Can myocardial dysfunction be detected in patients with rheumatoid arthritis with no cardiac symptoms?

OBJECTIVE: The aim of our study was to investigate the role of tissue Doppler and Myocardial Performance Index (MPI) in evaluating cardiac involvement in patients with rheumatoid arthritis (RA) with no cardiac symptoms, to determine whether these measurements differ between healthy controls and RA patients, and whether they can be used to determine the risk of cardiovascular disease and predict prognosis. PATIENTS AND METHODS: 50 RA patients fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA criteria and 50 healthy volunteering controls were included in the study. All patients and controls were assessed using electrocardiography (ECG), echocardiography, conventional Doppler echocardiography and tissue Doppler echocardiography. MPI values were calculated. In addition, RA patients were compared after being divided into two subgroups: seropositive and seronegative RA. Disease activity levels of the patients were determined based on Disease Activity Score in 28 Joints (DAS28). RESULTS: The control group and RA group were compared in terms of PR interval, left atrial diameter, E/A, E/e', and MPI values. Comparisons between the groups yielded statistically significant differences in left atrial diameter, E/A, E/e', and MPI values and no significant difference in PR intervals. These parameters were also compared between seropositive and seronegative patients. Left atrial diameter was significantly higher in seronegative patients than in seropositive patients. There was no significant difference in the other values. DAS28 scores had no correlation with cardiac parameters. CONCLUSIONS: Early detection of ventricular dysfunction in RA may be useful in clinical practice when predicting prognosis and optimizing treatment. The present study found that RA patients had impaired tissue Doppler measurements and MPI results compared to controls. MPI and tissue Doppler may be useful in early detection of ventricular dysfunction.

Determination of the embryotoxic effect of maropitant using an in ovo model.

The aim of this research was to determine the embryotoxic and teratogenic effects and lethal dose (LD50) of maropitant in ovo, using fertile chicken eggs. The study was designed in two stages, CHEST-I and CHEST-II. For CHEST-I, 210 fertile eggs were divided into seven equal groups; control, saline solution and 5 different doses of maropitant (10, 5, 2.5, 1.25, 0.625 mg/kg) injected groups. For CHEST-II, 150 fertile eggs were divided into five equal groups; control, saline solution and 3 different doses of maropitant (8, 6, 4 mg/kg)-injected groups. Eggs were opened on day 21 of incubation. Maropitant did not cause teratogenicity at any dose, while higher embryonic death rates were observed at doses above 4 mg/kg. The LD50 dose of maropitant was determined as 7.24 mg/kg. In conclusion, maropitant should only be used after full consideration of risks and benefits in pregnancy.

Evaluation of long-term dental implant success and marginal bone loss in postmenopausal women.

AIM: The aim of this study was to examine long-term implant success and marginal bone loss (MBL) of dental implants in postmenopausal women with osteoporosis/osteopenia. MATERIALS AND METHODS: Postmenopausal women who underwent dental implant treatment at least 3 years ago were divided into two study groups [Test (osteoporosis/osteopenia) Group and Control Group] according to bone mineral density (BMD) measurements. Besides clinical periodontal and radiographic examinations, any implant failures were also recorded. RESULTS: A total of 52 patients with a mean age of 59.51 ± 5.66 years (Test Group; 26 patients, mean age: 60.61; Control Group; 26 patients, mean age: 58.42) were included in the study. Implant survival rates were 96.2% and 100% with a mean follow-up 60.84 ± 22.13 and 60.07 ± 20.93 months in Test and Control Groups, respectively (P > 0.05). While peri-implant PI (plaque index) and PD (probing depth) were not different between the groups, BoP (bleeding on probing) was significantly higher in Test Group (P = 0,026). Although MBL in Test Group was higher than Control Group (0.82 ± 0,63 mm and 0.44 ± 0,33 mm respectively), the difference was not found statistically significant (P = 0.069). CONCLUSION: Within the limits of this retrospective study, it can be concluded that postmenopausal osteoporosis/osteopenia does not affect MBL and long-term implant success. The findings suggest that dental implant therapy is a reliable treatment modality in these patients to improve the quality of life by increasing function and aesthetics.

Do genetic polymorphisms affect susceptibility to periodontal disease? A literature review.

The pathogenesis of periodontal disease is not solely based on microbial dental plaque but is the result of the multifactorial and complex interaction between infection and host response. Many studies in the literature have demonstrated the differences between individuals in terms of host immune response and the presence of genetic components in numerous pathological conditions. Therefore, periodontitis may be defined as a complex genetic disorder with a phenotype formed by the genetic structure and environmental factors in the affected individual. So, determination of the genetic susceptibility profile associated with periodontitis might be very precious for developing novel diagnostic techniques and individual treatment strategies. To clarify the possible role of genetic polymorphisms in periodontal diseases, we searched PubMed for studies published on the subject since 1997 up to June 2018 and obtained data from original studies, meta analyzes, and systematic reviews. We included only case-control studies with large study populations.

Dose-dependent effects of adiponectin on ADAMTS-9 gene expression in human chondrocytes.

OBJECTIVE: A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS), comprising of 19 members is a family of peptidases. They have several vital functions in physiological and pathological processes in organisms. ADAMTS-9 has aggrecanolytic activity and is responsible for degradation of aggrecan mainly in articular cartilage. It is known that adiponectin is the most abundantly secreted adipokine (adipocytokines), and the characteristics of adiponectin have not been elucidated yet. It was assumed that adiponectin has anti-inflammatory effect before. However, an inflammatory feature of adiponectin was shown in researches. In our study, the effect of adiponectin on ADAMTS-9 gene expression in primary human chondrocytes was investigated. METHODS: Primary human chondrocytes were exposed to adiponectin at 1, 4, 8 and 12 µg/ml doses for certain time period. Total RNA was isolated and reverse-transcribed by random primer after incubation. ADAMTS-9 and ß-actin genes expression levels were determined using real-time polymerase chain reaction (qRT-PCR). RESULTS: The highest upregulation of ADAMTS-9 gene expression level was found at 12 µg/ml dose of adiponectin and 48 h incubation. CONCLUSION: Adiponectin is the key element in the maintenance of cartilage homeostasis. Similarly, the involvement of adiponectin in articular inflammatory diseases was demonstrated in detail. These findings bring adiponectin into central place in the research to develop adiponectin based new therapy methods for arthritic diseases. Together with these findings, our results suggest that adiponectin may be involved in the degradation of articular cartilage by increasing ADAMTS-9 gene expression (Tab. 1, Fig. 3, Ref. 35).

Dietary arginine silicate inositol complex inhibits periodontal tissue loss in rats with ligature-induced periodontitis.

The purpose of this study was to induce experimental periodontitis in rats previously fed diets containing arginine silicate inositol (ASI) complex and examine the biochemical, immunological, and radiological effects. Fifty two 8-week-old female Sprague Dawley rats were equally divided into four groups. The control group included those fed a standard rat diet with no operation performed during the experiment. The periodontitis, ASI I, and ASI II groups were subjected to experimental periodontitis induction for 11 days after being fed a standard rat diet alone, a diet containing 1.81 g/kg ASI complex, or a diet containing 3.62 g/kg ASI complex, respectively, for 8 weeks. Throughout the 11-day duration of periodontitis induction, all rats were fed standard feed. The rats were euthanized on the eleventh day, and their tissue and blood samples were collected. In the periodontitis group, elevated tissue destruction parameters and reduced tissue formation parameters were found, as compared to the ASI groups. Levels of enzymes, cytokines, and mediators associated with periodontal tissue destruction were lower in rats fed a diet containing ASI complex after experimental periodontitis. These results indicate that ASI complex could be an alternative agent for host modulation.

Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model.

BACKGROUND: Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. HYPOTHESIS: The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. MATERIALS AND METHODS: Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. RESULTS: Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. CONCLUSION: Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures.

Social problem-solving, perceived stress, negative life events, depression and life satisfaction in psoriasis.

BACKGROUND: Psoriasis is a chronic dermatosis which may cause significant impairment of the patient's quality of life. OBJECTIVE: The purpose of this study was to investigate the social problem-solving skills, perceived stress, negative life events, depression and life satisfaction in psoriasis patients. METHODS: Data were gathered by means of questionnaires and clinical evaluations from 51 psoriatic patients and 51 matched healthy controls. RESULTS: Average disease duration was 16.47 years and average Psoriasis Area and Severity Index score was 3.67. Compared with the controls, the patients displayed lower social problem-solving skills. They displayed higher negative problem orientation and impulsive-careless problem-solving style scores than the controls. Patients tended also to show more avoidant problem-solving style and lower life satisfaction than controls. There was no difference between psoriatic patients and controls in terms of depression, perceived stress and negative life events. Higher social problem-solving skills were associated with lower depression, perceived stress and fewer numbers of negative life events but higher level of life satisfaction. LIMITATIONS: The patient group largely included mild and moderate psoriatic cases. CONCLUSION: The findings of the study suggest that problem-solving training or therapy may be a suitable option for alleviating levels of psychological distress in patients suffering from psoriasis.

Resistant oral mucosal lesions in pemphigus vulgaris responsive to double filtration plasmapheresis: First case report from Turkey.

BACKGROUND: Adjuvant therapeutic methods are employed when pemphigus vulgaris (PV) fails to be controlled by conventional corticosteroid treatment. OBJECTIVE: The efficacy of double filtration plasmapheresis (DFPP) was investigated in a PV patient with severe, refractory mucosal disease. METHODS: A total of 3 DFPP cycles, each cycle consisting of 5 double filtration sessions conducted on alternate days was completed. RESULTS: DFPP provided immediate clinical relief of symptoms as well as a significant decrease in anti-desmoglein antibody levels and allowed for a much lower corticosteroid dose. CONCLUSION: DFPP was an effective and safe adjuvant therapy in our patient with PV and it offers a valid treatment option in PV patients with recalcitrant disease.

An assessment of periodontal health in patients with schizophrenia and taking antipsychotic medication.

BACKGROUND AND OBJECTIVE: Severe periodontal disease is prevalent among patients with schizophrenia and is caused by the side effect of their medication, poor dental hygiene and smoking. The objective of this study was to evaluate whether the rate of periodontal disease could be modulated by changing the salivary flow rate (SFR) because of the use of antipsychotic medications in patients with schizophrenia. METHODS: Group A (n=33) included patients who used medications that may cause xerostomia, or dry mouth and Group B (n=20) included patients who used medications that may cause sialorrhea, an excessive secretion of saliva. The participants' periodontal status was assessed using the plaque index (PI), assessing bleeding on probing (BoP), probing pocket depth (PPD) and clinical attachment levels (CAL). RESULTS: The mean of PI and BoP was significantly higher in Group A than in Group B (P<0.001), but the PPD, CAL and decayed, missing and filled teeth (DMFT) scores were not significantly different in the two groups according to the statistical results (P>0.05). CONCLUSIONS: The researcher concluded that there is a high risk of periodontal disease among patients with schizophrenia, and there is an even higher risk of periodontal disease induced by medication that increased SFR. Preventive dental protocol should be increased during the dental health care of this disadvantaged patient group.

Adiponectin levels, insulin resistance and their relationship with serum levels of inflammatory cytokines in patients with Behçet's disease.

AIM: Increased frequency of cardiovascular disease and its possible relations with insulin resistance have been reported in patients with inflammatory diseases. The aim of our study was to investigate insulin resistance and serum adiponectin levels as cardiovascular risk markers in patients with Behçet's disease. METHOD: Study population consisted of 40 patients with Behçet's disease (BD) and a control group composed of age, gender, body mass index-matched 46 healthy individuals. All patients were examined for signs of Behçet's disease. Body mass index, waist and hip circumference were measured. Insulin resistance was evaluated using the homeostasis model assessment-insulin resistance method. Erythrocyte sedimentation rate (ESR), lipid profile, high sensitive CRP (hsCRP), adiponectin, TNF-α, IL-6 and IL-8 levels were measured. RESULTS: Erythrocyte sedimentation rate, serum hsCRP and IL-6 levels were significantly higher in patients with BD than those in the controls (P=0.001, P=0.001, P=0.001, respectively). Fasting plasma glucose, insulin levels and lipid profile were not different between the two groups. Insulin resistance and decreased levels of the serum adiponectin were not detected in the patients. There was no relationship between insulin resistance, adiponectin levels and inflammatory markers. Active and inactive patients did not differ in respect of any parameters. CONCLUSION: Being a systemic vasculitis, BD may cause cardiovascular involvement. In this study, dyslipidemia, insulin resistance and low adiponectin levels were not detected among our patients with Behçet's disease. Our results suggest that there exists no increased risk for atherosclerotic cardiovascular disease associated with adiponectin levels and insulin resistance in patients with Behçet's disease.

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey.

BACKGROUND: Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. METHODS: A cross-sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self-Esteem Scale (RSES). RESULTS: Five hundred and sixty-three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 +/- 1.05 years. Acne prevalence was 63.6% with 29.2% non-inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self-esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty-eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. CONCLUSION: Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.

Extremity fracture characteristics in children with impulsive/hyperactive behavior.

INTRODUCTION: To investigate which fracture characteristics were associated with impulsive/hyperactive behavior in children with extremity fractures. MATERIALS AND METHODS: A clinical sample of 95 consecutive children with extremity fractures admitted to the Orthopaedics and Traumatology Outpatient Clinic of a university hospital were included in the study. The Conners Parent Rating Scale (CPRS) was used to assess children's symptoms. Fracture characteristics were grouped according to trauma type, fracture localization, hospitalization requirement, treatment type and history of previous fracture(s). Descriptive analyses were performed; t-tests and univariate ANOVAs were utilized to compare groups with respect to impulsivity/hyperactivity subscale scores on the CPRS. RESULTS: Mean CPRS impulsivity/hyperactivity subscale score for the whole group was 6.94 (SD = 2.69). Children with fractures which occurred during solitary activities presented with more impulsive/hyperactive behavior than those with fractures which occurred during group activities. Children with more severe fractures that required open reduction also presented with more impulsive/hyperactive behavior. Children with lower extremity fractures had showed more impulsive/hyperactive behavior than children with upper extremity fractures. CONCLUSION: Detecting behavior problems in children admitted with fractures and referring them for treatment, is critical in preventing future serious injuries.

Computerized tomography scout view for determining distal femoral resection angle in intramedullary instrumentation of total knee arthroplasty.

This study aims to investigate the results of distal femoral resection by determining the difference between mechanical and anatomical axes of femur using computerized tomography (CT) scout views in pre-operative planning of total knee arthroplasty. CT scout view of the lower extremities was taken before and after the operation in 16 patients undergoing total knee arthroplasty. Distal femoral resection was performed according to the previously determined ideal resection angle (IRA) using intramedullary instrumentation. At post-operative scanogram, femoral component deviation (FCD) was measured. The results were statistically analyzed. The average IRA was 6.95 (5-9) degrees. At post-operative measurements, the average FCD was 0.63 (0-3) degrees. CT scout films improve the accuracy in distal femoral resection and femoral component alignment.

Etiology of senile osteoporosis: a hypothesis.

UNLABELLED: Osteoporosis is a major health problem characterized by compromised bone strength predisposing patients to an increased risk of fracture. It may cause morbidity and mortality in elderly men and women. The etiologic factors that lead to senile osteoporosis still are unclear. Based on the available experimental and clinical evidence, we update our earlier proposal that zinc deficiency plays a role in the pathogenesis of senile osteoporosis. However, the mechanism of zinc deficiency in osteoporosis remains unclear. Zinc deficiency may lead to the increase of endogenous heparin probably causing degranulation of mast cells and release of endogenous heparin, and an increase in the bone-resorbing effect of prostaglandin E2. Endogenous heparin and prostaglandin E2 are probably cofactors of parathyroid hormone and may have a role in the pathogenesis of senile osteoporosis enhancing the action of parathyroid hormone. Therefore, zinc replacement by dietary zinc supplementation might be valuable to prevent or treat senile osteoporosis. Additional studies are necessary for the evaluation of the possible role of zinc in the etiology of senile osteoporosis. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

Osteochondral multiple autograft transfer (OMAT) for the treatment of cartilage defects in the knee joint.

The ideal articular cartilage repair tissue should be durable and well-integrated. We have been performing osteochondral multiple autograft transfers (OMAT) since 1996 with the experience we had using carbon fiber implants. We call this technique OMAT instead of mosaicplasty because we use uniform osteochondral autografts. Osteochondral multiple autograft transfer (OMAT) was performed either by arthrotomy or arthroscopy on 12 patients (6 male and 6 female) for the treatment of cartilage defects in the knee joint. The patients ranged in age from 20 to 63 years (mean: 38 years). All had weightbearing-related pain or decrease in the range of motion. None had instability or malalignment. The average follow-up time was 4 years (range: 2 to 8 years). Clinical results were satisfactory. All of the paients were improved initially by the procedure and 85% are still pain free. The mean Lysholm knee rating score was 56 points preoperatively and 86 points postoperatively. Second-look arthroscopy (five patients) demonstrated a normal shiny appearance and color of the grafted area. We observed slight joint effusion postoperatively that disappeared in two months. There was no donor site morbidity. OMAT is a promising surgical technique for the treatment ofarticular cartilage defects. Long-term follow-up with more patients and histological and biomechanical evaluation of chondral interfaces are the subjects of our continuing study.

Ultrasonographic findings in pediatric fractures.

The aim of this study was to document and analyze ultrasonographic (US) findings in different types of pediatric fractures. Thirty-nine patients, aged between 1 and 14 years, with a fracture were included in the study. Patients were classified as complete or incomplete fractures. Greenstick fractures, torus fractures and plastic deformations were considered as incomplete fractures. Ultrasonographic findings (subperiosteal hematoma, bending, cortical disruption, and reverberating echo) were analysed for each type of fracture. Subperiosteal hematoma was present in all patients in the study. Bending sign was present in all patients in the incomplete fracture group, but not present in complete fractures. Cortical disruption and reverberating echo were present in all patients with complete and greenstick fractures. In conclusion, whether the fracture is complete or incomplete, subperiosteal hematoma, together with a cortical disruption, bending sign, or reverberating echo shown on US can confirm the fracture diagnosis in children.

Histological alterations after irradiation of cartilage using Ho:YAG laser.

OBJECTIVE: The authors carried out an experimental study to evaluate the histological alterations after irradiation of cartilage using Holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and Infra Tome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). BACKGROUND DATA: Recently, some authors reported cases with articular cartilage damage following arthroscopic laser surgery in the knee joint for the treatment of articular cartilage or meniscal pathology. MATERIALS AND METHODS: The cartilage specimens immersed in saline were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 microm, and pulse duration was 250 microsec. Power settings were 0.2-1 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 1.5 K joules. During the procedures, the handpiece was used at an angle of 30 degrees and at a distance of 1 mm. RESULTS: Electron microscopic evaluation demonstrated that the ultrastructure of the cartilage is preserved in both experiment and control groups. CONCLUSION: When Ho:YAG laser is used in optimal dosage (optimal joule and Hertz) with optimal technique (keeping the handpiece at an appropriate angle and distance) and avoiding overtreatment, it does not cause cartilage damage.

Innervation pattern of the abductor digiti minimi muscle of the hand.

This cadaver study investigated the innervation patterns of the abductor digiti minimi in Guyon's canal. There was only one branch to the abductor digiti minimi in 22 of the 30 specimens. Two branches were found in three hands, and three branches in two. Three other variations were documented.