Factors triggering familial mediterranean fever attacks, do they really exist?

Several possible factors are hypothesized to trigger familial Mediterranean fever (FMF) attacks; however, there is no consensus on this matter. We aimed to identify these triggering factors and analyze their relationship with the Mediterranean fever gene mutation status. We prepared a questionnaire that included the most commonly mentioned possible trigger factors of familial Mediterranean fever. We administered a questionnaire to 882 patients. We used a questionnaire assessing the following: psychological stress, consumption of tea and coffee, relationship with menses, menopause and post-menopausal alleviation, seasonal changes, traveling for long durations, relocation, starvation, sleeplessness, cold exposure, fatigue, wind exposure, and humidity. The most frequent triggering factor for familial Mediterranean fever attacks was psychological stress (75.2%). Cold exposure was a statistically significant trigger in patients with exon 10 mutations. Humidity was a statistically significant trigger in patients with exon 2 mutations. Seasonal changes, traveling for long durations, relocation, and cold exposure were statistically significant triggers of familial Mediterranean fever attacks in patients with homozygous M694V mutations. Identifying trigger factors can lead to better preventive measures and personalized therapies to decrease familial Mediterranean fever attacks. Patients can significantly decrease the number of familial Mediterranean fever attacks they experience by managing psychological stress and avoiding physical factors such as cold exposure and fatigue. Determining the relationship between trigger factors and patients' Mediterranean fever gene mutation status can lead to personalized therapy for the prevention of familial Mediterranean fever attacks.

Ship recycling perspective on environmental impacts - A case study for the ships in service.

Reducing the environmental impacts of maritime activities should involve the shipbuilding, operations, and recycling sectors. The measures taken within the sector should be determined independently for each subsector. To reduce and prevent environmental impacts, it is necessary to be able to measure the relevant impact prior to its occurrence. This study evaluates the Turkish merchant marine fleet's older than 30-year-old ships from a recycling standpoint. As an alternative cutting method, the calculated perspective and water jet cutting method scenarios are compared. The study's findings are presented in eleven categories of environmental impact. When the existing cutting method, oxy-fuel cutting method, and water jet cutting method are compared, the impact of global warming can be decreased by 40 %. In the oxy-fuel cutting method, the effect of oxygen consumption on the global warming potential has been calculated to exceed 60 %. The collected data indicate the environmental impact load of ship-cutting procedures on ships that will soon be recycled. This study will give statistics to guide the improvement processes of ship recycling industrialists, decision-makers, and other stakeholders by evaluating the environmental implications that will result from the recycling of ships older than 30 years.

Evaluation of cytotoxic and apoptotic effects of the extracts and phenolic compounds of Astragalus globosus Vahl and Astragalus breviflorus DC.

Astragalus L. is a genus member of the Fabaceae family, representing about 3,000 species all over the world and 380 species in Turkey. Astragalus species have been used in traditional medicine for many years. Astragalus globosus Vahl, known as "top geven", is a dwarf, scapose, perennial herb, Astragalus breviflorus DC., known as "yünlü geven", is an extremely spiny dwarf shrub. These endemic species grow in the Turkish cities of Erzurum, Kars, and Van. This is the first phytochemical and cytotoxic investigation of Astragalus globosus Vahl and Astragalus breviflorus DC. The main extracts and sub-fractions from the plants were evaluated for in vitro cytotoxic and apoptotic activities. The IC50 values of dichloromethane, n-butanol, and water extracts of the aerial parts of A. globosus against the MCF-7 cell line were determined as 28.39, 868.60, and 1753.00 µg/mL. The values for the MDA-MB-231 cell line were 264.00, 620.30, and 1300.50 µg/mL, respectively. From A. globosus, the following were isolated: a flavone glycoside, diosmetin-7-O-rutinoside (1); and two flavonol glycosides, isorhamnetin-3-O-rutinoside (2) and quercetin-3-O-galactoside (3). From A. breviflorus, two phenolic acids, caffeic acid (4) and chlorogenic acid (5), and a flavan-3-ol, catechin (6), were isolated. Diosmetin-7-O-rutinoside was isolated from Astragalus species for the first time and showed the highest cytotoxic activities on the MCF-7 and MDA-MB-231 breast cancer cell lines with IC50 values of 13.65 and 12.89 µg/mL, respectively. Moreover, we observed that diosmin exerts cytotoxic effects by causing cell necrosis.

Bilateral spondylolysis of inferior articular processes of lumbar vertebra with no active sports history: Case report and review of literature.

Lumbar spondylosis, though mostly occurs at pars interarticularis of vertebrae, it rarely occurs at articular processes. Like the ones in pars interarticularis, articular process fractures are stress fractures that are usually seen in people participated in active sprts activity. Most of the time, nonoperative treatment is adequate. When conservative treatment fails, removal of fragments accomplishes pain relief. In this report, we present a case with bilateral spondylolysis of inferior articular processes at 3rd lumbar vertebrae and discuss with regards to the literature.

Salivary levels of last generation specific pro-resolving lipid mediators (SPMs) (protectin and maresin) in patients with cardiovascular and periodontal disease: A case-control study.

BACKGROUND AND OBJECTIVE: Periodontal disease and cardiovascular disease (CVD), which are both deemed to be triggered by inflammation, are recognized as public health problems. Evidence of host modulation via pro-resolving lipid shown in previous studies supports a two-way relationship between periodontitis and CVD. Last generation endogenous specific pro-resolution lipid mediators (SPMs) such as protectins (PDs) and maresins (MaRs) may have potential effects on inflammatory pathogenesis via activation and resolution mechanisms. Currently, there are no data on SPM levels in patients with CVD and periodontal disease. We aimed to evaluate salivary levels of PD and MaR in patients with CVD and periodontal disease. MATERIALS AND METHODS: At total of 181 individuals comprising of 79 healthy controls (C) and 102 patients with diagnosed CVD were included cross-sectionally. Unstimulated total salivary samples were obtained, and clinical periodontal parameters were determined. Salivary levels of PD and MaR were evaluated by ELISA. The periodontal status of the study population was classified as gingivitis (g) or periodontitis (p). RESULTS: Patients with CVD showed lower sociodemographic characteristics, increased clinical periodontal parameters (p < .05), decreased salivary PD (p < .001), and increased salivary MaR levels (p > .05). In the CVDg group, leukocyte, hemoglobin, hematocrit, and high-density lipoprotein values were higher (p < .05). The CVDp group had a higher neutrophil-to-lymphocyte ratio (p < .05). While the PD level was highest in the Cg group, MaR was highest in the CVDp group. The salivary levels of PD and MaR were independent of other confounders in CVD and periodontal disease (p > .05). CONCLUSION(S): PDs and MaRs may play effective roles in pathogenesis associated with worsening cardiometabolic and periodontal status. These SPMs could also be predictors for conversion from a healthy (systemically and periodontally) to diseased state (CVD and/or periodontitis). Elucidation of the role of SPMs in the relationship between periodontal disease and CVD will enable the development of new host modulation strategies in the prevention and treatment of both diseases, and may also constitute an important public health step by increasing the quality of life of patients with CVD and periodontal disease.

Azathioprine as a Neuroprotective Agent in Experimental Traumatic Spinal Cord Injury.

AIM: To evaluate the protective effects of azathioprine, a macrophage-inhibiting agent, on secondary injury in spinal cord trauma. MATERIAL AND METHODS: A total of 40 Wistar rats were randomly divided into 4 groups. All the animals had undergone T8-10 laminectomy. Except in group I (control), all the animals were exposed to spinal cord trauma at the T9 level. Animals in group II (trauma) received no treatment following trauma. Animals in group 3 (treatment) and group IV (vehicle) were given intraperitoneal azathioprine 4 mg/kg and saline 2 ml, respectively, 30 minutes after the trauma. Half of the animals in each group were sacrificed 24 hours after injury and specimens were used for biochemical and immunohistochemical evaluations. The rest of the animals were followed-up for 4 weeks in terms of neurological functions and were also sacrificed to perform the histopathological analysis. RESULTS: Significant decrease in apoptotic cells and improved neurological function were observed in the animals treated with azathioprine. Biological and immunohistochemical analysis also showed less oxidative stress in this group compared to those without treatment. CONCLUSION: Azathioprine, a potent macrophage-inhibiting agent, has been shown to decrease the extent of secondary injury following spinal cord trauma.

Repeatability and Agreement of Macular Thickness Measurements Obtained with Two Different Scan Modes of the Optovue RTVue Optical Coherence Tomography Device

Objectives: To evaluate the repeatability and agreement of macular thickness measurements obtained with E-MM5 and MM6, two different scan modes, on the Optovue RTVue optic coherence tomography (OCT) device. Materials and Methods: Three consecutive macular thickness measurements in 30 healthy volunteers were taken using the OCT device E-MM5 and MM6 scan modes. The repeatability and agreement of these measurements obtained from the two scan modes and divided into nine anatomical regions based on early treatment diabetic retinopathy study were subjected to statistical analysis. Results: The mean age of the participants was 29.7±6.39 years. Intraclass correlation (all ICC values ≥0.86) and coefficient of variation (all coefficient of variation values ≤2%) analyses of consecutive OCT measurements in the nine regions of the macula obtained in both E-MM5 and MM6 scan modes gave high repeatability rates. Mean macular thickness values in the foveal region were 243.76±21.79 µm in E-MM5 mode and 247.04±19.83 µm in MM6 mode (p=0.543). Values for measurements obtained in E-MM5 and MM6 scan modes in parafoveal macular regions were also statistically similar (p>0.05 for all). However, a statistically significant difference was observed between the two modes in perifoveal macular measurements, except in the superior region. Conclusion: The Optovue RTVue OCT device gives highly repeatable measurement results for macular thicknesses in both E-MM5 and MM6 scan modes. However, it should be considered that measurements performed in E-MM5 and MM6 modes give different results in perifoveal regions.

The C2-Pars Interarticularis Screw as an Alternative in Atlanto-Axial Stabilization. A Biomechanical Comparison of Established Techniques.

AIM: To compare four different atlantoaxial stabilization techniques. MATERIAL AND METHODS: Eight human cervical spines (segments C0-C3) were tested in flexion/extension, lateral bending and axial rotation. Range of Motion (ROM) at a 1.5 Nm load was recorded. After native testing, the Harms (HARMS), pars screw (PARS), intralaminar screw (INTRA) and anterior transarticular screw (ATA) constructs were applied in a random order. RESULTS: FLEXION/EXTENSION: mean ROM (±SD) in native state was 15.9° (± 7.6°); HARMS 3.6° (± 2.0°); INTRA 5.5° (± 2.7°); PARS 2.8° (± 1.6°); ATA 3.7° (± 1.3°). A significant difference was found for all techniques compared to the native spine. LATERAL BENDING: ROM in native state was 3.2° (± 1.9°); HARMS 1.4° (± 0.4°); INTRA 2.5° (± 1.4°); PARS 1.3° (± 0.7°); ATA 0.9° (± 0.6°). There were no significant differences compared to native spine, although ATA and PARS showed a strong tendency. INTRA had a significantly higher ROM than ATA. AXIAL ROTATION: ROM in native state was 15.7° (± 6.6°); HARMS 1.5° (± 0.7); INTRA 2.7° (± 2.1°); PARS 1.7° (± 0.7); ATA 1.1° (± 0.3°). All instrumentation techniques significantly reduced ROM; there was no significant difference between the techniques. All instrumentation techniques were able to reduce ROM for most of the motions. The differences between the techniques were small. Nevertheless, the intralaminar screw showed deficits in lateral bending. CONCLUSION: Screw positioning seems to be of minor influence on stability in atlantoaxial stabilization. Therefore, the pars screw is a sound alternative to the established techniques from a biomechanical point of view. Anatomical considerations for screw placement should be kept in mind as a superior priority.

Lumbosacral Conjoined Root Anomaly: Anatomical Considerations of Exiting Angles and Root Thickness.

AIM: Conjoined nerve roots (CNR) can be damaged during lumbar disc surgery and lead to neuropathic pain due to excessive retraction. The purpose of this study was to investigate the factors that facilitate the identification of CNRs that can lead to the loss of fragments in the secondary axilla, nerve root injury or unpleasant surprises during lumbar disc surgery. Accordingly, we aimed to measure the thicknesses and exit angles of the nerve roots close to the pedicle to obtain scientific data regarding rare double roots. MATERIAL AND METHODS: The data of 612 patients who were operated for lumbar disc disease in our hospital between 2012 and 2014 were reviewed retrospectively. Twenty one cases of CNR were detected in this series. RESULTS: The mean nerve root thickness was 1.92 ± 0.45 mm for medially located roots and 3.33 ± 0.95 mm for laterally located roots. The comparison of medially located roots versus laterally located roots revealed a significant difference in mean values (p < 0.0001). The mean exit angle was 12.290± 4.890 for medially located roots, and 22.110 ± 5.420 for laterally located roots (p < 0.0001). In addition, the exit angles of the medially and laterally located roots increased as going down to caudal levels, (p=0.005, p=0.042). CONCLUSION: CNRs are congenital anomalies that are usually diagnosed during the surgical procedure and affect the success of discectomy. The presence of a more medially located or thinner root during surgical exploration and the absence of the fragment in the axilla in extruded or sequestered discs usually indicate a conjoined nerve root closer to the pedicle.

Concomitant intramedullary arteriovenous malformation and a vertebral hemangioma of cervical spine discovered by a pathologic fracture during bicycle accident.

INTRODUCTION: Spinal intramedullary arteriovenous malformations are uncommon and a challenging type of neurosurgical entities. They are rarely located to cervical segment. On the other hand, although hemangiomas are relatively common bone tumors, cervical involvement is again rare and clinically significant ones are infrequent. CASE PRESENTATION: A 14 year-old-male patient referred to an academic tertiary care unit and presented with neck pain and left hand weakness. Neurological examination revealed motor strength deficit at intrinsic muscles and hyperesthesia at the left hand. Furthermore the pathological reflexes were positive on the left hand side. Imaging studies showed compression fracture, lytic changes resembling a hemangioma at C7 vertebra, and also an intramedullary vascular pathology at C5-6 level which was shown to be an intradural-intramedullary arteriovenous malformation (AVM) on digital subtraction angiography. Based on neurological and radiological findings, the decision was to treat the patient. After embolization of the AVM, the neurological condition of the patient deteriorated and immediate MRI scan of the cervical spine revealed edema of the spinal cord at the C5-6 level. Thus an emergent surgery was performed and C5-6-7 laminectomies with C5-T2 posterior fixation and arthrodesis were implemented. A second stage operation was carried out as C7 corpectomy with a distractable titanium cage 2 weeks after initial surgery. A follow-up evaluation at five years revealed 4/5 motor strength on his left intrinsic hand muscles and mild hyperactive deep tendon reflexes. Imaging studies at the postoperative period showed stable placement of the construct and no evidence of contrast enhancement at the C5-6 level inside the spinal cord. CONCLUSION: A rare case of multiple pathologies affecting the cervical spine, coincidentally diagnosed after a pathological fracture during a bicycle accident as vertebral hemangioma and intradural-intramedullary AVM that was successfully treated with early detection, have been presented. One should assess such patients under multidisciplinary fashion and treat on a case-by-case basis for achieving the best results in patient care.

Isolated basal ganglia hemorrhage due to blast injury.

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. Bilateral basal ganglia hemorrhage secondary to blast injury has not described before. We report a case with bilateral basal ganglia hemorrhage secondary to explosion.

Giant intradiploic calvarial abscess of posterior fossa behaving progressive mass lesion.

A unique case of a large intradiploic abscess involving posterior fossa osseous structures is reported. A 16-year-old boy presented with a hard mass in the calvarium of posterior fossa region, fever and confusion. Radiological examination revealed an intradiploic collection with compression to cerebellum, fourth ventricle and brain stem, resulting in syringomyelia in cervical and thoracic spinal cord. After drainage and resection of the abscess wall, closure of a round dural defect was performed. The medical history of the patient and the intraoperative observations support the contention that the abscess in the reported case was a result of chronic and subclinical process of an intraosseous infection. The features concerned with diagnosis, differential diagnosis and pathogenesis of this rare entity are discussed.

Re-formation of acute parietal epidural hematoma following rapid spontaneous resolution in a multitraumatic child: a case report.

Acute epidural hematomas resulting from traumatic brain injury remain among the most common causes of mortality and disability. In the literature, there are cases about the resolution and recurrence of spinal epidural hematomas. This case is characterized by the rapid disappearance and re-formation of an acute cranial epidural hematoma (EDH) associated with no overlying skull fracture. Various authors have reported resolution of EDHs managed conservatively, but rapid resolution and recurrence of cranial EDH was not reported before.

The effect of phosphodiesterase inhibitor tadalafil on vasospasm following subarachnoid hemorrhage in an experimental rabbit model.

BACKGROUND: despite the years of study on it, cerebral vasospasm following subarachnoid hemorrhage is still an important cause of mortality and morbidity. The presented study was undertaken to show whether phosphodiesterase inhibitor tadalafil can attenuate the vasospasm process following subarachnoid bleeding. METHOD: in this study, 20 male New Zealand White rabbits weighing 2,500-3,000 g were randomly assigned to four groups. Animals in group 1 were controls. In group 2, animals were given oral tadalafil at 12, 24 and 36 h and SAH was not induced. SAH induced animals in group 3 did not receive any medication. In group 4, animals received tadalafil at 12, 24 and 36 h after SAH induction. All animals were sacrificed via exsanguination at 48 h after induction of SAH. Brains and brainstems with overlying basilar arteries were removed and stored in fixative at +4°C overnight. Basilar arteries were sectioned from four separate zones, and four sections were obtained from each rabbit. Basilar artery luminal section areas were measured by using SPOT for Windows version 4.1. Statistical comparisons were performed using Kruskal Wallis and ANOVA tests. FINDINGS: the SAH induced group which had been treated with tadalafil had significantly greater basilar artery luminal area than the untreated group (p < 0.05). There was no significant difference between control group and non-SAH induced group in terms of luminal areas. CONCLUSION: tadalafil has a potentially preventive effect in treatment of cerebral vasospasm following subarachnoid bleeding.

Comparison of nimodipine delivery routes in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.

BACKGROUND: nimodipine is the most widely preferred and administered calcium channel blocker in cerebral vasospasm prevention and treatment. There is no experimental or clinical study investigating the comparative effects of routine treatment modalities. METHOD: 35 male New Zealand White rabbits were assigned randomly to one of seven groups: Control, only SAH, SAH/oral nimodipine, SAH/IV nimodipine, SAH/IT nimodipine, SAH/IA nimodipine, SAH/angiography. FINDINGS: basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. Basilar artery thicknesses were significantly higher in group 2 and 7 than the others (p < 0.05). Luminal sectional areas in group 5 and 6 were significantly higher than other groups (p < 0.05). We found no significant difference in group 1, 5 and 6 (p > 0.05). Basilar section areas in group 3 and 4 were significantly higher than group 2 but lower than group 1. CONCLUSION: this is the first study to show the most effective drug delivery route in CVS after SAH. Nimodipine treatment in cerebral vasospasm is useful. This study showed that selective IA nimodipine treatment and IT nimodipine treatment must be preferred to IV and oral treatments of chronic vasospasm following SAH.

Comparison of intrathecal cilostazol and nimodipine treatments in subarachnoid hemorrhage: an experimental study in rabbits.

OBJECTIVE: intrathecal administration of calcium channel antagonists has been proposed to reduce cerebral vasospasm (CVS) in animal subarachnoid hemorrhage (SAH) models. Also, delayed CVS treatment model with oral administration of cilostazol can be seen in the literature. METHODS: in this study, 25 male New Zealand white rabbits were randomly assigned to five groups: control, SAH only, SAH/nimodipine, SAH/cilostazol, SAH/vehicle. The animals' basilar arteries were sectioned from four separate zones and four sections were obtained from each rabbit. Basilar artery luminal section areas were measured by using SPOT for windows Version 4.1 computer program. RESULTS: basilar artery luminal section areas in SAH/ nimodipine and SAH/ cilostazol groups were significantly higher than SAH only group (P < 0.05). CONCLUSION: phosphodiesterase 3 inhibitor cilostazol has vasodilatory effects without affecting cerebral blood flow. Nimodipine is a calcium channel blocker and is still used in vasospasm therapy either oral or intravenously. This study demonstrates that prophylactic bolus intrathecal administration of either cilostazol or nimodipine equally prevents SAH-associated CVS in an animal model. We therefore propose that cilostazol is a candidate for clinical trials in the treatment of delayed vasospasm.

Comparison of intrathecal dotarizine and nimodipine treatments in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.

BACKGROUND: cerebral vasospasm (CVS) is one of the most considerable complications of subarachnoid hemorrhage (SAH). The aim of this study was to assess and to compare the ability of intrathecal dotarizine and nimodipine to prevent and treat vasospasm in a rabbit model of subarachnoid hemorrhage. METHOD: thirty male New Zealand white rabbits weighing 2,500-3,000 g were allocated into five groups randomly. The treatment groups were as follows: Control, only SAH, SAH/Dotarizine, SAH/Nimodipine, SAH/Vehicle. Forty-eight hours after SAH injection, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal in the fifth day just before sacrifice. FINDINGS: basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. There was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). CONCLUSIONS: these findings demonstrate that calcium channel blocker dotarizine has marked vasodilatory effect in an experimental model of SAH in rabbits. Nimodipine is an effect-proven agent in CVS, but dotarizine may take place of it.

Comparison of intrathecal flunarizine and nimodipine treatments in cerebral vasospasm after experimental subarachnoid hemorrhage in rabbits.

BACKGROUND: the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nimodipine to prevent vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). METHOD: forty male New Zealand white rabbits were allocated into 5 groups randomly. The treatment groups were as follows: (1) control (no SAH [n = 8]), (2) SAH only (n = 8), (3) SAH plus vehicle (n = 8), (4) SAH plus nimodipine (n = 8), and (5) SAH plus flunarizine (n = 8). Before sacrifice, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal. FINDINGS: there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 2 (p < 0.05).Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 4 (p < 0.05). CONCLUSIONS: these findings demonstrate that flunarizine has marked vasodilatatory effect in an experimental model of SAH in rabbits.