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.

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.

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.

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.

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.

FPL tendon thickness, tremor and hand functions in Parkinson's disease.

INTRODUCTION: In Parkinson's disease (PD), a resting tremor of the thumb may affect the flexor pollicis longus (FPL) and influence hand functions. We investigated the relationship between FPL tendon thickness and hand function in PD patients and compared these characteristics with those in healthy controls. METHODS: The hand grip and pinch strengths were measured. The participants completed the Duruöz hand index, the Sollerman's hand function test, and the Nine Hole Peg Test. The thickness of the FPL tendon was measured using ultrasonography. RESULTS: The FPL tendon was thicker in PD patients but was not associated with tremor severity. In PD patients, despite functional performance of the hands are impaired and grip strength is decreased, pinch strengths are preserved. FPL thickness was not correlated with grip and pinch strengths. CONCLUSION: The thicker FPL tendon may be associated with greater pinch and grip strengths and manual dexterity in healthy individuals. The presence of tremor is associated with a thicker FPL tendon.

Association of rs11209032 and rs1004819 Polymorphisms in Interleukin-23 Receptor Gene With Ankylosing Spondylitis.

OBJECTIVES: This study aims to investigate the distribution of human leukocyte antigen B27 (HLA-B27) alleles (+/-) and interleukin-23 receptor (IL-23R) gene rs11209032 and rs1004819 polymorphisms among ankylosing spondylitis (AS) patients in a Turkish cohort. PATIENTS AND METHODS: The study sample comprised 106 AS patients (89 males, 18 females; mean age 38.9±10 years; range 19 to 65 years) and 82 healthy controls (70 males, 12 females; mean age 32.15±7.07 years; range 19 to 51 years). Distribution of HLA-B27 alleles (+)/(-) in AS patients were observed by reverse hybridization technique. Genotyping of IL-23R rs11209032 and rs1004819 polymorphisms of AS patients and healthy controls were performed by real time polymerase chain reaction. RESULTS: Of the AS patients, 69 (65.1%) were HLA-B27 positive. Distribution of rs11209032 genotype frequencies in AS group were 31.1% for GG, 50.9% for GA, and 17.9% for AA; while in control group, it was 34.1% for GG, 53.7% for GA, and 12.2% for AA. Distribution of rs1004819 genotype frequencies in AS group were 30.2% for CC, 52.8% for CT, and 17.0% for TT; while in control group, it was 42.7% for CC, 46.3% for CT, and 11.0% for TT. There was no significant difference between AS patients and controls in terms of genotype frequencies of IL-23R gene rs11209032 and rs1004819 polymorphisms. CONCLUSION: No association was found between AS and IL23R rs11209032 and rs1004819 polymorphisms in this Turkish AS cohort.

Comparison of Transcutaneous Electrical Nerve Stimulation and Paravertebral Block for Postthoracotomy Pain Relief.

BACKGROUND: Inadequate relief of postthoracotomy pain is a major reason of increased occurrence of postoperative complications. We aimed to investigate and compare the effects of transcutaneous electrical nerve stimulation (TENS) and paravertebral block (PVB) to relieve pain after thoracotomy procedures. MATERIALS AND METHODS: We studied 40 patients who underwent thoracotomy. Patients were randomly allocated to receive either PVB (group P, n = 20) or TENS (group T, n = 20) for postoperative pain. The electrodes of TENS were placed 2 cm under and 2 cm over the thoracotomy cut on both posterior and anterior sides. The surgeon inserted paravertebral catheters using direct vision at the end of the surgery. A patient-controlled analgesia (PCA) device was connected to all patients. Visual analog scales, patient demand, and consumption of tramadol were evaluated postoperatively. RESULTS: Mean visual analog scale (VAS) values were significantly lower in group P for all time points. The patients in group P needed lower amounts of opioid (tramadol) and the difference was statistically significant (258.4 ± 13.52 mg vs. 314.4 ± 8.65 mg, p = 0.005). In addition, the number of demand attempts recorded from the PCA device was significantly lower in group P (14.95 ± 13.64 vs. 26.7 ± 17.34, respectively and p < 0.001). CONCLUSION: TENS has beneficial effects for pain relief after thoracotomy, without any side effects; however, it cannot provide sufficient pain relief when compared with PVB.

Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study.

Lateral epicondylitis (LE) is a common disorder that causes pain on the outside of the elbow, as well as pain and weakness during gripping. In this prospective, randomized, controlled, assessor-blinded trial, we planned to investigate the effects of high-intensity laser therapy (HILT) in patients with LE and to compare these results with those of a brace and placebo HILT. Patients were randomly assigned to three treatment groups. The first group was treated with HILT. The second group (sham therapy group) received placebo HILT, while the third group (brace group) used the lateral counterforce brace for LE. The patients were assessed for grip strength, pain, disability, and quality of life. Outcome measurements and ultrasonographic examination of the patients were performed before treatment (week 0) and after treatment (after 4 and 12 weeks). HILT and brace groups showed significant improvements for most evaluation parameters (pain scores, grip strength, disability scores, and several subparts of the short-form 36 health survey (physical function, role limitations due to physical functioning, bodily pain, general health, and vitality)) after treatment (after 4 and 12 weeks). However, the improvements in evaluation parameters of the patients with LE in HILT and brace groups were not reflected to ultrasonographic findings. Furthermore, comparison of the percentage changes of the parameters after treatment relative to pretreatment values did not show a significant difference between HILT and brace groups. We conclude that HILT and splinting are effective physical therapy modalities for patients with LE in reducing pain and improving disability, quality of life, and grip strength.

Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study.

Myofascial pain syndrome (MPS) of the trapezius muscle is one of the main causes of neck pain. In this randomized, double-blind study, we evaluated the effects of high-intensity laser therapy (HILT) in female patients with chronic MPS of the trapezius muscle. The patients were assigned to two groups. The HILT group was treated with HILT and exercise, and the sham therapy group was treated with placebo HILT and exercise. The patients were assessed for pain, cervical active range of motion, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (weeks 4 and 12). Both groups showed significant improvement in all parameters at weeks 4 and 12. However, in a comparison of the percentage changes in the parameters at weeks 4 and 12 relative to pretreatment values, the HILT group showed greater improvement in pain scores, the neck disability index, and several subparts of the short-form 36 health survey (SF-36) (physical functioning, role limitations due to physical functioning, bodily pain, general health perceptions, social functioning, and role limitations due to emotional problems) than did the sham therapy group. We conclude that HILT is an effective therapeutic method in the treatment of patients with chronic MPS of the trapezius muscle.

Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis.

OBJECTIVE: The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS). METHODS: A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001). CONCLUSION: It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.

Assessment of opioid receptor µ1 gene A118G polymorphism and its association with pain intensity in patients with fibromyalgia.

Fibromyalgia may present with widespread pain and tenderness, fatigue, anxiety, and depression and is associated with a low pain threshold. The etiology of fibromyalgia is yet to be ascertained, although both genetic and environmental factors may play a role in the susceptibility of patients to fibromyalgia. Various genetic variations have been investigated to explain fibromyalgia susceptibility and differences in pain sensitivity, pain threshold, and tolerance. The A118G rs1799971 polymorphism in the opioid receptor µ1 gene (OPRM1) is one of the candidate genes. We hypothesized that the OPRM1 polymorphism may play a role in fibromyalgia susceptibility and impact the pain intensity and pain-related symptoms in fibromyalgia patients. This study comprised of 108 patients with fibromyalgia and 100 healthy controls. Overall, the 118G allele frequency was 16.3 % and was significantly lower in patients with fibromyalgia than in the control group (13.9 and 19 %, respectively). No difference was observed between fibromyalgia patients with and without the A118G allele with regard to the Beck Depression Inventory, widespread pain index, symptom severity, and Fibromyalgia Impact Questionnaire scores. All body parts of patients with fibromyalgia demonstrated lower pressure pain thresholds (PPT) compared to controls. The PPTs were higher in the 118 A/A genotype carrier fibromyalgia patients than in 118*/G carriers; however, the differences were not significant. As the A118G polymorphism frequency was lower in fibromyalgia patients, this polymorphism may exert a protective effect against fibromyalgia in Turkish women. However, the OPRM1 polymorphism does not have a significant effect on pressure pain and fibromyalgia severity.

The complementary role of the Kinect virtual reality game training in a patient with metachromatic leukodystrophy.

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease characterized by demyelination of the peripheral and central nerves. Patients with MLD can present with gait disturbances, progressive spastic quadriparesis, diffuse muscle atrophy, and areflexia attributable to central or peripheral nerve involvements. The rehabilitation of patients with MLD generally focuses on gait disturbances, balance impairments, and muscle weaknesses. Here, we present a case of MLD in which virtual reality (VR) training was used as an adjunctive therapy. We also discuss the complementary role of VR therapy, which was successfully integrated with a conventional rehabilitation program for a young patient with MLD who had impaired balance and gait. After completion of the integrated rehabilitation program, the patient demonstrated improvements in functional independency, mobility, walking speed, and balance. His total Functional Independence Measure score increased from 97 to 109, 6-minute walk test increased from 342 to 396 m, 10-minute walk test decreased from 11 to 7 seconds, and Berg Balance Scale score increased from 38 to 42 points. Moreover, 6 weeks after completion of the therapy, these improvements were sustained for the most part. Adding VR to a conventional rehabilitation program is an emerging trend in neurologic rehabilitation. Our patient with MLD demonstrated considerable improvements with a high level of enjoyment and satisfaction.

Accuracy in detecting knee effusion with clinical examination and the effect of effusion, the patient's body mass index, and the clinician's experience.

The purpose of this study was to determine the accuracy of detecting knee effusion with clinical examination and to evaluate whether the amount of effusion, patient obesity, and the clinicians' experience affect the clinicians' decisions in patients with knee osteoarthritis. Patients presenting with knee pain were examined by two residents with different levels of experience and underwent ultrasonographic examination, including measurement of effusion in the medial, mid, and lateral aspects of the suprapatellar bursa. One hundred seventy-two knees of 86 patients were examined. Of the knees investigated, 127 (73.8 %) had effusion. The consistency between ultrasonographic and resident examination were weak (κ = 0.193, p = 0.007 and κ = 0.349, p < 0.001), although the more experienced senior resident had a stronger agreement. The overall inter-rater agreement between the two residents was low (κ = 0.254). The senior resident had a significantly higher accuracy ratio (p = 0.036). In the knees without effusion, the two examiners had no agreement (κ = -0.028, p = 0.856); however, the ratios of the true decisions were similar (p = 1.0). The accuracy of the less experienced resident's decisions was affected by effusion depth (p = 0.005). Clinicians' decisions and their accuracy in detecting knee effusion during clinical examination were different, especially in the absence of effusion. The consistency between ultrasonography and residents was low. The accuracy of clinical examination was affected by effusion depth and experience, but not by patient obesity.