Erişkin kalça displazisinin değerlendirilmesinde normal radyolojik ölçüm değerleri; Anadolu toplumunda 1732 sağlıklı kalçanın değerlendirilmesi

Objectives: The purpose of this study is to determine the normal values of radiographic measurements used for the assessment of hip joint, particularly focusing on the hip dysplasia, on healthy young adults in Anatolian population. Materials and methods: This prospective study consisted 866 subjects ( > 18 years of age) without clinical evidence of hip disorder who underwent anterior-posterior (AP) x-ray of pelvic region for routine screening in our institution. Acetabular angle of Sharp, center edge angle, ACM angle, acetabular index, and Reimer's migration index were measured. Normative data regarding radiographic parameters were presented for both gender and body side and statistical comparison was performed between gender and body sides. Results: CE angles (M: 30.3±3.4 vs F: 28.8±2.7) and ACM (M: 41.0±1.8 vs F: 40.5±1.8) angles were higher in male subjects; AI (M: 3.5±0.6 vs F: 3.8±0.9) and Sharp angle (M: 37.9±2.5 vs F: 38.5±2.1) was higher in female subjects. Reimer's migration index was similar between genders (M: 12.6±3.5 vs F: 13.0±3.6). All measured variables were statistically different between body sides, except AI in male subjects. Conclusion: We emphasize that normal limits of acetabular angles obtained from our own population should be used as reference values in various orthopedic operations regarding acetabular region.Çalışmanın amacı, sağlıklı Anadolu insanında kalça ekleminin, özellikle de kalça displazinin değerlendirilmesi amacı ile normal radyolojik parametrelerinin saptanmasıdır. Hastalar ve metot: Prospektif olarak yapılan çalışmamıza, klinik olarak herhangi kalça rahatsızlığı bulunmayan ve merkezimizde rutin tarama amaçlı pelvik bölgeyi içeren, ön-arka direkt grafisi çekilmiş 866 erişkin hasta ( 18 yaşından büyük) dahil edilmiştir. Asetabular Sharp açısı, CE açısı, asetabular indeks (AI), ACM açısı ve Reimer’in migrasyon indeksi standart radyografiler üzerinden ölçüldü. Her iki cinsiyet ve her iki taraf kalça için ayrı olarak normal değerler saptanıp istatistiksel karşılaştırma yapılmıştır. Sonuçlar: CE (E: 30.3±3.4 - K: 28.8±2.7) ve ACM açıları (E: 41.0±1.8 - K: 40.5±1.8) erkek hastalarda istatistiksel olarak yüksek iken; AI (E: 3.5±0.6 -K: 3.8±0.9) ve Sharp açıları (E: 37.9±2.5 -K: 38.5±2.1) bayanlarda daha fazla idi. Reimer’in migrasyon indeksi cinsiyetler arasında benzer değerlere sahipti (E: 12.6±3.5-K: 13.0±3.6). Erkek hastalardaki AI (asetabular indeks) açıları haricinde tüm parametreler her iki cinste de sağ ve sol kalça için farklı idi. Çıkarımlar: Asetabular bölgeyi içeren ortopedik cerrahi işlemlerde kendi toplumumuzdan elde edilmiş normal asetabular açı değerlerinin kullanılmasını vurgulamaktayız

Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo. ¿hay una relación?

WOS: 000339241600035The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro

EVALUATION OF IN VIVO EFFECTS OF VISCUM ALBUM L. AND ITS CONSTITUENT O-COUMARIC ACID ON BILE ACID SYNTHESIZING CYPS

This research was designed to determine about the possible potency of medicinal plants Viscum album L. and its major polyphenolic ingredient, o-coumaric acid on rat liver cholesterol and bile acid metabolizing enzymes. Bioactive compounds of V. album extracts were identified using LC-MS technique. The water extracts of V. album (10 mg/kg) and o-coumaric acid (30 mg/kg) were injected intraperitoneally for 9 days. Then, in vivo effects of this plant and its major phenolic ingredient (o-coumaric acid) on rat liver cholesterol and bile acid metabolizing cytochromes P450s were analyzed by determining protein and mRNA expression levels using western blotting and qRT-PCR techniques, respectively. The results showed that V. album caused a 0.9 fold decrease in protein expression of CYP7A1 and CYP7B1, but 1.4 and 1.3 fold increases in protein expression of CYP27A1 and CYP8B I, respectively. V. album caused 9, 1.3 and 2.4 fold decrease in mRNA expression of CYP7A1, CYP27A1, CYP7B1, respectively, however, 4.2 fold increase in mRNA expression of CYP8B1. Injection of o-coumaric acid to rats resulted 0.8 fold decrease in protein expression of CYP7A1, CYP27A1, CYP8B1 and CYP7B1. However, o-coumaric acid caused 1.8, 1.3, 2.3 and 2.3 fold increase in mRNA expression of CYP7A1, CYP27A1, CYP8B 1 and CYP7B1, respectively. According to results, even though V. album and o-coumaric acid caused fold change in protein and mRNA expressions of bile acid metabolizing CYPs, serum cholesterol levels remained unchanged. Thus, the idea can be taken about the role of this plant and its major polyphenolic ingredient in drug discovery and development

Potential Marker Pathways in the Endometrium That May Cause Recurrent Implantation Failure

The aim of this prospective cohort study was to identify altered biologic processes in the endometrium that may be potential markers of receptive endometrium in patients with repeated implantation failure (RIF) as compared with fertile controls. The study was conducted in a university-affiliated in vitro fertilization (IVF) gynecology clinic and molecular biology and genetics laboratory. Healthy fertile controls (n = 24) and patients with RIF (n = 24) were recruited. Window of implantation gene profiling associated with RIF was performed. Six hundred forty-one differentially expressed genes were identified, and 44 pathways were found enriched. Upon clustering of the enriched pathways, 9 representative pathways were established. The important pathways that were identified included circadian rhythm, pathways in cancer, proteasome, complement and coagulation cascades, citrate cycle, adherens junction, immune system and inflammation, cell cycle, and renin-angiotensin system. The involvement of the circadian rhythm pathway and other related pathways may alter the endometrium's functioning to ultimately cause RIF. Furthermore, we found that the pathogenesis of RIF was multifaceted and that numerous processes were involved. We believe that a better understanding of the underlying mechanisms of RIF will ultimately give rise to better treatment opportunities and to better outcomes in IVF

Endometrial gene expression profiling of recurrent implantation failure after in vitro fertilization

Recurrent implantation failure (RIF) is diagnosed when good-quality embryos repeatedly fail to implant after transfer in several in vitro fertilization (IVF) treatment cycles. Different expression profiles in maternal mRNAs could be referring to many diseases including RIF. This study aimed to reveal significantly dysregulated selected genes expression between healthy fertile women and RIF patients in the implantation window days of the natural menstrual cycle. MME, WWC1, TNC, and FOXP3 genes were chosen as target genes regarding their possible relations with the implantation process. Pathways with these genes were identified and the relationship between these pathways and RIF was investigated. In this study, the endometrial biopsy samples were collected in the secretory phase (cycle day 20-24) of the menstrual cycle from RIF patients (n = 34) and healthy fertile controls (n = 34). After "Pathway and network-oriented GWAS analysis" (PANOGA) and "Kyoto Encyclopedia of Genes and Genomes" (KEGG) pathway analysis; "Membrane Metalloendopeptidase" (MME), "WW and C2 Domain Containing 1" (WWC1), "Tenascin C" (TNC) and "Forkhead Box P3" (FOXP3) genes were chosen as target genes by regarding their possible relation with implantation process. Detection of differences in mRNA expressions between the control group and RIF patients has been performed with the droplet digital PCR (ddPCR) method. Results of the study showed that MME and WWC1 genes expression levels are significantly (p < 0,05) up-regulated 4.9 and 5.2 times respectively and TNC gene expression level is significantly (p < 0,05) down-regulated 9 times in the RIF samples compared to the control group. However, no statistically significant difference was observed between the patient group and the control group in the expression of the FOXP3 gene (p < 0.05). Changes are observed in the expression of the renin-angiotensin system pathway in which the MME gene is involved in the implantation process. The increase in MME gene expression can be speculated to cause implantation failure by restricting the invasion of trophoblast cells. Increasing WWC1 gene expression in the Hippo signaling pathway inhibits "Yes-associated protein 1" (YAP) expression, which is a transcriptional cofactor. Inhibition of YAP protein expression may impair the implantation process by causing the failure of endometrial decidualization. The TNC gene is located in the focal adhesion pathway and this pathway reduces cell adhesion on the endometrial surface to facilitate the attachment of the embryo to the endometrium. The reason for implantation failure might be that the intercellular connections are not suitable for implantation as a result of decreased expression of the focal adhesion pathway in which the TNC gene is effective. Considering the relations between the pathways of the target genes and the implantation process, changes in the expression of target genes might be a cause of RIF

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research