Repair of critical size defects using bioactive glass seeded with adipose-derived mesenchymal stem cells.

Bioactive glass has been demonstrated as a biocompatible bone substitute. However bone healing process can be prolonged due to late resorption of the material. Adipose derived stem cells (ASC) have osteogenic differentiation potential and hence can be a cell source for bone regeneration. The aim of this study was to test whether combination of bioactive glass with ASCs would enhance bone regeneration. Following creation of critical sized defects on the calvaria of 32 Wistar rats, the animals were randomly divided into four groups: Group C (control): Defects were left untreated; Group G: Defects were covered with autologous bone graft; Group BG: Defects were filled with bioactive glass; Group BG/ASC: Defects were filled with bioactive glass seeded with ASCs. The defect size was significantly greater in Group C compared to all other groups. Bone density was significantly lower in Group C compared to Group G and Group BG/ASC. Bone regeneration score of Group C was significantly lower than other groups. Group BG/ASC demonstrated lamellar bone and havers canal formation. The results of this study demonstrated that bioactive glass implanted with ASC is a biocompatible construct stimulating radiologically and histologically evident bone regeneration similar to autologous bone grafting. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1002-1008, 2017.

Decreasing the Uterine Blood Flow with Electroacupuncture: Bidermatomal and Monodermatomal Applications.

BACKGROUND: Previously we demonstrated a uterine fibroma case in which the decrease in the uterine artery blood flow was obtained with bidermatomal electroacupuncture (EA). A prospective study was conducted to validate the efficacy of bidermatomal and monodermatomal EA applications. METHODS: Ten healthy women participated 3 times for 3 steps of the study. Each woman enrolled into a bidermatomal sham control group application, a bidermatomal 80 Hz EA and as a last step, a monodermatomal EA with 80 Hz. Color Doppler ultrasonographic recordings were made to detect baseline blood flow parameters by a pulsatility index (PI), volume flow, area and diameter of each uterine artery and after stimulations. RESULTS: Doppler ultrasonographic recordings demonstrated statistically significant decreases of the blood flow both with bidermatomal (p = 0.03 for the left side PI and p = 0.04 for the right side PI) and monodermatomal EA (p = 0.006 for the left PI and p = 0.002 for the right side PI). The sham control group did not show a significant change in blood flow parameters. CONCLUSIONS: The present study validates the efficacy of the bidermatomal but also the monodermatomal EA with 80 Hz on decreasing the blood flow to the uterus.

Sciatic neuroendometriosis: Magnetic resonance imaging defined perineural spread of endometriosis.

Catamenial sciatic radiculopathy resulting from endometriosis is a rare presentation of a common disease in which the pathogenesis of pain is still under debate. A 32-year-old woman presented complaining of infertility, catamenial sciatica, and pelvic and gluteal pain. Magnetic resonance imaging showed endometriotic infiltration of the left proximal lumbosacral plexus, sacral nerve track, sciatic nerve at the sciatic notch and pudendal nerve along the iliococcygeus muscle, together with left endometrioma and deep infiltrating endometriosis lesions. Laparoscopic endometriosis surgery was performed after all of the complications and possible outcomes of the surgery were discussed with the patient. Our case report highlights the importance of magnetic resonance imaging evidence of perineural spread, outlining the pathophysiology of the pelvic pain associated with neuroendometriosis.

Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre- and postmenopausal women without clinically evident pelvic organ descent.

Background Dynamic magnetic resonance imaging (dMRI) is an imaging tool that can be used to evaluate and stage pelvic organ prolapse (POP). Greater understanding of the incidental detection of POP in asymptomatic patients is needed. Purpose To evaluate the prevalence of dMRI-detected POP in pre-and postmenopausal women who were imaged for reasons unrelated to pelvic floor dysfunction. Material and Methods A total of 227 women who had diagnoses that did not include POP underwent abdominal/pelvic dMRI. Patients with a positive gynecological examination for or a clinical history of POP ( n = 11), hysterectomy ( n = 4), or gynecologic-oncology surgery ( n = 2) were excluded, as well as patients who were unable to strain during MRI ( n = 11). A total of 199 patients without visible prolapse were enrolled in the study. An H-line, M-line, pubococcygeal line (PCL), and mid-pubic line (MPL) were used to detect and grade prolapse. Results The prevalence of dMRI-identified POP was higher in postmenopausal subjects. The PCL led to a greater frequency of prolapse detection than the MPL. The frequency of middle compartment descent was similar regardless of whether the PCL or MPL was used as a reference line. There was a higher incidence of prolapse in the posterior compartment. Using an H-line and PCL as references, the anterior and posterior compartments were found to significantly differ between pre- and postmenopausal subjects. The MRI parameters that were used to define POP were not correlated with parity, vaginal birth, BMI, or fetal birth weight. With respect to the MPL, age was correlated with both the presence of an elongated H-line and with descent. Conclusion Dynamic MRI identified incidental pelvic organ prolapse in asymptomatic patients. The prevalence of dMRI-detected POP was higher in postmenopausal women without visible prolapse. These findings suggest the need for further studies to identify how to modify the currently used dMRI thresholds for postmenopausal women.

Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results.

BACKGROUND: Knowledge of the precise sites of deep infiltrating endometriosis (DIE) lesions is essential for preoperative workup and treatment. Susceptibility-weighted imaging (SWI) has high sensitivity for blood products and have recently been applied in abdominal imaging. PURPOSE: To determine the value of SWI in the diagnosis of DIE. MATERIAL AND METHODS: Forty-three clinically suspected DIE patients with sonographically diagnosed ovarian endometriomas who had tenderness or palpable nodule(s) on rectovaginal examination were referred to pelvic magnetic resonance imaging (MRI) including SWI. Two patients were excluded from the study because of low quality of SWI series. Twenty-eight patients who were offered laparoscopic endometriosis surgery (LES) preferred medical treatment over surgical approach. Thirteen out of 41 participants had LES. Lesions were evaluated for their locations, signal intensities on T1-weighted (T1W) and T2-weighted (T2W) images, and presence of signal voids on SWI using 3T MRI and correlated with LES findings. RESULTS: A total of 18 endometriosis foci were laparoscopically removed from 13 patients. DIE lesions removed at laparoscopy were located at the uterosacral ligament (9/18), rectovaginal region (4/18), retrocervical region (2/18), and fallopian tubes (3/18). Eleven out of 18 (61%) DIE foci were detected by their high-signal intensities on T1W images whereas 16 out of 18 (89%) DIE foci were detected by signal voids on SWI. CONCLUSION: SWI imaging with its high sensitivity to blood products, contributes to the diagnosis of DIE by depicting different phases of hemorrhage not seen by conventional MRI sequences.

Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester.

PURPOSE: The aim of this study is to determine if the Strain elastography (SE) of the placenta measured in the second trimester differs between normal pregnancies and pregnancies complicated by preeclampsia (PE). METHODS: 219 singleton pregnancies who had routine anomaly scanning between the 20th and 23rd weeks of gestation were included in this observational study. Women with either posterior placentations (n = 63) or other obstetric pathologies (n = 12) were excluded from the study, leaving 144 pregnant women for the evaluation of strain ratio with SE. One hundred and one women with normal pregnancies and normal deliveries without any perinatal complications formed Group A. Twenty-eight patients who were clinically diagnosed with early onset PE before anomaly scanning formed Group B. Fifteen normotensive pregnant women with either mild proteinuria, and past history of preeclampsia during their previous pregnancies formed Group C. The strain ratios were compared between the groups. RESULTS: The strain ratio of Group B was significantly higher than those of Group A and Group C (p < 0.05). CONCLUSIONS: The placental elasticity ratios measured by SE imaging during the second trimester differ between the normal pregnancies and the pregnancies complicated by PE. SE might be used as a supplement tool in addition to the existing methods for the prediction of PE.

Shear wave elastography in placental dysfunction: comparison of elasticity values in normal and preeclamptic pregnancies in the second trimester.

OBJECTIVES: The aim of this study was to determine whether shear wave elastography of the placenta differs between normal pregnancies and pregnancies complicated by preeclampsia between 20 and 23 weeks' gestation. METHODS: A prospective study was performed with 204 consecutive singleton pregnancies that had routine anomaly scanning between 20 and 23 weeks' gestation. One hundred twenty-nine of these patients were examined with shear wave elastography; 101 women who had clinically normal pregnancies with normal fetal biometric measurements and normal deliveries without any perinatal complications formed group A, and 28 women who had a clinical diagnosis of early-onset preeclampsia before anomaly scanning formed group B. Women with either posterior placentations (n = 63) or other obstetric disorders (n = 12) were excluded from the study. RESULTS: Shear wave elastographic values for group B were significantly higher than those for group A (P < .05). No statistically significant difference was found between the elasticity values measured at the center or edge of the placenta (P > .05). CONCLUSIONS: Shear wave elastography differentiates between the placental elasticity of normal pregnancies and pregnancies complicated by preeclampsia when performed during the second trimester. As a new method for tissue characterization, shear wave elastography is useful for evaluation of placental function and can be used as a supplement to existing methods for prediction of preeclampsia.

Coexistence of aplasia cutis and nevus psiloliparus--report of a novel case.

Nevus psiloliparus is a type of mesodermal nevus of the scalp classically seen with encephalocraniocutaneous lipomatosis. The close association between nevus psiloliparus and aplasia cutis congenita is called didymosis aplasticopsilolipara. Although typically associated with neurologic, ocular, and skeletal findings, didymosis aplasticopsilolipara can be seen without the context of encephalocraniocutaneous lipomatosis.

Effects of levothyroxine treatment on insulin sensitivity, endothelial function and risk factors of atherosclerosis in hypothyroid women.

OBJECTIVES: Contradictory results are encountered in literature regarding the effects of hypothyroidism on the risk factors of atherosclerosis. We aimed to explore the changes in atherosclerotic risk factors and insulin sensitivity before and after levothyroxine replacement therapy in women with primary hypothyroidism and compare with that of healthy controls. PATIENTS AND METHODS: Twelve patients (mean age of 34±11.7years) without an evident disease except for primary hypothyroidism (TSH≥20mIU/L) and eleven euthyroid, age-matched (33.8±8.4years) female volunteers as controls were included. Baseline thyroid hormones, lipid parameters, homocysteine, fibrinogen levels were measured in both groups. Flow-mediated endothelial-dependent vasodilatation (FMD) method was used to evaluate endothelial dysfunction. Insulin sensitivity was assessed by M values based on euglycemic hyperinsulinemic clamp technique. The same measurements were performed after 6months of levothyroxine treatment and recovery of euthyroid state in hypothyroid patients. RESULTS: Treatment reduced total cholesterol (P<0.005), LDL-cholesterol (P<0.005), lipoprotein(a) (P<0.01), fibrinogen (P<0.0001) and homocysteine (P<0.0005) levels. Treatment significantly improved M values of hypothyroid patients (3.68±1.53mg/kg.min vs 6.02±1.21mg/kg.min, P<0.0001) and FMD (9.1±3.7% vs 16.4±4.4%, hypothyroid vs euthyroid, P<0.0001). Significant correlations were found between M values and TSH (r=-0.6, P<0.005), fibrinogen (r=-0.53, P<0.01) measurements, free T3 (r=0.51, P<0.02) and free T4 (r=0.49, P<0.02) levels. FMD was significantly correlated with fibrinogen levels (r=-0.49, P<0.05). CONCLUSION: Insulin resistance, endothelial dysfunction, atherosclerotic risk markers improves with treatment of hypothyroidism.

Evaluation of asymptomatic venous disease by venous Doppler ultrasonography in patients with Behcet's disease without overt thrombosis.

One of the major causes of mortality and morbidity in Behcet's disease (BD) is vascular involvement. Limited data suggest a high prevalence of venous insufficiency (VI) and some cases of asymptomatic thrombosis in BD. In this study, we aimed to investigate asymptomatic venous disease by venous Doppler ultrasonography (US) prospectively in patients with BD, without known vascular disease. The study included 93 patients with BD (M/F, 45/48; age, 36.4 ± 10 years), 97 patients with ankylosing spondylitis (AS) (M/F, 50/47; age, 37.5 ± 9.5 years), and 43 healthy controls (HC) (M/F, 25/18; age, 34.7 ± 4.5 years). All patients were examined for the clinical findings of venous thrombosis. Vessels of both upper and lower extremities were examined, while the subjects were in supine position by venous Doppler US. Clinical signs ("C"), the various etiologies ("E"), anatomical sites ("A"), and pathophysiological disorder ("P") (CEAP) severity score was used to evaluate the severity of the VI. We did not detect any "silent thrombosis" in any group. VI findings in lower extremity were detected in 32.2 % (n = 30) in the BD group, 28.8 % (n = 28) in AS group, and 9.3 % (n = 4) in the HC group. Both BD and AS patients had significantly higher VI rates than controls (p = 0.007 and 0.015). Similarly, CEAP severity score in BD (0.34 (0-3)) was significantly higher than controls (0, p = 0.008) but similar to AS (0.18 (0-39), p = 0.18). No correlations were present between C-reactive protein elevation (>5 mg/L) and VI in both BD (p = 0.546) and AS (p = 0.754). A high prevalence of VI was present in both BD and AS patients without symptomatic thrombosis. Presence of VI also in AS, a disease without a major tendency to venous thrombosis, might suggest that chronic inflammation might cause a mild insufficiency detected only by Power US in venous vessels. Long-term consequences of this finding require further follow-up studies to show whether asymptomatic venous disease is a predictor of future venous thrombotic events in patients with BD.

Decreasing bleeding due to uterine fibroid with electroacupuncture.

OBJECTIVE: To report the usefulness of electroacupuncture (EA) for the management of menorrhagia due to submucous uterine fibroid. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 48-year-old woman with a symptomatic submucous uterine fibroid, who presented with severe menorrhagia. INTERVENTION(S): Electroacupuncture. MAIN OUTCOME MEASURE(S): Doppler ultrasonographic assessment of uterine blood flow and number of pads used during menorrhagia. RESULT(S): Doppler ultrasound revealed decreased blood flow of the uterine artery with EA stimulation. With repetitive sessions of EA fewer pads were used during menorrhagia. CONCLUSION(S): We present the first human case in which decreasing uterine artery blood flow with EA improved menorrhagia due to uterine fibroma. Electroacupuncture could be a useful, alternative, and relatively noninvasive tool for the management of fibroids with menorrhagia as a severe complaint.

Effect of night symptoms and disease severity on subjective sleep quality in children with non-cystic-fibrosis bronchiectasis.

BACKGROUND: Night-time symptoms and hypoxemia during sleep may affect sleep quality in children with chronic lung disease such as bronchiectasis. Poor sleep quality may impair growth, learning, and emotional development of children. Our aim was to assess the sleep quality and associated factors in children with non-cystic fibrosis bronchiectasis. METHODS: Fifty-four patients with bronchiectasis and age-matched controls were included to the study. Pittsburgh Sleep Quality Index (PSQI) and Pediatric Sleep Questionnaire (PSQ) were used to evaluate sleep quality and presence of sleep disordered breathing. A global sum of 5 or more according to PSQI indicated a poor sleep quality. A cut-off value of 0.33 in PSQ was used to identify pediatric sleep disordered breathing. Association between PSQI, pulmonary function tests, symptoms and HRCT scores were evaluated. RESULTS: Thirty-seven percent of patients with bronchiectasis and 17% of patients in the control group had poor sleep quality (P < 0.05). Patients with sputum and wheezing had poorer sleep scores (P = 0.003 and P = 0.005). The association of wheezing and breathlessness during night time with sleep quality tended to be significant (P = 0.05). Twenty-two percent of patients with bronchiectasis and 9% of controls had sleep disordered breathing (P = 0.003). Bronchiectasis patients who snored had poorer sleep quality (P < 0.001) and patients with wheezing had significantly higher rate of snoring (P = 0.04). Children with worse HRCT scores also had worse sleep quality (r = 0.28, P = 0.04). CONCLUSIONS: Patients with bronchiectasis have disturbed sleep associated with severity of disease. Night symptoms increase the risk of poor sleep quality. Sleep disordered breathing and sleep quality should be assessed in these patients.

Transarterial glue embolization in iatrogenic renovascular injuries.

Iatrogenic injuries of the intrarenal arterial system include pseudoaneurysms and fistulas. They can cause hematuria and life-threatening hemodynamic instability, and therefore should be treated promptly. Endovascular treatment is recommended for these cases due to its effectiveness. Among the different agents used for embolization, n-butyl-2-cyanoacrylate (glue) has rarely been used. We present 15 patients with pseudoaneurysms and/or arteriovenous or caliceal fistulas who were treated by glue embolization. In our patient group, five had a history of percutaneous nephrolithotomy, six had renal biopsies, three had nephron-sparing surgery, and one had percutaneous nephrostomy. Glue embolizations were performed with the microcatheter technique. All patients were successfully treated, and all but one had excellent follow-ups. One patient suffered from disseminated intravascular coagulation secondary to transfusion and died after the procedure. We think glue embolization is a safe and effective treatment for this group of patients and present our experience along with the technical approach.

Point- and frequency-specific response of the testicular artery to abdominal electroacupuncture in humans.

OBJECTIVE: To clarify the role of the abdominal acupuncture points and the frequency of short-term electroacupuncture (EA) stimulation on testicular blood flow (TBF) in humans. DESIGN: A prospective, randomized study. SETTING: University hospital, Department of Radiology, ultrasound unit. PATIENT(S): Eighty healthy male volunteers were randomly allocated to three groups in stage one and to a single group in stage two. In the first stage of the study, the abdominal acupuncture points ST-29 (guilai) were stimulated using simple needle insertion, 2 Hz burst EA or 10 Hz EA, in three different groups. In the second stage of the study, abdominal acupuncture points ST-25 (tianshu) were stimulated with the frequency found to be more effective in stage one. Stimulation was for 5 minutes in each group. INTERVENTION(S): Electroacupuncture and Doppler flowmeter. MAIN OUTCOME MEASURE(S): Four groups were compared for volume flow and other related parameters of TBF. RESULT(S): The 10-Hz EA stimulation of ST-29 (guilai) increased TBF, but simple needle insertion and 2-Hz burst stimulation did not. The 10-Hz EA stimulation of ST-25 (tianshu) did not result in significant changes in TBF. CONCLUSION(S): For the first time point- and frequency-specific effects of abdominal EA on TBF are shown in humans. Further investigation is required to ascertain whether these findings may be helpful in the clinical treatment of infertile men.

Association between inflammatory markers in induced sputum and clinical characteristics in children with non-cystic fibrosis bronchiectasis.

To study clinical, radiological and laboratory features of children with non-cystic fibrosis (non-CF) bronchiectasis (BE) and the association between symptom scores, spirometry, high-resolution computed tomography (HRCT) findings and inflammatory markers in induced sputum in these children. Twenty-seven children with steady-state non-CF BE were cross-sectionally evaluated by symptom scores, pulmonary function tests, anatomic extension and severity scores of BE in HRCT and tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) levels in induced sputum. There were 16 girls and 11 boys. Median (interquartile range) age of study group was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years and symptom scores were 4 (3-6). Pulmonary function tests revealed FEV(1) of 82%pred (72-93), FVC of 82%pred (74-92), and FEF(25-75%) of 82%pred (68-95). According to anatomic extent of BE on HRCT; 2 patients had mild, 4 had moderate and 21 had severe BE. Based on severity scores of HRCT; 10 patients had mild, 10 had moderate and 7 had severe BE. Neutrophils consisted 29.9% (14.9-53.7) of the total leucocytes in induced sputum samples. Sputum concentration of TNF-alpha was 58 pg/ml (9.2-302) while IL-8 concentration was 2.7 ng/ml (1.7-2.8). Symptom scores correlated with FEV(1) and sputum IL-8 levels (r=-0.49, r=0.67, P<0.05). There was a significant correlation between HRCT severity scores and symptoms, FEV(1), sputum IL-8 and TNF-alpha levels (r=0.64, r=-0.68, r=0.41, r=0.41, respectively, P<0.05). In children BE is associated with ongoing inflammation. This inflammation can be reliably monitored by radiological scores, spirometry, as well as sputum inflammatory markers. Follow-up of children with BE using these clinical tools may improve patient care.

Sonographic measurement of kidney size in geriatric patients.

PURPOSE: The aim of this study was to compare the value of absolute and relative renal length (ARL and RRL, respectively) measurements in determining variations in normal kidney size related to sex, body height, and increasing age among patients older than 60 years. METHODS: Kidney sizes were prospectively measured sonographically in patients older than age 60 years. Longitudinal renal lengths (ARLs) were measured, and the RRLs were calculated by dividing the ARL by the body height. ARL and RRL measurements were analyzed according to sex, age, and body height. RESULTS: The ARLs and RRLs of the left kidney in 236 patients were significantly greater than those of the right kidney (p < 0.05) in both sexes. The ARLs for both kidneys were also significantly greater in men than they were in women (p < 0.05). In contrast, the RRLs for both kidneys were significantly lower in men than they were in women (p < 0.05). Both left and right ARLs decreased significantly with increasing age regardless of sex (p < 0.01 and p < 0.05, respectively). The same was true for left and right RRLs (p < 0.01 and p < 0.05, respectively). CONCLUSIONS: Renal size decreases with increasing age among patients older than 60 years. In our series of geriatric patients, the use of RRLs could not completely eliminate variations related to a subject's height, sex, and age. Therefore, we recommend that the ARL be used for renal measurements in geriatric patients.