose challenge test to predict small-for-gestational-age neonates.

BACKGROUND: To determine a cutoff value for the 50-g glucose challenge test (50-g GCT) for the prediction of small-for-gestational-age (SGA) neonates. METHODS: This retrospective cohort study was conducted among pregnant women who were screened with the 50-g GCT at Hacettepe University Hospital between 1 January 2016 and 31 March 2019. Patients with 50-g GCT values <74 mg/dL (<10th percentile) served as the study group (n = 244), while patients with 50-g GCT values between 74 to 139 mg/dL served as the control group (n = 3104). Groups were compared in terms of demographic features, clinical characteristics, and obstetric outcomes. Logistic regression analysis was used to determine independent predictors of SGA. Receiver operating characteristic curves were used to assess the performance of 50-g GCT values in predicting SGA. RESULTS: Lower birthweight, birthweight percentile, and 5th-minute Apgar values, together with higher rates of SGA, were observed in the study group (P < .001 for all). A 50-g GCT value below the 10th percentile (odds ratio: 3.29, 95% CI: 2.31-4.69, P < .001) was a significant independent factor for SGA. A cutoff value of 89.5 mg/dL (84.9% sensitivity, 85.6% specificity) was determined for SGA. CONCLUSIONS: Low 50-g GCT values (<89.5 mg/dL) may be an early indicator for SGA.

Possible impact of immunosuppressive therapy regimens on histopathologic outcomes of abnormal uterine bleeding in solid-organ transplant recipients.

BACKGROUND: In this study, we aimed to determine the frequency of histopathologic outcomes of solid-organ transplantation in women with abnormal uterine bleeding (AUB) receiving immunosuppressive therapies. METHODS: This is a retrospective study including a single-center experience. Data were extracted from hospital records, and solid-organ transplant recipients who were diagnosed with AUB were included. RESULTS: Fifty-five of these patients were renal transplant recipients (79.7%), and 14 were liver transplant recipients (20.3%). Histopathologic examination showed various histopathologic patterns of endometrium in patients with AUB consisting of normal histopathologic findings of endometrium in 31 patients (48.4%); 29 hormonal imbalance during proliferative and secretory phases of menstrual cycle and two atrophic endometrium. Endometrial hyperplasia without atypia was observed in 11 patients (17.2%). Polyp was seen in 22 patients (34.4%); 21 endometrial polyp and one endocervical polyp. There were significant differences in terms of histopathologic findings among the three groups of patients according to different immunosuppressive regimens (P = .029). There was no endometrial hyperplasia in women receiving sirolimus-based immunosuppressive regimens. Moreover, there was no endometrial hyperplasia in the liver transplant recipient group. CONCLUSIONS: Sirolimus-based immunosuppressive regimens may be administered to patients who have risk factors for endometrial precancerous lesions, such as endometrial hyperplasia. However, additional well-designed, large-scale studies are warranted to confirm our findings.