Determination of periodic deformation from InSAR results using the FFT time series analysis method in Gediz Graben

Permanent Scatterers (PS) point velocities obtained by the interferometric synthetic aperture radar (InSAR) method are generally determined using the linear regression model, which ignores periodic and seasonal effects. In this study, software was developed that can detect periodic effects by applying fast Fourier transformation (FFT) time series analysis to InSAR results. Using the FFT time series analysis, the periodic components of the surface movements at the PS points were determined, and then the annual velocity values free from periodic effects were obtained. The study area was chosen as the Gediz Graben, a tectonically active region where aseismic surface deformations have been observed in recent years. As a result, using the developed method, seasonal effects were successfully determined with the InSAR method at the PS points in the study area with a period of 384 days and an average amplitude of 19 mm. In addition, groundwater level changes of a water well in the region were modeled, and 0.93 correlation coefficient values were calculated between seasonal InSAR displacement values and water level changes. Thus, using the developed methodology, the relationship between the tectonic movement in the Gediz Graben in Turkey and the seasonal movements and the change in the groundwater level was determined.

Evaluate the safety and efficacy of dura sealant patch in reducing cerebrospinal fluid leakage following elective cranial surgery (ENCASE II): study protocol for a randomized, two-arm, multicenter trial

BACKGROUND

Cerebrospinal fluid (CSF) leakage is a frequent and challenging complication in neurosurgery, especially in the posterior fossa, with a prevalence of 8%. It is associated with substantial morbidity and increased healthcare costs. A novel dural sealant patch (LIQOSEAL) was developed for watertight dural closure. The objective of this study is to clinically assess the safety and effectiveness of LIQOSEAL as a means of reducing intra- as well as postoperative CSF leakage in patients undergoing elective posterior fossa intradural surgery with a dural closure procedure compared to the best currently available dural sealants.

METHODS

We will conduct a two-arm, randomized controlled, multicenter study with a 90-day follow-up. A total of 228 patients will be enrolled in 19 sites, of which 114 will receive LIQOSEAL and 114 an FDA-approved PEG sealant. The composite primary endpoint is defined as intraoperative CSF leakage at PEEP 20 cm H₂O, percutaneous CSF leakage within 90 days of, wound infection within 90 days of or pseudomeningocele of more than 20cc on MRI or requiring intervention. We hypothesize that the primary endpoint will not be reached by more than 10 patients (9%) in the investigational arm, which will demonstrate non-inferiority of LIQOSEAL compared to control.

DISCUSSION

This trial will evaluate whether LIQOSEAL is non-inferior to control as a means of reducing CSF leakage and safety TRIAL REGISTRATION: ClinicalTrials.gov NCT04086550 . Registered on 11 September 2019.

POS1357 THE 10-YEAR OUTCOME OF PATIENTS WITH BEHCET’S SYNDROME: A SINGLE-CENTER EXPERIENCE

Background

Behcet’s syndrome (BS) is a vasculitis characterized by recurrent oral and genital ulcers, as well as ocular, cutaneous, vascular, gastrointestinal, musculoskeletal, and central nervous system manifestations.

Objectives

The study aimed to evaluate the 10-year outcome of patients with BS.

Methods

A cohort of 682 patients diagnosed with BS between January 2007 and December 2009 in the rheumatology outpatient clinic of Gulhane Training and Research Hospital were re-evaluated in November 2021. The data regarding the clinical course of 84 patients (84/682) were obtained from patients’ files and detailed telephone interviews.

Results

The study included 84 patients (63 male, 21 female) with a mean age of 47.1±10.6 years. The mean disease duration was 17.6±5.7 years. At the time of the diagnosis, the mean age of the patients was 29.5±9.4 years. Oral ulcer (100%), papulopustular lesions (82.1%), genital ulcer (77.4%), and erythema nodosum (59.5%) were the most frequent manifestations at the time of diagnosis. Ocular (46.4%), musculoskeletal (35.7%), vascular (19%), gastrointestinal (3.6%), and neurological (1.2%) manifestations were seen in decreasing frequency. The most frequent ocular disease was posterior uveitis, whereas superficial thrombophlebitis and deep venous thrombosis were the most prevalent forms of vascular involvement. One patient had transverse myelitis as neurological involvement. Colchicine (88.1%) and corticosteroids (57.1%) were the most preferred drugs for the initial treatment. Fifty-one (60.7%) patients received at least one immunosuppressive agent. After 10-year, there was a statistically significant decrease in all manifestations of BS (Table 1). Nevertheless, 9 (10.7%) patients (8 male, 1 female) had new clinical findings. Five patients had (5.9%) mucocutaneous, 2 (2.4 %) arthritis and 2 (2.4%) vascular lesions as new clinical manifestations. The mean age of the patients with newly onset clinical findings was 48±8.9 years. There was no statistically significant difference between patients with and without new clinical findings with respect to age (p=0.79). The new onset mucocutaneous manifestations were genital ulcer and erythema nodosum. Besides, new onset vascular lesions were superficial and deep venous thrombosis of the lower extremities. The mean age of the patients who developed venous thrombosis at the time of the assessment was 37.0±7.07 years. Vascular involvement was detected more frequently in younger patients (p=0.03). However, ocular involvement is a frequent symptom after mucocutaneous involvement at the beginning, none of the patients had new eye involvement at the end of the follow-up. Colchicine, corticosteroid, and azathioprine were associated with the highest drug survival. Twenty-one (41.1%) patients of who were administered immunosuppressive agents as initial therapy were still using immunosuppressives 10 year later. The most frequently prescribed immunosuppressives were azathioprine and cyclosporine during the follow-up.

Table 1.

Clinical manifestations of Behcet’s syndrome

InitialAfter 10 yearspNoYesOral ulceration, n (%)No000<0.001*Yes84 (100)42 (50)42 (50)Genital ulceration, n (%)No19 (22.7)16 (84.2)3 (15.8)<0.001**Yes65 (77.4)54 (83.1)11 (16.9)Erythema nodosum and Papulopustular lesions, n (%)No6 (7.1)4 (66.7)2 (33.3)<0.001**Yes78 (92.9)44 (56.4)34 (43.6)Arthritis, n (%)No54 (64.3)52 (96.3)2 (3.7)<0.001**Yes30 (35.7)21 (70)9 (30)Vascular involvement, n (%)No68 (81)66 (97.1)2 (2.9)0.013**Yes16 (19)12 (75)4 (25)Gastrointestinal involvement, n (%)No81 (96.4)81 (100)0<0.001*Yes3 (3.6)3 (100)0Ocular involvement, n (%)No45 (53.6)45 (100)0<0.001**Yes39 (46.4)29 (74.4)10 (25.6)Neurological involvement, n (%)No83 (98.8)83 (100)0<0.001*Yes1 (1.2)1 (100)0

*McNemar-Bowker Test, **McNemar Test

Conclusion

The frequency of newly onset clinical manifestations decreases with age in BS, especially after age 40. Besides, especially male Behcet’s patients should be followed-up regularly for complications that may develop regardless of age.

Disclosure of Interests

None declared

Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura

OBJECTIVE

Helicobacter pylori (H. pylori) eradication therapy is known to increase the platelet count, but in immune thrombocytopenic purpura (ITP), the effect of H. pylori infection on the response to treatment is not clear. This study aims to determine whether the response to the first-line treatment is affected by the states of H. pylori-positivity and -negativity in ITP patients.

PATIENTS AND METHODS

Adult newly diagnosed or chronic ITP patients who had not received eradication therapy for H. pylori infection were included. Characteristics of the patients, presence and severity of bleeding, initial platelet count, administered treatments, and treatment response rates were inspected.

RESULTS

Of 119 total patients, 66 (55.5%) were female, 32 (26.9%) were H. pylori-positive, 87 (73.1%) were H. pylori-negative. H. pylori-positive and H. pylori-negative groups were not significantly different in terms of age (p=0.127), gender (p=0.078), diagnosis status (p=0.094) and the distribution of bleeding symptoms (p=0.712). The most common treatment was standard-dose steroid in both groups (62.5% vs. 68.9%, p=0.524). Rates of complete response, partial response, no response were comparable for the two groups (respectively, 75% vs. 73.6%, and 18.8% vs. 19.5%, and 6.2% vs. 6.9%), and there was no significant difference between the groups (p=0.283).

CONCLUSIONS

It can be stated according to the present study that in ITP patients in whom treatment is indicated, the response to the first-line treatment without the administration of H. pylori eradication therapy is similar between H. pylori-positive and H. pylori-negative patients.

The clinicopathological features and survival of Castleman disease: a multicenter Turkish study

OBJECTIVE

In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns.

PATIENTS AND METHODS

This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey.

RESULTS

The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died.

CONCLUSIONS

It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Syringe or mask? Loop electrosurgical excision procedure under local or general anesthesia: a randomized trial

BACKGROUND

Loop electrosurgical excision procedure may be performed under local anesthesia or general anesthesia, and practice patterns differ worldwide. No randomized head-to-head comparison has been published to confirm or refute either practice.

OBJECTIVE

This study aimed to compare loop electrosurgical excision procedure under local anesthesia vs general anesthesia regarding patient satisfaction and procedure-related outcomes such as rates of involved margins, complications, pain, and blood loss.

STUDY DESIGN

Consecutive women referred to our colposcopy unit were recruited. Loop electrosurgical excision procedure was performed under local anesthesia with 4 intracervical injections of bupivacaine hydrochloride 0.5% or under general anesthesia with fentanyl, propofol, and a laryngeal mask with sevoflurane maintenance. The primary endpoint was patient satisfaction assessed on the day of surgery and 14 days thereafter using a Likert scale (score 0-100) and a questionnaire. Secondary endpoints included rates of involved margins, procedure-related complications, pain, blood loss, and surgeon preference. Results were compared using nonparametric and chi-square tests.

RESULTS

Between July 2018 and February 2020, we randomized 208 women, 108 in the local anesthesia arm and 100 in the general anesthesia arm. In the intention-to-treat analysis, patient satisfaction did not differ between the study groups directly after surgery (Likert scale 100 [90-100] vs 100 [90-100]; P=.077) and 14 days thereafter (Likert scale 100 [80-100] vs 100 [90-100]; P=.079). In the per-protocol analysis, women in the local anesthesia arm had significantly smaller cone volumes (1.11 cm³ [0.70-1.83] vs 1.58 cm³ [1.08-2.69], respectively; P<.001), less intraoperative blood loss (Δhemoglobin, 0.2 g/dL [-0.1 to 0.4] vs 0.5 g/dL [0.2-0.9]; P<.001), and higher satisfaction after 14 days (100 [90-100] vs 100 [80-100]; P=.026), whereas surgeon preference favored general anesthesia (90 [79-100] vs 100 [90-100], respectively; P=.001). All other secondary outcomes did not differ between groups (resection margin status R1, 6.6% vs 2.1% [P=.26]; cone fragmentation, 12.1% vs 6.3% [P=.27]; procedure duration, 151.5 seconds [120-219.5] vs 180 seconds [117-241.5] [P=.34]; time to complete hemostasis, 60 seconds [34-97] vs 70 seconds [48.25-122.25] [P=.08]; complication rate, 3.3% vs 1.1% [P=.59]). In a multivariate analysis, parity (P=.03), type of transformation zone (P=.03), and cone volume (P=.02) and not study group assignment, age, body mass index, and degree of dysplasia independently influenced the primary endpoint.

CONCLUSION

Loop electrosurgical excision procedure under local anesthesia is equally well tolerated and offers patient-reported and procedure-related benefits over general anesthesia, supporting the preferred practice in some institutions and refuting the preferred practice in others.

Serum asymmetric-dimethylarginine, apelin and NT-pro BNP levels in dialysis patients

Background

The relationships among serum Apelin, Asymmetric- dimethylarginine (ADMA), N-terminal probrain natriureticpeptide (NT-proBNP) levels, and blood pressures in dialysis patients are not well known.

Materials and Methods

Age and sex matched 30 hemodialysis (HD), 30 peritoneal dialysis (PD) patients, and 20 healthy controls were recruited. Serum apelin-36, ADMA, NT-proBNP levels, and blood pressures of both patients and healthy controls were measured and compared.

Results

Serum ADMA and Apelin levels in HD patients were significantly higher than in PD patients. In multiple regression analyses the predictors of higher serum apelin levels were higher BMI, higher ADMA and lower systolic blood pressure. The predictors of serum ADMA levels were being on HD. The predictors of serum NT-proBNP levels were lower serum albumin and higher systolic blood pressure.

Conclusion

Being on HD is a predictor of high ADMA levels. HD might be less effective on ADMA removal than PD. It seems that higher serum apelin levels related with lower sytolic blood pressure levels, whereas higher NT-proBNP levels related with higher sytolic blood pressure levels indicating potential roles as independent prognostic factors for systolic hypertension in dialysis patients.

Does the plasma application time affect the tensile bond strength between PMMA and a silicone-based denture liner?

Aims

This study evaluated the effect of oxygen plasma and argon plasma treatments with different application times on tensile bonding of a silicone-based denture liner to polymethylmetacrylate (PMMA).

Methods

Seven groups (n = 5) were prepared and six of them treated by argon plasma or oxygen plasma with 30s, 60s, and 120s, respectively; one group was left untreated served as control. After processing of denture liner, the specimens were deflasked and stored dry for 24 h, and they were then subjected to tensile bond strength testing. Differences in tensile bond strength values were determined using one-way ANOVA (α = 0.05).

Results

Highest tensile bond strengths were observed in the oxygen plasma groups, followed by untreated group and argon plasma groups in turn in order. Tensile bond strenght were increased with time for both type of plasma applications tested.

Conclusion

This study suggests that the adhesion between PMMA and denture liner is improved under conditions of oxygen plasma treatment with extended exposure time rather than argon plasma treatment.

Distinguishing Extravascular from Intravascular Ferumoxytol Pools within the Brain: Proof of Concept in Patients with Treated Glioblastoma

BACKGROUND AND PURPOSE

Glioblastoma-associated macrophages are a major constituent of the immune response to therapy and are known to engulf the iron-based MR imaging contrast agent, ferumoxytol. Current ferumoxytol MR imaging techniques for localizing macrophages are confounded by contaminating intravascular signal. The aim of this study was to assess the utility of a newly developed MR imaging technique, segregation and extravascular localization of ferumoxytol imaging, for differentiating extravascular-from-intravascular ferumoxytol contrast signal at a delayed 24-hour imaging time point.

MATERIALS AND METHODS

Twenty-three patients with suspected post-chemoradiotherapy glioblastoma progression underwent ferumoxytol-enhanced SWI. Segregation and extravascular localization of ferumoxytol imaging maps were generated as the voxelwise difference of the delayed (24 hours) from the early (immediately after administration) time point SWI maps. Continuous segregation and extravascular localization of ferumoxytol imaging map values were separated into positive and negative components. Image-guided biologic correlation was performed.

RESULTS

Negative segregation and extravascular localization of ferumoxytol imaging values correlated with early and delayed time point SWI values, demonstrating that intravascular signal detected in the early time point persists into the delayed time point. Positive segregation and extravascular localization of ferumoxytol imaging values correlated only with delayed time point SWI values, suggesting successful detection of the newly developed extravascular signal.

CONCLUSIONS

Segregation and extravascular localization of ferumoxytol MR imaging improves on current techniques by eliminating intrinsic tissue and intravascular ferumoxytol signal and may inform glioblastoma outcomes by serving as a more specific metric of macrophage content compared with uncorrected T1 and SWI techniques.

The impact of TFPI on coronary atherosclerotic burden

OBJECTIVES

We aimed to associate a coronary artery disease (CAD) presence and severity with endothelial dysfunction (ED), carotid intima media thickness (CIMT) and Tissue Factor Pathway Inhibitor (TFPI).

BACKGROUND

ED has a central role in atherosclerosis. CIMT and TFPI activity are also related with atherosclerosis and CAD.

METHODS

In our prospective observational study, 50 patients had CAD and 30 had normal coronary arteries. Endothelial function was evaluated by endothelium-dependent flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements. CIMT and Serum TFPI levels were also measured.

RESULTS

TFPI was a statistically significant determinant between the two groups with an increased level in CAD (+) group (84.9 ± 19.3 vs 70.2 ± 14.7, p = 0.001). There was a positive correlation between CIMT and Gensini (r = 0.34, p = 0.014). There was a strong negative correlation between Gensini and FMD-NMD, statistically significant (FMD: r = -0.715, p < 0.001; NMD: r = -0.718, p < 0.001).

CONCLUSION

We observed that ED, increased CIMT and TFPI levels were associated with CAD. Additionally, increased CIMT measurements and decreased FMD and NMD values had a positive correlation with GSS (Tab. 4, Fig. 6, Ref. 50).