Morphometry of the Middle Cerebral Arteries: A Radio-Anatomical Study Based on Computed Tomography Angiography Findings / Morfometría de las Arterias Cerebrales Medias: Un Estudio Anátomo-Radiológico Basado en los Hallazgos de la Angiografía por Tomografía Computada

SUMMARY: Middle cerebral artery (MCA), which has the largest irrigation area of the arteries that feed the brain, is an important artery whose microanatomy should be well known because of its vascular variation. In pathologies which are known to affect the cerebrovascular system such as type 2 diabetes mellitus (T2DM) and hypertension, morphometric characteristics of MCA gain importance. The aim of this study is to compare the morphometric characteristics of M1 segment of MCA in T2DM and hypertensive patients with those of healthy control group by using computed tomographic angiography (CTA). The study was carried out with retrospective morphometric analysis of CTA images of 200 individuals between 40 and 65 years of age. The individuals were grouped in four as hypertensive patients (group 1), patients with T2DM (group 2), patients with hypertension and T2DM (group 3) and healthy control group (group 4). Length and diameter measurements of M1 segment were performed and recorded by using 3D CTA images. While statistically significant difference was found between bilateral M1 segment diameters of both women and men (p0.05). As a result of the post hoc analysis performed, it was concluded that right and left M1 segment diameter of group 1, group 2 and group 3 was found to be different from group 4 in both sexes (p<0.05). We believe that this study will both be a guide in radio-anatomic assessments to be performed and also increase microanatomic level of information in the surgical treatment of the artery by showing the morphometric changes that occur in M1 segment of MCA in T2DM diseases.

La arteria cerebral media (ACM), que otorga la mayor área de irrigación de las arterias que alimentan el cerebro, es un vaso importante cuya microanatomía debe ser bien conocida por su variación vascular. En patologías que afectan al sistema cerebrovascular, como la diabetes mellitus tipo 2 (DM2) y la hipertensión, las características morfométricas de la ACM cobran importancia. El objetivo de este estudio fue comparar las características morfométricas del segmento M1 de la ACM en pacientes con DM2 e hipertensos con las del grupo control sano mediante el uso de angiografía por tomografía computada (TC). El estudio fue realizado através de análisis morfométrico retrospectivo de imágenes de TC de 200 individuos entre 40 y 65 años de edad. Los individuos fueron divididos en cuatro grupos, como pacientes hipertensos (grupo 1), pacientes con DM2 (grupo 2), pacientes con hipertensión y DM2 (grupo 3) y grupo control sano (grupo 4). Las mediciones de longitud y diámetro del segmento M1 se realizaron y registraron utilizando imágenes 3D TC. Si bien se encontraron diferencias estadísticamente significativas entre los diámetros bilaterales de los segmentos M1 de mujeres y hombres (p0,05). Como resultado del análisis post hoc realizado, se concluyó que el diámetro de los segmentos M1 derecho e izquierdo del grupo 1, grupo 2 y grupo 3 fue diferente del grupo 4 en ambos sexos (p<0.05). Creemos que este estudio será una guía en las evaluaciones anátomo-radiológicas y también mejorará el nivel de información microanatómica en el tratamiento quirúrgico al mostrar los cambios morfométricos que ocurren en el segmento M1 de la ACM en las enfermedades con DM2.

Morphometric Examinations of Internal Carotid Arteries of Patients with Hypertension and Patients with Type 2 Diabetes Mellitus: A Radio Anatomic Study Based on Computed Tomography Angiography Findings.

AIM: The aim of this study is to examine the relationship between the morphological features of A.carotis interna (ICA) and symptoms affecting cerebral blood circulation including type 2 diabetes mellitus (T2DM) and hypertension (HT). MATERIAL AND METHODS: In this study, retrospective morphometric analysis of ICA measurements from 100 patients (45-60 years old) was performed on Computed Tomographic Angiography (CTA) images. The images were divided into four groups: patients with HT (group 1), patients with T2DM (group 2), patients with HT and T2DM (group 3), and healthy control group (group 4). Length and diameter measurements of the cervical, petrous, cavernous and terminal segments of the ICA were made by using 3D CTA images and recorded. The measurements of the male and female patients were compared by Mann Whitney-U test and the the groups were compared by using Kruskall Wallis H test. RESULTS: It was found that, there were statistically significant differences between male and female patients in terms of right and left petrous, cavernous and terminal segments of the ICA in Group 1, right and left cervical left cavernous in Group 3, left cervical, right and left petrous, cavernous and right cavernous in Group 4 (p 0.05). According to the Kruskall Wallis H test analysis results, it was determined that there was no statistically significant difference between the patients in 4 groups for all segment measurements (p 0.05). CONCLUSION: As a result; It was determined that ICA was more affected by hypertension than diabetes. In addition, we think that being knowledgeable of morphometric measurements of ICA will guide the radio-anatomical evaluations and increase the level of microanatomical knowledge in surgical treatment.

A study on sex estimation by using machine learning algorithms with parameters obtained from computerized tomography images of the cranium.

The aim of this study is to test whether sex prediction can be made by using machine learning algorithms (ML) with parameters taken from computerized tomography (CT) images of cranium and mandible skeleton which are known to be dimorphic. CT images of the cranium skeletons of 150 men and 150 women were included in the study. 25 parameters determined were tested with different ML algorithms. Accuracy (Acc), Specificity (Spe), Sensitivity (Sen), F1 score (F1), Matthews correlation coefficient (Mcc) values were included as performance criteria and Minitab 17 package program was used in descriptive statistical analyses. p ≤ 0.05 value was considered as statistically significant. In ML algorithms, the highest prediction was found with 0.90 Acc, 0.80 Mcc, 0.90 Spe, 0.90 Sen, 0.90 F1 values as a result of LR algorithms. As a result of confusion matrix, it was found that 27 of 30 males and 27 of 30 females were predicted correctly. Acc ratios of other MLs were found to be between 0.81 and 0.88. It has been concluded that the LR algorithm to be applied to the parameters obtained from CT images of the cranium skeleton will predict sex with high accuracy.

Comparison of the effects of conventional physiotherapy and proprioception exercises on pain and ankle proprioception in patients with lumbar radiculopathy.

BACKGROUND: Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a significant health problem frequently seen in the general population. OBJECTIVE: The purpose of this study was to compare the effects of conventional physiotherapy (CT) and proprioception exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group. METHODS: In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic were selected through convenience sampling. They were randomly assigned to three groups: CT (n= 27), PE (n= 31), CT&PE (n= 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with an isokinetic dynamometer at 10∘ dorsiflexion (DF), 11∘, and 25∘ plantarflexion (PF) angles. Lumbar pain was assessed by using the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS measurements in post-treatment evaluations (p< 0.05). Statistically significant differences were found between CT and PE groups and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and control groups within themselves (p> 0.05). CONCLUSION: The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.

Comparison of the Effects of the Somatotype on the Physical Activity, Kinesiophobia, and Fatigue Levels of Obstructive Sleep Apnea Syndrome Patients and Healthy Individuals.

BACKGROUND: We aimed to compare the physical activity, kinesiophobia, and fatigue levels of obstructive sleep apnea syndrome (OSAS) patients and healthy individuals in terms their somatotypes. METHODS: A total of 165 individuals were enrolled referred to the Department of Chest Diseases Sleep Disorders Center Outpatient Clinic of Inonu University, Malatya, Turkey in 2018. The somatotype analysis was conducted using the Heath-Carter method, the fatigue level was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale, the kinesiophobia level was assessed using the Tampa Scale for Kinesiophobia (TSK), and the physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ). RESULTS: The results of the somatotype analysis revealed 3 different somatotypes in the healthy individuals and the OSAS patients' mesomorph endomorph, endomorphic mesomorph, and mesomorphic endomorph. When comparing the somatotypes of the healthy individuals and the OSAS patients, statistically significant differences were found in the FACIT scores of the mesomorph endomorphs, the IPAQ and FACIT scores of the endomorphic mesomorphs, and the TSK and FACIT scores of the mesomorphic endomorphs (P<0.05). CONCLUSION: In all three somatotypes of the OSAS patients, the fatigue index scores were higher when compared to those of the healthy individuals. Moreover, when compared with the healthy individuals, the physical activity levels of the endomorphic mesomorphs with OSAS were low, while the kinesiophobia scores of the mesomorphic endomorphs with OSAS were high. Based on the results of this study, in OSAS patients, the endomorphic mesomorph somatotype could be a risk factor for reduced physical activity, while the mesomorphic endomorph somatotype could be a risk factor for increased kinesiophobia.

Effects of scapular stabilization exercises in patients of chronic neck pain with scapular dyskinesis: A quasi-experimental study.

OBJECTIVES: This study aims to investigate the effectiveness of scapular stabilization exercises in patients with chronic neck pain and scapular dyskinesis. PATIENTS AND METHODS: This single-center, prospective study included a total of 36 patients (17 males, 19 females; mean age: 41±12.8 years; range, 25 to 57 years) with chronic neck pain and scapular dyskinesis between April 2018 and September 2018. The patients were randomly assigned to three treatment groups. Group 1 (n=13) consisted of those receiving scapular stabilization exercises by a physiotherapy specialist control in addition to the routine physiotherapy and rehabilitation program; Group 2 (n=12) consisted of those receiving the routine physiotherapy and rehabilitation program in addition to scapular stabilization exercises in-home training program; and Group 3 (n=11) consisted of those receiving the routine physiotherapy and rehabilitation program alone. The assessments were made using the Visual Analog Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPQ). RESULTS: Significant differences were found in the pre- and post-treatment VAS scores, and Group 1 and Group 2 created this significant difference (p<0.05). A significant difference was also observed in the pre- and post-treatment NPQ scores among the groups (p<0.05). Group 1 showed the most significant improvement of the NPQ scores (p<0.05). CONCLUSION: Our study results suggest that addition of scapular stabilization exercises to the routine physiotherapy components may be an effective method for improving pain and functional results.

Analysis of the effects of hypothalamic-pituitary-adrenal axis activity in menstrual cycle on ankle proprioception, dynamic balance scores and visual-auditory reaction times in healthy young women.

OBJECTIVES: Menstrual cycle (MC) can affect not only the female reproductive system, but also functions such as neuromuscular performance. For this reason, the aim of this study is to investigate the effect of hypothalamic-pituitary-adrenal axis (HPA) activity in MC on proprioception, balance and reaction times. METHODS: For cortisol analysis, saliva samples were taken from the same women (n=43) in the four phases of MC. While State Trait Anxiety Inventory-I (STAI-I) was applied in each phase to support cortisol analysis, pain was measured with visual analogue scale (VAS). Proprioception, dynamic balance, visual and auditory reaction times (VRT-ART) measurements were made in the four phases of MC. RESULTS: Cortisol, STAI-I and VAS scores, angular deviations in proprioception measurements, dynamic balance scores, VRT and ART measurements were found to show statistically significant difference between MC phases (p<0.05). As a result of the post hoc test conducted to find out which MC phase the statistical difference resulted from, it was found that statistically significant difference was caused by the mensturation (M) phase (p<0.05). CONCLUSIONS: It was found that neuromuscular performance and postural control was negatively affected by HPA axis activity in M phase of MC and by pain, which is a significant menstrual symptom.

Evaluation of visual and auditory reaction time, pain, and hand grip strength performance before and after conventional physiotherapy in patients with herniated cervical intervertebral disc with radiculopathy.

Objective: Herniated cervical intervertebral disc (cervical disc herniation [CDH]) with radiculopathy is known to occur in seven or eight out of 100 people worldwide. This disease causes movement limitation, loss of strength, and pain of upper extremity. The aim of this study is the effect of conventional physiotherapy agents on predetermined parameters in patients with cervical radiculopathy and to compare the results with healthy controls. Methods: A total of 102 patients with CDH with radiculopathy and 98 healthy controls were included in the study. Visual reaction time (VRT) and auditory reaction time (ART) measurements were evaluated with reaction timer, while the pain was assessed with visual analog scale (VAS) and handgrip strength (HGS) assessed with hand dynamometer, respectively. Conventional physiotherapy (transcutaneous electrical nerve stimulation, hot pack application, and therapeutic ultrasound) agents were applied 5 days/week for 3 weeks as treatment protocol. Results: As a result, VAS, VRT, and ART scores were significantly decreased, and HGS scores increased significantly in both female and male patients post-treatment measures (p<0.05). There was no statistically significant difference between patient group and control group measurements in post-treatment evaluations (p>0.05). Conclusion: This study presents the conclusion to literature that conventional physiotherapy agents have the effect of decreasing pain and regaining motor function and also a therapeutic effect on VRT and ART in the treatment of patients with CDH with radiculopathy.

Evaluation of scapular dyskinesis and ergonomic risk level in office workers.

Purpose. The purpose of this study is to evaluate the association between ergonomic risk level and scapular dyskinesis in office workers. Methods. This cross-sectional study included office workers aged 20-65 years. A lateral scapular slide test (LSST) was used to evaluate scapular dyskinesis, and the quick exposure check (QEC) method was used to analyze the ergonomic risk level. Results. In all, 37 (45.7%) participants were men and 44 (54.3%) participants were women. Of the participants with scapular dyskinesis in any of the three LSST positions, 10.3% had low, 20.6% had medium, 30.9% had high and 37.9% had very high ergonomic risk level (p = 0.001). A low, positive linear correlation was observed between ergonomic risk level and LSST-1, LSST-2 and LSST-3 values. Conclusion. These results indicate that patients with scapular dyskinesis have a high ergonomic risk level. We believe that our work will serve as a foundation for intervention studies assessing ergonomic risk management.

Early rehabilitation results in a child who developed herpes simplex encephalitis.

In this case, a 4-year-old girl was admitted to the emergency service with the complaints of a sudden onset of fever, shortness of breath, jerking motions of the hands and feet and a sliding mouth. Her condition deteriorated, and she was kept under observation in the intensive care unit for 6 days. The Glasgow Coma Score of the patient was 1. Lumbar puncture revealed a white blood cell count of 0 and cerebrospinal fluid was positive for herpes simplex virus 1 and 2. Antiviral therapy was administered for 14 days. One month earlier, the patient had experienced a herpes labialis infection, which suggested herpes simplex encephalitis (HSE). Cranial magnetic resonance imaging indicated significant bilateral cerebral ischemic changes, which also supported suspicion of HSE. After antiviral treatment, the patient was referred to the department of physical therapy and rehabilitation. The Functional Independence Measure for Children (WeeFIM) scale was used to evaluate the patient. A 30-session rehabilitation program based on the Bobath concept of neurodevelopmental therapy was implemented. Before the treatment, the WeeFIM score was 20 points, and at its conclusion, the score was 88 points. The patient began to walk without limitation and the choreoathetosis was almost completely corrected. The patient was discharged with medical treatment and a home-based exercise training program.

The effects of pre-obesity on quality of life, disease activity, and functional status in patients with ankylosing spondylitis.

OBJECTIVE: This study was an investigation of effects of pre-obesity on clinical characteristics and quality of life in patients with ankylosing spondylitis (AS). METHODS: Total of 28 AS patients and 30 age- and sex-matched healthy controls were included in the study. Patients and controls with any systemic inflammatory disease and/or cognitive and mental problems were excluded. Disease activity and functional capacity were measured using the Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. For quality of life assessment, 36-Item Short Form Health Survey was used in both groups, and AS group also responded to Ankylosing Spondylitis Quality of Life questionnaire. RESULTS: There was no significant difference in sociodemographic characteristics between AS patients and healthy controls (p>0.05). Mean quality of life scores were significantly lower in the pre-obese AS patients compared with controls (p<0.05). Functional capacity was positively and significantly associated with body mass index (BMI) (p=0.024) and disease activity was significantly associated with female gender (p=0.011). CONCLUSION: Increased BMI in patients with AS is factor that affects quality of life, disease activity, and functional capacity. Multidisciplinary rehabilitation programs will support improved quality of life for pre-obese patients with AS.