Treatment Emergent Central Sleep Apnea: Should We Repeat Titration?

Most patients with Obstructive sleep apnea syndrome are treated with continuous positive airway pressure (CPAP). However, in some patients central apnea arises during CPAP titration. This clinical condition is defined as treatment-emergent central sleep apnea (CSA). Here, we would like to present a case who was diagnosed with treatment-emergent CSA during the first titration study, however CSA was lost in the second titration. Before the diagnosis of treatment-emergent CSA, factors of titration should be reviewed and if it is not found satisfactory, procedure should be repeated. In most cases CPAP therapy eliminates CSA. However, in some cases bilevel positive airway pressure- spontaneous/timed or adaptive servo ventilator is needed. Repeated titration could be useful tool to predict whether the patient needs CPAP or advanced therapies

Is the function of the core muscles affected during pregnancy?

Introduction and hypothesis: The aim of our study is to examine the changes in core muscle functions during pregnancy. Methods: Our study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]–external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann–Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship. Results: In the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels (p < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles. Conclusions: In women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done

Predictive value of serum and follicular fluid chemerin concentrations during assisted reproductive cycles in women with polycystic ovary syndrome

Aims To evaluate the effect of serum and follicular fluid (ff) Chemerin levels on Assisted Reproductive Technology (ART) outcomes in lean patients with PCOS. Materials and methods The study included 76 infertile reproductive aged women, between 21-35 years who underwent intracytoplasmic sperm injection (ICSI) procedure. Serum and ff Chemerin levels were evaluated. Fertilization and clinical pregnancy rate were compared between the groups. Results Serum (13.32 ng/ml versus 29.82 ng/ml) and ff chemerin (35.90 ng/ml versus 87.60 ng/ml) levels were significantly higher in lean PCOS patients compared to controls (p < .01). Serum (24.5 ng/ml versus 18.4 ng/ml) and ff chemerin (71.7 ng/ml versus 52.8 ng/ml) levels were higher in subjects without clinical pregnancy compared to the subjects with clinical pregnancy (p < .05). A cutoff value of 36.2 ng/ml in the ff chemerin level was found to estimate clinical pregnancy with 83% sensitivity and 52% specificity (Area under the curve 0.66; 95% confidence interval, 0.53-0.79). A cutoff value of 12.7 ng/ml in the serum chemerin level was found to estimate clinical pregnancy with 91% sensitivity and 49% specificity (Area under the curve 0.65; 95% confidence interval, 0.52-0.78). Clinical pregnancy rates were significantly higher in group with lower serum chemerin levels (80.0% versus 30.4%, p < .001). High serum chemerin levels are associated with failure of assisted reproduction [OR:0.1(95% CI, 0.03-0.4, p < .001)]. Conclusions PCOS is associated with higher serum and ff chemerin levels and high serum chemerin level is a risk factor for failed ART cycle

Effects of prunus spinosa L. fruits on experimental wound healing

Farelerde oluşturduğumuz deneysel yara modellerinde, Prunus Spinosa L. metanollü meyve ekstresini kullanarak, bu ekstrenin yara iyileşmesindeki etkisini araştırdık. Otuz iki adet C57/Black fare ile 4 deney grubu oluşturuldu. Birinci grup kontrol grubu, 2. grup taşıyıcı (gliserin) grup, 3. grup Prunus spinosa, 4. grup ma- decassol grubu idi ve her bir grupta farelerin sırtında eksizyonel yara modeli oluşturularak Prunus Spinosa L. ve madecassol 10. gün boyunca uygulandı. Onuncu gün sonunda yara bölgeleri his- tolojik takip için alındı, yara dokuları hematoksilen-eosin ve im- munohistokimyasal (TGF-?, COL1A1) boyalarla boyanarak, yara iyileşmesi için epidermal ve dermal rejenerasyon, granülasyon doku oluşumu, anjiogenezis (yeni damar oluşumu), immunohis- tokimyasal boyalarla yeni oluşan kollajen yapılanması ve TGF ? artışı değerlendirilerek skorlandı. Prunus spinosa L’nin yara do- kusunda iyileşme oranlarını, granülasyon dokusunu, epidermal rejenerasyonu ve anjiogenezisi artırarak gösterdiği yine immü- nohistokimyasal boyamalarda kollajen ve TGF ? oranlarında ista- tistiksel olarak anlamlı bir artışın olduğu gözlendi. Yine 4. günün ve 10. günün sonunda yara kontraksiyonunda ve yara yerinin reepitelizasyonunda ilaç ve madecassol grubunda kontrol gru- buna kıyasla anlamlı bir artış gözlenmiştir. Bulgularımız, Prunus spinosa L’nin yara iyileşmesini desteklediğini göstermiştir. Prunus spinosanın antiinflamatuvar, antioksidan ve antibakteriyel etki- si ile, kollajen sentezini artırarak ve inflamatuvar hücre sayısını azaltarak yara iyileşmesinin tedavisinde kullanılabileceğini dü- şündürdü.We investigated the wound healing efficacy of the methanol extracts of Prunus spinosa L. fruits using an excisional cutane- ous wound model in mice. We used 32 C57/Black mice equally divided into four groups. Group 1 Control, Group 2 vehicle (glyce- rine), Group 3 Prunus spinosa L., Group 4 Madecassol. Prunus spinosa L.and Madecassol were applied for 10 days by creating a excisional wound model on the back of each mouse in each group. At the end of the 10th day, samples from wound areas were taken for histologic follow-up, scoring with hematoxylin- eosin and immunohistochemical (TGF-b, COL1A1) staining. Wo- und healing was evaluated and scored by newly formed collagen structure, increase in TGF b and epidermal and dermal regene- ration, granulation tissue thickness, angiogenesis (new vessel formation). Prunus spinosa L. increased wound healing rates by promoting granulation tissue, epidermal regeneration and angi- ogenesis. In addition there was a significant increase in collagen and TGF [beta] ratios in immunohistochemical staining. At the end of the 4 and 10 days after treatment, a significant increase was observed in wound contraction and re-epithelialization in both Prunus spinosa and madecassol treated groups compared to the control and vehicle groups. Our findings support the be- neficial effects of Prunus spinosa for augmenting wound healing. The anti-inflammatory, antioxidant and antibacterial activities of Prunus spinosa by way of increasing collagen synthesis and dec- reasing the number of inflammatory cells during wound healing have suggested that it may be useful for treating skin wounds

Effects of Prunus spinosa L. fruits on experimental wound healing

Farelerde oluşturduğumuz deneysel yara modellerinde, Prunus Spinosa L. metanollü meyve ekstresini kullanarak, bu ekstrenin yara iyileşmesindeki etkisini araştırdık. Otuz iki adet C57/Black fare ile 4 deney grubu oluşturuldu. Birinci grup kontrol grubu, 2. grup taşıyıcı (gliserin) grup, 3. grup Prunus spinosa, 4. grup ma- decassol grubu idi ve her bir grupta farelerin sırtında eksizyonel yara modeli oluşturularak Prunus Spinosa L. ve madecassol 10. gün boyunca uygulandı. Onuncu gün sonunda yara bölgeleri his- tolojik takip için alındı, yara dokuları hematoksilen-eosin ve im- munohistokimyasal (TGF-?, COL1A1) boyalarla boyanarak, yara iyileşmesi için epidermal ve dermal rejenerasyon, granülasyon doku oluşumu, anjiogenezis (yeni damar oluşumu), immunohis- tokimyasal boyalarla yeni oluşan kollajen yapılanması ve TGF ? artışı değerlendirilerek skorlandı. Prunus spinosa L’nin yara do- kusunda iyileşme oranlarını, granülasyon dokusunu, epidermal rejenerasyonu ve anjiogenezisi artırarak gösterdiği yine immü- nohistokimyasal boyamalarda kollajen ve TGF ? oranlarında ista- tistiksel olarak anlamlı bir artışın olduğu gözlendi. Yine 4. günün ve 10. günün sonunda yara kontraksiyonunda ve yara yerinin reepitelizasyonunda ilaç ve madecassol grubunda kontrol gru- buna kıyasla anlamlı bir artış gözlenmiştir. Bulgularımız, Prunus spinosa L’nin yara iyileşmesini desteklediğini göstermiştir. Prunus spinosanın antiinflamatuvar, antioksidan ve antibakteriyel etki- si ile, kollajen sentezini artırarak ve inflamatuvar hücre sayısını azaltarak yara iyileşmesinin tedavisinde kullanılabileceğini dü- şündürdü.We investigated the wound healing efficacy of the methanol extracts of Prunus spinosa L. fruits using an excisional cutane- ous wound model in mice. We used 32 C57/Black mice equally divided into four groups. Group 1 Control, Group 2 vehicle (glyce- rine), Group 3 Prunus spinosa L., Group 4 Madecassol. Prunus spinosa L.and Madecassol were applied for 10 days by creating a excisional wound model on the back of each mouse in each group. At the end of the 10th day, samples from wound areas were taken for histologic follow-up, scoring with hematoxylin- eosin and immunohistochemical (TGF-b, COL1A1) staining. Wo- und healing was evaluated and scored by newly formed collagen structure, increase in TGF b and epidermal and dermal regene- ration, granulation tissue thickness, angiogenesis (new vessel formation). Prunus spinosa L. increased wound healing rates by promoting granulation tissue, epidermal regeneration and angi- ogenesis. In addition there was a significant increase in collagen and TGF [beta] ratios in immunohistochemical staining. At the end of the 4 and 10 days after treatment, a significant increase was observed in wound contraction and re-epithelialization in both Prunus spinosa and madecassol treated groups compared to the control and vehicle groups. Our findings support the be- neficial effects of Prunus spinosa for augmenting wound healing. The anti-inflammatory, antioxidant and antibacterial activities of Prunus spinosa by way of increasing collagen synthesis and dec- reasing the number of inflammatory cells during wound healing have suggested that it may be useful for treating skin wounds

Multicenter study of levodopa carbidopa intestinal gel in Parkinson's disease: the Turkish experience

Background/aim: Our purpose was to determine the efficacy of levodopa carbidopa intestinal gel (LCIG) in a series of Turkish patients with Parkinson's disease (PD)