The association between growth differentiation factor 15 and presence and severity of coronary atherosclerosis.

PURPOSE: Growth differentiation factor 15 (GDF-15) is a member of the transforming growth factor beta superfamily and is faintly expressed under healthy conditions. GDF-15 is markedly elevated in a variety of diseases, including coronary artery disease (CAD), atrial fibrillation and heart failure. Here, we aimed to investigate the association of GDF-15 with the extent and severity of CAD in patients with stable CAD. METHODS: We enrolled 129 patients undergoing coronary angiography for the evaluation of stable CAD in the study. SYNTAX and SYNTAX II PCI/CABG scores were calculated. The CAD (+) study group was also stratified into two groups (high and low GDF-15) with respect to the mean GDF-15 value. Correlation and regression analyses were performed for further evaluation. RESULTS: Of the 129 patients, 75 had CAD. GDF-15 values were higher in the CAD (+) group (p â€‹< â€‹0.001). The two groups were compared according to a cut-off value of 2451.77. SYNTAX and SYNTAX II PCI/CABG scores were significantly associated with the high GDF-15 group (p â€‹< â€‹0.001). Additionally, correlation analysis showed a strong positive correlation between GDF-15 and SYNTAX (r: 0.859, p â€‹< â€‹0.001), SYNTAX II PCI (r: 0.921, p â€‹< â€‹0.001) and SYNTAX II CABG (r: 0.874, p â€‹< â€‹0.001) scores. Multivariate analysis identified GDF-15 as an independent predictor of CAD. CONCLUSION: GDF-15 is an independent predictor of CAD and is associated with CAD severity in terms of SYNTAX, SYNTAX II PCI and SYNTAX II CABG scores.

Trunk control in people with multiple sclerosis with different disability level: a cross-sectional study.

BACKGROUND: Trunk control is significant for a quality movement. Trunk control is reduced in people with Multiple Sclerosis compared to healthy individuals. OBJECTIVE: The study aims to compare trunk control in people with Multiple Sclerosis according to disability level and to examine the relationship between disability level and trunk control. METHODS: A total of one hundred-two people with Multiple Sclerosis were included in the study. The disability level was recorded with the Expanded Disability Status Scale score. Trunk control was evaluated with the Trunk Impairment Scale and core stability tests. Additionally, people with Multiple Sclerosis were divided into subgroups according to their disability levels (Expanded Disability Status Scale ≤ 3 and ≥ 3.5). RESULTS: Trunk Impairment Scale scores and core stability test results were statistically significantly lower in the group of people with Multiple Sclerosis with a higher Expanded Disability Status Scale score (3.5-6.5) than in the group with a lower Expanded Disability Status Scale score (1-3) (p = 0.001). A correlation was found between the level of disability and all parameters of trunk control in the total sample (p = 0.001). A significant relationship was detected between the disability level and most trunk control parameters in the Expanded Disability Status Scale ≤ 3 and ≥ 3.5 subgroups (p < 0.05). CONCLUSIONS: As the level of disability increases in people with Multiple Sclerosis, trunk control decreases, suggesting that care should be taken regarding trunk control during the progression of the disease. Evaluation of trunk control will be guiding when creating treatment programs.

Effects of high-intensity interval training program on pituartry function in basketball players: a randomized controlled trial.

The aim of the study was to determine how the short high-interval training program affects cortisol levels in basketball players. A total of 27 male basketball players volunteered for the study and were randomly assigned to one of two groups: Control Group (CG) (n = 13, mean age; 20,56 ± 1,45 years, mean height; 184,53 ± 6,65 cm) and Experimental Group (EG) (n = 14, mean age; 20,71 ± 2,12 years, mean height; 86,51 ± 8,21 cm). The experimental group received a 7-week interval training program. Blood samples were taken at the beginning and end of the study. Cortisol, Adrenocorticotropic Hormone, Triiodothyronine, Tetraiodothyronine, Parathyroid Hormone, Thyroid Stimulating Hormone, Insulin, and Glucose levels were measured of the EG and CG. To test the differences between groups and compare the effects of pre and post-intervention, a two-way ANOVA for repeated measures was used. Consequently, the post-test levels of TSH, PTH, and ACTH in the exercise group showed a significant difference when compared to the pre-test values (p = 0.000). Moreover, the post-test levels of Glucose, Cholesterol, Triglyceride, HDL, and Mg in the exercise group showed statistical significance when compared to the pre-test values (p = 0.000). Significant differences were seen in the post-test PTH and ACTH levels of the control group when compared to the pre-test values (p = 0.000). Furthermore, the exercise group showed significant differences in post-test values for HDL and Cholesterol compared to the pre-test (p = 0.000). In addition, when comparing the post-test values and pre-test values of both the exercise group and the control group, it was found that all parameters, with the exception of Ca, exhibited substantial differences in favor of the exercise group. It may be claimed that the implementation of interval training has favorable outcomes on pituitary function parameters. Additionally, the regulation of energy consumption during exercise is favourably influenced, along with the reduction of physiological stress resulting from prolonged exercise.

Experience of Daratumumab in Relapsed/Refractory Multiple Myeloma: A Multicenter Study from Türkiye

Objective: This study aimed to evaluate patients with relapsed/refractory multiple myeloma (RRMM) who underwent daratumumab (DARA) therapy. Materials and Methods: This multicenter retrospective study included 134 patients who underwent at least two courses of DARA from February 1, 2018, to April 15, 2022. Epidemiological, disease, and treatment characteristics of patients and treatment-related side effects were evaluated. Survival analysis was performed. Results: The median age at the start of DARA was 60 (range: 35-88), with 56 patients (41.8%) being female and 48 (58.2%) being male. The median time to initiation of DARA and the median follow-up time were 41.2 (5.1-223) and 5.7 (2.1-24.1) months, respectively. The overall response rate after DARA therapy was 75 (55.9%), and very good partial response or better was observed in 48 (35.8%) patients. Overall survival (OS) and progression-free survival (PFS) for all patients were 11.6 (7.8-15.5) and 8.0 (5.1-10.9) months, respectively. OS was higher for patients undergoing treatment with DARA and bortezomib-dexamethasone (DARA-Vd) compared to those undergoing treatment with DARA and lenalidomide-dexamethasone (DARA-Rd) (16.9 vs. 8.3 months; p=0.014). Among patients undergoing DARA-Rd, PFS was higher in those without extramedullary disease compared to those with extramedullary disease (not achieved vs. 3.7 months; odds ratio: 3.4; p<0.001). The median number of prior therapies was 3 (1-8). Initiation of DARA therapy in the early period provided an advantage for OS and PFS, although it was statistically insignificant. Infusion-related reactions were observed in 18 (13.4%) patients. All reactions occurred during the first infusion and most reactions were of grade 1 or 2 (94.5%). The frequency of neutropenia and thrombocytopenia was higher in the DARA-Rd group (61.9% vs. 24.7%, p<0.001 and 42.9% vs. 15.7%, p<0.001). Conclusion: Our study provides real-life data in terms of DARA therapy for patients with RRMM and supports the early initiation of DARA therapy.

Reply: Comparison of Two Anticoagulants for Pain Associated with Platelet-Rich Plasma Injections.

We read the letter titled "Comparison of Two Anticoagulants for Pain Associated with Platelet-Rich Plasma Injections" authored by Pensato et al. in Aesthetic Plastic Surgery. The authors emphasized an important point. PRP treatments have a lot of variables; preparation method, application, amount of PRP injections, and content (such as number of platelet concentration, presence of leucocytes, and pH). However, in our study, we focused on the pain of injections. We showed that there is a pain difference by using different anticoagulants during PRP preparation, but we did not investigate for possible reason of this pain difference. The use of different anticoagulants may have caused changes in the content, and these alterations could be responsible for the variation in pain. Researches could be done to investigate the reason and the physiology of this effect.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment options in primary mediastinal B cell lymphoma patients, retrospective multicentric analysis; a Turkish oncology group study.

Introduction and Aim: Primary mediastinal B-cell lymphomas (PMBL) are aggressive B- cell lymphomas. Although the initial treatment models vary in PMBL, appropriate treatment methods are not known. We aim to show real-life data on health outcomes in adult patients with PMBL who received various type of chemoimmunotherapies in Turkey. Method: We analyzed the data of 61 patients who received treatments for PMBL from 2010 to 2020. The overall response rate (ORR), overall survival (OS) and progression-free survival (PFS) of the patients were evaluated. Results: 61 patients were observed in this study. The mean age of the study group was 38.4 ± 13.5 years. From among them, 49.2% of the patients were female (n = 30). For first-line therapy, 33 of them had received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen (54%). Twenty-five patients had received rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) regimen. The ORR was 77%. The median OS and PFS were as follows: 25 months (95% CI: 20.4-29.4) and 13 months (95% CI: 8.6-17.3), respectively. The OS and PFS at 12 months were 91.3% and 50%, respectively. The OS and PFS at five years were 64.9% and 36.7%, respectively. Median follow-up time period was 20 months (IQR 8.5-38.5). Conclusion: R-CHOP and DA-EPOCH-R showed good results in PMBL. These remain one of the best determined systemic treatment options for first-line therapy. Also, the treatment was associated with good efficacy and tolerability.

Is early or late biological maturation trigger obesity? A machine learning modeling research in Turkey boys and girls.

Biological maturation status can affect individual differences, sex, height, body fat, and body weight in adolescents and thus may be associated with obesity. The primary aim of this study was to examine the relationship between biological maturation and obesity. Overall, 1,328 adolescents (792 boys and 536 girls) aged 12.00 ± 0.94-12.21 ± 0.99 years, respectively (measured for body mass, body stature, sitting stature). Body weights were deter-mined with Tanita body analysis system and adolescent obesity status was calculated according to the WHO classification. Biological maturation was determined according to the somatic maturation method. Our results showed that boys mature 3.077-fold later than girls. Obesity was an increasing effect on early maturation. It was determined that being obese, overweight and healthy-weight increased the risk of early maturation 9.80, 6.99 and 1.81-fold, respectively. The equation of the model predicting maturation is: Logit (P) = 1/(1 + exp. (- (-31.386 + sex-boy * (1.124) + [chronological age = 10] * (-7.031) + [chronological age = 11] * (-4.338) + [chronological age = 12] * (-1.677) + age * (-2.075) + weight * 0.093 + height * (-0.141) + obesity * (-2.282) + overweight * (-1.944) + healthy weight * (-0.592)))). Logistic regression model predicted maturity with 80.7% [95% CI: 77.2-84.1%] accuracy. In addition, the model had a high sensitivity value (81.7% [76.2-86.6%]), which indicates that the model can successfully distinguish adolescents with early maturation. In conclusion, sex and obesity are independent predictors of maturity, and the risk of early maturation is increased, especially in the case of obesity and in girls.

A Statistical Approach for the Integration of Multi-Temporal InSAR and GNSS-PPP Ground Deformation Measurements.

Determining and monitoring ground deformations is critical for hazard management studies, especially in megacities, and these studies might help prevent future disaster conditions and save many lives. In recent years, the Golden Horn, located in the southeast of the European part of Istanbul within a UNESCO-protected region, has experienced significant changes and regional deformations linked to rapid population growth, infrastructure work, and tramway construction. In this study, we used Interferometric Synthetic Aperture Radar (InSAR) and Global Navigation Satellite System (GNSS) techniques to investigate the ground deformations along the Golden Horn coastlines. The investigated periods are between 2015 and 2020 and 2017 and 2020 for InSAR and GNSS, respectively. For the InSAR analyses, we used sequences of multi-temporal synthetic aperture radar (SAR) images collected by the Sentinel-1 and ALOS-2 satellites. The ground displacement products (i.e., time series and velocity maps) were then cross-compared with those achievable using the Precise Point Positioning (PPP) technique for the GNSS solutions, which can provide precise positions with a single receiver. In the proposed analysis, we compared the ground displacement velocities obtained by both methods by computing the standard deviations of the difference between the relevant observations considering a weighted least square estimation procedure. Additionally, we identified five circle buffers with different radii ranging between 50 m and 250 m for selecting the most appropriate coherent points to conduct the cross-comparison analysis. Moreover, a vertical displacement rate map was produced. The comparison of the vertical ground velocities derived from PPP and InSAR demonstrates that the PPP technique is valuable. For the coherent stations, the vertical displacement rates vary between -4.86 mm/yr and -23.58 mm/yr and -9.50 and -27.77 mm/yr for InSAR and GNSS, respectively.

Visualization of HeartMate 3 Outflow Graft Twisting by Selective Graft Angiography.

A 55-year-old male patient presented with a history of left ventricular assist device (LVAD) implantation due to ischemic cardiomyopathy. Low-flow alarms were detected on the LVAD, which was temporarily stopped to demonstrate retrograde flow from the aorta through the outflow graft. Selective visualization was performed after engagement of a pigtail catheter in the outflow graft. Twisting at the beginning of the outflow graft was clearly depicted. The patient underwent surgery to correct the twisting. After correction, flow increased immediately back to normal levels.

Impact of COVID-19 on Outcomes of Patients with Hematologic Malignancies: A Multicenter, Retrospective Study.

Objectives: Patients with hematological malignancies have a high risk of mortality from coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematological malignancies and to determine risk factors associated with all-cause mortality. Methods: A multicenter, observational retrospective analysis of patients with hematological malignancies infected with COVID-19 between July 2020 and December 2021 was performed. Demographic data, clinical characteristics, and laboratory parameters were recorded. Patients were grouped as non-survivors and survivors. All-cause mortality was the primary outcome of the study. Results: There were 569 patients with a median age of 59 years. Non-Hodgkin lymphoma (22.0%) and multiple myelomas (18.1%) were the two most frequent hematological malignancies. The all-cause mortality rate was 29.3%. The highest mortality rates were seen in patients with acute myeloid leukemia (44.3%), acute lymphoid leukemia (40.5%), and non-Hodgkin lymphoma (36.8%). The non-survivors were significantly older (p<0.001) and had more comorbidities (p<0.05). In addition, there were significantly more patients with low lymphocyte percentage (p<0.001), thrombocytopenia (p<0.001), and high CRP (p<0.001) in the non-survived patients. Age ≥ 65years (p=0.017), cardiac comorbidities (p=0.041), and continuation of ongoing active therapy for hematological cancer (p<0.001) were the independent risk factors for the prediction of mortality. Conclusions: In patients with hematological malignancies, coexistent COVID-19 leads to a higher mortality rate in elderly patients with more comorbidities. Acute myeloid and lymphoid leukemia and non-Hodgkin lymphoma have the highest mortality rates. Older age, cardiac diseases, and continuation of ongoing active therapy for hematological cancer are the independent risk factors for mortality in hematological malignancy patients with COVID-19.

Association of spontaneous echo contrast with Systemic Immune Inflammation Index in patients with mitral stenosis.

OBJECTIVE: Spontaneous echo contrast (SEC) is the appearance of swirling, smoke-like echoes in the left atrium (LA) and is accepted as an independent predictor of thromboembolic risk. There is an established relationship between the inflammatory state and the prothrombotic state. Therefore, we investigated the relationship between the Systemic Immune Inflammation Index (SII), a new inflammation parameter introduced recently, and SEC in patients with mitral stenosis (MS). MATERIAL AND METHODS: A total of 262 patients who underwent percutaneous mitral valvuloplasty (PMBV) for MS were included in this study. The patients were divided into two groups: patients with MS complicated by SEC and patients with MS without SEC, based on whether SEC occurred in the LA. RESULTS: There were 79 patients (mean age 47.1 ± 6.6, 30.3% male gender) in the SEC (+) group, while there were 183 patients (mean age 46.4 ± 8.6, 29.5% male gender) in the SEC (-) group. In multivariate analysis, high levels of SII were an independent risk factor for SEC in patients with MS (OR: 1.001, 95% confidence interval (CI): 1.000-1.001, p<0.001) together with high levels of C-reactive protein (OR: 1.145, 95% CI: 1.027-1.277, p=0.014). The receiver operating characteristics (ROC) curve analysis showed that at a cutoff value of 547.6 for SII to predict SEC with 74.6% sensitivity and 77.6% specificity (area under ROC curve=0.736 (95% CI: 0.668-0.805), p<0.001). CONCLUSION: Our study showed that the SII levels were independently associated with SEC in patients with MS.

Streptococcus mitis septic arthritis after leucocyte-rich platelet-rich plasma injection for the knee osteoarthritis: A case report.

A 62-year-old female patient having comorbidities of hypertension, hyperlipidemia, obesity, peptic ulcer, and bilateral Grade II knee osteoarthritis was admitted with a complaint of knee pain. An intra-articular leukocyte-rich platelet-rich plasma (LR-PRP) injection was administered to both knees after clinical and laboratory examinations. Three days later, the pain increased and synovial effusion developed in her left knee. The patient was diagnosed with Streptococcus mitis-induced septic arthritis. Clinical and laboratory improvement was obtained with immediate ceftriaxone treatment in addition to irrigation and debridement. This is the first case report in the literature describing septic arthritis developing after intra-articular injection LR-PRP injection.

Left ventricular assist device implantation following multisystem inflammatory syndrome in children due to SARS-CoV-2.

Multisystem inflammatory syndrome in children (MIS-C) is rare, however, severe hyperinflammatory condition in children generally weeks after acute SARS-CoV-2 infection. A subset of MIS-C patients is presented with severe heart failure. We hereby report 8-year-old girl presenting acute severe left ventricular failure. Various medical treatments including inotropic agents and drugs related to SARS-CoV-2 infection and MIS-C were applied. However, venoarterial extracorporeal membrane oxygenation (ECMO) was needed to be performed. Due to unsuccessful attempts for ECMO weaning, left ventricular assist device was implanted to the patient with temporary right ventricular support from ECMO.

Diagnostic importance of bone marrow aspiration evaluation: A single-center study.

Background & Objective: Early diagnosis can be made based on the morphological examination of bone marrow aspiration (BMA) until the bone marrow biopsy (BMB) result is reported. This allows for treatment to be started immediately, especially in hematological malignancies for which urgent treatment is indicated. This study aimed to determine the sensitivity and importance of bone marrow aspiration in the diagnosis of hematological malignancies. Methods: In this study, the data of patients who underwent bone marrow aspiration and bone marrow biopsy in Van Yuzuncu Yil University hospital between 2017 and 2019 were retrospectively analyzed. A total of 500 patients who simultaneously underwent BMA and BMB were included in the study. Data were obtained from electronic medical records. Results: Indication for bone marrow evaluation was abnormalities in complete blood count in 270 (54%) of patients. The diagnosis was made based on the evaluation of BMA in 475 (95%). In 456 (96%) of the 475 patients diagnosed with BMA, the diagnosis was consistent with that of BMB. Agreement of BMB with BMA was 100% in acute and chronic leukemias, while BMA was not sufficient for the diagnosis of lymphoma and solid organ metastasis. Conclusion: Our study showed that the evaluation of BMA was highly sensitive in the diagnosis of hematological malignancies, such as acute leukemias, chronic leukemias, and multiple myeloma.

Comparison of Isocaloric and Hypercaloric Diet in Undernourished Patients.

OBJECTIVE: To determine efficacies of fiber-containing isocaloric and hypercaloric enteral supplements generally used to treat undernutrition. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Department of Pediatrics, Sanliurfa Halfeti State Hospital, Turkey from September 2019 to June 2020. METHODOLOGY: Pediatric patients aged 1-19 years were diagnosed solely with primary undernutrition, were given fiber containing isocaloric or hypercaloric enteral supplements for six months based on their energy requirements. A comparative analysis of anthropometrical data was made with each formula. The analysis included baseline weight, height, BMI of patients, and important micro-nutrient levels at three and six months after intervention. RESULTS: BMI, weight and height z-scores (p <0.001) were improved over six months. There were no differences in BMI and weight scores except for a significant improvement in height between baseline and third month, which was observed in patients who received hypercaloric formula unlike isocolaric formula. There was a two-tailed improvement in blood biochemistry values of both groups. CONCLUSION: Both isocaloric and hypercaloric supplementation had positive effects on anthropometry and blood biochemistry. These results show that both formulae are highly beneficial for children with primary undernutrition. Key Words: Pediatrics, Body mass index, Therapeutics, Gastroenterology, Undernutrition.

Clinical Characteristics and Outcomes of COVID-19 in Turkish Patients with Hematological Malignancies

Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey. Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection. Results: Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use. Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

The measurement of wound tensile strength and the effect of PRP on wound tensile force: an experimental investigation on rabbits.

Platelets in PRP are used for their functions in the initiation and regulation of the wound healing process and are used for the repair of injured tissues and the rejuvenation of healthy tissues. In this study, we evaluated the effect of a single dose platelet-rich plasma on skin wound healing and we demonstrated the effect of platelet-rich plasma on skin wound healing by measuring changes in the wound tensile strength.Material and methods: A total of 8 incisions, each 3 cm long, were made on the back skin on both sides of the vertebral column of 12 rabbits. After suturing their backs with staples, platelet rich plasma (PRP) was injected into the edges of the wounds on the left side and saline solution (saline) was injected into the edges of the wounds on the right side. The tensile force that causes wounds to rupture by applying tension was measured on the 7th, 14th, 21st, and 28th days with the help of a special home-designed device.Results: The mean PRP enrichment was 3.19 fold over peripheral blood. The saline to PRP tensile strength ratios on the 7th, 14th, 21st, and 28th days were calculated as 75.7%, 104.0%, 105.3% and 86.5%, respectively. Overall, the difference in the tensile strength for wounds that had received saline or PRP was in-significant.Conclusion: The application of PRP increases the tensile strength of the wound in the early period. It is possible to measure the tensile strength precisely in in vivo studies with economical home-designed devices.

The Manchester procedure combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling

This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time, and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix.

Effect of static knee joint flexion on vastus medialis obliquus fiber angle in patellofemoral pain syndrome: An ultrasonographic study.

INTRODUCTION: In patients with patellofemoral pain syndrome, the vastus medialis obliquus muscle fiber angle measured by ultrasound at knee extension was found to be different from that in healthy individuals. An important feature of patellofemoral pain syndrome is the increase in pain severity during activities that require knee flexion. OBJECTIVE: To investigate whether there was an ultrasonographic change in the vastus medialis obliquus fiber angle by flexing the knee joint in patients with patellofemoral pain syndrome compared to healthy pain-free individuals. DESIGN: A cross-sectional clinical study. SETTING: An outpatient clinic of a tertiary care hospital. PARTICIPANTS: Forty-seven patients with patellofemoral pain syndrome (median age of 40 years) and 43 healthy volunteers (median age of 39 years) were included in the study. INTERVENTIONS: No intervention. MAIN OUTCOME MEASURES: Vastus medialis obliquus fiber angle measured by ultrasonography at three different positions of knee joint including extension, 30° of flexion, and 45° of flexion. RESULTS: There was no significant change in the vastus medialis obliquus fiber angle with knee flexion in both groups (p > .05 for each group). However, the median vastus medialis obliquus fiber angle values in the group with patellofemoral pain syndrome were significantly lower at all knee joint angles than those in the comparison group (p < .05 at all knee joint angles). CONCLUSIONS: Although the vastus medialis obliquus fiber angle does not change with static knee flexion, the lower angle of the vastus medialis obliquus fiber in those with patellofemoral pain syndrome implicitly suggests that vastus medialis obliquus dysfunction may exist.

Results of multicenter registry for patients with inherited factor VII deficiency in Turkey.

INTRODUCTION: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. METHODS: Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. RESULTS: Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). CONCLUSION: Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.