Investigation of hemispheric asymmetry in Alzheimer's disease patients during resting state revealed BY fNIRS.

Alzheimer's disease (AD) is characterized by the gradual deterioration of brain structures and changes in hemispheric asymmetry. Meanwhile, healthy aging is associated with a decrease in functional hemispheric asymmetry. In this study, functional connectivity analysis was used to compare the functional hemispheric asymmetry in eyes-open resting-state fNIRS data of 16 healthy elderly controls (mean age: 60.4 years, MMSE (Mini-Mental State Examination): 27.3 ± 2.52) and 14 Alzheimer's patients (mean age: 73.8 years, MMSE: 22 ± 4.32). Increased interhemispheric functional connectivity was found in the premotor cortex, supplementary motor cortex, primary motor cortex, inferior parietal cortex, primary somatosensory cortex, and supramarginal gyrus in the control group compared to the AD group. The study revealed that the control group had stronger interhemispheric connectivity, leading to a more significant decrease in hemispheric asymmetry than the AD group. The results show that there is a difference in interhemispheric functional connections at rest between the Alzheimer's group and the control group, suggesting that functional hemispheric asymmetry continues in Alzheimer's patients.

Ultrasound guided quadro-iliac plane block: another novel fascial plane block.

STUDY OBJECTIVE: We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. DESIGN: A cadaveric examination that evaluates the spread of QIP block. SETTING: Cadaver laboratory. PATIENTS: One unembalmed cadaver. INTERVENTIONS: Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. MEASUREMENTS: Dye spread in cadaver. MAIN RESULTS: There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. CONCLUSION: The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread.Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.

The effect of platelet-rich fibrin, platelet-rich plasma, and concentrated growth factor in the repair of full thickness rotator cuff tears.

BACKGROUND: Rotator cuff lesions rank among the prevalent causes of shoulder pain. Combining surgical interventions with growth factors, scaffolds, and stem cell therapies can effectively decrease the likelihood of rotator cuff repair recurrence. Platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF), isolated from blood and rich in growth factors, have a critical role in cell migration, cell proliferation, and angiogenesis during the tissue regeneration process. Investigations have further substantiated the beneficial impact of PRP and PRF on the biomechanical and histologic attributes of the tendon-bone interface. We aimed to investigate the effectiveness of CGF compared with PRF and PRP in the repair of rotator cuff lesions as a new treatment strategy. METHODS: Incision was performed on both shoulder regions of 21 adult rabbits. After 8 weeks, both shoulders of the rabbits were repaired by suturing. PRF and CGF were administered to 2 separate groups along with the repair. Tissues were collected for biomechanical measurements and histologic evaluations. RESULTS: Histologically, CGF, PRF, and PRP showed similar results to the healthy control group. The level of improvement was significant in the PRF and PRP groups. In the PRF group, the distribution of Ki67 (+), CD31 (+), and CD34 (+) cells was determined intensely in the tendon-bone junction regions. Apoptotic cells increased significantly in the repair group compared with the healthy group, whereas fewer apoptotic cells were found in the PRF-, PRP-, and CGF-applied groups. In the biomechanical results, no statistical difference was recorded among the groups. CONCLUSION: The use of PRF, PRP, and CGF in rotator cuff repair shows promise in shortening the treatment period and preventing the recurrence of rotator cuff lesions.

Re-evaluation of the symptoms of Hirayama disease through anatomical perspective.

Hirayama disease is a rare disease of the anterior horn motor neuron caused by compression of the cervical spinal cord when the neck is flexed. Cervical myelopathy may accompany the disease. It is characterized by symmetrical or asymmetrical muscle weakness and atrophy of muscles innervated by lower cervical and upper thoracic motor neurons. We recorded two male cases of Hirayama disease between the ages of 15 and 21 based on magnetic resonance imaging (MRI) features obtained from the cervical neutral state and from the flexion position which appeared in the right upper extremity. Loss of strength and atrophy in the right upper extremities was existent in clinical findings of these patients. When MRI was taken in the flexion position, there were dilated veins as hypointense signal void on T2 weighted series in posterior epidural area. The contrast enhancement was seen on these veins. It was observed that the posterior dura was displaced anteriorly and the anterior subarachnoid space was narrow. In cases which show clinical findings such as atrophy and loss of strength, having normal MRI results obtained in the neutral position makes it difficult to diagnose Hirayama Disease. In case of a suspicion of Hirayama disease the diagnosis can be made more easily by MRI taken in the flexion position. These case reports aim to bring Hirayama disease to mind and optimize the management of affected individuals.

Radiological evaluation of patellofemoral instability and possible causes of assessment errors.

Patellofemoral instability (PI) is the disruption of the patella's relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.

The Endoscopic Trans-Sinusoidal Trans-Pterygopalatine Route to the Foramen Rotundum Approach in Trigeminal Neuralgia Treatment.

AIM: To describe a new, minimally invasive, and safe access to foramen rotundum via the endoscopic endonasal trans-sinusoidal route for trigeminal nerve blockage. MATERIAL AND METHODS: We studied 5 fresh cadavers bilaterally, and 10 pterygopalatine fossae and maxillary nerves using the endoscopic endonasal trans-sinusoidal trans-pterygopalatine approach. RESULTS: The proposed approach enabled the maxillary nerve to be visualized after revealing the foramen rotundum with the help of some craniometric measurements. Distance between sphenoid sinus lateral wall and maxillary sinus posterior wall was measured. This measurement was found to be an important triangulation point to determine the location of the entrance to the pterygopalatine fossa. The distance between the foramen rotundum and the sphenopalatine artery was found to be significant. The foramen rotundum diameter was calculated, and the maxillary nerve was found to be situated inferolateral to the foramen rotundum. Therefore, the safe entry zone was determined superomedially. No significant difference was found between male and female and the right and left nostrils. CONCLUSION: Various surgical procedures have been applied to treat drug-resistant trigeminal neuralgia. Nevertheless, their cure rates remain less than anticipated. Recurrences up to 30% have been reported in the literature. In this study, the endoscopic endonasal transmaxillary trans-pterygopalatine route offers a new perspective on the foramen rotundum approach and provides a panoramic and safe view in previously high-risk percutaneous interventions.

Gluteoperinealis muscle: a surgically important variation.

BACKGROUND: Anatomical variations are common in gluteal region. This report presents two cases of gluteoperinealis muscles detected during radiological imaging. CASE PRESENTATION: Our study was conducted on two patients. This report describes an accessory muscle detected in the gluteal region on MRI examination of a patient who admitted to our clinic after a firearm injury and a second patient examined with CT imaging who had signs of pelvic infection. In the first case, this accessory muscle originated bilaterally from the fascia of the gluteus maximus throughout its posteromedial side and was attached to the perineal body. In the second case, it extended forward from the fascia of the gluteus maximus muscle and inserted to the cavernous body of penis on the left side and to the perineal body on the right. In the literature, this accessory muscle has been described as the gluteoperinealis muscle being a rare variation. CONCLUSION: Considering the origin and insertion of the muscle, this variation may be important during the surgical operations of the gluteal and perineal regions.

Evaluation of Anatomoradiological Findings on Trigeminal Neuralgia Patients Using Computed Tomography and Cone-Beam Computed Tomography.

The study aimed to establish and evaluate anatomoradiological landmarks in trigeminal neuralgia patients using computed tomography (CT) and cone-beam CT. CT images of 40 trigeminal neuralgia (TN) and 40 healthy individuals were retrospectively analyzed and enrolled in the study. The width and length of the foramen rotundum (FR), foramen ovale (FO), foramen supraorbitale, and infraorbitale were measured. The distances between these foramen, between these foramen to the median plane, and between the superior orbital fissure, FO, and FR to clinoid processes were also measured bilaterally. Variations were evaluated according to groups. Significant differences were found for width and length of the foramen ovale, length of the foramen supraorbitale, and infraorbitale between TN and control subjects (p < 0.05). On both sides, FO gets narrower and the length of the infraorbital and supraorbital foramen shortens in the TN group. In most of the control patients, the plane which passes through the infraorbital and supraorbital foramen intersects with impression trigeminale; 70% on the right-side, and 67% in the left-side TN groups. This plane does not intersect with impression trigeminale and deviates in certain degrees. The determination of specific landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures in trigeminal neuralgia patients.

Importance of sonographic paratracheal lymph node evaluationin early autoimmune thyroiditis.

BACKGROUND/AIM: To review the sonographic views of paratracheal lymph nodes (PLNs) in the diagnosis and during different stages of autoimmune thyroiditis. MATERIALS AND METHODS: Features of the PLNs (left and right), thyroid sonography, and laboratory data were investigated in 126 cases. Patients were divided into three groups by using thyroid sonographic criteria in the literature (group 1: control, group 2: early-stage/indeterminate, group 3: definite thyroiditis). Indeterminate patients were followed up for 1 year and included as indeterminate/early-stage thyroiditis patients. RESULTS: Percentage of right and left PLN was 13.3% and 46.2% in control cases, 21.2% and 80% in early-stage/indeterminate cases, and 41.3% and 88.5% in definite thyroiditis cases. Significant among-group differences were evident in terms of right and left PLNs presence (Pearson chi-squared test, P = 0.011 and P = 0.001). CONCLUSION: Careful and thorough review of the PLNs can ensure diagnosis of autoimmune thyroiditis even in cases of early stage of the disease and prevent false-negative diagnoses.

The effect of removable partial dentures on alveolar bone resorption: a retrospective study with cone-beam computed tomography.

PURPOSE: The aim of this study was to compare vertical and horizontal mandibular alveolar bone resorption by measuring bone morphological variation in Kennedy Class II removable partial denture (RPD) wearers and non-wearers using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: In total, 124 sites in the CBCT scans of 62 (29 RPD non-wearers, 33 RPD wearers) Kennedy Class II patients were analyzed retrospectively. Three-dimensional representations of the mandible with superimposed cross-sectional slices were developed with the CBCT scans to evaluate the mandibular alveolar height and width by measuring distances between the mandibular canal, mylohyoid ridge, alveolar crest, and lower border of the mandible in four regions (eight sites) of Kennedy Class II non-wearers and wearers of RPDs. RESULTS: Mandibular alveolar bone height and width were significantly lower in edentulous sites when compared with dentate sites in both Kennedy Class II non-wearers and wearers of RPDs (p < 0.05). Additionally, mean vertical and horizontal mandibular bone resorption was significantly higher in RPD wearers than in non-wearers (p < 0.05). CONCLUSIONS: Vertical and horizontal alveolar bone resorption was found to be higher in the RPD wearing patients when comparing the dentate and edentulous sites.

Cervicofacial emphysema after dental treatment with emphasis on the anatomy of the cervical fascia.

Fascial organization of the neck is quite complex and highly variable between individuals. Fascial layers separate very important structures in the neck, and by this way, they build anatomical walls against spread of infections, although this alignment could lead to spread of infection very easily throughout connected fascial spaces. We tried to discuss the possible anatomical pathways resulting in cervicofacial emphysema with a case.The development of cervicofacial emphysema after dental treatment is a well-known complication especially when using high-speed turbines. A 39-year-old female patient is referred to our private dental clinic with complaints of swelling on her right supraclavicular region with edema of right orbita with absence of pain. In our case, emphysema reaches to supraclavicular region using retropharyngeal space and prevertebral fascia.This case illustrates anatomically how air or other materials, including pathogens or infections, could pass easily from oral cavity into thorax or even abdomen using facial planes.

Evaluation of bifid mandibular canals with cone-beam computed tomography in a Turkish adult population: a retrospective study.

PURPOSE: Knowing the anatomic location and also variations of the mandibular canal is especially important for surgical procedures on mandible such as dental implant surgery, impacted molar extraction and sagittal split ramus osteotomy. The purpose of this study was to clarify the incidence and location of bifid mandibular canals in an adult Turkish population to avoid complications during surgical procedures. METHODS: A retrospective study using cone beam CT images was performed to evaluate bifid mandibular canal in mandible of 242 patients. Both right and left sides were studied (n = 484). Axial, sagittal, cross-sectional and panoramic images were evaluated, and three-dimensional (3D) images were also reconstructed and evaluated, as necessary. The course and length of bifid mandibular canals and the superior and inferior angles between canals were measured. RESULTS: Bifid mandibular canals were observed in 225 (46.5%) of 484 sides examined. The most frequently encountered type of bifid canal was the forward canal (29.80%), followed by the retromolar (28.10%) the buccolingual (14.50%) and the dental canal type (8.30%). Mean lengths of bifid canals were 13.6 mm in the right side and 14.1 mm in the left side. Mean superior angles were 139° on the right and 141° on the left side, whereas mean inferior angles were 38° on the right side and 32° on the left side. No statistically significant differences were found in the lengths or angles between the right and left sides and also for gender (p < 0.05). CONCLUSIONS: This study, which utilized CBCT images, uncovered a higher prevalence of bifid mandibular canals than what has been reported in previous studies using conventional radiography techniques.