Transfer of single dose of intravitreal injection of ranibizumab and bevacizumab into milk of sheep

AIM: To investigate whether single-dose intravitreal injections of bevacizumab and ranibizumab transfer into milk. METHODS: This study included lactating 12 sheep and a single 3-month old suckling lamb of each sheep. Two groups consisting of 6 sheep and their lambs were constituted; the ranibizumab group and the bevacizumab group before the administration of intravitreal injections, blood and milk samples were obtained from all sheep and, following the injections, blood and milk samples of all sheep and blood samples of all lambs were collected at regular time points. Serum and milk concentrations of bevacizumab and ranibizumab were measured using an enzyme-linked immunosorbent assay (ELISA) kit. The limit of determination was 0.9 ng/mL for bevacizumab and 0.62 ng/mL for ranibizumab. RESULTS: At 6h after intravitreal injections, bevacizumab concentration was above the limit of determination in the blood of all sheep. At 3wk, when the study was terminated, bevacizumab concentrations were high in 4 sheep. Even though bevacizumab concentrations in milk showed fluctuations, the drug transferred into the milk of all sheep at detectable concentrations. Ranibizumab drug concentrations in the blood and milk of sheep and those in the blood of lambs were below the limit of determination by the ELISA kit. CONCLUSION: This sheep model study demonstrate that intravitreal injection of ranibizumab, which did not transfer into the milk of sheep and suckling lambs, is safer than bevacizumab during lactation period.     

Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis

A woman aged 68 years who experienced recurrent right hemiparesis caused by hypoglycemia was admitted to our hospital. When she was experiencing a low level of glucose, diffusion-weighted MR imaging showed the presence of hyperintensity lesions in the bilateral internal capsule. Diffusion-weighted MR imaging has been infrequently performed in patients with hypoglycemia. We report the reversible hyperintensity lesions on diffusion-weighted MR imaging in a hypoglycemic period in a patient with reversible hemiparesis. A reduction of apparent diffusion coefficient in a hypoglycemic period was clearly shown.     

Ultrasound-guided injection for MR arthrography of the hip: comparison of two different techniques

Objective

The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for MR arthrography of the hip.

Materials and methods

Fifty-nine consecutive patients (21 men, 38 women) referred for MR arthrographies of the hip were prospectively included in the study. Three patients underwent bilateral MR arthrography. The two injection techniques were quantitatively and qualitatively compared. Quantitative analysis was performed by the comparison of injected contrast material volume into the hip joint. Qualitative analysis was performed with regard to extraarticular leakage of contrast material into the soft tissues. Extraarticular leakage of contrast material was graded as none, minimal, moderate, or severe according to the MR images. Each patient rated discomfort after the procedure using a visual analogue scale (VAS).

Results

The injected contrast material volume was less in femoral head puncture technique (mean 8.9?±?3.4?ml) when compared to femoral neck puncture technique (mean 11.2?±?2.9?ml) (p?<?0.05). The chi-squared test showed significantly more contrast leakage by femoral head puncture technique (p?<?0.05). Statistical analysis showed no difference between the head and neck puncture groups in terms of feeling of pain (p?=?0.744) or in the body mass index (p?=?0.658) of the patients.

Conclusion

The femoral neck injection technique provides high intraarticular contrast volume and produces less extraarticular contrast leakage than the femoral head injection technique when US guidance is used for MR arthrography of the hip.     

Head posture in cleft lip and palate patients with oronasal fistula and its relationship with craniofacial morphology.

OBJECTIVE: This study aimed to evaluate the relationship between head posture and craniofacial morphology in nonsyndromic cleft lip and palate children with oronasal fistula. PATIENTS: A total of 31 cleft lip and palate patients with a mean skeletal age of 7.59 (+/-2.11) years were involved. Fifteen had complete unilateral cleft lip and palate, 13 had complete bilateral cleft lip and palate, and three had complete cleft palate. Each of the cleft patients was matched with a noncleft Class I subject, on the basis of sex and skeletal age. DESIGN: Lateral cephalograms were taken of all subjects in the standardized upright posture and in orthoposition. Sixteen postural parameters and 44 morphological parameters were evaluated. RESULTS: The correlations with the cranio-cervical and mandibulo-cervical parameters indicated a trend of retrusion in the incisors with extention of the head. The positive nontopographical relationship between the nasolabial angle and some of the postural parameters supplemented the retrusion tendency in the upper incisors with head extension. Vertical skeletal morphological parameters correlated with the postural parameters. Cranio-cervical parameters seemed to be mostly related to mandibular position. CONCLUSION: Most of the cranio-cervical parameters measured confirmed an increased cranio-cervical angulation in the cleft sample when compared to controls. This head posture change was associated with alterations in tooth position and craniofacial morphology when comparisons were made to the control group.     

Relationship Between Skin Diseases and Extracutaneous Complications of Diabetes Mellitus: Clinical Analysis of 750 Patients

Background

The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear.

Objective

We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM.

Methods

A total of 750 patients with DM were prospectively enrolled. Demographic and clinical features, skin disorders, glycosylated hemoglobin (HbA_1c) levels, and presence of nephropathy, neuropathy, and retinopathy were noted.

Results

Of the patients, 38.0 % had neuropathy, 23.3 % had nephropathy, and 22.9 % had retinopathy. Any skin disorder was present in 79.2 % (n = 594) of patients. The most common skin manifestations were cutaneous infections (47.5 %), xerosis (26.4 %), and inflammatory skin diseases (20.7 %). The frequency of cutaneous infections, fungal infections, diabetic foot, rubeosis faciei, and pigmented purpuric dermatitis was higher in patients with nephropathy than in those without nephropathy. Cutaneous infections, diabetic foot, rubeosis faciei, and diabetic dermopathy were more common in patients with neuropathy. Fungal infections, diabetic foot, rubeosis faciei, diabetic dermopathy, and pigmented purpuric dermatitis were more frequent in patients with retinopathy. Patients with HbA_1c ≥8 mmol/mL had more skin disorders than those with HbA_1c <8 mmol/mL (P < 0.05 for all).

Conclusion

Skin disorders may be clues to the presence of associated microvascular complications of DM.     

Prevalence and risk factors for human papillomavirus DNA in cervical cytology

Objectives

This study aimed to detect the presence and prevalence of HPV-DNA in the cervical swab samples obtained from patients with cervical cancer, premalignant cervical lesions and benign cervical smear results, and to identify the potential risk factors influencing this prevalence.

Study design

Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts, existence of cervical infection and the history of circumcision of male sexual partners were recorded.

Results

Six hundred and forty-two women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Multiplex PCR testing revealed that prevalence of HPV-DNA was 38.9% in our study population. HPV-DNA was detected in 78.3% of the women with cervical cancer and 76.9% of the women with HGSIL. Abnormal cervical cytology was observed in 30% of HPV-DNA positive cases and in 5.4% of HPV-DNA negative cases. Our findings also indicate that smoking habit, number of sexual partners, history of sexually transmitted diseases, and abnormal cervical cytology were associated with HPV infection. With respect to parity, there was a decreased risk of HPV infection with the increase in the number of births.

Conclusions

Estimates of the prevalence of HPV infection vary greatly around the world, so the factors that contribute to the rare occurrence of cervical cancer after HPV infection might also differ from country to country. Information gathered from this study could be used to prioritize limited screening and treatment services given to woman who have specific characteristics that may put them at an increased risk of HPV disease.     

Association of mean platelet volume with DSM-IV major depression in a large community-based population: the MELEN study

The relationship between major depression and increased platelet activity has been previously stated by several studies. This study sought to test the relationship between mean platelet volume (MPV)--an indicator of platelet activity--and major depression, in an adult Turkish population sample. Respondents were 2286 participants interviewed in a regional survey. The diagnosis of current (one month) major depression was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. MPV was measured along with total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, BMI, and waist circumference. Two hundred eighty-nine participants (12.5%) were diagnosed as having major depression. Patients with major depression were found to have increased MPV levels in comparison with participants without depression (p = 0.001). After excluding the subjects with risk factors capable of influencing platelet activity, MPV was still found to be elevated in patients with major depression compared with non-depressed individuals (p < 0.01). Linear regression analysis revealed a significant independent association of major depression with MPV levels (r = 0.123; p = 0.001). According to the findings of this study, increased MPV (or platelet activation) is associated with current (one month) diagnosis of major depression. Future research should investigate the effect of depression treatment on MPV.     

Finite element model of the Jefferson fracture: comparison with a cadaver model

This study tries to explain the reason why the Jefferson fracture is a burst fracture, using two different biomechanical models: a finite element model (FEM) and a cadaver model used to determine strain distribution in C1 during axial static compressive loading. For the FEM model, a three-dimensional model of C1 was obtained from a 29-year-old healthy human, using axial CT scans with intervals of 1.0 mm. The mesh model was composed of 8200 four-noded isoparametric tetrahedrons and 37,400 solid elements. The material properties of the cortical bone of the vertebra were assessed according to the previous literature and were assumed to be linear isotropic and homogeneous for all elements. Axial static compressive loads were applied at between 200 and 1200 N. The strain and stress (maximum shear and von Mises) analyses were determined on the clinically relevant fracture lines of anterior and posterior arches. The results of the FEM were compared with a cadaver model. The latter comprised the C1 bone of a cadaver placed in a methylmethacrylate foam. Axial static compressive loads between 200 and 1200 N were applied by an electrohydraulic testing machine. Strain values were measured using strain gauges, which were cemented to the bone where the clinically relevant fracture lines of the anterior and posterior arches were located. As a result, compressive strain was observed on the outer surface of the anterior arch and inferior surface of the posterior arch. In addition, there was tensile strain on the inner surface of the anterior arch and superior surface of the posterior arch. The strain values obtained from the two experimental models showed similar trends. The FEM analysis revealed that maximum strain changes occurred where the maximum shear and von Mises stresses were concentrated. The changes in the C1 strain and stress values during static axial loading biomechanically prove that the Jefferson fracture is a burst fracture.