A new device for assessment and training the human balance and coordination: Marmara Balance and Education System (MarBES).

BACKGROUND: Balance and coordination are important for performing activities of daily living. Balance and coordination assessment and training are used by physiotherapists in many different rehabilitation areas. Marmara Balance and Education System (MarBES) is a device developed to evaluate and improve balance and coordination. AIMS: To examine the test-retest reliability of the MarBES device. METHODS: Double-leg and single-leg (eyes open-closed) tests were applied to healthy young adult participants for balance testing on the MarBES device. Weight data is estimated from pressure sensors located in 4 different corners and a score is calculated with computer software for the individual's center of gravity (center of pressure X, Y) and the amount of deviation from the center for each axis. Weight transfer to the target surface was measured for assessment of the participants' coordination performance. Participants rested for 10 min and all measurements were repeated by the same evaluator. The obtained data were recorded and the reliability of the measurements was evaluated with Spearman's rho correlation analysis. RESULTS: A total of 40 healthy young individuals (28 female) with a mean age of 21 years were included. The balance assessments with MarBES showed moderate to good reliability (ICC: 0.535-0.903). The coordination assessment results showed moderate to good reliability (ICC: 0.575-0.712). CONCLUSIONS: Objective evaluation of balance and coordination parameters is very important in rehabilitation. Results of the study showed that the MarBES device developed by the researchers is a reliable method for the evaluation of balance and coordination in healthy young individuals.

Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers.

BACKGROUND: In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. METHODS: In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). RESULTS: Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. CONCLUSION: We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Evaluation of Renal Function in Alzheimer's Disease and Geriatric Patients: Results from a Turkish Two-center Study.

BACKGROUND: Alzheimer's disease (AD) is a severe multifactorial neurodegenerative proteopathy associated with advanced age. Discrepancies in the renal function of these patients compared to geriatric patients with dementia have rarely been reported. In this study, we aimed to disclose the importance of associated renal changes for the pathogenesis of AD. METHODS: Patients with AD (n=107) and geriatric patients with dementia and without dementia (n=124) (231 patients in total) from Dokuz Eylul and Cukurova University Hospitals were enrolled in the study. We measured serum Na, K, Cl, Ca, BUN, creatinine, total protein levels and MDRD [eGFR] in all groups. RESULTS: From Izmir Center, the first study arm consisted of patients with AD dementia (n=74), and the second arm included geriatric patients with dementia (n=79). From Adana, 78 patients were recruited to the study, of which 33 were with AD and 45 were geriatric patients without dementia. When we analyzed comparatively the AD and geriatric dementia patients study arms, a statistically significant difference was observed both in the median age (p<0.001), as well as in the biochemical parameters from Izmir Center: Na (p<0.001), K (p<0.001), Cl (p<0.05), Ca (p<0.001), BUN (p<0.05), creatinine (p<0.001), total protein (p<0.001) and MDRD [eGFR] (p<0.001). However, these were not significantly different between AD and geriatric patients without dementia in the Adana group. CONCLUSIONS: Our results indicate that renal function is prone to alterations in different age groups of patients with AD. However, there is no conclusive evidence that renal function is one of the risk factors in AD.

Anticonvulsant efficacy of melatonin in an experimental model of hyperthermic febrile seizures.

INTRODUCTION: The anticonvulsant effects of melatonin (MT) have been demonstrated in several different experimental seizure models. Thus, the present study aimed to determine the anticonvulsant efficacy of MT, the optimum time for its administration prior to the induction of a seizure, and its effective dose in a rat model of hyperthermic febrile seizures (FSs). METHODS: The present study included 72 male Sprague-Dawley rat pups divided into eight groups. The seizures were induced by keeping the rats in 45 °C water and the experiments were performed in two steps. In the first step, the control group was given a vehicle injection and the study groups were given a MT injection (150 mg/kg, intraperitoneal [i.p.]) at either 5, 10, or 15 min prior to the induction of the seizure to determine the anticonvulsant effects of MT and its optimum time of administration. In the second step, a vehicle injection and three different doses of MT (80, 100, and 150 mg/kg, i.p.) were administered 15 min prior to the induction of the seizure to determine the dose at which anticonvulsant effects could be achieved. The anticonvulsant effects were assessed based on the latency of the FSs. RESULTS: In the first-step experiments, the FS latency of the control group was 143.4 ± 15.3s and the latencies of the groups given melatonin at either 5, 10, or 15 min prior to the seizure were 174.2 ± 28.9, 177.4 ± 21.0, and 193.7 ± 17.6s, respectively. Compared with the control group, the latencies for each of the study groups were significantly longer (p<0.001), with the longest latency observed in the group given melatonin 15 min before the seizure. In the second-step experiments, the FS latencies of the groups that were given 80, 100, and 150 mg/kg of MT 15 min before the seizure were 238.7 ± 4.0, 240.0 ± 0.0, and 193.7 ± 17.6s, respectively. These latencies were significantly longer than those of the control group (172.3 ± 30.3s, p<0.001). CONCLUSION: The present study demonstrated that MT exerts anticonvulsant effects in a rat model of hyperthermic FSs and achieved its optimum efficacy at a dose of 80 mg/kg when administered 15 min prior to the induction of a seizure.

The role of shear wave elastography in the diagnosis of chronic autoimmune thyroiditis.

AIMS: The aim of this study is to assess the applicability of shear wave elastography (SWE) in the diagnosis of chronic autoimmune thyroiditis (CAT) patients. MATERIAL AND METHODS: The study group consisted of 50 patients with first-diagnosed CAT and 40 control subjects (CS). In all patients with CAT and CS, sonoelastographic measurements were made in both thyroid lobes. Optimal cut-off values were chosen to maximize the sum of sensitivity and specificity. Positive predictive value (PPV), negative predictive value (NPV), and accuracy values were also calculated. RESULTS: Quantitative elastographic analysis evaluated by SWE in CAT patients (2.56 +/- 0.30 m/s) was significantly higher compared with CS (1.63 +/- 0.12 m/s) (p<0.001). The optimal cut-off value was 2.42 m/s. SWE had 77% sensitivity, 71% specificity, 92% PPV, 81% NPV, and 87% accuracy for the presence of CAT. CONCLUSIONS: Our data indicate that SWE correctly defines the elasticity of thyroid parenchyma, and this technique may assist in the diagnosis and treatment monitoring of CAT.

The changing pattern of perinatal mortality and causes of death in central Anatolian region of Turkey.

In this study, the perinatal mortality is presented in 2009 compared to 1998. Changing patterns of the perinatal mortality rate (PNMR), the stillbirth rate (SBR), early neonatal mortality rate (ENMR) and the causes of the perinatal mortality in Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBH) were described. This is the largest maternity hospital of Ankara in the central Anatolian region of Turkey. The total deliveries were 22,777 and 18,567 in 1998 and 2009, respectively. PNMR was 27.7 per 1000, and SBR was 23.7 per 1000 total births. ENMR was 4 per 1000 in 1998. PNMR is 20.7 per 1000, and SBR was 16.3 per 1000 and ENMR was 4.6 per 1000 total births in 2009. It is important to know the causes of mortality. In this study, the causes of perinatal deaths were classified according to the Wigglesworth classification. Antepartum stillbirth (62.3%) was the most frequent cause in 1998. Perinatal asphyxia is the majority (46.6%) of the perinatal deaths in 2009. This study shows that even prenatal care is getting better, obstetric care as well as close follow-up throughout the intrapartum period and diminishing the preterm delivery rate is also important for preventing and reducing perinatal mortality.

Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Value of the Likert dyspepsia scale in differentiation of functional and organic dyspepsia in children.

AIM: Dyspeptic symptoms may not allow clinicians to differentiate organic and functional gastrointestinal disorders. According to our dyspeptic patients' answers to dyspepsia questionnaire, we aimed to define the symptom scores directing organic dyspepsia (OD) before upper gastrointestinal endoscopy. PATIENTS AND METHODS: One hundred sixty-one patients (ages 10-17 years, mean 13.5 ± 2.3 years, male/female: 2/3) with chronic upper gastrointestinal system symptoms lasting for at least 3 months were enrolled. Patients with predominated reflux symptoms were excluded by 24-hour pH monitoring. Before upper gastrointestinal endoscopy, severity and incidence of 8 gastrointestinal symptoms (epigastric pain, upper abdominal discomfort, retrosternal pyrosis, bitter or sour taste in mouth, halitosis, belching, nausea, and early satiety) were measured by 5-point Likert scale. Total score indicated severity score multiplied by incidence score. Antral biopsy samples were obtained. OD is defined as peptic ulcer, erosive esophagitis, erosive or nodular gastritis, and erosive duodenitis in endoscopy and/or moderate to severe antral gastritis in histology. Functional dyspepsia (FD) is defined as normal findings/mucosal hyperemia in endoscopy and/or mild antral gastritis in antral histology. We evaluated the relation among severity and incidence scores of each dyspeptic symptom in patients with OD or FD. Age, sex, body mass index, drug history, nutritional habits, the quality of life related to dyspepsia were also investigated in patients with OD and FD. RESULTS: According to patients' histological and endoscopic findings, 100 (62%) patients were in the OD group and 61 (38%) patients were in the FD group. Of the dyspeptic complaints, the severity, incidence, and total scores of epigastric pain were significantly correlated with dyspepsia type (respectively, P = 0.042, P = 0.028, and P = 0.005). Of 93 patients who had an epigastric pain severity of 4 and 5 (namely, moderate to severe pain), 65 (70%) patients were in the OD group and 28 (30%) patients were in the FD group. Of 68 patients who had an epigastric pain severity of 0 to 3 (no epigastric pain or mild pain), 33 (48.5%) were in the OD group and 35 (51.5%) were in the FD group, and the difference was statistically significant (P = 0.042). After analyzing the total scores of 8 dyspeptic symptoms, one by one or in different combinations, we could not find a threshold (cutoff) score value that was able to indicate OD definitely. Age, sex, body mass index, and nutritional habits were not significantly different between patients with OD or FD. Nocturnal abdominal pain, pain before meals, and resolution of symptoms after meals or ingestion of antacid drugs were not significantly related to OD. Nocturnal abdominal pain was observed to be higher in the group with moderate to severe gastric inflammation. CONCLUSIONS: In the present study, the severity, incidence, and total scores of epigastric pain were significantly related to OD; however, a cutoff value of dyspepsia symptom score for differentiation of OD and FD could not determined. In our study, Likert dyspepsia scale was not beneficial in differentiation of the OD/FD groups. We suggest that the Likert dyspepsia scale should be redesigned for children or the same scale should be applied in a larger cohort of dyspeptic children.

Body height estimation from head and face dimensions: a different method.

As there are cases brought for forensic examination where only the craniofacial region is available, estimation of stature from craniofacial dimensions is without doubt important in forensic cases. The study presented here attempts to estimate stature from craniofacial dimensions in the Turkish population. In the second phase of the study, the correlations between craniofacial dimensions and stature were also evaluated according to different head and face types. All measurements were taken from 286 healthy males with a mean age of 22.71 ± 4.86 years. The sample was then reclassified according to different head and face indexes. For the whole sample, correlation coefficients were low, changing only between 0.012 and 0.229. Thus, no significant increase in correlation coefficients was observed after the samples had been reevaluated according to different head and face types. As a conclusion, craniofacial dimensions are not good predictors for body height for the Turkish population.

Repositioning of the masseter muscle and its effect on skeletal growth.

OBJECTIVE: The aim of this study was to establish a model to aid in understanding the influences of bilateral masseter muscle relocation on the bone and muscle, and to determine the influences of bilateral masseter muscle relocation on mandibular growth pattern in rabbits. STUDY DESIGN: Ten 3-month-old growing white New Zealand rabbits were included. Digital lateral cephalometric radiographs were obtained before operation and 6 months after surgery. The Co-Gn, gonial angle, FMA, ANS-Me, GoGn-SN, Y-axis, and Jarabak values were compared by using Student t test. RESULTS: There was a statistically significant difference between the groups in the gonial angle (P < .05). Vertical height values (GoGn-SN, FMA, Y-axis, and ANS-Me) showed statistically significant increases in animals in the control group. In contrast, vertical height values in the experimental group did not show statistically significant increase. CONCLUSIONS: Anterior relocation of the masseteric muscle influenced the direction of vertical growth significantly compared with the control group.

Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study.

INTRODUCTION: The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms. MATERIAL AND METHODS: Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper. RESULTS: Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females. CONCLUSIONS: Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome.

Correlation between proteinuria level and renal morphology with special reference to electron microscopy in kidney donors.

The aims of this study were to evaluate whether there is a correlation between protein level in urine and renal morphology in kidney transplant donors, as well as to detect the role of electron microscopy. For this purpose, kidney biopsies of 10 donors with urine protein levels were evaluated. Seven patients were female and three were male. Two had physiologic proteinuria (< 150 mg/24h), four had non-significant proteinuria (150-300 mg/24h), and three had significant (> 300 mg/24h) proteinuria. Serum creatinine levels were in normal ranges in all patients except for one who had a slight increase (1.76 mg/dL). Seven cases were reported to have normal or nonspecific light microscopic findings. Two of those seven cases had physiologic proteinuria, three had non-significant proteinuria, and two had significant proteinuria. One case had IgA nephropathy with significant proteinuria. One donor had early stage focal segmental glomerulosclerosis with non-significant proteinuria, and one donor had focal interstitial fibrosis with normal urine protein level. There was no statistically significant difference between score means of ultrastructural morphology of the six patients with same patients' light microscopic results and score means of light microscopic results with urine protein levels of all patients. However, there was a significant difference between score means of ultrastructural morphology with urine protein levels of those six patients. In conclusion, urine protein levels and light microscopic findings did not always reflect the detailed morphology alone and together. Therefore, combining with electron microscopic examination could be more beneficial in relieving problems occurring in long-term prognoses.

A study on dominant eye measurement / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To examine a new performance test for detecting eye dominance by testing and re-testing with two different methods of the same subjects for comparing and discussing the reliabilities of these tests. ·METHODS: A total of 179 university students (mean age±SD was 19.37±1.62 years) were voluntarily participate in this survey consisting of 110 females (61.5%) and 69 males (38.5%). Eye dominances were determined by two different methods which were named McManus examined using a test-retest method. ·RESULTS: Without sex difference right eyes were found dominant for 128 (71.5%) participants by McManus test. The right eye dominance were found for 110 (61.5%) subjects. The results of these two methods were related significantly by Fisher Exact test (P ＜ 0.01), with an agreement scores (κ=0.256, P＜ 0.001). In females the right eye dominance were found for 74 (67.3%) and left eye were found for 36 (32.7%) by McManus test. When the right eye dominance was found as 62 (56.4%); and the left eye dominance was found for 48 (43.6%) females were related significantly by Fisher Exact test (P＜ 0.05), with a weak agreement scores (κ=0.239, P ＜ 0.01). In males the right/left eye dominance were found respectively 54 (78.3%), 15(21.7%) in McManus test as it was found as 48 (69.6%), 21 (30.4%) for the same test and Fisher exact test were used for the analysis of categorical data. The agreement between different methods was analyzed with Kappa statistics. Comparison of proportions was made by two proportions z test. P value less than 0.05 was considered as significant. ·CONCLUSION: Without gender difference and also in both females and males marked right eye dominance was observed. The right eye dominance was considering functional laterality may due to the dominance of left hemisphere instead of right hemisphere. It is an important topic future research in laterality, and it may well become an important model system for future research.

Ultrastructural examination of glomerular and tubular changes in renal allografts with acute rejection.

Acute rejection is the most important threat to transplanted kidneys in the early phase after transplantation. With the advances in renal transplant surgery and immunosuppressive therapies, one-year graft survival rates reached 90%, but long-term graft survival did not improve to a similar degree. To prevent acute rejection more effectively and decrease the risk of chronic nephropathy development, the pathogenesis and effects of acute rejection on renal grafts should be further explored. This study aimed to examine the glomerular and tubular changes ultrastructurally. Tissues were obtained from 11 renal allografts with acute rejection, fixed in 1% Osmium tetra oxide embedded in Epon. The changes in glomerular basement membrane, podocyte, mesangium, and proximal tubules were examined by electron microscope. Tubular changes such as tubular basement membrane multi-lamellation, MN and PMN cells in peritubular capillaries, tubular vacuolization, mitochondrial changes (increase in number, alterations in cristae organization, or cristae effacement), and infiltration of tubular epithelium by MN cells (mainly lymphocytes) were found statistically significant (p < 0.01) when compared to those of control group. Some forms of endothelial injury (swelling of endothelial cells or fenestrae loss) were also statistically significant (p < 0.01). Acute rejection is an important predictor of long-term graft survival, and there may be no clinical clue to make diagnosis easier. Therefore ultrastructural changes may help solve this problem together with molecular studies.

Analysis of prothrombotic mutations and polymorphisms in children who developed thrombosis in the perioperative period of congenital cardiac surgery.

In this study, we investigated some of the prothrombothic mutations and polymorphisms in 15 children with congenital cardiac malformations who developed severe thrombosis in the perioperative period following surgical repair. The mutations and polymorphisms included in the study were Factor V Leiden, prothrombin G20210A, methylentetrahydrofolate reductase C677T, endothelial nitric oxide synthase intron 4 VNTR, alpha-fibrinogen Thr312Ala, Factor XIII Val34Leu, and insertion or deletion of angiotensin 1 converting enzyme. Compared to the healthy Turkish subjects, our patients had a similar rate of mutation of Factor V Leiden, Factor XIII Val34Leu, and endothelial nitric oxide synthase a/b polymorphisms, but higher frequency of the prothrombotic angiotensin 1 converting enzyme deletion/deletion genotype, and lower frequency of the antithrombotic alpha fibrinogen Thr/Thr genotype. None of the patients exhibited mutations involving prothrombin G20210A or methylentetrahydrofolate reductase C677T. The results of our study suggest that, in addition to prothrombotic mutations such as Factor V Leiden, single-nucleotide polymorphisms should be considered in all children with congenital cardiac malformations who develop thrombosis. Malformations of the heart are the most common of all serious lesions that are present at birth, with an incidence of 4 to 8 cases per 1,000 live births. If needed, corrective surgery is usually the optimal treatment for these anomalies, but perioperative morbidity and mortality still remain high due to several factors. Arterial or venous thrombosis, or both varieties of thrombosis, is among these factors. Prior to surgery, the most frequent time at which these children develop thrombosis is during cardiac catheterization. Postoperative thrombosis in this group of patients is a more complex disorder, which can affect both small and large vessels, and is associated with a high morbidity and mortality. Recent studies indicate that both point mutations and single-nucleotide polymorphisms of genes that encode proteins involved in the coagulative and anticoagulative cascades are important risk factors for development of thrombosis. Patients with these risk factors are most likely to develop thrombosis when triggering elements, such as placement of catheters, prolonged immobilization, or surgery, are also present. In this study, we investigated some of the above-mentioned mutations and polymorphisms in children who developed thrombosis in the perioperative period after correction of congenital cardiac malformations.