An enzyme-free technique enables the isolation of a large number of adipose-derived stem cells at the bedside.

Adipose tissue derived stromal cells (ADSCs) play a crucial role in research and applications of regenerative medicine because they can be rapidly isolated in high quantities. Nonetheless, their purity, pluripotency, differentiation capacity, and stem cell marker expression might vary greatly depending on technique and tools used for extraction and harvesting. There are two methods described in the literature for isolating regenerative cells from adipose tissue. The first technique is enzymatic digestion, which utilizes many enzymes to remove stem cells from the tissue they reside in. The second method involves separating the concentrated adipose tissue using non-enzymatic, mechanical separation methods. ADSCs are isolated from the stromal-vascular fraction (SVF) of processed lipoaspirate, which is the lipoaspirate's aqueous portion. The purpose of this work was to evaluate a unique device 'microlyzer' for generating SVF from adipose tissue using a mechanical technique that required minimal intervention. The Microlyzer was examined using tissue samples from ten different patients. The cells that were retrieved were characterized in terms of their cell survival, phenotype, proliferation capacity, and differentiation potential. The number of progenitor cells extracted only from the microlyzed tissue was in comparable amount to the number of progenitor cells acquired by the gold standard enzymatic approach. The cells that were collected from each group exhibit similar levels of viability as well as proliferation rates. In addition, the differentiation potentials of the cells derived from the microlyzed tissue were investigated, and it was discovered that cells isolated through microlyzer entered the differentiation pathways more quickly and displayed a greater level of marker gene expression than cells isolated by enzymatic methods. These findings suggest that microlyzer, particularly in regeneration investigations, will allow quick and high rate cell separation at the bedside.

De Novo Malignancies After Kidney Transplant: Where Do We Stand and Does the Head and Neck Region Require More Caution?

OBJECTIVES: The aim of this study was to investigate the characteristics of de novo malignancies arising in kidney transplant recipients followed in a tertiary hospital in Turkey and to examine the tumors in the head and neck region as a subgroup. MATERIALS AND METHODS: Data from kidney transplant recipients treated at our institution between January 2010 and July 2022 were retrospectively analyzed in this single-center study. Data regarding malignancies were noted according to the pathologists' reports. In situ malignancies and those arising after graft loss were not evaluated. RESULTS: The study population comprised 231 patients (165 men; 71.4%) with a median follow-up of 11 years (2853 patient-years). The recipients had a higher cancer risk than the general population (standardized incidence rate = 3.04; 95% CI, 1.82-4.26). Thirty de novo malignant tumors were detected in 24 patients (10.4%). The mean age at diagnosis of cancer was 54.88 ± 11.44 years. The median time from transplant to cancer diagnosis was 11.5 years (range, 7-18.8 y). Nonmelanoma skin cancers (56.7% of all tumors) were the most common malignancies. Twenty-two lesions (73.3%) that developed in 17 patients (7.4%) were localized to the head and neck region: 15 (68.2%) were cutaneous and 7 (31.8%) were noncutaneous. The median time from transplant to head and neck cancer diagnosis was 12 years (range, 7.5-17.5 y). Mortality rate was higher in cancer patients (10 [41.7%] vs 17 [8.2%]; P < 0.01). CONCLUSIONS: The incidence of de novo malignancy in kidney transplant recipients was relatively higher compared with previous data. Nonmelanoma skin cancers were the most common type. Three-quarters of all lesions were in the head and neck region, and two-thirds were of cutaneous origin.

Effects of ultrasound-guided platelet rich plasma injection in patients with piriformis syndrome.

BACKGROUND: Piriformis syndrome (PS) is the common entrapment neuropathy causing buttock pain. Patients are conventionally treated with lifestyle modification, exercise, non-steroidal anti-inflammatory drugs, corticosteroid or botulinum toxin injections. However, some patients may not respond to these conventional treatment methods. Platelet rich plasma (PRP) injection has been shown to be beneficial in various muscular injuries, but its effects have not yet been investigated in PS. OBJECTIVE: The aim of this study was to explore the effect of PRP on pain and functional status in patients with PS, and to identify any correlations between clinical changes and demographic features. METHODS: A total of 60 patients with PS were randomly separated into two groups (PRP and control groups). All patients received one session of either PRP or saline injection performed under ultrasound guidance. The pain was measured with a visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were noted at three intervals in both groups: before treatment, 1 week after treatment and 1 month after treatment. RESULTS: The VAS and ODI scores were improved in both groups. The improvement was more obvious in the PRP group in the first week, and the results were similar for both groups when measured 1 month after the treatment. CONCLUSION: Ultrasound-guided PRP injection provided greater improvements in both pain and functional status in patients with PS, starting in the early period after treatment. A repeat injection might be needed for a long-term effect.

The effect of the anticoagulant on the cellular composition and growth factor content of platelet-rich plasma.

BACKGROUND: The cellular and biochemical composition of the platelet rich plasma (PRP) may impact its regenerative capacity. PRP composition have been shown to vary substantially among different separation systems and protocols. The type and the dose of anticoagulant might affect the content of PRP. OBJECTIVE: The objective of this study was to evaluate the effect of anticoagulant use, on cellular composition and the amount of growth factors in fresh PRP. METHODS: Three different methods were used to prepare PRP from 12 healthy participants. The protocol 1 included standart dose sodium citrate (SC) (0.9 ml, 3.8%), protocol 2 included 0.5 ml SC and no anticoagulant was used in protocol 3. The PRP's were compared in regards to cellular content, capture efficiency of platelets (CE), concentrations and total doses of fresh studied vascular endothelial growth factor (VEGF), platelet derived growth factor -BB, (PDGF-BB), transforming growth factor ß1 (TGF-ß1) levels. RESULTS: The CE and total platelet count were highest in protocol 1. The white blood cells (WBC) and VEGF were highest in protocol 3. The highest total TGF-ß1 and total PDGF levels were obtained with protocol 1, while the highest total VEGF levels were obtained with protocol 3. CONCLUSION: The results of this study revealed that the use and the dose of SC affects the cellular content of PRP and GFs measured in fresh PRP. The CE and platelet dose increases while the WBC and VEGF decreases with the use of SC.

Ultrasound imaging and guidance in the management of knee osteoarthritis in regenerative medicine field.

Ultrasound (US) is an excellent imaging tool to evaluate most of the structures in the knee joint. US is useful in various applications of regenerative medicine, starting from the biomaterial harvesting stage of the procedures, it can thus/conveniently be used for the diagnosis and treatment of various forms of knee osteoarthritis (OA) where the interventions need to be carried out under US guidance. In this paper, we have reviewed US guided bioharvesting of venous blood, bone marrow and adipose tissue, the US evaluation of the knee joint and the relevant findings in knee OA along with US guided regenerative interventions for the knee joint.

Lhermitte-Duclos Disease: A Rare Lesion with Variable Presentations and Obscure Histopathology.

Since Lhermitte-Duclos is a quite rare disorder with both neoplastic and hamartomatous features, clinical and pathological diagnosis can sometimes be challenging. For the pathologist it is of extreme importance to be aware of variable clinical and histopathological presentations of such a rare lesion particularly to differentiate it from the low-grade glial and neuronal tumors. We present four cases of Lhermitte-Duclos in a histopathological perspective. Although enlargement of the internal granular layer of the cerebellum is a consistent finding in our cases, morphological severity was highly variable and in some cases the enlargement was insignificant. Frozen sections of one case did not reveal diagnostic findings. The vacuolar change observed in the paraffin sections was obscure in the frozen. Pathological diagnosis of Lhermitte-Duclos disease can be extremely difficult in the absence of proper clinical information and the pathologist should be watchful for any irregularity in the internal granular layer in evaluating the cerebellar tissue which is otherwise normal.

Ultrasound-Guided Platelet-Rich Plasma Injection in a Patient with a Plantar Fascia Tear.

We report the case of a 40-year-old female patient presenting with resistant heel pain attributable to plantar fascia rupture. She was treated with ultrasound-guided platelet-rich plasma injection, and her pain was decreased. Additionally, ultrasound was useful for diagnosis, intervention and follow-up of the patient.

Does the corticotropin-releasing hormone system play a role in the pathogenesis of lichen planus?

INTRODUCTION: Lichen planus (LP) is a chronic inflammatory disease, where the psychogenic factors seem to play an important role in the pathogenesis. AIM: To determine the expression of corticotropin-releasing hormone (CRH) receptor type 1 (CRH-R1) in LP. MATERIAL AND METHODS: Thirty-two LP patients and 17 age/gender-matched controls were included in the study. Detailed information about the disease and body surface area (BSA) covered by the lesions was recorded. Immunohistochemically, the expression of CRH-R1 was stained in the lesional skin of patients with LP and in the control group. RESULTS: The comparison of CRH-R1 expression showed a statistically significant difference between LP patients and the controls (p < 0.05). Additionally, we did not observe any correlation between BSA and staining intensity in LP patients. CONCLUSIONS: Our study showed an increase in CRH-R1 expression in LP lesions. These results support the participation of the cutaneous CRH/CRH-R1 system in the pathogenesis of LP skin lesions.

Lack of evidence of HPV etiology of prostate cancer following radical surgery and higher frequency of the Arg/Pro genotype in turkish men with prostate cancer

ABSTRACT Objectives The aim of this study was to assess the possible role of HPV in the development of prostate cancer (PCa) and investigate the distribution of the p53 codon 72 polymorphism in PCa in a Turkish population. Materials and methods A total of 96 tissues, which had been obtained using a radical surgery method, formalin-fixed and parafin-embedded, were used in this study. The study group consisted of 60 PCa tissues (open radical prostatectomy) and the control group contained 36 benign prostatic hyperplasia tissues (BPH) (transvesical open prostatectomy). The presence of HPV and the p53 codon 72 polymorphism was investigated in both groups using real-time PCR and pyrosequencing. Results The results of the real-time PCR showed no HPV DNA in any of the 36 BPH tissue samples. HPV-DNA was positive in only 1 of the 60 PCa samples (1.7%). The HPV type of this sample was identified as HPV-57. The distribution of the three genotypes, Arg/Arg, Arg/Pro and Pro/Pro was found to be 45.6, 45.6, and 8.8% in the PCa group and 57.1%, 34.3% and 8.6% in the control group, respectively. Compared with the control group, patients with PCa had a higher frequency of the Arg/Pro genotype and Proline allele (odds ratio (OR)=1.67, 95% confidence interval (CI)=0.68-4.09, p=0.044; OR=1.13, 95% CI=0.76-1.68, p=0.021, respectively). Conclusions The results of the study do not support the hyphothesis that prostate cancer is associated with HPV infection but indicated that Proline allele can be a risk factor in the development of PCa in the Turkish population.

Lack of evidence of HPV etiology of prostate cancer following radical surgery and higher frequency of the Arg/Pro genotype in Turkish men with prostate cancer.

OBJECTIVES: The aim of this study was to assess the possible role of HPV in the development of prostate cancer (PCa) and investigate the distribution of the p53 codon 72 polymorphism in PCa in a Turkish population. MATERIALS AND METHODS: A total of 96 tissues, which had been obtained using a radical surgery method, formalin-fixed and parafin-embedded, were used in this study. The study group consisted of 60 PCa tissues (open radical prostatectomy) and the control group contained 36 benign prostatic hyperplasia tissues (BPH) (transvesical open prostatectomy). The presence of HPV and the p53 codon 72 polymorphism was investigated in both groups using real-time PCR and pyrosequencing. RESULTS: The results of the real-time PCR showed no HPV DNA in any of the 36 BPH tissue samples. HPV-DNA was positive in only 1 of the 60 PCa samples (1.7%). The HPV type of this sample was identified as HPV-57. The distribution of the three genotypes, Arg/Arg, Arg/Pro and Pro/Pro was found to be 45.6, 45.6, and 8.8% in the PCa group and 57.1%, 34.3% and 8.6% in the control group, respectively. Compared with the control group, patients with PCa had a higher frequency of the Arg/Pro genotype and Proline allele (odds ratio (OR)=1.67, 95% confidence interval (CI)=0.68-4.09, p=0.044; OR=1.13, 95% CI=0.76-1.68, p=0.021, respectively). CONCLUSIONS: The results of the study do not support the hyphothesis that prostate cancer is associated with HPV infection but indicated that Proline allele can be a risk factor in the development of PCa in the Turkish population.

Assessment of Pain Sensitivity in Patients With Chronic Low Back Pain and Association With HTR2A Gene Polymorphism.

OBJECTIVES: This study aims to investigate the association of two common HTR2A gene polymorphisms, rs6313 (102 T/C) and rs6311 (1438 A/G), with chronic low back pain (CLBP) and the pain threshold, disability, and sex differences. PATIENTS AND METHODS: A total of 121 patients (40 males, 81 females; mean age 36.8±9.9 years; range 18 to 50 years) having CLBP and 91 healthy controls (26 males, 65 females; mean age 34.1±10.2 years; range 18 to 55 years) were included. Pressure pain thresholds (PPTs) of all participants were examined with manual algometer in certain sites of their body. RESULTS: The PPTs were all decreased in CLBP patients (p<0.05). Although PPTs were lower in healthy female subjects, there was no sex difference regarding PPTs in CLBP patients (p>0.05). rs6311 polymorphism of HTR2A gene was associated with CLBP (p<0.05). In rs6313 polymorphism, at least one copy of T carriers and in rs6311 polymorphism, at least one copy of G carriers showed higher disability. CONCLUSION: The PPT decreases in CLBP patients similar to other chronic pain conditions without any sex difference. Although rs6311 single nucleotide polymorphism of HTR2A gene was associated with CLBP and rs6313 polymorphism was not, rs6311 might have a protective effect on disability of these patients.

The effect of aquatic exercise on spasticity, quality of life, and motor function in cerebral palsy.

OBJECTIVES: The primary aim of this study was to compare the effects of aquatic exercises and land-based exercises on spasticity, quality of life, and motor function in children with cerebral palsy (CP). The secondary aim was to assess the morphology of spastic muscle using ultrasonography. PATIENTS AND METHODS: Thirty-two children (17 boys, 15 girls; mean age 9.7±2.7 years; range 4 to 17 years) with CP were enrolled in this study. The patients were randomly assigned to two groups to receive 30 sessions of an aquatic or a land-based exercise program. The patients were assessed for the impairment level, functional measures, and quality of life before and after therapy. Ultrasonographic assessment of spastic gastrocnemius muscle was also performed. RESULTS: Both group showed significant improvements in most functional outcome measures. There were no significant differences in the percentage changes of the scores for functional outcome measures between the two groups. However, aquatic exercise produced a higher improvement in quality of life scores than the land-based exercises. Post-treatment ultrasonographic assessment of spastic gastrocnemius muscle showed a significant improvement in the compressibility ratio in the aquatic exercise group. The modified Ashworth Scale score of spastic gastrocnemius muscle in patients with CP showed a negative and weak-to-moderate correlation with the compressibility ratio based on the ultrasonographic evaluation. CONCLUSION: Our study results suggest that the aquatic exercises are as effective as land-based exercises for spasticity management and motor function improvement in children with CP. Aquatic exercise can result in a higher level of improvement in quality of life scores than the land- based exercises. Ultrasonographic muscle compressibility ratio may be used to evaluate muscle elasticity in children with CP.

Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit.

INTRODUCTION: Serious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation. METHODS: Thirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated. RESULTS: Lower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P = 0.014) and 2 (from 4.00 to 5.00, P = 0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P = 0.038, P = 0.046 and P = 0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation. CONCLUSION: This study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated.

A Rare Cause of Nasal Obstruction: Metastatic Renal Cell Carcinoma.

Introduction. Renal cell carcinoma can present with several interesting symptoms, paraneoplastic syndromes, and unusual metastatic sites. Head and neck region is one of the rare locations for renal cell carcinoma metastasis. Case Report. A 50-year-old man was admitted to the hospital with nasal congestion and snoring. Physical examination revealed nasal serous secretion. First taken biopsy was misinterpreted. The symptoms of the patient were not revealed and he was readmitted to the hospital. On radiologic examination, a vascular rich mass in maxillary sinus extending to the nasal cavity was observed. Biopsy was diagnosed as renal cell carcinoma metastasis. Herein, we present a patient with renal cell carcinoma presenting nasal obstruction and snoring as first and recurrent symptom.

Ultrasound detection of knee joint degeneration in patients with multiple sclerosis.

OBJECTIVE: Early degeneration of the knees might occur in patients with multiple sclerosis secondary to balance and walking impairment and muscle weakness. The aims of this study were to evaluate the knee joints of patients with multiple sclerosis compared with healthy controls, using ultrasono-graphy, and to investigate whether there is any correlation between femoral cartilage degeneration and disease-related parameters. DESIGN: Study participants were 79 patients with multiple sclerosis and 60 healthy controls. The disease-related parameters, Expanded Disability Status Scale (EDSS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, visual analogue scale (VAS) for pain severity, and Berg Balance Scale (BBS) scores were recorded. Femoral cartilage and knee effusion were evaluated using ultrasonography. RESULTS: Femoral cartilages of patients with multiple sclerosis were more degenerated than those of healthy controls. Moreover, patients with multiple sclerosis had more effusion in their knees than did controls. In the multiple sclerosis group there was no correlation between cartilage degeneration grade, amount of effusion, and VAS-pain, BBS, WOMAC and EDSS scores. CONCLUSION: Patients with multiple sclerosis may have more rapid degeneration of the knee cartilage and increased effusion compared with healthy controls. Ultrasonography is an effective method to detect these changes. However, cartilage degeneration was not found to be associated with disease-related parameters in multiple sclerosis.

Ligamentum flavum thickening at lumbar spine is associated with facet joint degeneration: An MRI study.

OBJECTIVE: Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). METHODS: A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. RESULTS: Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. CONCLUSION: The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level.

Assessment of pulsed electromagnetic field therapy with Serum YKL-40 and ultrasonography in patients with knee osteoarthritis.

AIM: The use of biomarkers of osteoarthritis (OA) have potential for early diagnosis, evaluation of disease severity and monitoring treatment. Serum and synovial fluid YKL-40 levels are increased in severe knee OA. Pulsed electromagnetic field (PEMF) therapy is a novel treatment method for OA. However, studies evaluating the PEMF therapy in treatment of knee OA revealed conflicting results. This study was conducted to objectively assess the effect of PEMF therapy in patients with knee OA, by using ultrasonographic measurements and a novel biomarker, YKL-40. METHODS: Forty patients were randomized into two treatment groups. Both groups received conventional physical therapy, while Group 1 received additional PEMF therapy. The patients were asked to rate their pain on a visual analogue scale (VAS) and complete a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Serum YKL-40 levels were measured, and knee effusion and cartilage degeneration level were evaluated with ultrasonography before and after treatment. RESULTS: Pre-treatment YKL-40 level was correlated with WOMAC pain subscale (P = 0.032, r = 0.339). VAS and WOMAC scores significantly improved in both treatment groups (P < 0.05). The effusion in the right knee significantly decreased in Group 1. The change in YKL-40 level was not correlated with the change in VAS, WOMAC scores and knee effusion. CONCLUSION: This study revealed that adjuvant PEMF therapy has no additional effect on pain in patients with knee OA. Serum YKL-40 level seems to be unuseful for monitoring the treatment in knee OA.