Soft Electromagnetic Vibrotactile Actuators with Integrated Vibration Amplitude Sensing

Soft vibrotactile devices have the potential to expand the functionality of emerging electronic skin technologies. However, those devices often lack the necessary overall performance, sensing-actuation feedback and control, and mechanical compliance for seamless integration on the skin. Here, we present soft haptic electromagnetic actuators that consist of intrinsically stretchable conductors, pressure-sensitive conductive foams, and soft magnetic composites. To minimize joule heating, high-performance stretchable composite conductors are developed based on in situ-grown silver nanoparticles formed within the silver flake framework. The conductors are laser-patterned to form soft and densely packed coils to further minimize heating. Soft pressure-sensitive conducting polymer-cellulose foams are developed and integrated to tune the resonance frequency and to provide internal resonator amplitude sensing in the resonators. The above components together with a soft magnet are assembled into soft vibrotactile devices providing high-performance actuation combined with amplitude sensing. We believe that soft haptic devices will be an essential component in future developments of multifunctional electronic skin for future human-computer and human-robotic interfaces.

AB0114 INVESTIGATION OF THE EFFECTS OF EXERCISE ON MIRNA EXPRESSIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The goal of treatment for patients with RA is achieve to remission, or at least a state of low disease activity. Exercise is recommended for patients with RA in addition to drug therapy. It has been found to be effective in greatly improving functionality and reducing cardiovascular risk without exacerbating disease activity. Therefore, it is recommended that all RA patients should be encouraged to include aerobic and resistant exercise training as part of their routine treatment (1).

miRNAs(miRNA) are known to protect the pathophysiological process specific to RA. miRNA-146a is one of the miRNAs extensively studied in RA, its expression was found to be higher in the synovial fluid and synovial tissue of RA patients compared to healthy individuals (2).

Many studies have found that miRNA-146a, along with miRNA-16 and miRNA155 may be related to disease pathology. It has also been found that high levels of miRNA-16 expression correlate with active disease and low levels of expression with inactive disease. It has been found that the increased level of miRNA-155 causes a problem in the modulation of arthritis It has been found that the expression level of miRNA-145 is increased in peripheral blood mononuclear cells of RA patients and synovium supporting osteoclastogenesis (3,4,5).

Objectives:

It is aimed to investigate the effect of exercise on microRNA expressions in patients with rheumatoid arthritis (RA).

Methods:

30 patients and 30 healthy controls aged 18-60 years who met the 2010 ACR / EULAR RA criteria were included in the study. A program consisting of strengthening and stretching exercises 2 days a week was applied to the study group for 8 weeks. One day a week, 30 minutes of mild moderate walking was requested. Of the cases at the beginning and at the end of the treatment; 5-10 cc peripheral blood samples were taken into one EDTA tube. Then Numeric Rating Scale (NRS) was used for pain, 28-joint Disease Activity Score (DAS28) was used to calculate disease activity, Health Assessment Questionnaire (HAQ) was used to assess general health and Short Form-36 (SF-36) was used to evaluate quality of life. 5-10 cc peripheral blood samples were taken to only 1 EDTA tube of the control group. In the samples taken, gene expressions of miRNA-146a, miRNA-155, miRNA-16, miRNA-145 were determined by real-time PZR method.

Results:

There was a significant difference in DAS28, SF-36, NRS, HAQ scales before and after treatment in the RA group of patients (p 0.05). The expression level of MiRNA-146a does not differ significantly before and after treatment (p> 0.05). However, these two groups differ significantly with the control group (p 0.05). No significant difference was observed in the miRNA-155 and miRNA-16 expression levels in the pretreatment, posttreatment, and control groups (p> 0.05).

Conclusion:

Exercise therapy has a good effect on pain, disease activity, quality of life and general health in patients with RA. It has been found that exercise can affect vii some of the miRNAs involved in disease pathogenesis. However, more comprehensive studies are needed.

References:

[1]Cooney JK, Law RJ, Matschke V, Lemmey AB, Moore JP, Ahmad Y, et al. Benefits of exercise in rheumatoid arthritis. Journal of Aging Research. 2011. p. 14.

[2]Abou-Zeid A, Saad M, Soliman E. MicroRNA 146a expression in rheumatoid arthritis: Association with tumor necrosis factor-alpha and disease activity. Genet Test Mol Biomarkers. 2011;15(11):807–12.

[3]Murata K, Yoshitomi H, Tanida S, Ishikawa M, Nishitani K, Ito H, et al. Plasma and synovial fluid microRNAs as potential biomarkers of rheumatoid arthritis and osteoarthritis. Arthritis Res Ther. 2010;12(3):86.

[4]Pauley KM, Satoh M, Chan AL, Bubb MR, Reeves WH, Chan EKL. Upregulated miR-146a expression in peripheral blood mononuclear cells from rheumatoid arthritis patients. Arthritis Res Ther. 2008;10(4):101.

[5]Evangelatos G, Fragoulis GE, Koulouri V, Lambrou GI. Micrornas in rheumatoid arthritis: From pathogenesis to clinical impact. Autoimmun Rev. 2019;18(11):102391.

Disclosure of Interests:

None declared

Effectiveness of Modified HEART Score in Predicting Major Adverse Cardiac Events

Objective

The most important problem for emergency physicians in patients presenting with chest pain is deciding whether to discharge the patient or not. Therefore, many scoring systems have been developed to help with this decision making process. We aim to achieve a modified HEART value by combining the VAS value with the HEART score.

Materials and Methods

Data were collected on age, sex, duration of the symptoms, pain severity using a 10-point visual analog scale (VAS), and the presence of a major adverse cardiac event (MACE). The HEART score was calculated and modified (mHEART) by adding 1 point to the total HEART score for a VAS score of ≥7.

Results

During the study period, 4781 patients were admitted, and 293 participants were analyzed. Of the patients, 34(11.6%) experienced MACE within a month after the encounter. The mean VAS scores were 5.65±1.44. However, 77(26.3%) patients had VAS scores ≥7. Taking 3 as the threshold, 42(14.3%) patients had HEART scores of 4 and above, where 47(16.0%) had mHEART scores ≥4. The mHEART scoring demonstrated better test indicators than the HEART score. According to the HEART score, 6(2.3%) of the 251 patients predicted as negative would develop MACE, but this number decreased to 1(0.4%) in 246 using the mHEART score.

Conclusion

Although the HEART score performs reasonably well in discriminating patients who are MACE negative, it is possible to further improve the score by adding the VAS item. After validation by other studies, we would suggest modifying the HEART score by including the VAS item.

Use of hyperbaric oxygen therapy of purpura fulminans in an extremely low birth weight preterm: A case report

Purpura fulminans (PF) is a rare and fatal complication of septic shock or diffuse intravascular coagulation (DIC) resulting in skin and soft tissue necrosis. PF can be caused by congenital or acquired protein C (PC) or protein S (PS) deficiency. The most common cause of PF in a neonate is sepsis. In our extremely low birth weight preterm case, due to PF that started in the right-hand fingers, examination was made and protein S deficiency was detected as well as MTHFR (A1298C) and Factor V Leiden (R506Q) homozygous mutations. While being unresponsive to fresh frozen plasma (FFP) and unfractionated heparin (UFH) therapy, we want to highlight the curative treatment with hyperbaric oxygen (HBOT), which has not previously been used in extremely low birth weight preterm infants for this purpose.

Self-Assembly of Topologically Networked Protein-Ti3C2Tx MXene Composites

Hierarchical organization plays an important role in the stunning physical properties of natural and synthetic composites. Limits on the physical properties of such composites are generally defined by percolation theory and can be systematically altered using the volumetric filler fraction of the inorganic/organic phase. In natural composites, organic materials such as proteins that interact with inorganic filler materials can further alter the hierarchical order and organization of the composite via topological interactions, expanding the limits of the physical properties defined by percolation theory. However, existing polymer systems do not offer a topological parameter that can systematically modulate the assembly characteristics of composites. Here, we present a composite based on proteins and titanium carbide (Ti₃C₂T_x) MXene that manifests a topological network that regulates the organization, and hence physical properties, of these biomimetic composites. We designed, recombinantly expressed, and purified synthetic proteins consisting of polypeptides with repeating amino acid sequences (tandem repeats) that have the ability to self-assemble into topologically networked biomaterials. We demonstrated that the interlayer distance between MXene sheets can be controlled systematically by the number of tandem repeat units. We varied the filler fraction and number of tandem repeat units to regulate the in-plane and out-of-plane electrical conductivities of these composites. Once Ti₃C₂T_x MXene sheets are separated enough to facilitate formation of cross-links in our proteins with the number of tandem repeat units reaching 11, the linear I-V characteristics of the composites switched into nonlinear I-V curves with a distinct hysteresis for out-of-plane electron transport, while the in-plane I-V characteristics remained linear. This highlights the impact of synthetic protein templates, which can be designed to modulate electronic transport in composites both isotropically and anisotropically.

Zeolite-loaded alginate-chitosan hydrogel beads as a topical hemostat

Hemorrhage is the leading cause of preventable death after a traumatic injury, and the largest contributor to loss of productive years of life. Hemostatic agents accelerate hemostasis and help control hemorrhage by concentrating coagulation factors, acting as procoagulants and/or interacting with erythrocytes and platelets. Hydrogel composites offer a platform for targeting both mechanical and biological hemostatic mechanisms. The goal of this work was to develop hydrogel particles composed of chitosan, alginate, and zeolite, and to assess their potential to promote blood coagulation via multiple mechanisms: erythrocyte adhesion, factor concentration, and the ability to serve as a mechanical barrier to blood loss. Several particle compositions were synthesized and characterized. Hydrogel bead composition was optimized to achieve the highest swelling capacity, greatest erythrocyte adhesion, and minimal in vitro cytotoxicity. These results suggest a polymer hydrogel-aluminosilicate composite material may serve as a platform for an effective hemostatic agent that incorporates multiple mechanisms of action. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1662-1671, 2018.

Spray-Processed Composites with High Conductivity and Elasticity

Highly conductive elastic composites were constructed using multistep solution-based fabrication methods that included the deposition of a nonwoven polymer fiber mat through solution blow spinning and nanoparticle nucleation. High nanoparticle loading was achieved by introducing silver nanoparticles into the fiber spinning solution. The presence of the silver nanoparticles facilitates improved uptake of silver nanoparticle precursor in subsequent processing steps. The precursor is used to generate a second nanoparticle population, leading to high loading and conductivity. Establishing high nanoparticle loading in a microfibrous block copolymer network generated deformable composites that can sustain electrical conductivities reaching 9000 S/cm under 100% tensile strain. These conductive elastic fabrics can retain at least 70% of their initial electrical conductivity after being stretched to 100% strain and released for 500 cycles. This composite material system has the potential to be implemented in wearable electronics and robotic systems.

ADHD Medication Trends in Turkey: 2009-2013

OBJECTIVE

To investigate the change of ADHD medication prescriptions in Turkey between 2009 and 2013.

METHOD

Consumption data of ADHD medications, immediate release (IR) methylphenidate (MPH; Ritalin), OROS MPH (Concerta), and atomoxetine (Strattera) were obtained from IMS Health database for the November 2008 to October 2013 period. Defined daily dose (DDD) of each drug was calculated according to WHO definitions and time-series analysis was conducted.

RESULTS

There was a significant seasonal effect for prescription of all drugs. Annual use of ADHD medications increased 2.18 times for all ADHD medications combined. DDDs per 1,000 population per day for all ADHD medications were 0.28 in 2009, 0.41 in 2010, 0.52 in 2011, and 0.59 in 2012. OROS MPH represented almost 75% of all ADHD medication utilization.

CONCLUSION

As reported from several other countries, ADHD medication use increased in Turkey. Results suggested that over- and underdiagnosis might be seen at the same time.

Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: A case report

•

The panreatic IPMN and neuroendocrine carcinoma is very unusual.

•

The IPMN component of our patient has high grade dysplasia, which is very rare.

•

In presence of contrast enhancing nodular foci, while evaluating IPMN on imaging studies, possibilty of neuroendocrine tumor should be in mind.

Introduction

Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature.

Presentation

A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma.

Discussion

The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated IPMNs were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association.

Conclusion

Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.

Sprayable elastic conductors based on block copolymer silver nanoparticle composites

Block copolymer silver nanoparticle composite elastic conductors were fabricated through solution blow spinning and subsequent nanoparticle nucleation. The reported technique allows for conformal deposition onto nonplanar substrates. We additionally demonstrated the ability to tune the strain dependence of the electrical properties by adjusting nanoparticle precursor concentration or localized nanoparticle nucleation. The stretchable fiber mats were able to display electrical conductivity values as high as 2000 ± 200 S/cm with only a 12% increase in resistance after 400 cycles of 150% strain. Stretchable elastic conductors with similar and higher bulk conductivity have not achieved comparable stability of electrical properties. These unique electromechanical characteristics are primarily the result of structural changes during mechanical deformation. The versatility of this approach was demonstrated by constructing a stretchable light emitting diode circuit and a strain sensor on planar and nonplanar substrates.

Serum oxidative stress, visfatin and apelin in healthy women and those with premenstrual syndrome

The aim of this study was to investigate whether there is a relationship between premenstrual syndrome and oxidative stress, visfatin and apelin. The study included 40 women with premenstrual syndrome and 40 healthy women. In all subjects, serum visfatin, apelin and oxidative stress parameters were studied in venous blood samples. The oxidative stress parameters were higher in the premenstrual syndrome group than among the controls, but this difference did not reach statistical significance (p > 0.05). It was found that total antioxidant capacity was similar in both groups. For the insulin-serotonin cycle markers, no significant difference was found between groups in terms of visfatin level (p = 0.893), although apelin was found to be significantly higher in the premenstrual syndrome group when compared with the controls (p < 0.001). According to our results, apelin can be used as an ancillary laboratory test in the diagnosis of premenstrual syndrome.

Anal atresia, abnormal genitalia, and absent thumb: congenital malformations associated with mosaic ring chromosome 13

Because of the deletion of a segment of the chromosome during the formation of a ring, several clinical findings may be associated with ring chromosomes. Ring chromosome 13 is one of such disorders in which the genotype-phenotype correlation is stronger by virtue of the accumulating literature. It can be associated with multiple congenital abnormalities and severe mental retardation. We report a case with mosaic ring chromosome 13 whose prenatal ultrasound revealed bilateral ventriculomegaly. Anal atresia, unidentifiable external genitalia, and an absent thumb were observed in the postmortem examination.

²²⁶Ra, ²³²Th and ⁴⁰K radionuclides enhancement rate and dose assessment for residues of lignite-fired thermal power plants in Turkey

A total of 77 coal, slag and fly ash samples collected from six thermal power plants were measured by gamma-ray spectrometry. The average (226)Ra activity concentrations in coal, slag and fly ash were measured as 199.8±16.7, 380.3±21.8 and 431.5±29.0 Bq kg(-1), respectively. The average (232)Th activity concentrations in coal, slag and fly ash were measured as 32.0±2.4, 74.0±9.0 and 87.3±9.8 Bq kg(-1), respectively. The average (40)K activity concentrations in coal, slag and fly ash were found to be 152.8±12.1, 401.3±25.0 and 439.0±30.2 Bq kg(-1), respectively. The radium equivalent activities of samples varied from 147.6±8.5 to 1077.4±53.3 Bq kg(-1). The gamma and alpha index of one thermal power plant's fly ash were calculated to be 3.5 and 5 times higher than that of the reference values. The gamma absorbed dose rates were found to be higher than that of the average Earth's crust. The annual effective dose of residues measured in four thermal power plants were calculated higher than that of the permitted dose rate for public, i.e. 1 mSv y(-1).

Acute formation of lumbar discal cyst: what is the mechanism?

Lumbar discal cysts are extremely rare pathologies, with only few reports describing these lesions in the literature. Moreover, their definite pathogenesis is still unknown, with proposed theories based on radialogic and histologic findings. In this report, the authors present an acute formation of a discal cyst, which is reported for the first time. Also, we center our case on the discussion of the possible pathogenesis. Also, this is the first case of discal cyst reported in Turkey. A 67-year-old woman, whose complaints, and clinical and radiological findings demonstrated lumbar disc herniation with acute Modic 1 degererative changes of the adjacent end plates of L3-4 level. After medical and physical therapies, follow-up lumbar MRI has been taken to demonstrate a discal cyst formation on the adjacent intervertebral disc, showed cranially migrated cyst superior posterior on herniated disc, in 2 weeks period. The patient was treated by microsurgical resection of the cyst, and her complaints resolved completely.

Gangliocytic paraganglioma of the cauda equina with significant calcification: first description in pediatric age

A 17-year-old boy was referred with a 2-month history of low back pain and bilateral sciatica and difficulty in ambulation. Neurological examination found mild muscle weakness and diminished deep tendon reflexes in his right leg. Lumbar magnetic resonance imaging revealed an intradural-extramedullary tumor at the level of the L4, exiting through the right L4-L5 intervertebral foramen into the right psoas muscle. After total resection of the tumor, histopathological diagnosis revealed a gangliocytic paraganglioma. There are 184 paraganglioma cases reported at the lumbar region to date, and only 4 of them were in the pediatric age group. This report is the fifth paraganglioma case in the lumbar region and the first gangliocytic paraganglioma case in the pediatric age population.

Synthesis of 2-methyl-4-aryl-4,6,7,8-tetrahydro-5(1H)-quinolone derivatives and their effects on potassium channels

In this study, twelve compounds having 2-methyl-4-aryl-4,6,7,8-tetrahydro-5(1H)-quinolone structure have been synthesized by the reaction of 4-aryl-3-butene-2-on derivatives with 1,3-cyclohexanedione analogs in the presence of ammonium acetate in methanol. The structures of the compounds have been elucidated by IR, 1H-NMR, 13C-NMR, mass spectroscopy and elementel analysis. Their potassium channel opener activities have been investigated on isolated rabbit bladder smooth muscle using pinacidil (CAS 85371-64-8) as standard. The test compounds and pinacidil caused concentration-dependent relaxation responses in bladder smooth muscle strips precontracted with 80 mmol/L KCl with the efficacy order: pinacidil > or = 3g > or = 3j > or = 3a > or = 3l = 3i > or = 3c = 3b > or = 3d > or = 3h > or = 3k. In bladder smooth muscle strips precontracted with 15 mmol/L KCl, the efficacy order was: pinacidil > 3h > or = 3c > or = 3j > or = 3g > or = 3l > or = 3i = 3b > or = 3k > or = 3f > or = 3a. The test compounds and pinacidil caused concentration-dependent inhibition of electrical field stimulation-evoked contractile responses in the bladder smooth muscle strips with the efficacy order: 3j > or = 3l pinacidil > or = 3k > or = 3h > or = 3a > or = 3g > or = 3c > or = 3i > or = 3b > or = 3f.

Natural radioactivity measurement in pumice samples used raw materials in Turkey

The activity concentrations of 232Th, 226Ra, and 40K in different pumice samples have been determined by high-resolution gamma-ray spectrometry using a 110% HpGe detector. The radium equivalent activities (Raeq), external hazard index (Hex), and internal hazard index (Hin) associated with the natural radionuclides and representative level index (Igamma r) are calculated to assess the radiation hazard of the natural radioactivity in the pumice samples. The mean values of the measured radioactivity concentrations of 232Th, 226Ra, and 40K for pumice samples from the region of lakes (ROL) are 232.4+/-8.0, 196.9+/-7.8, and 1325.8+/-20.4 Bqkg(-1) and for pumice samples from Cukurova region (CR) 16.3+/-4.0, 16.1+/-4.9, and 479.7+/-170.4 Bqkg(-1), respectively. The calculated Raeq values vary from 435.9+/-12.5 to 883.6+/-41.5 Bqkg(-1) with a mean of 630.9+/-20.2 Bqkg(-1) for the ROL samples and from 49.7+/-3.3 to 101.9+/-7.2 Bqkg(-1) with a mean of 76.3+/-23.7 Bqkg(-1) for the CR samples. For the ROL samples, Raeq are above the limit of 370 Bqkg(-1), equivalent to external gamma dose of 1.5 mSv yr(-1), recommended for the safe use of construction materials by NEA-OECD, while for the CR samples, Raeq values are lower than the limit.

Cochlear implantation in chronic otitis media

Patients with chronic otitis media (COM) may have profound sensorineural hearing loss either due to the disease process or secondary to a surgical procedure. Some patients who are candidates for cochlear implantation may have COM coincidentally. The patients in this group need special attention when cochlear implantation is applied. The aim of this study is to evaluate the potential risks and complications in patients with COM.

Cochlear implantation was performed in six patients with COM or an infected radical cavity and profound hearing loss. Five of them underwent a two-stage operation, and one had a single-stage operation. Cochlear implantation was performed in all patients without complications. The follow-up period was uneventful.

Although such patients have some potential risks, when certain surgical rules are followed very strictly cochlear implantation can be successfully performed in patients with COM.

Cardiac effects of a single course of antenatal betamethasone in preterm infants

AIM

To show the effects of a single course of antenatal betamethasone on cardiac measurements and systolic functions in premature newborn infants.

METHODS

Seventy six newborn infants with a gestational age of 25-33 weeks were included in the study. They were first classified according to their gestational age: 25-29 weeks (n = 28) and 30-33 weeks (n = 48). They were then reclassified as betamethasone positive (mother received one course of betamethasone) or betamethasone negative (mother did not receive any antenatal glucocorticoid treatment). Cross sectional M mode echocardiographic scans were performed during the first three postnatal days and at the end of the first and third weeks. Left interventricular septum (IVS), left ventricular posterior wall (LVPW), left ventricular end diastolic (LVED), and left ventricular end systolic (LVES) dimensions, aortic root (AO), and left atrial diameters (LAs) were measured. The IVS to LVPW ratio was calculated to identify asymmetrical septal hypertrophy.

RESULTS

In neither group was any statistically significant difference noted in IVS, LVED, LVES, LVPW, LA, and AO measurements during the three cardiac ultrasonography scans. Systolic function, as assessed by fractional shortening, was not significantly different in infants who received betamethasone antenatally, in either age group. There was no difference in the IVS/LVPW ratios between those who received antenatal steroid and those who did not for the 25-29 week and 30-33 week groups during these three consecutive scans.

CONCLUSION

One course of antenatal betamethasone did not affect the cardiac wall thicknesses and systolic function in premature infants.

Preliminary results on correlation between neural response imaging and ‘most comfortable levels' in cochlear implantation

During cochlear implantation, precise placement of the cochlear electrodes against the cochlear nerve is one of the most important steps, necessary to enable the patient to be aware of the stimulus from the implanted device. Neural response imaging (NRI) is a new tool which measures the evoked compound action potential generated as a result of electrical stimulation of the cochlea by properly placed electrodes during surgery.

The aim of this study was to examine the correlation between intra-operative NRI recordings and ‘most comfortable levels’ (M levels) measured during standard fitting with the SoundWave fitting software, in cochlear implantation patients. Seven adult subjects were included in the study. The average duration of profound bilateral deafness was seven years (range = 19 years) and the mean age at implantation was 24 years (range = 17–34 years). All subjects underwent implantation and reached the one-month fitting session; one patient reached the two-month fitting session. The intra-operative NRI threshold (tNRI) was observed to be much higher than the first fitting M levels. The tNRI was 203 per cent of the sequential M value and 246 per cent of the paired M value. All but one intra-operative tNRI values were greater than 150 clinical units (CU), and all first fitting M levels were on average below 100 CU. No obvious correlation was found between individual intra-operative tNRI and first fitting M levels. The M levels at one month were much higher than the first fitting M levels, with much more dispersion.

Effectiveness of functional magnetic versus electrical stimulation in women with urinary incontinence

AIM

Urinary incontinence is one of the most common medical complaints in women. We here propose to evaluate and compare the effects of 2 conservative treatment modalities, functional electrical stimulation (FES) and functional magnetic stimulation (FMS).

METHODS

We studied 22 female patients with urinary incontinence and divided them into 2 treatment groups (14 patients in the FES and 8 in the FMS group). The mean age of the patients in the FES group was 51.14+/-11.9 and in the FMS group 42.25+/-6.9 years. Functional electrical stimulation was applied continuously at 10 Hz and 30-50 Hz in urge and stress urinary incontinence respectively. In mixed urinary incontinence stimulation was applied at 10 Hz for 15 min and at 50 Hz for 15 min. The treatment sessions were for 20 min, 3 times a week for 6-8 weeks (12 with mixed, 2 with stress incontinence). FMS was applied by a magnetic chair, twice weekly for 6 weeks (6 with mixed, 1 with stress urinary and 1 with urge urinary incontinence). The efficacy of the treatment was judged from patient impressions, records in urinary diaries, results of 1 h pad test, perineometry value and digital palpation score.

RESULTS

The perineometry value, digital palpation score increased significantly during stimulation compared with prestimulation levels in both groups (P<0.05). For the pad test significant improvement was also noted in both groups (P<0.05). The urinary diaries and frequency of micturition were significantly more cured or improved in the FES group (P<0.05). However, reduction of the frequency of nocturnal micturition wasn't significant in either group (P>0.05).

CONCLUSIONS

Both FES and FMS treatments were effective. FMS does not involve intravaginal stimulation and it is twice a week. Although FMS is not often used it is more cost effective than FES. In order to have exact knowledge of this issue; more research than has been done in a greater number of subjects is required.

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.

Antimycobacterial screening of some Turkish plants

Extracts of 44 plant species distributed among 17 families from Turkey were screened against Mycobacterium tuberculosis H(37)Ra using microplate Alamar blue assay test. Six plants inhibited growth of M. tuberculosis H(37)Ra at 50 microg/ml concentrations.

Central nervous system infection due to Penicillium chrysogenum. Fallbericht. ZNS-Infektion durch Penicillium chrysogenum

Penicillium chrysogenum was isolated from three subsequent cerebrospinal fluid (CSF) specimens of a 73-year-old male patient without immunological compromise. The isolated was tested against five antifungal agents according to the NCCLS M38-P macrodilution method. MICs were determined as follows: amphotericin B (AMB), 2 microg ml(-1); fluconazole (FLZ), 8 microg ml(-1); itraconazole (ITZ), 1 microg ml(-1); flucytosine (5FC), 0.125 microg ml(-1); and terbinafine (TRB), 0.06 microg ml(-1). The patient has been cured with FLZ.

Children with cochlear implants: parental perspective

OBJECTIVE

Evaluation of the parental perspective regarding cochlear implants and the child's progress after a minimum of 1 year after cochlear implantation.

STUDY DESIGN

A closed-set questionnaire was used to assess the parental point of view. The questionnaire that was mailed to families included the following sections: decision to implant, process of implantation, positive effect of the implant, communication, supporting the child, self-reliance, well-being and happiness, social relationships, education, and pre- and postoperative services provided by the implant center.

SETTING

The study was conducted at SSK Ankara Hospital, which is a tertiary care center.

PATIENTS

Parents of 28 children with congenital deafness or who became deaf before the age of 3 years and received cochlear implantation were included in the study. To obtain reliable information, selected patients had a minimum of 1 year experience after implantation. The subjects were the parents of a group of children including 19 boys and 9 girls with ages ranging from 2 to 13 years (mean, 5.07 years; standard deviation, 2.33 years). The period of cochlear implant usage ranged from 12 to 30 months (mean, 19.5 months; standard deviation, 15.95 months).

MAIN OUTCOME MEASURE

Assessment of parental view about cochlear implantation.

RESULTS

Of 28 questionnaires sent, 27 were returned. Making decision for cochlear implantation was one of the most stressful steps for the parents. Although speech and language development was the major concern, parents reported outstanding improvement in communication skills, social relationships, and self-confidence for their child. All the families were anxious about a possible device failure, and maintenance of the cochlear implant equipment was another major concern.

CONCLUSIONS

During pre- and postimplantation processes, parents provide an important link between the child and professional staff and have a vital role in the child's life and rehabilitation. The parental perspective presented in this study can be useful to the implant centers to revise their practice accordingly and improve the information given to candidate families.

Injury caused by deeply penetrating knife blade lodged in infratemporal fossa

Knife-inflicted, deeply penetrating head and neck trauma is an uncommon life-threatening injury and a challenging problem. An examination of the neurovascular and systemic physical status is a first requirement and the decision as to which approach to adopt for the removal of the blade is of critical importance. Here we report a rare case of a pre-auricular stab wound with the knife blade deeply lodged in the extracranial infratemporal fossa. Radiological investigations showed that the knife blade had entered from the temporomandibular joint and become lodged through the anterior margin of foremen magnum below the petrosal bone. Minimal left vocal cord paresis, left palatal weakness and a slight deviation of the tongue towards the left side were observed. The other neurological and systemic physical evaluations were normal. Simple withdrawal of the blade in the operating room did not cause serious neurovascular injury. Here we discuss and compare the expanded exposure of anatomical structures for blade removal and simple withdrawal in similar injuries.

Indications of Philadelphia collar in the treatment of upper cervical injuries

The principles of the management of upper cervical injuries remain controversial. The specific anatomical conditions render upper cervical injuries more problematic than lower cervical injuries. Here we present and discuss our experiences with upper cervical injury, comparing them with other treatment modalities. The 24 patients admitted to our department with upper cervical injury were treated surgically or conservatively according to their neurological and radiological status. Five patients were treated surgically due to neurological abnormality associated with compression to neural structures observed in computerized tomography/magnetic resonance imaging (CT/MRI). Patients with no neural compression were managed conservatively, with the Philadelphia collar. All patients showed stable fracture healing and experienced no additional clinical disability on follow-up after a minimum of 3 months, except one who died due to cardiac and respiratory failure. Regardless of the type of injury, indication for surgery in many cases of upper cervical injury is neurological abnormality associated with radiologically observed neural compression. It is our belief that, in the absence of both neurological abnormality and compression to neural structures observed in CT/MRI, treatment with the Philadelphia collar alone is safe, cost-effective and easily applicable for many cases of upper cervical injury.

Cerebral blood flow alterations in progressive communicating hydrocephalus: transcranial Doppler ultrasonography assessment in an experimental model

OBJECT

In many cases communicating hydrocephalus is the result of impairments in cerebrospinal fluid absorption in the arachnoid villi at the cranial convexity. Reported methods of creating experimental hydrocephalus have not sought to produce an arachnoidal adhesion in the cranial convexity. In this study the authors investigate alterations in cerebral blood flow (CBF) in experimental communicating hydrocephalus induced by the injection of kaolin into the subarachnoid space at the convexity in neonatal rats.

METHODS

In neonatal rats, kaolin was injected into the subarachnoid space at the cranial convexity. Assessment of CBF alterations was performed using transcranial Doppler ultrasonography preinjection and at 10 days, 4 weeks, and 8 weeks postinjection. Light microscopy examination was also performed at 4 weeks and 8 weeks postinjection. Conspicuous lateral ventricle enlargements of different dimensions were observed in kaolin-injected rats at 4 to 8 weeks postinjection. The third and fourth ventricles were dilated to a lesser extent. Resistance to CBF and increased mean CBF velocity were apparent 8 weeks after kaolin injection. Further, destruction and even loss of ependymal layers were more prominent at the chronic stage.

CONCLUSIONS

The present model may be considered a progressive communicating hydrocephalus because of marked changes in blood flow dynamics and destruction of the ependymal layer at the chronic stage.

Symptomatic wandering accessory spleen in the pelvis: sonographic findings

We describe the case of a mobile left lower quadrant mass associated with recurrent abdominal pain; at surgical exploration, the mass was found to be an accessory pelvic spleen. Although accessory spleens are present in 10-30% of individuals, a wandering accessory spleen located in the pelvis is not frequently seen. On sonography, the mass in our patient appeared well-defined and homogeneous. Spectral analysis and color Doppler imaging demonstrated a normal vascular branching pattern and high diastolic flow due to low resistance in the vascular bed. The parenchymal resistance index of the mass was similar to that of the native spleen.

Passive immunity of premature infants against measles during early infancy

The aim of this study was to evaluate the presence of transferred measles antibodies and seronegativity rates during early infancy in premature newborns whose mothers had infection-induced immunity. The premature group was composed of 22 and 35 newborns of gestational ages < 32 wk and > 32 wk, respectively, and the control group consisted of 28 term newborns. Enzyme-linked immunosorbent assay (ELISA) was used for the qualitative detection of IgG antibodies to measles virus. Mean cord blood relative values were significantly lower in both premature groups, < or = 32 wk (p < 0.0001) and > 32 wk (p < 0.001), when compared with term infants. No seronegative infant was found in the premature group at 2 mo of age. At 4 mo, the seronegativity rate was 27% for premature infants < or = 32 wk and 35% for those > 32 wk. At 6 mo, seronegativity increased to 86% and 74% for premature infants born at gestational ages < or = 32 wk and > 32 wk, respectively. Forty-six percent of the term infants became seronegative at that age. The differences between term infants and those in the two premature groups were statistically significant (p < 0.05 and p < 0.005). Premature infants, regardless of their prematurity degree, were thought to be more susceptible to measles infection than term ones at the age of 6 mo. Policies for their protection from measles infection are still to be investigated.

Peripheral arterial involvement in neurofibromatosis type 1--a case report

Neurofibromatosis is a dominantly inherited, progressive, generalized dysplasia of mesodermal and neuroectodermal tissues. Vascular lesions associated with neurofibromatosis type 1 (NF-1) are mainly characterized by stenosis, occlusion, aneurysm, pseudoaneurysm, and rupture or fistula formation of small, medium, and large-sized arteries. The authors hereby present a rare case of NF-1 with bilateral aneurysms and large pseudoaneurysms of the femoral and popliteal arteries and occlusion of the left superficial femoral artery.