A prospective study on fetal posterior cranial fossa assessment for early detection of open spina bifida at 11–13 weeks

The objective of this study was to test three measurements: brain stem (BS), intracranial translucency (IT) and brain stem to occipital bone distance (BSOB), as well as one landmark: cisterna magna (CM) visibility, for early diagnosis of open spina bifida (OSB) in a low risk population. A prospective observational study was undertaken in a university hospital. A sample of 1479 women consented to participate between 20 September 2013 and 30 June 2015. Measurements were performed from the mid‐sagittal view, as is routinely used for nuchal thickness assessment. CM visibility was assessed qualitatively as the third anechoic band in the posterior cranial fossa (PCF). All pregnancies were screened with a combination of maternal serum alpha‐fetoprotein and second trimester anomaly scan and followed until delivery. Predictive values were calculated for each marker. We were able to diagnose two OSB cases and highly suspect one Dandy‐Walker malformation case at the first trimester scan by the observation of PCF. PCF characteristics of OSB cases were increased BS diameter, increased BS‐BSOB ratio and non‐visualization of the CM. All the markers demonstrated high sensitivity and specificity but CM visibility reached the highest positive predictive value. Due to relatively high false positive rates, PCF measurements could not reach a satisfactory performance to validate their clinical use as a single marker. CM visibility has the advantage of being a qualitative marker and reduces the need for sophisticated and time‐consuming measurements. Intracranial translucency and BS‐BSOB ratio measurements should be used when the CM visibility is absent or in doubt.     

Meibomian gland alterations in polycystic ovary syndrome

PURPOSE: Polycystic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism where hyperinsulinemia can be seen. Hormonal changes can affect meibomian gland function. In this study, we evaluated tear function in PCOS. MATERIALS AND METHODS: Twenty-seven women having PCOS and 22 normal individuals aged between 18-42 years were enrolled in the study. Patients were asked about dry eye symptoms. Schirmer test, tear film breakup time, and rose Bengal staining were performed. Conjunctival brush cytology specimens were obtained and goblet cell count was done. RESULTS: Dry eye symptoms were more frequent in subjects with PCOS (p=0.025). Mean breakup time was shorter in women with PCOS (p=0.034). Schirmer test results, rose Bengal staining scores, and goblet cell count were not different between groups (p=0.48, p=0.18, p=0.82, respectively). CONCLUSION: Meibomian gland function and tear film lipid layer can be affected in cases with PCOS.     

Influences of cyclopentolate hydrochloride on anterior segment parameters with Pentacam in children

Purpose: To investigate the effects of cyclopentolate hydrochloride 1% on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in children. Setting: Ege University Faculty of Medicine, Department of Ophthalmology. Methods: Pentacam measurements of 50 (23 boys and 27 girls) children before and after 45 min of cyclopentolate hydrochloride 1% instillation were performed and compared with 31 (17 boys and 14 girls) no medication instilled control group. Measurements of the control group (cycloplegia‐free) were taken at two separate sessions with 45‐min intervals. For comparison of the test parameters, paired t‐test in the groups and unpaired t‐test in between the groups were used. Results: Mean ages in the study and control groups were 10.06 ± 2.87 (range 6 and 16 years) and 9.87 ± 2.72 (range 6 and 16 years), respectively, and the difference was statistically insignificant (p > 0.05). In the study group, measurements between two sessions were significantly different for the parameters of anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) (p < 0.05), whereas none of the parameters was different between two sessions for control group. Conclusions: Cyclopentolate hydrochloride 1% instillation leads to significant decrement in CCT. ACD and ACV are the other important refractive parameters that increase significantly after cycloplegia. Effects of cycloplegia on these parameters for Pentacam measurements should be regarded for proper clinical interpretation in children.     

Dermatofibrosarcoma protuberans and gastrointestinal stromal tumor as models for targeted therapy in soft tissue sarcomas

Introduction: The development of novel targeted treatment in soft tissue sarcomas (STS) is important since many sarcoma subtypes are resistant to chemotherapy and effective therapeutic options are limited.

Areas covered: This review discusses the molecular background and treatment in two STS types which became a model for targeted therapy – gastrointestinal stromal tumor (GIST) and dermatofibrosarcoma protuberans (DFSP). DFSP is characterized, by chromosomal translocation which results in the formation of COL1A1-PDGFB fusion gene causing platelet-derived growth factor receptor beta(PDGFRB) signaling activation in tumor cells. The majority of GIST malignancies are associated with activating, constitutive, mutually exclusive mutations of two genes: KIT and PDGFRA (PDGF receptor-alpha). Molecular diagnostics are an essential part of GIST and DFSP management. The first effective systemic therapy in clinical practice in GIST and DFSP was imatinib – tyrosine kinase inhibitor acting on KIT and PDGFR alpha/beta. Use of the drug revolutionized treatment of inoperable and/or metastatic cases and demonstrated activity in locally advanced cases. This review summarizes the analogies of therapy and perspectives of GIST and DFSP management.

Expert commentary: The next generation of kinase inhibitors are approved for use after the progression of GIST during imatinib treatment. However, little is known about treatment beyond progression in DFSP.     

Low-field compact magnetic resonance imaging system for the hand and wrist in rheumatoid arthritis

PURPOSE: To investigate the feasibility of an originally developed compact MRI system for evaluating rheumatoid arthritis (RA), and determine its advantages and disadvantages as an imaging modality for evaluating RA. MATERIALS AND METHODS: We prospectively studied 13 healthy controls with no clinical symptoms of arthritis, and 13 patients with hand and wrist pains (including pain from RA) with a 0.2 T permanent-magnet compact MR imager. All MR images were obtained while the subjects were in a sitting position. Coronal three-dimensional spin-echo T1-weighted images and coronal two-dimensional short tau inversion recovery (STIR) images were obtained with image matrix = 256 x 128 and field of view (FOV) = 20.48 cm. Plain radiograph findings and MRI findings of patients were compared. RESULTS: In three of the patients with suspected early RA (N = 7), early RA was evaluated based on STIR images. All RA patients showed morphologic or signal intensity changes that allowed an evaluation of RA from MR findings. Four of five RA patients showed high signal intensity on STIR images in the wrist, proximal interphalangeal (PIP) joint, or metacarpophalangeal (MCP) joint that suggested synovitis. Multiple erosions in the hand and wrist were seen in four RA patients, with low signal intensity on T1-weighted images. CONCLUSION: RA was correctly evaluated, and early RA could be identified with the compact MRI system. However, the current system has limitations, such as the nonselective STIR sequence used and magnetic field inhomogeneity.     

The role of the medial olivocochlear system in the complaints of understanding speech in noisy environments by individuals with normal hearing

Objective

The aim of our study is to investigate the relationship between the complaint of speech understanding in noisy environments and the findings of contralateral suppression of transient evoked otoacoustic emissions and speech recognition in noise test methods in individuals with normal hearing.

Methods

Sixty-nine subjects between 18 and 53 years of age with normal hearing participated in the present study. The subjects were assigned to one of two groups, reported difficulty understanding speech in noise or no reported difficulty understanding speech in noise. After hearing and immitancemetric evaluation, contralateral suppression of transient evoked otoacoustic emissions and speech recognition in noise tests were administered to both groups. Suppression was calculated in half-octave frequency bands centered at 1.0, 1.5, 2.0, 3.0 and 4.0 kHz.

Results

We found out that the speech recognition in noise scores and contralateral suppression values were lower in subjects with the complaint of speech understanding in noise than those who do not have such complaints.

Conclusions

We concluded that the complaint of speech understanding in noise may be related to the medial efferent system dysfunction, so central auditory nervous system.     

Use of the iPhone for radiographic evaluation of hallux valgus

Objective

The purpose of this study was to compare the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients.

Materials and methods

Two observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison. The difference between computerized measurements and all iPhone measurements, and the difference between the first and second iPhone measurements for each observer were calculated. Inter- and intraobserver reliability of the smartphone measurement method was also tested.

Results

The variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA, and DMAA. The maximum mean difference between the two techniques was 1.25?±?1.02° for HVA, 0.92?±?0.92° for IMA, and 1.10?±?0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA, and DMAA. The maximum mean difference between observers was 1.31?±?0.89° for HVA, 0.90?±?0.92° for IMA, and 0.78?±?0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA, and DMAA.

Conclusions

We conclude that the Hallux Angles software for the iPhone can be used for measurement of hallux valgus angles in clinical practice and even for research purposes. It is an accurate and reproducible method.