P–573 PGT-M for two or more disease carrier patients diagnosed after whole exome sequencing

Study question

Can whole exome sequencing (WES) before PGT-M identify previously unknown mutations for consanguineous couples having an increased risk of carrying more than one genetic disease?

Summary answer

WES has been successfully applied in combination with PGT-M by identifying new pathogenic mutations in addition to known gene mutations, extending the scope of PGT-M.

What is known already

Most couples ignore their risk of being a carrier of an inherited genetic disease until they have an affected child. Rare, atypical, and undiagnosed autosomal-recessive disorders frequently occur in the offspring of consanguineous couples. Routine single gene diagnostic tests fail to detect any possible gene defects other than the clinically apparent one. Prospective WES or genetic carrier screening testing of consanguineous couples could identify couples who both are carriers of autosomal recessive diseases and thus encourage them to make informed reproductive decisions. Screening tests using NGS technology simultaneously sequence exons and exon-intron boundaries to determine disease carrier status.

Study design, size, duration

Between January 2017 and October 2020, a total of 206 PGT-M couples applied to Istanbul Memorial Hospital ART Center. Of these couples, multigene PGT-M workups were carried for twelve couples who were carriers of more than one inherited disease. Eight couples were found to be carriers for two different diseases and four couples were carrying three diseases. All biopsies were performed at the blastocyst stage.

Participants/materials, setting, methods

For the 12 couples with multigene PGT-M workups the average female age was 31.0 ± 6.2. Nine of them initiated an ART cycle and the mean number of cumulus-oocyte complexes, metaphaseII oocytes, biopsied blastocysts and transferrable PGT-M embryos were 15 ± 6.9, 13.3 ± 6.3, 5.9 ± 2.0 and 2.9 ± 1.9, respectively. PGT-A was routinely performed for all couples with transferrable PGT-M tested embryos except one couple who refused PGT-A.

Main results and the role of chance

A total of 28 different gene workups were completed for 26 genes. The inheritance mode of the 26 conditions was as follows: 20 autosomal recessive, four autosomal dominant and two X-linked recessive. Out of 12 couples, 9 of them initiated an ART cycle and transferrable embryos were found after PGT-M followed by PGT-A. Eight women had frozen embryo transfers resulting in five healthy babies (3 singletons and 1 twin), two pregnancies still ongoing and one biochemical miscarriage at the time of data collection. The couple who declined PGT-A testing prior to their frozen embryo transfer had anegative bhCG test. Three couples completed their workups but postponed their ART and PGT-M cycle due to Covid–19 pandemic.

Limitations, reasons for caution

The probability of finding at least one transferrable embryo after PGT-M is influenced by the inheritance mode of the disease. Late-onset diseases presumed to be caused by variants of unknown significance and polygenic diseases that are possibly influenced by environmental factors were not included in this study.

Wider implications of the findings: With decreasing costs and improved availability of WES and genetic carrier screening panels, couples, especially consanguineous couples, who were previously shown to have one inherited disease may be offered to be screened for additional undiagnosed inherited diseases that may pose a threat for their offspring.

Trial registration number

Not applicable

Validity and reliability of the Turkish version of the Michigan Neuropathy Screening Instrument

Background/aim

The aim of this study was to demonstrate the validity and reliability of the Turkish version of the Michigan Neuropathy Screening Instrument (MNSI-TR).

Materials and methods

The study included 127 patients aged 45–76 years who were previously diagnosed with type 1 or 2 diabetes. Stability of the instrument was assessed by intraclass correlation coefficient. Reliability of the MNSI-TR was assessed using the Kuder–Richardson formula 20 test, item-total correlations, and floor/ceiling effect. Validity was evaluated with receiver operating characteristic curve analysis. A logistic regression model was used to determine to what degree the MNSI-TR explain nerve conduction study (NCS) results in the prediction of neuropathy.

Results

With a cut-off value of 3.5 for the questionnaire, sensitivity and specificity of the MNSI-TR were 75.5% and 68.1%, respectively. A cut-off of 2.75 for the physical assessment part of the scale resulted in 87.5% sensitivity and 93.6% specificity. The scale was able to diagnose neuropathy in the rate of 71.5% of the patients diagnosed with neuropathy by NCS.

Conclusion

The MNSI-TR is a valid and reliable method for evaluating diabetic peripheral neuropathy in Turkish speaking societies. It must be obtained a minimum of 4 points from the questionnaire part and a minimum of 2.5 points from the physical assessment part for the diagnosis of neuropathy

Cross-cultural adaptation, reliability and validity of the Turkish version of Patient-Specific Functional Scale in patients with chronic neck pain

Background/aim

Current clinical guidelines recommend to use both clinical and self-reported measurements for evaluation of chronic neck pain. Among the self-reported outcomes, Neck disability index and patient-specific functional scale are the most widely used and recommended instruments. The purpose of our study was to determine the test-retest reliability and validity of patient-specific functional scale which was not validated in Turkish language previously.

Materials and methods

Translation and adaptation process had conducted according to the Beaton et al. Sociodemographic data, Turkish version of patient-specific functional scale and neck disability index were recorded at the initial assessment. Retest assessment was produced for reliability analyses and intraclass correlation coefficient (ICC3,2) was determined. The correlations between patient-specific functional scale and neck disability index and hypothesis testing were examined for the convergent and construct validity analysis.

Results

The final form was completed by 110 chronic neck pain patients (Male: 33; mean ages: 43.13 ± 13.75 years, Female: 77; mean ages: 44.45 ± 14.38). Test-retest reliability of patient-specific functional scale was found good level (ICC: 0.85). The relationship between patient-specific functional scale and neck disability index was found moderate level (P < 0.05, rho: –0.578). The median score of PSFS-T in the low disability group was significantly higher than the high disability group in the hypothesis testing of construct validity (P < 0.001).

Conclusion

The Turkish version of the patient-specific functional scale is a valid and reliable scale for evaluating functional status in patients with chronic neck pain.

Effects of aquatic exercises on postural control and hand function in Multiple Sclerosis: Halliwick versus Aquatic Plyometric Exercises: a randomised trial

OBJECTIVES

Postural control and hand dexterity are significantly impaired in people with multiple sclerosis (pwMS). Aquatic interventions may have additional benefits in the treatment of pwMS. The purpose of this study is to compare the effects of two different aquatic exercises on postural control and hand function.

METHODS

Thirty pwMS, relapsing-remitting type were randomly divided into a Halliwick (Hallw) and an Aquatic Plyometric Exercise (APE) group. The Limits of Stability test was used to evaluate postural control using the Biodex Balance System. The Nine-Hole Peg Test was used to evaluate hand dexterity. Both exercise interventions were performed twice a week for 8 weeks, in a pool with a depth of 120 cm and water temperature of 30-31°C.

RESULTS

Limits of stability improved significantly in both groups (p<0.05) and Hallw group completed the test in a significantly shorter time (p<0.05). Hand dexterity improved significantly in both groups (p<0.01). Following intergroup analysis, Hallw group showed significantly higher improvement in hand dexterity and overall limits of stability test score (p<0.05).

CONCLUSIONS

This study provides evidence that both Halliwick and APE are effective to treat balance and hand dexterity. This paper is the first evidence on APE for pwMS and showed that it is safe and improved trunk control and hand dexterity.

Different types of exercise in Multiple Sclerosis: Aerobic exercise or Pilates, a single-blind clinical study

BACKROUND

The aim of our study is to examine effects of aerobic and Pilates exercises on disability, cognition, physical performance, balance, depression and fatigue in relapsing-remitting Multiple Sclerosis (MS) patients as compared to healthy controls.

METHODS

The subjects were divided as aerobic exercise (n = 26), Pilates (n = 9), and the healthy control group (n = 21). We used MSFC, physical performance, Berg balance scale, Beck depression scale, fatigue impact scale. All evaluations were performed before and after exercise training.

RESULTS

There are statistically meaningful differences between Nine hole testing, PASAT 3, physical performance and fatique impact scale before and after aerobic exercise. Also we found significant difference for physical performance in the Pilates group. There are no significant differences in measures of fatique impact scale and depression between aerobic exercise group and the healthy controls after exercise. We found significant differences between Pilates and control group's after measurements except depression. There were significant differences between the Pilates and aerobic group for cognitive tests in favor of the Pilates group.

CONCLUSION

Aerobic exercise and clinical Pilates exercises revealed moderate changes in levels of cognitive, physical performance, balance, depression, fatigue in MS patients.

PLA2G6 mutations associated with a continuous clinical spectrum from neuroaxonal dystrophy to hereditary spastic paraplegia

PLA2G6-associated neurodegeneration (PLAN) and hereditary spastic paraplegia (HSP) are 2 groups of heterogeneous neurodegenerative diseases. In this study, we report PLA2G6 gene mutations in 3 families from Turkey, Morocco, and Romania. Two affected Turkish siblings presenting HSP adds the disease to PLAN phenotypes. They were homozygous for the PLA2G6 missense c.2239C>T, p.Arg747Trp variant and the ages of onset were 9 and 21. Parkinsonism, dystonia or cognitive decline were not the clinical elements in these patients contrary to the cases that has been previously reported with the same variant, however, iron accumulation was evident in their cranial magnetic resonance imaging. The Moroccan patient was homozygous for a novel missense c.1786C>T, p.Leu596Phe variant and the Romanian patient had 2 novel mutations; c.1898C>T, p.Ala633Val and c.1765_1768del, p.Ser589ThrfsTer76. Both of these patients conformed better to childhood onset PLAN with the age of onset at 4 and 7 years, respectively. Interestingly, all identified mutations were affecting the highly conserved patatin-like phospholipase domain of the PLA2G6 protein.

Risk Factors for Premature Hair Graying in Young Turkish Adults

BACKGROUND

Premature hair graying (PHG) is a common condition resulting in loss of self-esteem. Studies investigating PHG risk factors for both sexes with a large number of patients are scarce. We sought to investigate the socioclinical risk factors for PHG in young Turkish men and women and the differences between the sexes.

METHODS

A cross-sectional study was conducted in 1,119 participants who answered a survey about PHG and some socioclinical characteristics between February and July 2015. The number of gray hairs, onset age of hair graying, and family history of PHG were asked about, as well as demographic characteristics, anthropometric measures, body mass index, smoking, alcohol consumption, sports life, diet, medical history, educational status, occupation, marital status, monthly income, and Fitzpatrick skin type.

RESULTS

Of 1,119 participants, 315 (28.1%) had PHG and 804 did not. Maternal and paternal PHG, alcohol consumption, presence of chronic disease, educational status, hair loss, perceived stress scale (PSS) score, age, and height were significantly higher in subjects with PHG. Rates of maternal and paternal PHG were high in women with PHG, and the rate of paternal PHG was high in men with PHG. According to the multivariate ordinal regression analysis, PSS score, age, hair loss, and family history of PHG were correlated with the severity of PHG.

CONCLUSION

PHG is closely related to factors causing oxidative stress, such as emotional stress, alcohol consumption, and chronic diseases in genetically predisposed men and women.

Effects of motor-motor and motor-cognitive tasks on balance in patients with multiple sclerosis

BACKGROUND

Dual tasking is frequently impaired in Multiple Sclerosis (MS), substantially impairing quality of life (QoL). We aimed to examine the effects of motor-motor and motor-cognitive tasks on balance in highly mobile patients with relapsing-remitting MS (RRMS), with mild disability.

METHODS

Thirty-eight patients and 34 controls were included. Steady Stance Test (SST), Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) were used to evaluate the balance. Expanded Disability Status Scale (EDSS), Mini-mental State Examination (MMSE), Beck Depression Inventory (BDI) and Fatigue Impact Scale (FIS) were used to evaluate disability, cognitive impairment, depression and fatigue, respectively.

RESULTS

BBS and ABC scores were significantly different between the groups. Also, balance was significantly impaired in patients. Eyes-open left single stance test was the most efficient test to reveal the balance impairment in RRMS patients independent of dual-task. Physical component of FIS affected this test independent of age and BMI. Visual input significantly increased the stance durations in majority of SST, especially in tough stance positions with reduced balance area. However, visual input during dual-tasking impaired the balance. In addition, eyes-closed left tandem stance test with MM dual task significantly improved the balance in patients. BBS was significantly correlated with EDSS(r: -0.336), ABC(r: 0.688), FIS physical subgroup(r: -0.614) and FIS social subgroup(r: -0.475).

CONCLUSION

Dual-tasking improves balance and increases QoL in patients with RRMS. Eyes closed balance treatment with motor-dual task could be beneficial.

The Place of Complementary Medicine in the Treatment of Autistic Children

OBJECTIVES

The purpose of this study is to achieve a vision for autistic children and their parents aimed at generating interest in ideas such as "Sanitas Per Aquam" (SPA), massage and music therapy, which has begun to have widespread use and to attract attention.

METHODS

This cross-sectional, descriptive study was carried out with autistic children and their parents from February to April 2015 in Muğla, Turkey. The study was began by interviewing experts in the field and by developing a suitable assessment questionnaire. In order to direct the flow of conversation between the researchers and the autisitc children and their parents, the researchers conducted semi-structured face to face interviews in a form that had been determined by using reports in the literature and the opinions of experts in the field.

RESULTS

Forty two boys (84%) and eight girls (16%) with autism participated in our study. Children in the 0 ─ 7 age group spent long time in the bathroom (P = 0.001). Boys liked to be hugged more than girls (P = 0.01). Children ages 0 ─ 7 years liked bright lighting while those 15 years of age and older liked gloomy lighting (P = 0.009). Except for these statistically significant sex- and age-related differences, no other statistically significant differences were noted in the parameters of this study. Although the result was not statistically significant, more children with mild autism disorder obeyed commands like inhale or exhale (P = 0.051).

CONCLUSION

Treatment for autism spectrum disorders is not yet fully possible, so many studies are being done to alleviate some symptoms and to improve the quality of life for individuals with autism and their families. As a result of our study, whether touching the areas the children want touched and listening to their favorite music are required to stimulate the brain remain as questions in our minds.

Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

[Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

New Results from the Search for Low-Mass Weakly Interacting Massive Particles with the CDMS Low Ionization Threshold Experiment

The CDMS low ionization threshold experiment (CDMSlite) uses cryogenic germanium detectors operated at a relatively high bias voltage to amplify the phonon signal in the search for weakly interacting massive particles (WIMPs). Results are presented from the second CDMSlite run with an exposure of 70 kg day, which reached an energy threshold for electron recoils as low as 56 eV. A fiducialization cut reduces backgrounds below those previously reported by CDMSlite. New parameter space for the WIMP-nucleon spin-independent cross section is excluded for WIMP masses between 1.6 and 5.5  GeV/c^{2}.

Prevalence of IgE mediated cow's milk and egg allergy in children under 2 years of age in Sanliurfa, Turkey: the city that isn't almost allergic to cow's milk

AIM

Food allergy is a common problem in children and adults. The aim of this study was to determine the frequency of cow's milk and egg allergy based on skin prick test and oral food challenge results

METHODS

We recruited 614 children aged 1 month-2 years in from different areas of Sanliurfa. An interview was conducted with each parents and family demographic, and prenatal-antenatal-postnatal information was recorded, then skin prick test was applied to the children for egg white, egg yolk and cow's milk. Cases that are required, sIgE levels for cow's milk, egg white and egg yolk were measured and food challenge tests were applied.

RESULTS

Cow's milk and egg allergy was determined in 1 case (0.16%) and 8 cases (1.30%) respectively from the results of the tests applied. Six cases (0.97%) were accepted as sensitive to egg white and egg yolk. Within the factors which were questioned, (only the egg allergy evaluation was made without the cow's milk allergy case) of those with parental consanguinity was determined at a statistically significantly high level (OR=5.8, 95% CI: 1.2-27.2, P=0.01).

CONCLUSION

The prevalence of cow's milk allergy in Sanliurfa is the lowest reported prevalence rate to date in children under 2 years of age. When infants develop a food allergy, this takes the form of egg allergy. Within the several factors evaluated to explain this situation, a significant relationship was determined only with parental consanguinity. However, as reported above, to date there is no genetic or epidemiological study to explain this situation.

First direct limits on lightly ionizing particles with electric charge less than e/6

While the standard model of particle physics does not include free particles with fractional charge, experimental searches have not ruled out their existence. We report results from the Cryogenic Dark Matter Search (CDMS II) experiment that give the first direct-detection limits for cosmogenically produced relativistic particles with electric charge lower than e/6. A search for tracks in the six stacked detectors of each of two of the CDMS II towers finds no candidates, thereby excluding new parameter space for particles with electric charges between e/6 and e/200.

Search for low-mass weakly interacting massive particles with SuperCDMS

We report a first search for weakly interacting massive particles (WIMPs) using the background rejection capabilities of SuperCDMS. An exposure of 577 kg days was analyzed for WIMPs with mass <30  GeV/c(2), with the signal region blinded. Eleven events were observed after unblinding. We set an upper limit on the spin-independent WIMP-nucleon cross section of 1.2×10(-42)  cm(2) at 8  GeV/c(2). This result is in tension with WIMP interpretations of recent experiments and probes new parameter space for WIMP-nucleon scattering for WIMP masses <6  GeV/c(2).

Search for low-mass weakly interacting massive particles using voltage-assisted calorimetric ionization detection in the SuperCDMS experiment

SuperCDMS is an experiment designed to directly detect weakly interacting massive particles (WIMPs), a favored candidate for dark matter ubiquitous in the Universe. In this Letter, we present WIMP-search results using a calorimetric technique we call CDMSlite, which relies on voltage-assisted Luke-Neganov amplification of the ionization energy deposited by particle interactions. The data were collected with a single 0.6 kg germanium detector running for ten live days at the Soudan Underground Laboratory. A low energy threshold of 170  eVee (electron equivalent) was obtained, which allows us to constrain new WIMP-nucleon spin-independent parameter space for WIMP masses below 6  GeV/c2.

Silicon detector dark matter results from the final exposure of CDMS II

We report results of a search for weakly interacting massive particles (WIMPS) with the silicon detectors of the CDMS II experiment. This blind analysis of 140.2 kg day of data taken between July 2007 and September 2008 revealed three WIMP-candidate events with a surface-event background estimate of 0.41(-0.08)(+0.20)(stat)(-0.24)(+0.28)(syst). Other known backgrounds from neutrons and 206Pb are limited to <0.13 and <0.08 events at the 90% confidence level, respectively. The exposure of this analysis is equivalent to 23.4 kg day for a recoil energy range of 7-100 keV for a WIMP of mass 10  GeV/c2. The probability that the known backgrounds would produce three or more events in the signal region is 5.4%. A profile likelihood ratio test of the three events that includes the measured recoil energies gives a 0.19% probability for the known-background-only hypothesis when tested against the alternative WIMP+background hypothesis. The highest likelihood occurs for a WIMP mass of 8.6  GeV/c2 and WIMP-nucleon cross section of 1.9×10(-41)  cm2.

Assessment of physical activity in patients with chronic low back or neck pain

AIM

To investigate physical activity level in patients with chronic low back and neck pain.

MATERIAL AND METHODS

32 preoperative patients, 32 outpatients with low back or neck pain and 32 healthy controls were included in study. The physical activity level of the participants was evaluated with the International Physical Activity Questionnaire. The Oswestry Disability Index and Neck Pain Disability Index, Short Form-36, Pittsburgh Sleep Quality Index and Beck Depression Inventory were used for assessment of disability, quality of life, sleep quality and depression.

RESULTS

Statistical significant differences was found in disability, sleep quality, depression, physical activity level and quality of life scores between three groups (p < 0.05). All scores of preoperative patients were significantly lower than outpatients except sleep parameter (p < 0.05). Sleep quality, disability and depression scores of patients with chronic neck pain were significantly lower and physical activity level and quality of life scores were significantly higher than patients' with chronic low back pain (p < 0.05).

CONCLUSION

Physical activity modification was found in patients with chronic low back and neck pain. Physical activity level, disability, sleep, depression and quality of life scores of preoperative patients with low back pain more affected than neck patients.

DTI findings during spontaneous migraine attacks

PURPOSE

Previous functional neuroimaging studies showed that the brainstem may have an important role in migraine and recently, DTI studies demonstrated that structural alterations in migraineurs may extend beyond the normal appearing brain tissue. The aim of our study was to find out if DTI may detect any abnormality during the spontaneous migraine attacks.

METHODS

The DTI images obtained in a 3T system during spontaneous migraine episodes. Patients with any systemic or metabolic disorder and abnormal signal intensity in conventional sequences were excluded. We measured the FA and ADC values of red nuclei, periaquaductal gray matter, thalami, posterior limbs of internal capsules and subcortical white matter. Fifteen healthy volunteers served as control group.

RESULTS

Fourteen patients enrolled in the study. The only site where we found an abnormality was the red nuclei, where the ADC values in migraineurs were statistically higher than in healthy volunteers. There was no statistical correlation between the DTI measurements and patients' ages, duration of disease, frequency of attacks and localization of pain.

CONCLUSION

Our findings supported the findings of previous functional neuroimaging studies, which concluded that the brainstem might have a role in the pathogenesis of a migraine episode. We think that the increase of ADC values in red nuclei may reflect vasogenic edema, which cannot be detected in conventional sequences. However, the exact underlying mechanism for this observation is unclear and we do not know whether these changes are responsible for triggering an attack or if they are the consequents of the attack itself.

The effect of TENS on pain, function, depression, and analgesic consumption in the early postoperative period with spinal surgery patients

AIM

The aim of our study was to examine the effects of the use of Transcutaneous Electrical Nerve Stimulation (TENS) in patients who had undergone spinal surgery on pain, functionality, depression and consumption of analgesic agents.

MATERIAL AND METHODS

Fifty-Four patients were randomized and placed into two groups, patient-controlled analgesia (PCA) plus TENS and only PCA. To assess the pain levels of the patients, the Visual Analog Scale (VAS) was used. In the assessment of their functional levels, the Timed Up and Go test (TUG) was utilized and in the assessment of their depression, the Beck Depression Inventory (BDI) was used. The measurements were performed before the operation and on the first and second postoperative days. The side effects were recorded from the analgesic agents.

RESULTS

During the first and second days after the operation, a decrease in the pain levels was noticed in the TENS group (p < 0.05. In the TENS group, the consumption of analgesic agents also decreased and thus side effects were less frequent. From the viewpoint of functional and depression levels, no significant difference between the groups was noticed (p > 0.05).

CONCLUSION

TENS was effective in reducing analgesic agent-related side effects and in reducing analgesic consumption. In addition, TENS also decreased activity related pain.

Hand-foot syndrome due to sorafenib in hepatocellular carcinoma treated with vitamin E without dose modification; a preliminary clinical study

PURPOSE

Sorafenib has been found to have significant clinical activity against hepatocellular carcinoma (HCC). Hand-foot skin syndrome (HFS) has been described with the usage of sorafenib. It is a dose-limiting toxicity and may lead to compromised efficacy because of dose reduction.

METHODS

From 14 patients diagnosed with HCC 10 who developed HFS while on treatment with sorafenib were included in this study. Sorafenib was administered orally at a dose of 400 mg twice daily vitamin E usage can be effective in HFS due to sorafenib, therefore vitamin E 300 mg/day was started when HFS occurred. HFS was graded according to the National Cancer Institute (NCI) criteria.

RESULTS

Grade 2-3 HFS was found in 10 of 14 patients. Vitamin E was started to all patients without using topical agents. Mean time to the appearance of HFS was 15 ± 3 days (range 10-22) after starting sorafenib. Grade was 3 in 4 patients, 2 in 4 patients and 1 in 2 patients. Vitamin E administration had a marked effect after 10-12 days of its initiation. Skin lesions disappeared without any dose modification.

CONCLUSION

Sorafenib is the gold standard for HCC treatment. Dose modification due to HFS decreases the effectiveness of this agent. Adding vitamin E to sorafenib is effective in HFS without dose reduction or treatment interruption. This is the first clinical study to report resolution of HFS with vitamin E due to sorafenib therapy.

Use of tape measure in people with or without back pain in assessment of reposition error

AIM

Examining lumbar repositioning error (RE) using a tape measure in nonspecific low back pain (NLBP) and control groups and determining whether RE is different in subjects with nonspecific back pain than in controlled subjects.

MATERIAL AND METHODS

The study was totally applied to 36 subjects of whom 18 were healthy subjects and 18 were NLBP patients. The ability of the subjects to take the targeted positions was assessed. In subjects with NLBP the evaluation of the pain was assessed by using Visual Analog Scale (VAS), and disability measurement was made using Oswestry Disability Index (ODI).

RESULTS

RE was found in all the measurements except for lumbar flexion with eyes open(p=0.15) in control group (p < 0.05). There were RE for all the measurements in NLBP grpup (p < 0.05). When RE of two groups compared only lumbar flexion with eyes open measurement (p = 0.04) in NLBP group was higher then control group.

CONCLUSION

As a result of our study, it has been seen that RE measurement of the lumbar spine with tape measure, which is cheap and clinically practical, is a reliable method, and can be used in the assessment of NLBP patients and in the determination of the rehabilitation program.

The relationship between health locus of control and quality of life in patients with chronic low back pain

AIM

To investigate the relationship between health locus of control and quality of life in patients with chronic low back pain.

MATERIAL AND METHODS

Pain intensity by visual analog scale, quality of life related to health by the World Health Organization Quality of Life (WHOQOL) assessment and disability level by Turkish version of Oswestry Disability Index (ODI) were evaluated. Multidimensional Health Locus of Control (MHLC) for the perception to responsibility and control of the individual over his/her own health was used.

RESULTS

Patients were separated into two groups according to the scores of ODI as group with Low Disability [0-40 minimal/moderate disability; n=53] and group with High Disability [40-100 severe disability /crippled/bedbound/ exaggerating; n=60]. Scores of chance health locus of control (CHLC) in the subscale of MHLC were significantly higher in the patients who had high disability (p < 0.05). Negative correlation between CHLC scores and all domains of WHOQOL, positive correlation between CHLC scores and disability level and pain severity was found (p < 0.05).

CONCLUSION

Quality of life was negatively influenced in the patients with low back pain who had chance health locus of control. LOC is an important parameter in evaluation and treatment of patients with LBP.

The application of positron emission tomography/computed tomography in radiation treatment planning: effect on gross target volume definition and treatment management

AIMS

To analyse the effect of the use of molecular imaging on gross target volume (GTV) definition and treatment management.

MATERIALS AND METHODS

Fifty patients with various solid tumours who underwent positron emission tomography (PET)/computed tomography (CT) simulation for radiotherapy planning from 2006 to 2008 were enrolled in this study. First, F-18 fluorodeoxyglucose (FDG)-PET and CT scans of the treatment site in the treatment position and then a whole body scan were carried out with a dedicated PET/CT scanner and fused thereafter. FDG-avid primary tumour and lymph nodes were included into the GTV. A multidisciplinary team defined the target volume, and contouring was carried out by a radiation oncologist using visual methods. To compare the PET/CT-based volumes with CT-based volumes, contours were drawn on CT-only data with the help of site-specific radiologists who were blind to the PET/CT results after a median time of 7 months.

RESULTS

In general, our PET/CT volumes were larger than our CT-based volumes. This difference was significant in patients with head and neck cancers. Major changes (> or =25%) in GTV delineation were observed in 44% of patients. In 16% of cases, PET/CT detected incidental second primaries and metastatic disease, changing the treatment strategy from curative to palliative.

CONCLUSIONS

Integrating functional imaging with FDG-PET/CT into the radiotherapy planning process resulted in major changes in a significant proportion of our patients. An interdisciplinary approach between imaging and radiation oncology departments is essential in defining the target volumes.

Smaller pituitary volume in adult patients with obsessive-compulsive disorder

AIMS

Another structure in the obsessive-compulsive disorder (OCD) circuit may be the pituitary gland because of the fact that limbic-hypothalamic-pituitary-adrenal (LHPA) axis abnormality has been reported in patients with OCD. There has been only one prior study, however, concerning pituitary volumetry, in which the sample was a pediatric group. The purpose of the present study was therefore to investigate this in an adult OCD patient group using magnetic resonance imaging (MRI).

METHODS

Pituitary volume was measured in 23 OCD patients and the same number of healthy control subjects. Volumetric measurements were made on T1-weighted coronal MRI, with 2.40-mm-thick slices, at 1.5 T, and were done blindly.

RESULTS

A statistically significantly smaller pituitary volume was found in OCD patients compared to healthy controls (age and intracranial volume as covariates). With regard to gender and diagnosis, there was a significant difference in pituitary gland volume (F = 4.18, P < 0.05). In addition, post-hoc analysis indicated near-significant difference in men with OCD as compared with women with OCD (P = 0.07) and significant difference between control men and control women (F = 10.96, P < 0.001).

CONCLUSIONS

Taking into consideration that the prior study found decreases in pituitary volume in pediatric patients with OCD as compared with healthy control subjects, future large MRI studies should investigate pituitary size longitudinally, with a careful characterization of hypothalamo-pituitary-adrenal (HPA) function in conjunction with anatomic MRI evaluation.

Evaluation of patients with spinal operation according to functional mobility

OBJECTIVE

The aim of our study is to determine the effect of age, BMI (Body Mass Index: kg/m(2)), gender, level of lumbar disc operation and standardized physiotherapy of the patients during hospitalization on the Physiotherapy Functional Mobility Profile (PFMP).

DESIGN

A retrospective study.

PATIENTS

Eighty three patients who had undergone surgery with lumbar disc hernia were included in the study. Data were separately interpreted considering such parameters as age, BMI, gender, and level of operation which we believe might have affected the associated consequences.

METHODS

PFMP was used in the assessment of the patients. Evaluations were made on the days when they were referred and discharged.

RESULTS AND CONCLUSION

Increases were observed in totals and subheadings of PFMP scores during the early period of the inpatients exposed to lumbar disc operations to whom we applied standardized physiotherapy programs, with increases in subheadings involving ambulation being found significant. It follows from the conclusions of grouping our patients that functionality was positively influenced by 4th decade muscularity and by one-level operation in the early period.

Value of perineural edema/inflammation detected by fat saturation sequences in lumbar magnetic resonance imaging of patients with unilateral sciatica

BACKGROUND

Routine lumbar spine magnetic resonance imaging (MRI) may not show any evidence of the cause of sciatica in some cases. The relationship between nerve root compression detected on lumbar MRI and sciatica is also sometimes uncertain.

PURPOSE

To ascertain whether axial (and, when necessary, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted MRI findings can be used to study the level of sciatica in patients with a non-yielding routine MRI examination.

MATERIAL AND METHODS

A total of 215 patients with unilateral sciatica underwent MRI. All patients were asked to complete pain drawing forms describing their pain dermatomal distributions. Perineural edema/inflammation corresponding to the pain location indicated by the pain drawings was sought on short-tau inversion recovery or fat-saturated T2-weighted images.

RESULTS

Routine MRI findings revealed that 110 of the 215 patients had nerve root compromise related to the patients' symptoms. Routine MRI could not ascertain the cause of these symptoms in the remaining 105 patients. In 31 (29.5%) of these 105 patients, short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images revealed perineural edema/inflammation surrounding the nerve roots related to the pain locations indicated in the pain drawings.

CONCLUSION

Axial (and, when required, sagittal and coronal) short-tau inversion recovery or fat-saturated T2-weighted magnetic resonance images may be helpful for revealing additional findings in cases of unexplained sciatica in standard magnetic resonance imaging. However, the value of this imaging may be not great enough to justify routine use of these additional sequences to study the level of sciatica.

The physical activity of patients after herniated lumbar disc surgery

OBJECTIVE

We evaluated the level of pain, disability, performance, and physical activity changes in patients who underwent lumbar disc hernia surgery.

METHODS

This study included 31 patients who underwent lumbar disc hernia surgery in the Neurosurgery Department of Dokuz Eylul University Hospital, Izmir, Turkey over a 13-month period from April 2003 to May 2004. Changes in the patients` pain were determined using a visual analog scale, and disability changes were evaluated using the Oswestry Disability Index. Total times for the following performance tests were recorded: rolling from right to left and vice versa, loaded reach, repeated sitting/standing, 50-foot walk, and 5-min walk. The Compendium of Physical Activities questionnaire was used to assess physical activity levels in a 24-hour period. The assessments were performed 2, 4, and 6 months postoperatively.

RESULTS

Significant differences were observed in the pain, disability, performance, and physical activity levels 2, 4, and 6 months postoperatively (p=0.000), with the worst values at 2 months and the best at 6 months.

CONCLUSION

A need exists not only to direct patients toward more active lifestyles and physical fitness, but also to use assessments to accelerate the recovery period, ensuring continuity in the postoperative period.

Expression of c-kit protooncogen in hepatitis B virus-induced chronic hepatitis, cirrhosis and hepatocellular carcinoma: has it a diagnostic role?

AIM

There are more than 350 million people worldwide chronically infected with hepatitis B virus (HBV), who are at high risk for the development of hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Because of the conflicting results about c-kit expression in HCC and the key role played by c-kit in gastrointestinal stromal tumours (GIST) and other solid tumours, the aim of this study was to determine c-kit expression in the course of hepatitis B infection.

MATERIALS AND METHODS

Paraffin-embedded tissues in Cukurova University Faculty of Medicine Department of Pathology between January 2002 and February 2006 were searched restrospectively to investigate this issue. We performed immunohistochemistry on biopsies of 125 patients with HBV infection, grouped as: mild, moderate and severe hepatitis, cirrhosis and HCC, 25 patients in each of them, using anti c-kit monoclonal antibody. The severity of parenchymal inflammation and of interface hepatitis was semiquantitatively graded on a haematoxylin and eosin stained paraffin sections. Additionally, 50 more HCC, formed on HBV basis, were studied to determine the prevalence of c-kit overexpression.

RESULTS

In cirrhotic liver, lower intensity of staining and rarely c-kit positivity were present. The greatest number of the c-kit positivity and higher intensity of staining was found in the livers of patients with severe hepatitis and HCC. In chronic hepatitis B infection, the staining intensity was parallel with the grade and stage of the disease. In the areas where fibrosis was seen, c-kit positivity was rare or absent. In the HCC specimens, c-kit positivity appeared both inside and around the cancerous nodes. C-kit expression was observed in 62 of 75 HCC tissue specimens (82%) (p < 0.001).

CONCLUSIONS

C-kit positivity was observed in the mitotic, proliferating and also dysplastic hepatic cells. These results suggest that c-kit expression may be used as an early diagnostic indicator for HBV induced HCC.

Hippocampus and amygdalar volumes in patients with refractory obsessive-compulsive disorder

Functional and structural neuroimaging studies have implicated the hippocampus-amygdala complex in the pathophysiology of obsessive-compulsive disorder (OCD), although no consensus has been established. These brain regions have not been investigated in refractory OCD patients. Volumes of the hippocampus, and amygdala were measured by magnetic resonance imaging (MRI) in a sample of 14 refractory OCD patients and 14 healthy comparison subjects. The mean left and right hippocampal and amygdala volumes of the patients were smaller than those of the healthy controls. OCD severity was not correlated with amygdala volumes but was related to the left hippocampus. Duration of illness was correlated with both hippocampus and left amygdala. Our findings suggest that hippocampus and amygdalar abnormalities can be considered in refractoriness to OCD.