What Do Anticoagulants Say about Microemboli?

BACKGROUND: In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ultrasound (TCD) in patients with atrial fibrillation (AF) under anticoagulant therapy, and we compared the treatment groups. METHODS: Ninety-nine patients with nonvalvular AF with a history of stroke using warfarin (46%), 67 patients using rivaroxaban (31%), and 49 patients using dabigatran (23%), that is, a total of 215 patients, who have been referred to the stroke outpatient section of our department from May 2013 to November 2014, were included in the study. CHA(2)DS(2)VASc scoring was made for all patients, and International Normalized Ratio (INR) value was evaluated in patients using warfarin. All patients were monitored with TCD on the middle cerebral arteries bilaterally for 30 minutes. Embolic signals were evaluated according to their density and the mean number of signals in 2 consecutive recordings. RESULTS: The incidence of emboli in the treatment group was 32 (32%) for warfarin, 24 (36%) for rivaroxaban, and 17 (35%) for dabigatran. The analysis of variance revealed that there was no statistically significant differences between the treatment groups in terms of patients' age (P = .145), CHA(2)DS(2)VASc scores (P = .968), and the number of emboli (P = .783). As CHA(2)DS(2)VASc score increases, number of emboli increase. A statistically significant negative correlation between the number of emboli and INR scores was found in the warfarin group. The number of emboli decreases as INR decreases. CONCLUSIONS: As we aim to reduce the risk of emboli to a minimum with anticoagulant therapy, this screening for MES can give us an idea for the risk of stroke.

Development of [18F]DASA-10 for enhanced imaging of pyruvate kinase M2.

PURPOSE: The aim of this study was to develop a positron emission tomography (PET) radiotracer for measuring pyruvate kinase M2 (PKM2) with improved physicochemical and pharmacokinetic properties compared to [18F]DASA-23. EXPERIMENTAL DESIGN: First, we synthesized [18F]DASA-10 and tested its uptake and retention compared to [18F]DASA-23 in human and mouse glioma cell lines. We then confirmed the specificity of [18F]DASA-10 by transiently modulating the expression of PKM2 in DU145 and HeLa cells. Next, we determined [18F]DASA-10 pharmacokinetics in healthy nude mice using PET imaging and subsequently assessed the ability of [18F]DASA-10 versus [18F]DASA-23 to enable in vivo detection of intracranial gliomas in syngeneic C6 rat models of glioma. RESULTS: [18F]DASA-10 demonstrated excellent cellular uptake and retention with values significantly higher than [18F]DASA-23 in all cell lines and timepoints investigated. [18F]DASA-10 showed a 73 % and 65 % reduced uptake respectively in DU145 and HeLa cells treated with PKM2 siRNA as compared to control siRNA treated cells. [18F]DASA-10 showed favorable biodistribution and pharmacokinetic properties and a significantly improved tumor-to-brain ratio in rat C6 glioma models relative to [18F]DASA-23 (3.2 ± 0.8 versus 1.6 ± 0.3, p = 0.01). CONCLUSION: [18F]DASA-10 is a new PET radiotracer for molecular imaging of PKM2 with potential to overcome the prior limitations observed with [18F]DASA-23. [18F]DASA-10 shows promise for clinical translation to enable imaging of brain malignancies owing to its low background signal in the healthy brain.

Cross-culturally modified University of Pennsylvania Smell Identification Test for a Turkish population.

BACKGROUND: The University of Pennsylvania Smell Identification Test (UPSIT) is a well-developed and popular olfactory test, which has been validated in various populations. However, there was only one study in a Turkish population, and this study indicated that the North American version of the UPSIT was not enough to evaluate the olfactory functions of Turkish population. So, we developed a cross-cultural adaptation of the UPSIT, the UPSIT-Turkish (UPSIT-T). Thus, the goal of this study was to investigate the applicability of the UPSIT-T in healthy Turkish subjects. MATERIAL AND METHODS: The study included 51 healthy individuals who reported having normal olfactory function. The participants were administered the North American version of the UPSIT firstly, and then, after a day UPSIT-T was applied to the participants. The results of two smell tests were compared, and the applicability of UPSIT-T was evaluated. RESULTS: The mean (standard deviation) value for correctly identified odors was 27.2 ± 5.7 (range, 14-38) with the UPSIT application, whereas the mean (standard deviation) value for correctly identified odors was 35.9 ± 3.1 for UPSIT-T. There was a statistically significant increase in the scores of the participants when UPSIT-T was performed (p < 0.001). The identification rates of 10 test odorants were <80% for our study group, and 2 of 10 were <70% for the UPSIT-T. CONCLUSION: The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.

Olfactory and gustatory dysfunction in Myasthenia gravis: A study in Turkish patients.

OBJECTIVE: Myasthenia gravis (MG) is commonly viewed as a muscle disorder. Less is known about neurosensory function and dysfunction in MG. We aim to evaluate olfactory and gustatory behavior in Turkish patients with MG, and compare these results with age and sex-matched healthy controls. MATERIAL/METHODS: 30 individuals with MG, and 30 healthy volunteers were studied. Olfactory function was studied with the Sniffin' sticks test. Taste strip test was used for studying taste function. The t-test was used for analyzing continuous variables, and the chi-square test for categorical data. Clinical staging and medication status were included in a model analyzed using analysis of variances. RESULTS: MG patients showed significantly lower olfactory (p<0.001) and gustatory scores (p<0.001) than the healthy controls. In addition, olfactory loss correlated with the severity of the disease. Medications for MG did not influence these results. CONCLUSION: This study replicates the olfactory dysfunction found elsewhere in MG. Further, gustatory dysfunction, an activity unrelated to muscle strength, was also unveiled. Medications used for treating MG must not be blamed for the chemosensory dysfunction found in this neurological disorder.

Inferior vena cava filter presenting as chronic low back pain.

Our purpose is to report a rare complication of an inferior vena cava (IVC) filter with vertebral bone penetration, interval fracture, subsequent endovascular management and outcome. We report a case of an IVC filter embedded within the second lumbar vertebral body and in which one of the primary struts fractured, which presented as chronic low back pain. The filter was retrieved percutaneously approximately 2 years after placement. A fractured small strut remained within the vertebral bone; patient's pain resolved. Symptomatic filter in situ should be retrieved even when fractured.