EURO-MUSCULUS/USPRM Basic Scanning Protocols for wrist and hand

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned wrist/hand structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for shoulder

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned shoulder structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

The association between anti-Müllerian hormone and IVF-ICSI outcome in poor responder patients performing long protocol

PURPOSE OF INVESTIGATION

Ovarian reserve reflects the capacity of the ovaries for a successful pregnancy. Anti-Müllerian hormone (AMH) could be a useful marker to predict ovarian reserve and to adjust controlled ovarian stimulation. The aim of this study was to assess the relationship between AMH and intracytoplasmic sperm injection-in vitro fertilization (IVF-ICSI) outcome in poor responder women.

MATERIALS AND METHODS

This study was conducted prospectively for a period of 12 months. Inclusion criteria were FSH value > 15 iu/l or antral follicle number < 4, on the 2nd day of cycle. All patients underwent GnRH agonist stimulation with long protocol. Serum AMH levels were measured in the treatment cycle just before the stimulation. After the treatment, patients who were pregnant formed the study group and patients who were not pregnant formed the control group. Serum AMH level was the main outcome measure.

RESULTS

The study and control group consisted of 34 and 70 patients, respectively. No significant difference was found in duration of infertility, antral follicular count, basal E2 and FSH levels. The mean serum AMH level was significantly higher in study group (p = 0.005). The retrieved oocyte number, metaphase 2 oocyte number, and fertilization rate were also significantly higher in the study group.

DISCUSSION

Evaluation of serum AMH seems to be a useful marker to predict IVF-ICSI outcome in poor responder patients.

Ultrasonographic evaluation of sciatic nerves in patients with spinal cord injury

STUDY DESIGN

Cross-sectional, controlled study.

OBJECTIVE

To evaluate the sciatic nerves of subjects with spinal cord injury (SCI) by using ultrasound (US) imaging and to explore whether US measurements are associated with clinical and electrophysiological findings.

SETTING

National Rehabilitation Center in Ankara, Turkey.

METHODS

Fifteen SCI subjects (12 male (M), 3 female (F)) and 23 (16 M, 7 F) healthy controls were included in the study. After clinical assessment of the subjects, lower limb nerve conduction studies and US imaging of the sciatic nerves were performed. Cross-sectional area (CSA) values of the sciatic nerves were correlated with the clinical and electrophysiologic data.

RESULTS

Mean CSA values were lower in the patient group when compared with the control group (P=0.042). Reduced compound motor action potentials regarding tibial and peroneal nerves were observed in the patient group (P=0.003 and P=0.005, respectively). US measurements did not correlate with the electrophysiological findings. However, sciatic nerve CSA values were positively correlated with body mass index in the control (r=0.534, P<0.05) and patient (r=0.482, P<0.05) groups.

CONCLUSION

Sciatic nerves seem to be smaller in subjects with SCI. Together with our electrophysiological data, this preliminary finding could possibly be attributed to primary axonal loss.

Does dehydroepiandrosterone supplementation really affect IVF-ICSI outcome in women with poor ovarian reserve?

OBJECTIVES

It is difficult to choose the correct fertility treatment in women with poor ovarian reserve. Although various methods have been used, the management of controlled ovarian hyperstimulation is not easy in poor responders. The aim of this study was to evaluate the efficacy of dehydroepiandrosterone (DHEA) on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcome of poor responders.

STUDY DESIGN

This was a randomized, prospective controlled trial. Women with serum antimullerian hormone<1 ng/ml or serum follicle-stimulating hormone>15 IU/l and antral follicle count <4 on day 2 of the menstrual cycle were considered to have poor ovarian reserve. All women were treated with a microdose induction protocol. Women in the study group received IVF-ICSI and DHEA 75 mg daily for 12 weeks. Women in the control group received IVF-ICSI without DHEA supplementation.

RESULTS

In total, 208 women with diminished ovarian reserve was enrolled in the study, 104 in the study group and 104 in the control group. The number of oocytes retrieved and the fertilization rate were slightly higher in the study group, but the pregnancy rate was higher in the control group. The differences were not significant.

CONCLUSIONS

The results failed to show that DHEA supplementation enhances IVF-ICSI outcome in women with poor ovarian reserve.

Monitoring of CD3(+) T-cell count in patients receiving antithymocyte globulin induction after cadaveric renal transplantation

AIM

Although antithymocyte globulin (ATG) has been used for years, its ideal dose and administration period is obscure. Herein, we sought to use the CD3(+) cell count to detect the optimal ATG dosage.

MATERIAL AND METHODS

Twenty-one patients who underwent cadaveric donor renal transplantation from January 2009 to January 2012 received a 1 mg/kg ATG initial dose at the time of the operation. Patients were randomized into 2 cohorts. Group 1 (n = 11) received ATG according to the clinical and total lymphocyte count and group 2 (n = 10), the dose was tailored according to the CD3(+) cell count. We compared the total and daily ATG dosages, ATG administration period, side effects of ATG, the number of days to a serum creatinine level <2 mg/dL, graft function at 3 months, acute rejection episodes, infection rates, costs of CD3(+) analysis, and ATG amounts.

RESULTS

Both groups showed similar gender, age, and human leukocyte antigen matching data. There was no difference in presensitizing events or panel-reactive antibody class 1 and 2 levels. The number of days to a serum creatinine level of <2 mg/dL was 11 ± 1.5 for group 1 versus 10.4 ± 0.8 for group 2 (P = .45). Between groups 1 and 2, there was a significant difference between the mean total (P = .031) and mean daily ATG dosages (P = .006). We used a total dose of 3800 mg ATG for group 1 and 2200 mg for group 2 and for the group 2 who underwent 43 CD3(+) cell counts. The expenditure per patient was 20% higher among group 1 than group 2.

CONCLUSION

Determination of appropriate ATG dosages by CD3(+) cell counts was useful, reliable, and cost effective.

Effect of supervision on ultrasonographic measurements. A blinded randomized cross-over study

BACKGROUND

Musculoskeletal ultrasound is becoming an increasingly popular clinical tool in the hands of physiatrists. Herewith, although the role of direct supervision (by an expert) is universally recognized as the core element for appropriate ultrasound training, to our best notice, its impact on ultrasonographic measurements has not been studied quantitatively in the hitherto literature.

AIM

To quantify the effect of supervision in the early period of musculoskeletal ultrasound training by using three different tissues (muscle-cartilage-tendon) as models.

DESIGN

A blinded randomized cross-over study.

SETTING

Physical Medicine and Rehabilitation Department of a University Hospital.

POPULATION

A total of 9 sonographers (8 novice and 1 expert) were involved whereby the novice sonographers were randomly divided into two groups; Group A (N.=4) and Group B (N.=4).

METHODS

All sonographers performed three thickness measurements; medial head of the gastrocnemius muscle, patellar tendon and femoral cartilage on the left lower limb of the same subject. The expert supervised Group A in the first half of the study (9 days), and Group B in the second half (9 days). Throughout the study period, all the participants were blinded to the data. Relative effectiveness, expert effect, order effect, treatment-period effect were studied for cross-over variance analysis.

RESULTS

For all the three sites, measurements under the supervision of the expert were significantly different than those without him -p values pertaining to relative effectiveness, expert effect were 0.014, 0.013 for femoral cartilage; <0.001, <0.001 for gastrocnemius and <0.001, <0.001 for patellar tendon, respectively). For gastrocnemius muscle measurements, studying with the expert in the second half of the study (vs in the first half) was better concerning the precision of the measurements (order effect P<0.001).

CONCLUSION

Supervision during measurements of novice sonographers is crucial and their data should otherwise be interpreted attentively.

The use of single incision thoracoscopic pleurectomy in the management of malignant pleural effusion

BACKGROUND

A number of procedures have been used in the management of malignant pleural effusion including repeated thoracentesis, tube thoracostomy, drainage with catheter, chemical pleurodesis, pleurectomy and pleuro-peritoneal shunt. However, the optimal method of management remains unclear. On the other hand, single incision thoracoscopic surgery has been defined as a less invasive method than the standard threeportal videothoracoscopy. We herein present our series of patients who underwent single incision thoracoscopic pleurectomy for malignant pleural effusion.

PATIENTS AND METHODS

We performed a single incision thoracoscopic pleurectomy in a total of 19 consecutive patients, 11 (57.8%) male and 8 (42.2%) female with a mean age of 56.3 +/- 16.9 years who had malignant pleural effusions. We made a single 2-2.5 cm incision at the seventh or eighth intercostal spaces on the midaxillary line for the procedure.

RESULTS

We performed a total of 23 single incision thoracoscopic total pleurectomies consisting of 11 (57.8%) right-sided, 4 (21.1%) left-sided and 4 (21.1%) bilateral procedures. The mean total postoperative drainage was 553 +/- 266 cc (Median; 470 cc), and the mean chest tube removal time was 2.3 +/- 0.4 days (Median; 2 days). We observed neither morbidity nor mortality. No patient required an additional port or a conversion to thoracotomy. Median follow-up was 83 days (range, 30 to 359 days). Pleural effusion recurred in two (8.6%) out of 23 procedures which resulted in a success rate as 91.4% for the procedure.

CONCLUSION

Single incision thoracoscopic pleurectomy is a safe, less invasive and an effective method of pleurodesis with a low recurrence rate in patients with malignant pleural effusion.

Alpha fetoprotein levels and its relationship with histopathological findings in patients with non-alcoholic fatty liver disease

BACKGROUND

Non alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver disorders ranging from simple steatosis (SS) to cirrhosis. In addition, increasing evidence indicates that hepatocellular carcinoma (HCC) may represent a late complication of NAFLD. Alpha-fetoprotein (AFP) serum levels can rise in adults with HCC.

AIM

In the present study, we aimed to investigate circulating AFP concentrations in subjects with histologically proven NAFLD. In addition, the relationship of AFP with liver histology was also searched.

PATIENTS AND METHODS

One hundred and three male NAFLD patients and 57 healthy male controls were enrolled in the study. In addition, patients with NAFLD grouped as nonalcoholic steatohepatitis (NASH) (n = 72) and SS (n = 31). AFP serum levels were measured in duplicate by the chemiluminescence's method.

RESULTS

Age and gender were similar in subjects with NAFLD and controls. AFP serum levels were not different between two groups. In subgroup analysis, AFP levels were also found to be similar in patients with NASH and SS. Moreover, no significant relationship was found between AFP and histopathological findings in patients with NAFLD.

CONCLUSIONS

The results of this preliminary study suggest that AFP is not involved in the pathogenesis of NAFLD.

Leptin receptor (Ob-R) mRNA expression and serum leptin concentration in patients with colorectal and metastatic colorectal cancer

The objective of the present study was to investigate the effect of leptin on the progression of colorectal carcinoma to metastatic disease by analyzing the serum leptin concentration and Ob-R gene expression in colon cancer tissues. Tissue samples were obtained from 31 patients who underwent surgical resection for colon (18 cases) and metastatic colon (13 cases) cancer. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA) and Ob-R mRNA expression by real-time polymerase chain reaction (RT-PCR) for both groups. ELISA data were analyzed by the Student t-test and RT-PCR data were analyzed by the Mann-Whitney U-test. RT-PCR results demonstrated that mRNA expression of Ob-R in human metastatic colorectal cancer was higher than in local colorectal cancer tissues. On the other hand, mean serum leptin concentration was significantly higher in local colorectal cancer patients compared to patients with metastatic colorectal cancer. The results of the present study suggest a role for leptin in the progression of colon cancer to metastatic disease without weight loss. In other words, significantly increased Ob-R mRNA expression and decreased serum leptin concentration in patients with metastatic colon cancer indicate that sensitization to leptin activity may be a major indicator of metastasis to the colon tissue and the determination of leptin concentration and leptin gene expression may be used to aid the diagnosis.

The impact of C4d staining as a humoral injury marker

PURPOSE

Acute and chronic humoral injuries in renal transplant recipients are the main reasons for graft rejection and failure. Histological and clinical characteristics of humoral rejection and symptoms are variable and not always helpful for differential diagnosis. Clinical monitoring of the allograft, an elevated serum panel-reactive antibody (PRA), and the presence of donor-specific antibody (DSA) during immune monitoring as well as C4d staining of biopsy material can establish the differential diagnosis. Even without a cellular component, humoral rejection reaction is serious because the target tissue is the graft endothelium. Because the kidney graft has a rich vascular structure this attack causes permanent injury to the kidney in the long term. Graft dysfunction in this setting is usually more severe, requiring dialysis therapy, compared with acute cellular reactions. Positive C4d staining of peritubular capillaries in biopsy material represent a hallmark of complement-dependent cytotoxicity, supporting the diagnosis of humoral rejection. We analyzed C4d staining as a hallmark of humoral rejection.

METHODS

From 2009 to 2011, we analyzed the relationship between pathological findings of C4d immunohistochemistry staining and the clinical outcomes of 45 kidney transplant recipients who underwent a kidney biopsy because of graft dysfunction due to possible humoral rejection.

RESULTS

Biopsy specimens of 15 patients stained C4d positive; the remaining 30 showed negative results. Intravenous steroids, PP + IVIG with or without antithymocyte globulin (ATG), was administered for treatment. Sixty six percent (n = 10) of patients were C4d positive with 16% (n = 5) of those showing C4d-negative biopsy results, losing their grafts, and returning to hemodialysis.

CONCLUSIONS

C4d staining refractory humoral rejection injury was related to poor graft outcomes.

The use of single incision thoracoscopic surgery in diagnostic and therapeutic thoracic surgical procedures

BACKGROUND

As a minimal invasive procedure, a standard threeportal videothoracoscopy may have complications such as chronic and residual pain. However, a single incision thoracoscopic surgery is a less invasive procedure with minimal complications. We present our series of patients who had single incision thoracoscopic surgical procedures.

PATIENTS AND METHODS

A total of 49 patients, 29 (59.2%) male and 20 (40.8%) female with a mean age of 45.7 +/- 17.6 years (range, 16 to 86 years) underwent a total of 59 single incision thoracoscopic surgical procedures. We most often made a 2-2.5 cm single incision on the seventh or eighth intercostal space at the midaxillary line. VAS (Visual analogue scale) scores for pain at postoperative day 1 and the mean of chest tube removal times were recorded for each procedure. The patients were discharged following chest tube removal.

RESULTS

We performed an overall of 59 procedures including 8 (13.7%) wedge resections for either histologic diagnosis or spontaneous pneumothorax, 4 (6.8%) pleural biopsies, 23 (38.9%) pleurectomies, 9 (15.2%) deloculation and decortications, 5 (8.6%) traumas in and 10 (17.5%) sympathectomies. No patient required an additional thoracoscopic port or conversion to thoracotomy. The overall mean of postoperative VAS scores for all procedures at postoperative day 1 and day 30 were 3.2 +/- 0.9 and 1.4 +/- 0.5, respectively (p <0.0001). The overall mean of chest tube removal time was 2.3 +/- 0.8 days (median; 2). We observed neither morbidity nor mortality.

CONCLUSIONS

In selected patients, single incision thoracoscopic surgery is an effective and a safe procedure with lower levels of pain and shorter hospital stay. A wide spectrum of thoracic surgical procedures can be performed with the use of single incision thoracoscopic surgery.

Choosing a scholarly journal during manuscript submission: the way how it rings true for physiatrists

BACKGROUND

Research and publications are increasing in Physical and Rehabilitation Medicine (PRM). Hence, there appears to be a multifaceted and challenging turnover in our scientific niche involving authors, editors, publishers and readers in a complex interplay.

AIM

To explore the manuscript submission process from the side of the authors, and to better understand their perceptions and preferences.

DESIGN

A survey study.

SETTING

E-mail and personal contact.

POPULATION

European researchers working in the field of PRM.

METHODS

A questionnaire was specifically prepared for this study. The first part included questions regarding personal and scientific background; in the second part the attendants rated 20 items (with respect to several journal characteristics) on a 4-point semantic differential scale; and the third part contained two open ended questions regarding additional factors that the authors considered during submission.

RESULTS

Area of interest (mission and contents) of the journal within the "Rehabilitation" category, absolute impact factor of the journal, match between perceived "quality" of their study and journal impact factor were considered to be the three most important factors by the authors.

CONCLUSION

In a scientific environment where the numbers of research and publication outlets alike are growing, it is important to understand how authors choose where to publish their papers.

CLINICAL REHABILITATION IMPACT

We believe that editors, and publishers as well, would take into account our findings to best meet the needs of all actors in the competitive marketplace of scholarly publishing in PRM.

The effect of ammonia on carbon nanotube growth using simple thermal chemical vapour deposition

We report the use of a new precursor as active agents to promote the growth of carbon nanotubes (CNT) in methane ambient using a simple thermal chemical vapour deposition method. The agents consist of ammonia and methanol mixed at different ratios and was found to enhance the growth of CNTs. The optimum methanol to ammonia ratio was found to be 8 to 5, whereby longer and denser CNTs were produced compared to other ratios. The result was found otherwise when the experiment was done solely in methane ambient. In addition, CNT growth on substrates coated with double layer Ni catalyst was improved in terms of quality and density compared to a single coated substrates. This finding is supported by Raman spectrometry analysis.