Radiographic analysis of the lumbar and sacral region angles in young Turkish adults.

OBJECTIVE: To determine the normal angular ranges of the lateral spinal alignments in the lumbar and sacral regions. METHODS: This cross-sectional study was conducted at the Kilis State Hospital, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey, from February to August 2017, and comprised patients aged 18-27 years who underwent standardised standing lateral lumbar radiography to eliminate hip and low back disorders. All radiographs were obtained from the hospital database as well as the demographic and contact information of each subject. Patients were invited for an interview and physical examination. Standard standing lateral radiographs of the lumbar spine were obtained from those who had no complaint of back pain and/or lower back problems. Sacro-horizontal angle, lumbosacral joint angle and sacral inclination angle were measured on the radiographic images. SPSS 22 was used to analyse data. RESULTS: Of the 150 subjects evaluated, 80(53.33%) were women and 70(46.77) were men. There was no statistically significant difference between women and men regarding lumbar lordosis angle, sacro-horizontal angle and lumbosacral angle (p>0.05). Sacral inclination angle and lower limb length in men were greater than in women (p<0.05). A positive correlation was observed between the lumbar lordosis angle, sacral inclination angle and sacro-horizontal angle values, while a negative correlation with the lumbosacral angle (p<0.05). There was no relationship observed between age, weight, height and body mass index, and sacral inclination, sacro-horizontal and lumbosacral angle values (p>0.05). Lumbar lordosis angle increased depending on the increase of the body mass index (p<0.05). CONCLUSIONS: Values identified can be considered as reference values for young healthy Turkish adults.

Investigation of hemorheological parameters in periodontal diseases.

Periodontal diseases are frequently associated with cardiovascular diseases (CVD). On the other hand, occurrence of CVD has also been related with increased blood viscosity. This study was planned to investigate four main hemorheological parameters contributing to blood viscosity - hematocrit, erythrocyte deformability, erythrocyte aggregation and plasma viscosity - and also some biochemical parameters (hs-CRP, fibrinogen, globulin etc.) in patients with periodontal disease. We hypothesized that poor periodontal health would be associated with deterioration of hemorheological properties. According to periodontal health status, subjects were divided into three groups as control (healthy), with plaque induced gingivitis and with chronic periodontitis. All groups included 15 males who had not received periodontal therapy in the last six months before the study, were non-smokers, had no systemic diseases and were not on any medication. Erythrocyte deformability and erythrocyte aggregation were measured with laser-assisted optical rotational cell analyzer (LORCA). Plasma viscosity was measured by a cone-plate viscometer. Data were analyzed with Kruskal-Wallis, Mann-Whitney U Test and Spearman Correlation Coefficient. Plasma viscosity (1.36 ± 0.01 mPa.s in the control group and 1.43 ± 0.02 mPa.s in the chronic periodontitis group, P <  0.01), erythrocyte aggregation tendency (aggregation index, amplitude and t½ were 58.82 ± 1.78% , 20.22 ± 0.40 au, 2.80 ± 0.25 s respectively in the control group, and 67.05 ± 1.47% , 22.19 ± 0.50 au, 1.84 ± 0.15 s in the chronic periodontitis group, P <  0.01), hs-CRP, fibrinogen and globulin levels were significantly higher, whereas HDL level was significantly lower in the chronic periodontitis group (P <  0.05) compared to the control group. All of these conditions may contribute to cardiovascular morbidity and mortality observed in people with periodontal disease, via increasing blood viscosity.

Does imprint cytology improve the accuracy of transrectal prostate needle biopsy?

OBJECTIVE: To evaluate the accuracy of imprint cytology of core needle biopsy specimens in the diagnosis of prostate cancer. METHODS: Between December 24, 2011 and May 9, 2013, patients with an abnormal DRE and/or serum PSA level of >2.5 ng/mL underwent transrectal prostate needle biopsy. Samples with positive imprint cytology but negative initial histologic exam underwent repeat sectioning and histological examination. RESULTS: 1,262 transrectal prostate needle biopsy specimens were evaluated from 100 patients. Malignant imprint cytology was found in 236 specimens (18.7%), 197 (15.6%) of which were confirmed by histologic examination, giving an initial 3.1% (n = 39) rate of discrepant results by imprint cytology. Upon repeat sectioning and histologic examination of these 39 biopsy samples, 14 (1.1% of the original specimens) were then diagnosed as malignant, 3 (0.2%) as atypical small acinar proliferation (ASAP), and 5 (0.4%) as high-grade prostatic intraepithelial neoplasia (HGPIN). Overall, 964 (76.4%) specimens were negative for malignancy by imprint cytology. Seven (0.6%) specimens were benign by cytology but malignant cells were found on histological evaluation. On imprint cytology examination, nonmalignant but abnormal findings were seen in 62 specimens (4.9%). These were all due to benign processes. After reexamination, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate of imprint preparations were 98.1, 96.9, 98.4, 92.8, 99.3, 1.6, 3.1%, respectively. CONCLUSION: Imprint cytology is valuable tool for evaluating TRUS-guided core needle biopsy specimens from the prostate. Use of imprint cytology in combination with histopathology increases diagnostic accuracy when compared with histopathologic assessment alone.

Immunohistochemical expression of Insulin-like growth factor-1, Transforming growth factor-beta1, and Vascular endothelial growth factor in parathyroid adenoma and hyperplasia.

BACKGROUND: Insulin-like growth factor (IGF), transforming growth factor-beta1 (TGF-ß1), and vascular endothelial growth factor (VEGF) are commonly studied growth factors, but little data are available on the immunohistochemical expression of these factors in parathyroid lesions. MATERIALS AND METHODS: Tissue specimens from 36 patients with primary hyperparathyroidism (P-HPT) (26 adenomas and 10 primary hyperplasias) were examined. Normal parathyroid tissue adjacent to the adenoma or area of hyperplasia was used as control tissue. Preoperative laboratory testing [serum Ca and P, creatinine and parathormone levels (PTH)] which led to the diagnosis of P-HPT had been performed, the size and weight of the parathyroid glands measured, and postoperative serum PTH levels determined. Paraffin-embedded parathyroid tissue specimens were stained with antibodies to IGF-1, VEGF, and TGF-ß1 using standard immunohistochemical procedures. RESULTS: IGF-1 immunoreactivity was seen in 50% of hyperplasia and in 46% of adenoma samples, but in 87% of normal parathyroid tissue in the vicinity of the adenomas (P = 0.005). TGF-ß1 immunoreactivity was observed in 90% of hyperplasia, in 92% of adenoma samples, and in 95% of normal tissues around adenomas. VEGF immunoreactivity was observed in 70% of hyperplastic and 65% of adenomatous tissues, as well as in 54% of normal tissues in the vicinity of the adenoma. No significant differences in the expression of IGF-1, TGF-ß1, and VEGF were observed between primary adenomas compared to hyperplasia samples (P > 0.05). CONCLUSIONS: Parathyroid tissue is clearly a site for production of IGF-1, TGF-ß1, and VEGF. IGF-1 receptor activity was higher in normal parathyroid tissue compared to hyperplastic and adenomatous tissue.

Comparison of efficacy of topical phenytoin with hypericin in second-degree burn wound healing: an experimental study in rats.

BACKGROUND: This experiment was performed to compare the effects of Phenytoin (PHT) and Hypericin (HP) cream on healing of burn wounds in rats. MATERIAL AND METHODS: Twenty rats were divided into 3 groups and second-degree burn wounds were created. The burn wounds in the first, second, and third groups were covered twice daily with PHT cream, HP cream, and saline (control), respectively. At the end of days 3, 7, 14, and 21, full-thickness skin biopsies were done for histopathologic and immunohistochemical analyses. RESULTS: Histopathologic evaluations at the 14th day showed that re-epithelialization scores were greater in the HP group than the PHT group, but on day 21, re-epithelialization scores were higher in the PHT group than the HP group. Collagen content on days 3 and 14 in the PHT group was found to be higher than in the HP group. Well-vascularized granulation tissue on day 7 in the PHT group was higher than in other groups. HP and PHT groups had a significant increase in VEGF and TGF-b expression in burn wound healing area compared to the control group on all days. CONCLUSIONS: Topical application of HP can promote re-epithelialization in burn wounds to shorten the wound healing time for superficial burns. Phenytoin, on the other hand, contributes to healing by increasing vascularized granulation tissue and collagen synthesis through re-epithelialization. The increased VEGF and TGF-b expression following PHT and HP treatment strongly indicate that PHT and HP treatment promotes VEGF and TGF-b production and action in the burn wound area.

Relationship between hemorheology and endothelial dysfunction in renal transplant patients receiving calcineurin inhibitors.

BACKGROUND: Calcineurin inhibitors, mainly cyclosporin A (CsA), are associated with endothelial dysfunction in renal transplant recipients (RTRs). Hemorheological disturbances including decreased erythrocyte deformability (ED), increased plasma viscosity and erythrocyte aggregation (EA) have also been reported in CsA-treated RTRs. The aim of this study was to investigate the relationship between hemorheological factors and endothelial dysfunction in CsA- and tacrolimus (Tc)-treated RTRs. METHODS: Thirty-one RTRs and 16 healthy subjects were recruited. The RTR group received either CsA (n = 16) or Tc (n = 15). Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery. ED and EA were measured with laser-assisted optical rotational cell analyzer, and plasma viscosity by a cone-plate viscometer. RESULTS: FMD of the CsA group was significantly lower than that of controls (6.3% ± 5.1% vs. 11.9% ± 5.6%, p = 0.024), whereas, there was no significant difference between the Tc group (8.8% ± 5.4%) and controls. At shear stresses ranging between 0.95 and 30 Pa, EDs of the CsA group were significantly lower compared with controls. In the Tc group, the decrease in ED was significant at shear stresses ranging between 0.53 and 5.33 Pa. ED indices did not correlate with FMD in any of the groups. CONCLUSIONS: The degree of endothelial dysfunction and reduction in ED were more remarkable in patients on CsA therapy. Hemorheological factors were not likely to be associated with endothelial dysfunction in RTRs.

Hemorheological changes with strontium ranelate treatment do not seem to be related to its claimed prothrombotic effects.

Strontium ranelate is claimed to be related with increased risk of thromboembolic events. No explanation of this increased incidence of thromboembolism has been identified. However, growing evidence has clearly demonstrated the involvement of blood rheology in any thrombotic process. The aim of this study was to assess hemorheological changes with strontium ranelate treatment in elderly women with osteoporosis. This study was designed in a prospective manner. Twenty-two elderly women diagnosed with osteoporosis were included. During a 2-month treatment period, participants received strontium ranelate 2g/day. Hemorheological parameters including erythrocyte deformability, erythrocyte aggregation and plasma viscosity were measured before and after 2 months therapy with strontium ranelate. The median age of the patients was 70.0 (range=65-80) years. After 60 days of treatment, there was no statistically significant change in hemorheological parameters. None of the subjects developed clinical venous thromboembolic event (VTE) during the 2-month period of strontium ranelate treatment. Our study demonstrated that in elderly women, treatment of osteoporosis with strontium ranelate did not change hemorheological parameters over 2 months of time. However, its long-term effects on hemorheologic parameters should be evaluated further with a larger sample.

Blood viscosity changes in slow coronary flow patients.

Microvascular dysfunction is implicated in the pathogenesis of slow coronary flow (SCF), but less attention has been paid to intrinsic properties of blood that can also impair the microcirculatory flow. In this study we aimed to evaluate the blood viscosity focusing on erythrocyte aggregation, erythrocyte deformability and plasma viscosity in SCF. Thirty-three patients with SCF (21 male, 54 ± 12.8 years) and 23 subjects with normal coronary arteries (13 male, 59 ± 10.3 years) were included in the study. Coronary flow was quantified by means of thrombolysis in myocardial infarction (TIMI) frame count and aggregation and deformability of erythrocytes were measured by an ektacytometer. Plasma viscosity was measured by a cone-plate viscometer. Aggregation amplitude (23 ± 3.8 au vs. 15.7 ± 6.1 au, respectively, p < 0.001) and area A index (area above syllectogram) (153.2 ± 30.7 au.s vs. 124.9 ± 49.3 au.s, respectively, p < 0.01) were higher in SCF patients. Aggregation half-time, aggregation index, elongation index and plasma viscosity values were similar between two groups. Correlation analysis revealed a significant relationship between the TIMI frame count for left anterior descending artery and aggregation amplitude in SCF patients (r = 0.679, p < 0.0001). The result of this study reveals changes in erythrocyte aggregation which may contribute to the pathophysiology of SCF. Larger studies are needed to make more robust conclusions on this issue.

Effects of oral acrylamide intake on blood viscosity parameters in rats.

Acrylamide which is formed via reaction of reducing sugars with amino acids during food processing at high temperatures is not only neurotoxic and carcinogenic, but it also damages erythrocyte membrane and generates micronucleated erythrocytes. In the present study, effects of chronic administration of acrylamide at a dose which does not induce neurotoxicity were evaluated on blood viscosity parameters (hematocrit, erythrocyte deformability, erythrocyte aggregation and plasma viscosity). Twenty adult male Sprague-Dawley rats were divided into control and acrylamide groups. The acrylamide group received 10 mg/kg/day acrylamide, whereas the control group received saline (vehicle), both in 10 ml/kg/day volume via gastric gavage. Erythrocyte aggregation and deformability were measured with LORCA and plasma viscosity with cone-plate viscometer. Erythrocyte deformability was measured before, and at the end of the 3rd and the 5th weeks of acrylamide administration. Hematocrit, erythrocyte aggregation and plasma viscosity were measured only at the end of the 5th week. Acrylamide caused a significant decrease in the deformability index of erythrocytes (at the end of the 3rd week, control: 0.606 ± 0.003, acrylamide: 0.595 ± 0.003, p < 0.05) (at the end of the 5th week, control: 0.606 ± 0.002, acrylamide: 0.588 ± 0.002, p < 0.01). Aggregation tendency and plasma viscosity were slightly higher in the acrylamide group, however the difference was not statistically significant. These results imply that acrylamide which does not cause neurotoxicity in rats may alter blood viscosity if chronically taken.

The association of ocular blood flow with haemorheological parameters in primary open-angle and exfoliative glaucoma.

PURPOSE: To evaluate the ocular blood flow velocities and haemorheological parameters in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG) and exfoliation syndrome (XFS) and to compare their results with those of healthy controls. METHODS: Twenty-five patients with POAG (group 1), 25 patients with XFG (group 2), 25 patients with XFS (group 3) and 25 healthy controls (group 4) were included in the study. Ocular blood flow velocities of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs) were measured using colour Doppler imaging (CDI). Haemorheological parameters (erythrocyte elongation and aggregation index, aggregation amplitude, aggregation half-life, plasma viscosity, haematocrit) were measured in venous blood samples of all patients. RESULTS: The peak systolic velocity (PSV) and end-diastolic velocity (EDV) values were lower and resistive indices (RI) were higher for the OA, CRA and SPCA of glaucomatous (groups 1 and 2) patients compared with those of controls (group 4) (PSV: OA, 40.4 ± 11.3 versus 52.6 ± 12.8 cm/second, p < 0.001; CRA, 12.9 ± 2.9 versus 15.3 ± 4.2 cm/second, p = 0.02; SPCA, 21.7 ± 6.6 versus 26.6 ± 8.3 cm/second, p = 0.013) (EDV: OA, 10.3 ± 4.3 versus 14.2 ± 5.1 cm/second, p < 0.001; CRA, 3.7 ± 1.1 versus 4.5 ± 1.3 cm/second, p = 0.025; SPCA, 5.2 ± 1.8 versus 7.7 ± 3.2 cm/second, p = 0.001) (RI: OA, 0.75 ± 0.05 versus 0.66 ± 0.07, p < 0.001; CRA, 0.73 ± 0.08 versus 0.68 ± 0.10, p = 0.223; SPCA, 0.70 ± 0.10 versus 0.63 ± 0.11, p = 0.004). There were no statistically significant differences between the haemorheological parameters of glaucomatous and non-glaucomatous patients. The reduction in ocular blood flow velocities in groups 1, 2 and 3 were not associated with changes in haemorheological parameters. CONCLUSION: Our results suggest that impairment of the retrobulbar blood flow in POAG and XFG is not associated with alterations in haemorheological parameters.

Functional effects of endothelial nitric oxide synthase genetic polymorphisms on haemorheological parameters in healthy human individuals.

The constitutive endothelial nitric oxide synthase (eNOS) plays a major role in circulatory homoeostasis and shows genetic polymorphism. eNOS is expressed and functional in blood cells, including erythrocytes. There is limited knowledge about the consequences of eNOS genetic variability in haemorheological parameters and erythrocyte functioning. The purpose of this study was to investigate the effects of three eNOS genetic polymorphisms, namely exonic G894T (Glu298Asp), intronic VNTR (27-bp repeat) and 5'-flanking T(-786)C polymorphisms on haemorheological variables, such as erythrocyte deformability and erythrocyte aggregation (rouleaux formation) in healthy non-smoking volunteers. Sixty subjects (19 women, 41 men) were examined for genotypes and haemorheological variables. Genotypes were determined by polymerase chain reaction and restriction analysis. Haemorheological variables were measured by means of a laser-assisted optical rotational cell analyser (LORCA). Erythrocyte aggregation was significantly decreased in individuals with 894TT genotype when compared to subjects with the (G) allele. Aggregation indices (AI) were 54.7±3.2% versus 61.0±0.9% (p=0.026), and the half-lives (t(1/2) ) for aggregation formation were 3.43±0.43 versus 2.55±0.12 sec. (p=0.024), respectively. Similarly, VNTR-bb genotype significantly altered erythrocyte aggregability. AI values were 58.7±1.1% in subjects with VNTR-a allele versus 63.7±1.2% in subjects with bb genotype (p=0.011); t(1/2) values were 2.86±0.16 versus 2.20±0.13 sec., respectively (p=0.016). T(-786)C polymorphism did not change any haemorheological parameters. These findings suggest that eNOS 894TT genotype is associated with decreased erythrocyte aggregation, while VNTR-bb genotype increases aggregability in healthy human individuals. eNOS genetic variants may contribute in the pathogenesis of microvascular disorders by altering erythrocyte functions in human beings.

Effects of pravastatin on cellular ultrastructure and hemorheology in rats after traumatic head injury.

Pravastatin has neuroprotective effects against aging but its role in brain injury remains unclear. This study evaluated the effects of pravastatin on the ultrastructural changes and hemorheological parameters in rats after traumatic brain injury (TBI) of right parietal cortical contusion by a controlled weight-dropping method. There were three groups: (I) Sham operated group; (II) TBI + vehicle (saline) group; and (III) TBI + pravastatin group. Right parietal craniectomy was performed in all groups. In TBI + pravastatin group, pravastatin was administered orally at a dose of 1 mg/kg every day for 7 days starting at 24 hours after the injury. Plasma viscosity, erythrocyte deformability and erythrocyte aggregation were measured from blood samples of all rats on 2nd, 7th and 15th days. At the same time electron microscopic study was done on designated days for groups II and III. Treatment with pravastatin markedly increased aggregation amplitude and γIsc max values and significantly decreased erythrocyte deformability but did not change plasma viscosity in 2 weeks time. Ultrastructural parameters such as perinuclear edema, mitochondrial swelling and intraneuronal vacuoles were detected in lower degree in the statin group when compared to the saline group, especially decreased demyelinization and endothelial detachment was prominent. As a result, the hyperviscosity state with increased erythrocyte aggregation and decreased erythrocyte deformability induced by pravastatin in this study was accompanied by an improvement of the ultrastructural findings in TBI. This hyperviscosity state may be a compensatory mechanism to increase the oxygenation of the injured tissue by inducing the release of antiaggregant and vasodilatory substances by increasing shear stress. Therefore, we suggest that prolonged pravastatin usage may exert affirmative effects on traumatic brain injury conditions by increasing blood viscosity.

Melatonin prevents lipid peroxidation in human erythrocytes but augments deterioration of deformability after in vitro oxidative stress.

Oxidative stress decreases the deformability of erythrocytes. Anti-oxidant measures may alleviate, pro-oxidative damage may augment this decrease. Melatonin is reported to exert both anti-oxidant and pro-oxidant properties on erythrocytes. The aim of the present study was to evaluate the effects of melatonin on erythrocyte deformability under oxidative stress conditions induced by the combination of hydrogen peroxide (20 mM) and sodium azide (100 microM). Erythrocyte suspensions were incubated for 10 min with melatonin (1-1000 microM) prior to oxidative stress. Erythrocyte deformability was measured by Laser-assisted Optical Rotational Cell Analyzer (LORCA). Lipid peroxidation was determined via malondialdehyde (MDA) measurements by HPLC. Melatonin alone did not change erythrocyte deformability. Oxidative stress alone decreased the deformability of erythrocytes by 25.8 +/- 3.1% (P<0.05). Melatonin pre-treatment augmented the decrease in erythrocyte deformability but prevented lipid peroxidation. Melatonin (1 microM) did not cause any additional effect on erythrocyte deformability. Higher concentrations (10-1000 microM) further decreased deformability (P<0.05). Erythrocytes exposed to oxidative stress had MDA levels of 116.3 +/- 14.3 micromol/g Hb. Melatonin (1 microM) slightly increased MDA levels, but 1000 microM melatonin reduced it by 35% (P<0.05). These findings indicate that melatonin exerts antioxidant effect on lipids. Deterioration of erythrocyte deformability may be due to a separate pro-oxidative action on proteins.

Erythrocyte deformability, plasma viscosity and oxidative status in patients with severe obstructive sleep apnea syndrome.

BACKGROUND AND PURPOSE: In patients with severe obstructive sleep apnea syndrome (OSAS), diurnal changes of plasma viscosity and erythrocyte deformability were measured to elucidate the possible mechanism of cardiovascular diseases in OSAS patients. PATIENTS AND METHODS: Plasma viscosity and erythrocyte deformability was determined in 11 OSAS patients and 11 healthy subjects matched by sex and age. Plasma viscosity was measured by a cone-plate viscometer, and erythrocyte deformability was determined by filtration technique. Whole blood counts were performed and oxidative status of the patients' plasma and erythrocytes were evaluated. RESULTS: OSAS patients had higher plasma viscosity than controls, both in the morning (1.74+/-0.3 vs. 1.36+/-0.2 mPas, P<0.002) and evening (1.55+/-0.2 vs. 1.27+/-0.1 mPas, P<0.002), and morning plasma viscosity was significantly higher than the evening level (P<0.05). Morning plasma viscosity of patients was inversely correlated with their mean nocturnal SaO(2). Morning plasma malonyldialdehyde level was significantly higher in the patients than in the controls (69.7+/-30.5 vs. 45.5+/-11.0 nmol/l, P<0.005). Erythrocyte deformability of the patients was slightly lower. CONCLUSIONS: We have observed that plasma viscosity is high both in the morning and in the evening in severe OSAS patients. This elevation may predispose OSAS patients to myocardial infarction and stroke by increasing blood viscosity. Low nocturnal mean SaO(2) may be responsible for the high plasma viscosity in these patients.