EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for (Adult) Hip

ABSTRACT

In this dynamic scanning protocol, ultrasound assessment of the adult hip is described using different maneuvers for various conditions. Real-time patient examination and ultrasound scanning videos are coupled for convenience as well as for better insight. The text covers the common conditions around the hip where especially dynamic ultrasound scanning provides valuable information in addition to static imaging. The protocol is prepared by an international consensus of several experts in the field of musculoskeletal ultrasound.

Differential Expression and in Silico Functional Analysis of Plasma MicroRNAs in the Pathogenesis of Non-segmental Vitiligo

Vitiligo is a disease characterized by acquired depigmentation, white macules, and patches on the skin due to the dysfunction of epidermal melanocytes. In this study, we attempt to profile the microRNA (miRNA) expression patterns and predict the potential targets, assessing the biological functions of differentially expressed miRNAs in the blood of generalized vitiligo patients. Peripheral blood samples were taken from all participants, and the expression levels of 89 identified miRNAs were analyzed with real-time quantitative polymerase chain reaction (PCR). The results indicated significant upregulation of six miRNAs and downregulation of 19 miRNAs in the plasma of vitiligo patients. The top three upregulated miRNAs were hsa-miR-451a, hsa-miR-25-3p, and hsa-miR-19a-3p, and the top three downregulated miRNAs were hsa-miR-146a-5p, hsa-miR-940, and hsa-miR-142-3p. Moreover, the miRNA expression profiles of patients with Type 3 and Type 4 phototypes were substantially different in such a way that the patients with Type 3 phototype would be more prone to the emergence of melanoma and cancer. While significant variations in the expression patterns of miRNAs in male and female vitiligo patients were demonstrated, miR-let-7i-5p, miR-19a-3p, miR-25-3p, and miR-451a were commonly upregulated, and miR-142-3p and miR-146a-5p were commonly repressed in both sexes. This study may shed light on the roles of differentially expressed miRNAs in vitiligo patients by examining the miRNA expression patterns and the combined effects of miRNA and their predicted targets.

Ultrasonographic Evaluation of the Metacarpal Cartilage Thicknesses in Weightlifters and Volleyball Players

OBJECTIVE

The aim of the study was to evaluate the possible effects of impact and loading on the metacarpal cartilage and hand functions in young elite athletes.

DESIGN

In this cross-sectional study athletes with at least 3 yrs of sport background and who have been under a scheduled training program were enrolled. The second to fifth fingers' metacarpal head cartilage thicknesses were measured bilaterally by using ultrasonography. Handgrip and pinch strengths were measured. Michigan Hand Outcomes Questionnaire was also completed for every participant.

RESULTS

A total of 42 male athletes (19 weightlifters, 23 volleyball players) and 46 healthy control subjects were enrolled. Metacarpal cartilage thicknesses of the athletes were thicker than those of the healthy controls (all P < 0.001). There were no differences between the dominant and nondominant hands (all P > 0.05). In the weightlifting group, Michigan Hand Outcomes Questionnaire work performance and pain scores were worse than the other groups (both P < 0.001).

CONCLUSIONS

The presence of increased cartilage thickness measurements in the athletes suggests that sports activities might affect the metacarpal articular cartilage. Highest pain scores and lowest work performance scores in the weightlifters with highest metacarpal cartilage thickness might suggest that impact and loading during their sports play could lead to cartilage edema.

Search for New Physics in Electronic Recoil Data from XENONnT

We report on a blinded analysis of low-energy electronic recoil data from the first science run of the XENONnT dark matter experiment. Novel subsystems and the increased 5.9 ton liquid xenon target reduced the background in the (1, 30) keV search region to (15.8±1.3)  events/(ton×year×keV), the lowest ever achieved in a dark matter detector and ∼5 times lower than in XENON1T. With an exposure of 1.16 ton-years, we observe no excess above background and set stringent new limits on solar axions, an enhanced neutrino magnetic moment, and bosonic dark matter.

Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults

BACKGROUND

Several studies reported that impaired nutrition is associated with reduced muscle mass, muscle strength, and physical performance. Chewing ability is essential to maintain balanced oral nutrient intake. The study was designed to define the possible relationship between chewing ability and nutrition-related problems (malnutrition, sarcopenia, and frailty) in a holistic perspective.

METHODS

This cross-sectional study recruited adults aged ≥65 years. All patients were evaluated with comprehensive geriatric assessment. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criterion. Malnutrition was determined according to body mass index, calf circumference, and Mini Nutritional Assessment short form (MNA-SF). Frailty status was diagnosed with the Clinical Frailty Scale. Masseter and gastrocnemius muscle thicknesses (MTs) were measured via ultrasonography imaging. Oral examinations were carried out by a dentist, and chewing performance was examined with a color-changeable chewing gum.

RESULTS

Overall, 135 older adults (76 females) were analyzed. Mean ± SD age was 75.7 ± 7.2 years; 37.0% of the patients were frail, 3.7% were malnourished, 12.6% were sarcopenic, and 20.0% had poor chewing function. In the poor chewing function group, age and frailty scores were increased and the MNA-SF scores, handgrip strength, skeletal muscle index, and masseter MT were reduced (all P < 0.05). After adjusting for confounders, regression analysis showed that low grip strength and low gastrocnemius MT were independently associated with poor chewing ability.

CONCLUSIONS

Chewing ability was related to sarcopenia. Age and low grip strength in females and low cognitive scores and having low gastrocnemius MT in males were independent variables affecting chewing ability.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow

ABSTRACT

In this dynamic protocol, ultrasound examination of the elbow using different maneuvers is described for several/relevant elbow problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide-prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine])-will help musculoskeletal physicians perform a better and uniform/standard approach.

AB0212 COMPARISON OF THE EFFECTS OF POLYPHARMACY IN THE TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS AND PSORIATIC ARTHRITIS PATIENTS WITH PERIPHERAL JOINT INVOLVEMENT

Background

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic, progressive inflammatory diseases that can be accompanied by other diseases. These patients use several medications, especially due to their comorbidities and widespread pain. In recent years, with the increase in the lifespan of individuals, the concept of polypharmacy has become more prominent. Accordingly, in our study, we aimed to present the prevalence of polypharmacy and its effects on these diseases.

Objectives

Demonstrating the prevalence of polypharmacy in RA and PsA, which are among the most frequently encountered inflammatory arthritides, and the effects of polypharmacy on disease activity.

Methods

This study included PsA patients with only peripheral joint involvement and no distal interphalangeal joint involvement and RA patients. The numbers of medications used by the patients at the onset of their treatment and in the sixth month of their treatment were recorded. Non-prescribed (over the counter), topical and herbal/homeopathic medications were excluded. Polypharmacy was accepted as the simultaneous use of at least five medications by the person. Disease activity score in 28 joints C-reactive protein (DAS-28 CRP) was used for disease activity for both diseases. In addition to these, the scores of the patients who attended their follow-ups in the 12th month were calculated and analyzed. The Charlson Comorbidity Index (CCI) scores of the patient were calculated based on their chronic diseases.

Results

The sample of the study included 232 RA and 73 PsA patients. Demographic and some clinical characteristics are shown in Table 1. The mean numbers of medication used by the patients at the onset of their treatment were respectively 5.09±2.89 and 4.03±2.7 for the RA and PsA patients, whereas these mean numbers were found consecutively as 8.67±3.58 and 7.71±3.3 in the sixth month of their treatment. Polypharmacy was present in the sixth month of the treatment in 217 (93.5%) RA and 61 (83.6%) PsA patients.

Table 1.

Demographic and some clinical features

RA (n=232)PSA (n=73)Age (mean±SD)55.2±13.6648.4±13.43Age Group<65 years171(73.7)65(89)≥65 years61(26.3)8(11)SexFemale, n (%)172(74.1)50(68.5)Male, n (%)60(25.9)23(31.5)Current smoker, n (%)82(35.3)33(45.2)The numbers of medication used8.67±3.587.71±3.3Polypharmacy at the Beginning of Treatment115(49.6)28(38.4)Polypharmacy in the sixth month of treatment217(93.5)61(83.6)CCI (n=232/72) (mean±SD)1.25±0.881.31±0.710th month DAS-28 CRP (mean±SD)4.91±1.284.68±1.036th month DAS-28 CRP (mean±SD)3.14±1.062.86±0.9912th month DAS-28 CRP (n=83/29) (mean±SD)2.73±1.182.8±1.12

While the mean ages of the RA and PsA patients who had polypharmacy treatment at the beginning were respectively 59.21±12.65 and 53.5±13.81, their ages were significantly higher than the ages of those who did not receive polypharmacy treatment (respectively, 51.26±13.53 and 45.22±12.3).

In RA ve PsA patients, the status of polypharmacy is higher in the groups in the groups aged 65 and over than those under 65 years of age, and it is statistically significant (p=0.001 and p=0.048, respectively). The risk of polypharmacy in people over 65 years of age in RA patients was 8.2 times, and the risk of polypharmacy in people over 65 years old in PSA patients was increased 6.3 times (p=0.015).

In both the RA and PSA groups, patients with baseline polypharmacy had statistically significantly higher DAS-28 CRP scores at 6 months of treatment than those without baseline polypharmacy. (p<0.001). While the higher DAS-28 CRP score was maintained at 12 months in the RA group with polypharmacy at baseline (p=0.006), this was not significant in the PSA group (p=0.07).

Conclusion

Polypharmacy was present both at the time of diagnosis and in the treatment process in the RA and PsA patients, and the presence of polypharmacy at the beginning of the treatment was among the factors that affected the treatment of these patients by significantly affecting their 6th-month DAS-28 CRP values.

Disclosure of Interests

None declared

Musculoskeletal ultrasonography: ninety-nine reasons for physiatrists

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Predictors of malignancy in patients with solitary pulmonary nodules undergoing pulmonary resection

Background

The management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis.

Objective

We tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis.

Methods

We made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis.

Results

We had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy.

Conclusion

Age, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.

Evaluation of occurrence, fate and removal of priority phthalate esters (PAEs) in wastewater and sewage sludge by advanced biological treatment, waste stabilization pond and constructed wetland

Phthalate Esters (PAEs), detected in high concentrations generally in treated wastewater discharged from wastewater treatment plants (WWTPs), are important pollutants that restrict the reuse of wastewater. Investigating the fate of these endocrine-disrupting chemicals in WWTPs is crucial in order to protect both receiving environments and ecosystems. For this purpose, di(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DNOP) and benzyl butyl phthalate (BBP) in the group of PAEs were monitored in simultaneously both in wastewater and sludge lines of selected two nature-based WWTPs and one advanced biological WWTP. Although it was frequently stated that phthalates were significantly removed in WWTPs in many studies found in literature, negative removal efficiencies of selected phthalates in investigated WWTPs during the sampling period were observed generally in this study. One of the reasons for this concentration increase could be releasing of phthalates from microplastics in wastewater during the treatment process or the desorption of PAEs from treatment sludge. DNOP was the compound with the highest concentration increase at almost each treatment unit of the three WWTPs. On the other hand, total PAEs load was 1997 g d^-1 in advanced biological WWTP and adsorption onto sludge of PAEs were determined as 90%. The side-stream total load returned from the decanter supernatant was 0.02% of the total PAEs load coming to advanced biological WWTP from the sewer system. As a result of detailed statistical analysis, the correlation between raw wastewater and primary clarifier (PC) effluent was determined as an increasing linear relation for DEHP and DNOP. On the other hand, moderate and strong correlations were observed both between septic tank and constructed wetland (CW) processes with raw wastewater. In the waste stabilization pond (WSP), while a significant correlation was not found between the sludge line data, homogeneous variance, strong and moderate correlations were obtained in the wastewater line data. However, while mean differences for all investigated PAEs were not significant (p > 0.05) in the wastewater line, mean differences of DEHP (p < 0.05) were significant in the sludge line according to ANOVA analysis.

The relationship between vitamin D deficiency, body composition, and physical/cognitive functions

Vitamin D deficiency is still an important subject due to its significant effects on various tissues and functions. We found a relationship between vitamin D deficiency and increase in adipose tissue thicknesses. This situation reveals the importance of vitamin D supplementation, the harms of weight gain and obesity, and the importance of a balanced diet.

PURPOSE

Although the relationship between vitamin D (VitD) levels with body composition and physical/cognitive functions have been investigated in various studies, however, there is no study evaluating all these parameters together. In accordance with, we aimed to evaluate the relationship between VitD deficiency with body composition (i.e., skin, subcutaneous fat, and muscle thicknesses) and physical/cognitive functions.

METHODS

A total of 203 adults (78 M, 125 F, aged 19-91 years) who had recent 25-OH-vitamin D measurements were included. Ultrasonographic (US) measurements (skin, subcutaneous fat, and muscle thicknesses) were made from the dorsum of the hand, and anterior sides of forearm, arm, and thigh. Handgrip strength, gait speed, Timed Up and Go Test, and Chair Stand Test were evaluated. Additionally, cognitive status was also evaluated with Mini-Mental State Exam.

RESULTS

Subjects were classified as VitD deficient group (< 20 ng/ml, N = 125) and control group (≥ 20 ng/ml, N = 78). The groups were not significantly different as regards age, gender, and anthropometric measurements (all p > 0.05). Subcutaneous fat tissues were thicker in the VitD deficient group (all p < 0.05). All the other US measurements and functional/cognitive tests were not significantly different between the groups (all p > 0.05). According to linear regression analyses, body mass index (BMI) was independently related with all subcutaneous fat thicknesses in both genders, and VitD deficiency was related with all subcutaneous fat thicknesses in females and anterior forearm subcutaneous fat thickness in males (all p < 0.05).

CONCLUSION

We imply that together with BMI, VitD deficiency is independently related with increased regional subcutaneous fat tissue. We also underscore the role of US measurements for evaluation of body composition in related clinical scenarios.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Shoulder

ABSTRACT

In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach.

Ultrasound Imaging for the Diagnosis and Evaluation of Sarcopenia: An Umbrella Review

There is an increasing number of reviews investigating the value of ultrasound (US) in the assessment of aging-related muscle loss. The present umbrella review aimed to systematically investigate the evidence of US imaging in the diagnosis and evaluation of sarcopenia. PubMed, Medline, Embase and Web of Science were searched from their inceptions to 31 October 2021. Systematic reviews and reviews using a systematic strategy for literature search were enrolled. The extracted data were narrated at the level of systematic reviews and meta-analyses. This umbrella review included four articles pertaining to 125 original studies and yielded several important findings. First, US is a reliable and valid imaging tool for the assessment of skeletal muscle mass. Second, among all the US parameters in B-mode, muscle thickness is the most commonly used one, which has good correlation with other standard measurements. Third, although sonoelastography and contrast-enhanced US are promising imaging modalities, their clinical utility is still limited at the current stage. Finally, a future systematic review is warranted to analyze how different ultrasonographic diagnostic criteria influence the prevalence of sarcopenia as well as its adverse health outcomes.

Intrapericardial pneumonectomy for unicentric hilar castleman disease

INTRODUCTION

The intrapulmonary involvement of Castleman disease is extremely rare with very few cases reported in the literature.

CASE REPORT

We present a case of a 16-year-old male who underwent pulmonary resection for Castleman disease. The tumor was located at the right hilum and measured 10 cm in diameter. The patient underwent an intrapericardial pneumonectomy with a mediastinal lymph node dissection because the tumor showed infiltration into the lung parenchyma, the major pulmonary vessels and the main bronchus.

CONCLUSION

We emphasize that some cases with intrapulmonary Castleman disease may require a pneumonectomy if the tumor is centrally located.