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Mustafa Calik,1 Dilek Sen Dokumaci,2 Suna Sarikaya,3 Mahmut Demir,4 Ilhan Isik,5 Halil Kazanasmaz,4 Cemil Kaya,4 Hasan Kandemir6 1Department of Pediatric Neurology, 2Department of Radiology, 3Department of Neurology, 4Department of Pediatrics, Harran University School of Medicine, 5Department of Pediatric Neurology, Eyyubiye Training and Research Hospital, 6Department of Child and Adolescent Psychiatry, Harran University School of Medicine, Sanliurfa, Turkey Abstract: Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS). Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05). Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells. Keywords: brain metabolite, children, breath holding, magnetic resonance spectroscopy

Objectives: To investigate the effects of adding interactive videogames to conventional rehabilitation programmes on radiological progression and upper extremity functional status., Patients and Methods: A total of 18 patients with hemiplegic stroke were randomized into two groups as conventional rehabilitation (control) group ( n  = 9), and the conventional rehabilitation + interactive videogames (intervention) group ( n  = 9). Each group received a 4-week program (5 days/week). Radiological progression (diffuse tensor imaging), and upper extremity functional status (upper extremity motor functioning part of the Fugl Meyer Assessment, self-care part of the Functional Independence Measure (FIM), and Motor Activity Log) were assessed at baseline and 4-week later., Results: While no changes were detected in radiological status in the intervention group ( p  > 0.05), some regions on the affected side were improved significantly in the control group ( p  < 0.05). Total upper extremity motor functioning part of the Fugl Meyer Assessment scores and the self-care part of the FIM scores significantly improved in both groups ( p  < 0.05). No differences were detected in the amount of changes between groups ( p  > 0.05)., Conclusion: According to our results, adding videogames to a conventional rehabilitation program does not seem enhancing the radiological progression or the functional status of the upper extremities.

Objective: This preliminary study aimed to evaluate whether there are changes in the apparent diffusion coefficient (ADC) values of the brain in patients presenting with Eisenmenger syndrome (ES)., Methods: This cross-sectional study included 10 consecutively recruited patients with ES and 10 healthy control subjects. In the patients and controls, eight distinct neuroanatomical locations were selected for analysis. Quantitative measurements of ADC values of the frontal white matter (FWM), occipital white matter, lentiform nucleus (LN), thalamus, frontal cortex, anterior and posterior limbs of the internal capsule and caudate nucleus were measured. Statistical analysis was performed using SPSS ® (IBM Corp., New York, NY; formerly SPSS Inc., Chicago, IL) for Windows v. 20. Data were presented as mean ± standard deviation values. The Kruskal-Wallis test was used to assess differences in the ADC values of each brain location between the ES group and the control group. Statistical significance was accepted at the level of p < 0.05., Results: The ADC values of the FWM and LN were significantly higher in the ES group than that in the control group. The mean ADC levels of other brain regions were not significantly different between the groups., Conclusion: Chronic hypoxia in patients with ES may lead to diffusion changes in the brain tissue. There is a need for further studies to assess the clinical significance of cerebral ADC values in patients with ES. Advances in knowledge: The ratio of extracellular volume to intracellular volume in the FWM and LN can be considered to be increased in patients with ES.

Objective: The aim of this study was to compare the therapeutic efficacy of high-power pain threshold (HPPT) ultrasound therapy applied to the trigger points and dry needling (DN) in myofascial pain syndrome., Design: Sixty-one patients were randomly assigned to an HPPT (n = 30) and dry needling (n = 31) groups. The primary outcome measures were the Visual Analog Scale (VAS) and Neck Pain and Disability Scale (NPDS), both at 1 week and 4 weeks after treatment. The secondary outcome measures were the number of painful trigger points, range of the tragus-acromioclavicular joint, the Short Form-36, the Beck Depression Inventory, the Beck Anxiety Inventory, and sonoelastographic tests after a 1-week treatment., Results: More improvement was seen in anxiety in the HPPT group (P < 0.05). However, no significant differences were found between the groups with regard to other parameters (P > 0.05). A decrease in tissue stiffness was only seen in the HPPT group (P < 0.05). Significant posttreatment improvements were seen on all clinical scales in both groups (P < 0.05). After a treatment period of 4 weeks, a significant improvement was also observed on the visual analog scale and NPDS (P < 0.05)., Conclusions: Our study favors the efficacy of both treatment methods in myofascial pain syndrome. Although a significant decrease was shown in tissue stiffness with HPPT, neither of these treatments had an apparent superiority.

Purpose: We aimed to determine the prevalence of paratracheal air cysts (PTACs) and the relationship of PTACs with emphysema and bronchiectasis through retrospective analysis of multidetector computed tomography (MDCT) findings., Methods: MDCT findings of 1027 consecutive patients who underwent routine thorax examination between January 2012 and January 2013 were evaluated retrospectively for the presence of PTACs. Localization of the PTACs, as well as their size, shape, and relationship with the trachea were examined. Presence of emphysema and bronchiectasis was recorded, and bronchiectasis severity index was calculated when present. We randomly selected 80 patients who had no visible PTACs as the control group. The findings of patients with and without PTACs were compared., Results: PTACs were determined in 82 of 1027 patients (8%), in 8.8% of females and 7.3% of males. The presence of PTACs was determined to be independent of gender (P = 0.361). Eighty-one PTACs (98.8%) were located in the right side of the trachea and 56.1% had a tracheal connection. The presence of PTACs significantly correlated with the presence and severity of bronchiectasis (P = 0.001 and P = 0.005 respectively). There was no significant relationship between the presence of PTACs and the presence of emphysema on CT images (P = 0.125)., Conclusion: The prevalence of PTACs was determined as 8% in this study. There was significant association between PTACs and bronchiectasis.

Purpose: The aim of this study is to evaluate the elasticity index of thyroid nodules by sonoelastographic imaging, and to determine the cut-off value to distinguish malignant nodules from benign nodules with optimum sensitivity and specificity., Materials and Methods: Fine needle aspiration biopsy (FNAB) of 84 cases were evaluated with B-mode US and Sonoelastography (USE) preoperatively. The elasticity score (ELX 2/1) index of the nodules were calculated. Seventy-three patients with diagnostic biopsy results were included in this study., Results: According to the FNAB results, 9 (12 %) nodules were malignant, 64 (88 %) nodules were benign. All malignant nodules were papillary carcinoma, and their diagnosis was confirmed with thyroidectomy. The ELX 2/1 index of all malignant nodules was higher than 1.65. The ELX 2/1 index of 45 (70.3 %) benign nodules was lower than 1.65 whereas the ELX 2/1 index of 19 (29.7 %) benign nodules was higher than 1.65. Using an ELX 2/1 index cut-off value of 1.65 led to a sensitivity of 100 % and a specificity of 71 % in detecting papillary thyroid carcinomas., Conclusions: Assessing the ELX 2/1 index as a screening test and deciding on FNAB accordingly, in addition to gray-scale ultrasound findings of the nodules, will be beneficial in order to prevent unnecessary biopsies.