The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor.

PURPOSE: The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors. METHODS: The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT. RESULTS: Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results. CONCLUSION: Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning.

Specific early signs and long-term follow-up findings of progressive pseudorheumatoid dysplasia (PPRD) in the Turkish cohort.

OBJECTIVES: Progressive pseudorheumatoid dysplasia (PPRD) is a spondyloepiphyseal dysplasia caused by biallelic variants in CCN6. This study aimed to describe the early signs and follow-up findings in 44 Turkish PPRD patients. METHODS: The patients with progressive stiffness of multiple joints, characteristic wide metaphysis of interphalangeal (IP) joints and platyspondyly were clinically diagnosed with PPRD. Fifteen patients who had first symptoms under 3 years of age were grouped as early-onset, while others were grouped as classical. CCN6 sequencing was performed in 43 patients. RESULTS: Thirteen pathogenic/likely pathogenic variants were identified, five were novel. c.156C>A(p.Cys52*) variant was found in 53.3% of the families. The initial symptom in the early-onset group was genu varum deformity, while it was widening of IP joints in the classical group. The median age of onset of symptoms and of diagnosis was 4 and 9.7 years, respectively. The mean follow-up duration was 5.6 years. The median age of onset of IP, elbow, knee and hip stiffness, which became progressive with growth was 5, 9, 9 and 12.2 years, respectively. Waddling gait occurred in 97.7% of the patients. A total of 47.7% lost independent walking ability at the median age of 12 years. In the early-onset group, waddling gait occurred earlier than in classical group (P < 0.001). Two patients had atypical presentation with late-onset and mild or lack of IP involvement. CONCLUSION: We observed that genu varum deformity before the age of 3 years was an early sign for PPRD and almost half of the patients lost walking ability at the median age of 12 years.

Cementless total hip arthroplasty for severely dislocated hips previously treated with Schanz osteotomy of the proximal femur.

INTRODUCTION: We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). MATERIALS AND METHODS: Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. RESULTS: The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). CONCLUSION: THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.

Comparative Results of External Fixation, Plating, or Nonoperative Management for Diaphyseal Clavicle Fractures.

OBJECTIVE: The aim of this study was to compare the treatment outcomes of mid-diaphyseal clavicular fractures between an external fixator and more widely selected treatment options such as plate osteosynthesis or conservative methods. MATERIALS AND METHODS: The medical records of 64 patients who were treated for mid-diaphyseal clavicular fracture in our clinic from 2009 to 2013 were reviewed. The inclusion criterion was mid-diaphyseal closed clavicular fractures with shortening of more than 2 cm. The Constant and DASH (disabilities of the arm, shoulder, and hand) scores at the final follow-up, initial displacement, nonunion, and complication rates were compared. Statistical differences between groups were assessed with the Kruskal-Wallis test, and pairwise comparison analysis was used to evaluate the differences within the groups. RESULTS: Of the 64 patients, 24 (37.5%) were treated with plate osteosynthesis (group 1), 11 (17.2%) with an external fixator (group 2), and 29 (45.3%) conservatively with a figure-of-eight bandage (group 3). The mean follow-up periods were as follows: group 1: 37 ± 10.4 months, group 2: 33 ± 7 months, and group 3: 35 ± 9.4 months. The initial amount of displacement and DASH score were: group 1: 89.1 ± 7.8, group 2: 89.1 ± 7.8, and group 3: 6.1 ± 6.6) (p = 0.079). The Constant score of group 2 (93 ± 6.1) was significantly higher than that of group 3 (85 ± 8.4) (p = 0.013). No statistical difference was found in the distribution of nonunions (p = 0.387). However, in group 3, the number of malunions (11/29, 37.9%) was significantly higher compared to the other 2 groups (group 1: 1/24, 4.2%; group 2: 2/11, 18.2%) (p = 0.006). CONCLUSIONS: This study revealed that the treatment of acute clavicular fractures with an external fixator was a good alternative to plate osteosynthesis or conservative treatment.

Polypeptide Functional Surface for the Aptamer Immobilization: Electrochemical Cocaine Biosensing.

Electroanalytical technologies as a beneficial subject of modern analytical chemistry can play an important role for abused drug analysis which is crucial for both legal and social respects. This article reports a novel aptamer-based biosensing procedure for cocaine analysis by combining the advantages of aptamers as selective recognition elements with the well-known advantages of biosensor systems such as the possibility of miniaturization and automation, easy fabrication and modification, low cost, and sensitivity. In order to construct the aptasensor platform, first, polythiophene bearing polyalanine homopeptide side chains (PT-Pala) was electrochemically coated onto the surface of an electrode and then cocaine aptamer was attached to the polymer via covalent conjugation chemistry. The stepwise modification of the surface was confirmed by electrochemical characterization. The designed biosensing system was applied for the detection of cocaine and its metabolite, benzoylecgonine (BE), which exhibited a linear correlation in the range from 2.5 up to 10 nM and 0.5 up to 50 µM for cocaine and BE, respectively. In order to expand its practical application, the proposed method was successfully tested for the analysis of synthetic biological fluids.

Poly(methacrylic acid)-Coated Gold Nanoparticles: Functional Platforms for Theranostic Applications.

The integration of drugs with nanomaterials have received significant interest in the efficient drug delivery systems. Conventional treatments with therapeutically active drugs may cause undesired side effects and, thus, novel strategies to perform these treatments with a combinatorial approach of therapeutic modalities are required. In this study, polymethacrylic acid coated gold nanoparticles (AuNP-PMAA), which were synthesized with reversible addition-fragmentation chain transfer (RAFT) polymerization, were combined with doxorubicin (DOX) as a model anticancer drug by creating a pH-sensitive hydrazone linkage in the presence of cysteine (Cys) and a cross-linker. Drug-AuNP conjugates were characterized via spectrofluorimetry, dynamic light scattering and zeta potential measurements as well as X-ray photoelectron spectroscopy. The particle size of AuNP-PMAA and AuNP-PMAA-Cys-DOX conjugate were calculated as found as 104 and 147 nm, respectively. Further experiments with different pH conditions (pH 5.3 and 7.4) also showed that AuNP-PMAA-Cys-DOX conjugate could release the DOX in a pH-sensitive way. Finally, cell culture applications with human cervix adenocarcinoma cell line (HeLa cells) demonstrated effective therapeutic impact of the final conjugate for both chemotherapy and radiation therapy by comparing free DOX and AuNP-PMAA independently. Moreover, cell imaging study was also an evidence that AuNP-PMAA-Cys-DOX could be a beneficial candidate as a diagnostic agent.

Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating.

INTRODUCTION: The aim of this study was to compare the radiological and functional results of two different methods of fixation for the correction of femoral valgus deformities. METHODS: Patients who had undergone osteotomy and correction of a valgus deformity from 2007 to 2013 were prospectively followed. Thirty three patients (20 females, 13 males) with 39 lower limbs were included in the study. Seventeen lower limbs were treated with retrograde intramedullary nailing (IMN) and 22 with less invasive stabilization system plating. Standing orthoroentgenograms of the lower limbs were taken pre-operatively and at the final follow-up. mLDFA, aLDFA, mechanical axis deviation (MAD) were measured in this orthoroentgenograms. Knee osteoarthritis outcome score (KOOS) and knee range of motion were used pre-operatively and at the final follow-up as part of the evaluation of the clinical results. All patients duration of surgery, length of hospital stay were assessed. Operations were performed by two orthopedic surgeons. The choice of correction method for each patient was determined by the surgeon. Pre-operative and post-operative values were simultaneously measured by two additional orthopedic surgeons. RESULTS: The mean age of the patients was 26.2 years (18.0-51.0) in the plating group and 29.3 years (18.0-55.0) in the nailing group. Patients in the plating and nailing groups were followed up for 24.0 (12.0-60.0) and 27.8 (12.0-60.0) months. All patients were followed for a minimum of 12 months. No significant differences were observed between the groups in terms of age, sex, or duration of follow-up (p > 0.05) Comparison of the pre- and post-operative mLDFA, aLDFA, MAD, length of hospital stay, and duration of surgery between the plating group and nailing group, no significant difference was observed between the groups (p > 0.05). However, patients treated with retrograde IMN had significantly better post-operative results in terms of the KOOS and range of motion of the knee according to plating group (p < 0.05). CONCLUSION: Retrograde IMN does not provide a radiological advantage over the LISS plating technique for valgus deformity but retrograde IMN and correction offered better functional results in cases of femoral valgus deformity than did the LISS plating method.

What Would be the Difference Between Operative Treatment of Patients with Tibia Fractures out of Working Hours; Intramedullary Nailing for Tibial Shaft Fractures.

Objectives: Performing orthopedic surgery in and out of working hours may affect the success of the surgery. Timing of surgery in tibial shaft fractures is controversial. In this study, the effect of the timing of surgery on the success and complications of intramedullary nailing of tibial fractures is examined. Methods: Archieves of patients with tibial shaft fractures treated with reamed intramedullary nails between 2010 and 2016 were retrospectively analyzed. Fifty-seven patients were included in the study. Patients were categorized by the time of the surgery. Day time (Group I) is between 7:00 am and 5:00 pm and after hour (Group II) is between 5:00 pm and 07:00 am. Group I (n: 40) and Group II (n: 17) were evaluated. Technical errors, surgery time, and length of hospital stay statistical analysis was performed between the two groups in terms of technical errors, complication rates, length of hospital stay, and duration of surgery. Results: The mean duration of operation (p=0.419), number of distal screws (p=0.847), time to union (p=0.454), experience of the surgeon (p=0.192), and technical error rate (p=0.654) did not differ significantly between two groups. Length of hospital stay and time to surgery from emergency were significantly higher in day time group. Conclusion: Technical errors and surgery time of intramedullary nailing of tibial shaft fractures are not higher at after hour before midnight than day time. Non-urgent tibial shaft fractures might be treated with intramedullary nailing at after hours before midnight for efficient use of hospitals.

Phenotypic and Molecular Spectrum of a Turkish Cohort with Hereditary Multiple Osteochondromas.

OBJECTIVE: Hereditary multiple osteochondromas is an autosomal dominant disorder caused by heterozygous pathogenic variants in EXT1 or EXT2. We aimed to evaluate the clinical and molecular findings of a Turkish cohort with hereditary multiple osteochondroma. MATERIALS AND METHODS: Thirty-two patients aged 1.3-49.6 years from 22 families were enrolled. Genetic analyses were made by EXT1 and/or EXT2 sequencing and chromosomal microarray analyses. RESULTS: We found 17 intragenic pathogenic variants in EXT1 (13/17) and EXT2 (4/17), 12 of which are novel. Four probands had EXT1 deletions, including 2 patients with partial EXT1 microdeletions involving exons 2-11 and 5-11, and 2 patients with whole-gene deletions. In 21 variants, the frequency of truncating and missense variants was 76.1% and 23.8%, respectively. Two families had no detectable variants in EXT1 and EXT2. All patients had multiple osteochondromas at the long bones, mainly at the tibia, forearm, femur, and humerus. Bowing deformity of the forearms (9/32) and the lower extremities (2/32), and scoliosis (6/32) were observed. The clinical severity was not different between patients with EXT1 or EXT2 variants. One patient with an EXT2 variant and another with an EXT1 microdeletion had the most severe phenotype with class III disease. Four patients with no EXT1 or EXT2 variants had milder phenotypes. Intrafamilial variability in disease severity was not observed. CONCLUSION: We report a hereditary multiple osteochondroma cohort with clinical and molecular data including 12 novel intragenic variants in EXT1 or EXT2, and 4 microdeletions involving EXT1. Taken together, our data expand the existing knowledge of the phenotype-genotype spectrum in hereditary multiple osteochondroma.

A case report of Wernicke Korsakoff syndrome in a patient with cholangiocellular carcinoma: An underestimated cause of encephalopathy in cancer patients.

INTRODUCTION: Wernicke's encephalopathy, a disorder caused by thiamin deficiency, is characterized by a classical triad of encephalopathy, ataxia, and ophthalmoplegia. Although alcoholism is the most common predisposing factor, it can also be associated with nonalcoholic states (hyperemesis gravidarum, intestinal obstruction, bariatric surgery, and others). This work presents a case of nonalcoholic Wernicke-Korsakoff syndrome diagnosed in a cholangiocellular carcinoma patient and literature review. CASE REPORT: A 65-year-old male patient with a history of cholangiocellular carcinoma (Klatskin tumor) was treated with radiotherapy at the operation site after Roux-en-Y hepaticojejunostomy. During follow-up, the patient developed gastric outlet obstruction and was diagnosed with peritoneal carcinomatosis after a palliative gastrojejunostomy. As the patient could not tolerate oral nutrition during hospitalization, total parenteral nutrition was administered. After 10 days of admission, the patient showed decreased response to verbal stimuli as well as bilateral horizontal nystagmus, lethargy, and disorientation. Furthermore, the patient displayed confabulation. Clinical and imaging findings were consistent with Wernicke's encephalopathy. Therefore, treatment with intravenous thiamin replacement was initiated. The patient's encephalopathy regressed on the second day after treatment, and he recovered the place-person-time orientation. In the following month, the abnormal imaging findings were almost entirely resolved. CONCLUSION: In order to prevent irreversible brain damage induced by chronic thiamin deficiency, thiamin replacement therapy with parenteral nutrition solutions should be included as a treatment for hospitalized cancer patients unable to receive enteral nutrition for a long time.

Innovative transdermal delivery of insulin using gelatin methacrylate-based microneedle patches in mice and mini-pigs.

Painless and controlled on-demand drug delivery is the ultimate goal for the management of various chronic diseases, including diabetes. To achieve this purpose, microneedle patches are gaining increased attention. While degradable microneedle (MN) arrays are widely employed, the use of non-dissolving MN patches remains a challenge to overcome. In this study, we demonstrate that crosslinking gelatin methacrylate with polyethylene glycol diacrylate (PEGDA) is potent for engineering non-dissolving MN arrays. Incorporation of MoS2 nanosheets as a photothermal component into MN hydrogels results in MNs featuring on-demand release properties. An optimized MoS2-MN array patch formed using a hydrogel solution containing 500 µg mL-1 of MoS2 and photochemically crosslinked for 5 min shows required mechanical behavior under a normal compressive load to penetrate the stratum corneum of mice or pig skin and allows the delivery of macromolecular therapeutics such as insulin upon swelling. Using ex vivo and in vivo models, we show that the MoS2-MN patches can be used for loading and releasing insulin for therapeutic purposes. Indeed, transdermal administration of insulin loaded into MoS2-MN patches reduces blood glucose levels in C57BL/6 mice and mini-pigs comparably to subcutaneously injected insulin. We believe that this on-demand delivery system might alter the current insulin therapies and might be a potential approach for delivery of other proteins.

Photothermal Activatable Mucoadhesive Fiber Mats for On-Demand Delivery of Insulin via Buccal and Corneal Mucosa.

Electrospun fiber mats loaded with therapeutics have gained considerable attention as a versatile tool in the biomedical field. While these bandages are largely based on fast-dissolving polymers to release the cargo, stimuli-responsive fiber mats have the advantages of providing a timely and spatially controlled drug delivery platform, which can be refilled and reused several times. These benefits make electrospun fiber patches original platforms for painless and convenient on-demand hormone release. Because of the high need of more convenient and non-invasive methods for delivering insulin, a hormone that is currently used to treat hundred million people with diabetes worldwide, we have investigated the tremendous potential of reduced graphene oxide modified poly(acrylic acid) based fiber mats as an original platform for buccal and corneal insulin delivery on-demand. The PAA@rGO hydrogel-like fibers rendered water-insoluble by incorporating ß-cyclodextrin, followed by thermal cross-linking, which showed adequate tensile strength along with high adsorption capacity of insulin at pH 7 and good recyclability. The fiber mats maintained good fibrous morphology and high loading efficiency even after five loading-release cycles. The mucoadhesive nature of the fibers allowed their application for insulin delivery via the eye cornea and the buccal mouth lining, as evidenced in ex vivo studies. Insulin loaded PAA@rGO hydrogel-like fibers showed an insulin flux via buccal lining of pigs of 16.6 ± 2.9 µg cm-2 h-1 and 24.3 ± 3.1 µg cm-2 h-1 for porcine cornea. Testing on healthy adult volunteers confirmed the excellent, mucoadhesive nature of the bandage, with three out of six volunteers feeling completely comfortable (note 8.3) while wearing the patches in the buccal cavity.

Single-stage treatment of complete dislocation of radial head and forearm deformity using distraction osteogenesis in paediatric patients having multiple cartilaginous exostosis.

BACKGROUND: We are reporting the results of single-stage treatment for patients with forearm deformity and radial head luxation due to hereditary multiple exostosis using distraction osteogenesis. METHOD: Six patients with a mean age of 12 years were treated. Morphological evaluation was made according to Masada (3 of the cases were 2a and 3; 2b). Angular deformities of forearm and wrist were evaluated as described by Fogel (distal radial joint angle was 27°, ulnar variance was 12.8 mm and carpal slip was 71.3%). Mean forearm pronation was 48.4° whilst mean supination was 19.2°. Mean elbow range of motion was 26.6°-103.4° and the mean DASH score was 75. Common surgical procedures were deformity correction, ulnar lengthening and gradual radial head reduction using external fixators. RESULTS: Mean follow-up period was 4.2 years and mean external fixation time was 6 months. Mean amount of ulnar lengthening was 2.9 cm and the distraction index was 14.9 cm/day. Mean radial articular angle was 14.3°, ulnar variance 2.3 mm, carpal slip 55%, forearm pronation 65.9° and supination was 55°. Mean elbow range of motion was 15.8°-119.2°. In the last follow-up, the mean value of DASH score was 8.1. Major and minor complications were seen during the follow ups. CONCLUSIONS: Single-stage deformity correction, ulnar lengthening and radial head reduction technique that we have used provide satisfactory functional and cosmetic results. Early surgical correction may lead to even better results.

Shortening and secondary relengthening for chronically infected tibial pseudarthroses with poor soft tissues.

BACKGROUND: The treatment of chronically infected tibial pseudarthroses with poor soft tissues ends with amputation on many occasions. Aggressive débridement of bone and soft tissue and reconstruction of the extremity, performed as a limb salvage procedure, is an alternative treatment option to amputation. METHODS: Our patients had a mean age of 42 years. According to the Paley classification, one of the patients had A2 pseudoarthrosis, four had B2, and three had B3. One had localized infection, whereas the other seven had diffuse infection, according to the Cierny-Mader system. The mean duration of the infection was 10.75 years, and the mean number of previous operations was 5.13. The mean shortness was 2.4 cm, and the mean bone defect was 1 cm. RESULTS: The mean primary shortening was 8.6 cm, the mean duration of the fixator stay was 9.6 months, and the mean distraction index was 39.1 days/cm. The mean duration of follow-up was 25 months. The bone results were excellent in four cases, good in two, and fair in the other two. The functional results were excellent in one patient, good in six, and fair in one. A total of 11 minor and 3 major complications were seen during the treatment, and one case resulted in amputation. CONCLUSIONS: Despite the high rate of complications, our treatment method enabled limb salvage for patients who had previously been candidates for amputation. With this treatment, there is less need for a second operation, and an additional operation is not necessary for soft tissue coverage.

A Modification of Internal Bone Transport Method for Reconstruction of Nonunion of Forearm.

BACKGROUND: Defects of bone and soft tissue occur frequently after high-energy trauma, infections, and tumor resection. Treatment options are limited and outcomes are controversial in nonunion. Classical reconstruction methods are challenging. We describe a method of internal bone transport for treatment of complicated nonunion of the forearm. This method permits axial and internal bone transport without harming the distorted and complex neurovascular anatomy or soft-tissue envelope. MATERIALS AND METHODS: Five patients (mean age, 27 years) with defect nonunion (3 ulna, 2 radius) were treated. Mean preoperative defect size was 36 mm, mean shortening was 14 (0-30) mm, and the extent of surgical resection was 24 (20-40) mm. Total bone loss due to defect, resection, or shortening was 74 mm. According to Paley classification, two of the patients had B1, and three had B3 defect nonunion. This study treats defect nonunion of the forearm using an internal bone-transport method. Our method involved cannulated screws, a cerclage wire, and a circular fixator being used in combination. When transportation was completed, internal fixation of the docking site with a plate and screws was done, with bone grafting after fixator removal. Bone healing and functional outcomes were assessed with radiographs and disabilities of the arm, shoulder, and hand (DASH) scores, respectively. RESULTS: Mean followup was 67.6 months. Solid osseous union and functional improvement were achieved in all cases. Mean bone loss was 66 mm, mean fixator time was 131.8 days, the lengthening index was 1.3 days/mm, and the fixator index was 2.1 days/mm. DASH score was 82.2 before treatment and 15.36 after treatment. CONCLUSIONS: Using our method, internal bone transport and progressive axial docking of defects can be done with minimal effects on surrounding neurovascular arrangements and soft tissues. Size of fixators can be decreased and formation of painful scar tissue can be avoided.

A modified technique of internal bone transport.

A modification of the technique of internal bone transport is presented. It decreases bone and soft tissue complications during bone transport, increases patient's comfort, the volume of the fixator is smaller and painful scarring is limited. Nine patients with a mean age of 23.9 years were treated with this technique. The aetiology was tumour, trauma or sequelae of infection. The mean bone loss was 7.2 cm in length. Transportation was achieved with a special pulley system. The mean follow-up time was 18.3 months. The external fixation time ranged from 5 to 13.2 months, the mean distraction index was 12.1 days/cm. The mean length of bone transport done was 6.3 cm. An excellent bone result was obtained in 4 cases, a good result in 4 cases and a fair result in one case. An excellent functional result was obtained in 2 lower extremity cases, a good result in 3 cases. Preoperative DASH scores of the upper extremity cases improved from a mean of 80.1 to a mean of 15.85. Complications were seen in 4 cases.

Correction of a major flexion deformity developed after knee arthrodesis in child age: a case report.

Septic arthritis in child age results in sequelae when treated late or inappropriately. Arthrodesis is a salvage option which is rarely performed in children because of its complications and resultant disabilities. We report the case of a 16-year-old boy who had been treated with arthrodesis of his right knee at the age of seven and subsequently developed a progressive osseous deformity, eventually resulting in a 130 degrees flexion deformity of the knee. The deformity and the resulting limb length discrepancy were corrected using the Ilizarov method. In a single stage operation, a wedge resection osteotomy at the distal femur was performed and a ring fixator was applied. The mechanical axis was corrected first by gradual closing of the wedge thus avoiding damage to the posterior neurovascular structures, followed by lengthening.

Tracking Hyaluronan: Molecularly Imprinted Polymer Coated Carbon Dots for Cancer Cell Targeting and Imaging.

War against cancer constantly requires new affinity tools to selectively detect, localize, and quantify biomarkers for diagnosis or prognosis. Herein, carbon nanodots (CDs), an emerging class of fluorescent nanomaterials, coupled with molecularly imprinted polymers (MIPs), are employed as a biocompatible optical imaging tool for probing cancer biomarkers. First, N-doped CDs were prepared by hydrothermal synthesis using starch as carbon source and l-tryptophan as nitrogen atom provider to achieve a high quantum yield of 25.1 ± 2%. The CDs have a typical size of ∼3.2 nm and produce an intense fluorescence at 450 nm upon excitation with UV light. A MIP shell for specific recognition of glucuronic acid (GlcA) was then synthesized around the CDs, using the emission of the CDs as an internal light source for photopolymerization. GlcA is a substructure (epitope) of hyaluronan, a biomarker for certain cancers. The biotargeting and bioimaging of hyaluronan on fixated human cervical cancer cells using CD core-MIP shell nanocomposites is demonstrated. Human keratinocytes were used as noncancerous reference cells and indeed, less staining was observed by the CD-MIP.

[Occult scapholunate ganglion in patients with dorsoradial wrist pain]. / Dorsoradial el bilegi agrisi olan olgularda gizli skafolunat gangliyon.

OBJECTIVES: The aim of this study was to assess the results of surgical treatment of patients who had complaints of chronic wrist pain and were diagnosed as having an occult dorsal scapholunate interosseous ganglion, despite the presence of a normal x-ray and absence of trauma. METHODS: Thirteen wrists of 12 patients (2 males, 10 females; mean age 28 years; range 21 to 41 years) were treated with surgical excision for ganglia originating from the dorsal scapholunate interosseous ligament. Involvement was on the right side in six patients, and on the left in five patients, with one patient having bilateral involvement. None of the patients had a history of trauma, except two with a history of fall. All the patients had complaints of wrist pain that occurred during work and subsided at rest. The mean duration of wrist pain was 23 months (range 6 to 60 months). All the patients received conservative treatment previously with wrist splints and non-steroidal anti-inflammatory drugs. Finger extension test was positive and magnetic resonance imaging of the wrist showed ganglion in all the patients. Functional results were evaluated by the Mayo Clinic wrist pain assessment scores after a mean follow-up of 35 months (range 25 to 49 months). RESULTS: Complaints of wrist pain improved dramatically in all the patients. Scores of the Mayo Clinic wrist pain assessment were excellent in seven patients (53.9%), good in five patients (38.5%), and moderate in one patient (7.7%). All the patients returned to work without any limitation of wrist movements. No recurrences were seen during the follow-up period. CONCLUSION: Occult ganglia originating from the scapholunate ligament should be remembered in patients with dorsal scapholunate joint tenderness and pain unresponsive to conservative treatment and with a positive finger extension test.

Is intact fibula a disadvantage in treatment of tibial diaphysis fracture with intramedullary nailing?

BACKGROUND: The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary nailing method. METHODS: Records of 254 patients diagnosed with tibial diaphysis fracture and treated with intramedullary nailing between 2010 and 2013 were examined and 30 patients were included in the study. Group 1 comprised patients with solitary tibial diaphysis fracture, and Group 2 was made up of patients with tibial diaphysis fractures associated with fibula fracture. Patients in both groups were compared in terms of time to surgery, duration of surgical tourniquet, time to union, and varus, valgus, recurvatum, and antecurvatum deformities of the tibia at final follow-up. RESULTS: No statistically significant difference was found between the 2 groups in time to surgery, duration of surgical tourniquet, time to union, or varus, valgus, recurvatum, and antecurvatum deformities. CONCLUSION: Results indicated that intact fibula in tibial diaphysis fracture treated with intramedullary nailing was not a disadvantage; it did not affect rate of union or lead to loss of reduction, non-union, or malunion.