Relationship between nailfold capillaroscopy findings and the etiology and prognosis of interstitial lung disease.

OBJECTIVES: Connective tissue-associated interstitial lung diseases (CTD-ILD) are believed to be caused by microvascular damage. The objective of this study was to assess the nailfold capillaroscopy (NFC) pattern in patients diagnosed with both CTD-ILD and non-CTD-ILD to identify microvascular changes and determine the relation between capillaroscopic parameters, clinical variables, and disease-related measurements. PATIENTS AND METHODS: This cross-sectional study included 95 patients with interstitial lung disease who applied to our Rheumatology and Chest Clinics between September 2021 and July 2023. The patients were divided into two groups based on their diagnosis: non-CTD-ILD (group 1) and CTD-ILD (group 2). Nailfold capillaroscopy was performed. RESULTS: Ninety-five patients, 49 (51% female, mean age 62.31 ± 11.027 years) in group 1 and 46 (69.6% female, mean age 62.09 ± 10.887 years) in group 2, were included in the study. Abnormal capillary morphologies were both detected in the CTD-ILD group and the non-CTD-ILD groups. In patients with a usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT), tortuosity was higher than in patients with non-specific interstitial pneumonia (NSIP) (P = 0.041), and the proportion of tortuosity increased significantly as the duration of the disease increased (P = 0.016). CONCLUSION: Our study highlights capillaroscopic abnormalities alone may not be sufficient to differentiate CTD-ILD (other than systemic sclerosis) from non-CTD-ILD. The presence of NFC abnormalities in non-CTD-ILD may suggest that fibrotic lung disease could potentially play a role in the deterioration of the microvascular structure or abnormal angiogenesis. Our study demonstrated that a multidisciplinary approach, incorporating clinical, morphological, pathological, and serological evaluations, is necessary for interpreting ILD. Key Points • Capillaroscopic abnormalities can also be seen in non-CTD-ILD. • Capillaroscopy findings do not distinguish the non-Ssc etiology of ILD. • Nailfold capillaroscopy may have the potential to serve as a useful tool in predicting prognosis and monitoring the disease progression in patients with idiopathic pulmonary fibrosis (IPF).

The efficacy of vitamin E in preventing arthrofibrosis after joint replacement.

BACKGROUND: Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues. Vitamin E is an antioxidant with potential anti-fibroblastic effect. The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis. METHODS: We simulated knee replacement in 16 male Sprague-Dawley rats. We immobilized the surgical leg with a suture in full flexion. The control groups were killed at 2 and 12 weeks (n = 5 per group), and the test group was supplemented daily with vitamin E (0.2 mg/mL) in their drinking water for 12 weeks (n = 6). We performed histological staining to investigate the presence and severity of arthrofibrosis. Immunofluorescent staining and α2-macroglobulin (α2M) enzyme-linked immunosorbent assay (ELISA) were used to assess local and systemic inflammation. Static weight bearing (total internal reflection) and range of motion (ROM) were collected for functional assessment. RESULTS: The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups. Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue. Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels. The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group. CONCLUSIONS: This model is viable for simulating arthrofibrosis after joint replacement. Vitamin E may benefit postsurgical arthrofibrosis, and further studies are needed for dosing requirements.

Di-cumyl peroxide cross-linked UHMWPE/vitamin-E blend for total joint arthroplasty implants.

Majority of ultrahigh molecular weight polyethylene (UHMWPE) medical devices used in total joint arthroplasty are cross-linked using gamma radiation to improve wear resistance. Alternative methods of cross-linking are urgently needed to replace gamma radiation due to rapid decline in its supply. Peroxide cross-linking is a candidate method with widespread industrial applications. Oxidative stability and biocompatibility, which are critical requirements for medical device applications, can be achieved using vitamin-E as an additive and by removing peroxide by-products through high-temperature melting, respectively. We investigated compression molded UHMWPE/vitamin-E/di-cumyl peroxide blends followed by high-temperature melting in inert gas as a material candidate for tibial knee inserts. Wear resistance increased and mechanical properties remained largely unchanged. Oxidation induction time was higher than most of the other clinically available formulations. The material passed the local-end point biocompatibility tests per ISO 10993. Compounds found in exhaustive extraction were of no concern with margin-of-safety values well above the accepted level, indicating a desirable toxicological risk profile. Statement of Clinical Significance: Peroxide cross-linked, vitamin-E stabilized, and high-temperature melted UHMWPE has recently been cleared for clinical use in tibial knee inserts. With all the salient characteristics needed in a material that can provide superior long-term performance in total joint patients, peroxide cross-linking can replace the gamma radiation cross-linking of UHMWPE.

Hydrogel device for analgesic drugs with in-situ loading and polymerization.

The high prevalence of opioid addiction and the shortcomings of systemic opioids has increased the pace of the search for alternative methods of pain management. The local delivery of pain medications has started to be used as a tool for pain management and to decrease the use of systemic opioids for these patients. Here, we explored an in-situ polymerizable hydrogel system for the local delivery of analgesics and nonsteroid anti-inflammatory drugs (NSAID) for orthopaedic applications. We synthesized a series of methacrylated oligomeric polyethylene glycol-co-lactic acid polymer using microwave radiation for the delivery of bupivacaine hydrochloride as an analgesic and ketorolac tromethamine as an NSAID. We determined drug elution and gel degradation profiles in vitro. Biocompatibility was assessed against osteoblasts in vitro and by histological analysis after subcutaneous implantation for 4 weeks in vivo. Intra-articular and systemic concentrations and pharmacokinetic parameters were estimated using a two-compartment pharmacodynamic model based on in-vitro elution profiles. This type of in-situ applicable hydrogels is promising for extending the local efficacy of pain medication and further reducing the need for opioids.

Clinical trait-specific genetic analysis in Behçet's disease identifies novel loci associated with ocular and neurological involvement.

Behçet's disease is a complex inflammatory vasculitis with a broad spectrum of clinical manifestations. The purpose of this study was to investigate the genetics underlying specific clinical features of Behçet's disease. A total of 436 patients with Behçet's disease from Turkey were studied. Genotyping was performed using the Infinium ImmunoArray-24 BeadChip. After imputation and quality control measures, logistic regressions adjusting for sex and the first five principal components were performed for each clinical trait using a case-case genetic analysis approach. A weighted genetic risk score was calculated for each clinical feature. Genetic association analyses of previously identified susceptibility loci in Behçet's disease revealed a genetic association between ocular lesions and HLA-B/MICA (rs116799036: OR = 1.85 [95% CI = 1.35-2.52], p-value = 1.1 × 10-4). The genetic risk score was significantly higher in Behçet's disease patients with ocular lesions compared to those without ocular involvement, which is explained by the genetic variation in the HLA region. New genetic loci predisposing to specific clinical features in Behçet's disease were suggested when genome-wide variants were evaluated. The most significant associations were observed in ocular involvement with SLCO4A1 (rs6062789: OR = 0.41 [95% CI = 0.30-0.58], p-value = 1.92 × 10-7), and neurological involvement with DDX60L (rs62334264: OR = 4.12 [95% CI 2.34 to 7.24], p-value = 8.85 × 10-7). Our results emphasize the role of genetic factors in predisposing to specific clinical manifestations in Behçet's disease, and might shed additional light into disease heterogeneity, pathogenesis, and variability of Behçet's disease presentation across populations.

Microvascular damage evaluation based on nailfold videocapillarosopy in sarcoidosis.

OBJECTIVES: Microvascular damage is thought to play a role in the pathogenesis of sarcoidosis. We aimed to evaluate the nailfold capillaroscopy (NVC) pattern to detect microvascular changes in patients with sarcoidosis and the relationship of capillaroscopic parameters with clinical variables and disease-related measurements. PATIENTS AND METHODS: Forty-two patients with sarcoidosis and 42 age- and sex-matched patients with systemic sclerosis (SSc) and healthy individuals were included in this cross-sectional case-control study. Patients aged 18-80 years who met the current American Thoracic Society criteria for sarcoidosis were included. NVC was performed by a digital microscope under a magnification of × 200. Capillary density, number of dilated, giant and neoangiogenic capillaries, capillary loop diameter, capillary shape, micro-hemorrhages, and number of avascular areas, were evaluated by an assessor who was blind to the groups allocation. RESULTS: Among the capillaroscopic parameters, neoangiogenesis and dilated capillaries, which can be seen in the pattern of scleroderma, were detected in patients with sarcoidosis but not significantly different from the control group (p = 0.055; p = 0.433, respectively). The rate of tortuosity and crossing capillaries of 50% and above was significantly higher in the sarcoidosis group than in SSc and healthy controls (p < 0.05). In patients with sarcoidosis, the only statistically significant finding was; forced expiratory volume (FEV1) in one second was lower in patients with a crossed capillary rate > 50% than in patients with a crossed capillary rate of less than 50% (FEV1; 87.21 ± 19.3, 102.5 ± 14.8, p = 0.04; respectively). CONCLUSION: Patients with a diagnosis of sarcoidosis have different capillaroscopic patterns. The presence of these nonspecific abnormal patterns may reflect microvascular damage in the pathophysiology of sarcoidosis. Key Points • Microvascular damage may play a role in the pathogenesis of sarcoidosis. • There may be some nonspecific abnormal findings in capillaroscopy findings in sarcoidosis. • Capillaroscopy may be valuable in reflecting sarcoidosis lung injury.

The Co-Use of Stromal Vascular Fraction and Bone Marrow Concentrate for Tendon Healing.

OBJECTIVE: The Achilles tendon is the most frequently injured tendon in the human body, despite being the strongest. Many conventional treatments including medication, surgical interventions, and physical therapy are available, however, the desired results are often not achieved. Stromal vascular fraction (SVF) and bone marrow concentrate (BMC) are two additional cellular treatment options. The purpose of this study is to evaluate the effect of SVF and BMC, used as a combination, for the treatment of Achilles tendon injuries. METHODS: Five male New Zealand rabbits were used for each of the 6 study groups. A 3-mm of SVF and BMC were injected on the Achilles tendons at certain ratios. The histological results were classified by the Movin grading system for tendon healing. The collagen type-I and type-III structures in the tendons were examined by immunohistochemical evaluation. The expressions of tendon-specific genes were also examined by using the RT-PCR method to analyze tendon healing. RESULTS: Histological and immunohistochemical evaluation indicated that tendons receiving the SVF and BMAC mixture performed better than control and individual groups (p < 0.05). Moreover, RT-PCR evaluation showed that mixture-receiving groups were the closest similar to the uninjured group (p < 0.05). CONCLUSION: The combined use of BMC and SVF improved Achilles tendon healing when compared to the individual use of each mixture.

Midterm Clinical, Radiological, and Functional Results of Arthroscopic Excision of Osteoid Osteoma of the Hip Joint: a Case Series.

Purpose: We aimed to evaluate the midterm functional and clinical outcomes of the patients who underwent arthroscopic excision of hip osteoid osteoma (OO). Methods: We reviewed records of patients diagnosed with intra-articular hip OO, treated with hip arthroscopic excision procedure, and a minimum of 1-year postoperative between 2011 and 2020. Clinical outcomes were assessed range of motion (ROM) pre and postoperatively, and functional outcomes were evaluated with a modified Harris hip score (modified HHS) and Visual analog scale test. All patients were assessed by hip radiography, and three radiological measurements, including lateral center-edge angle (LCEA), alpha angle, and Tönnis angle, were measured. These parameters were compared with unaffected hips. Results: Fifteen (5 female and 10 male) patients were included in the study, with a mean age of 32.6 ± 12.7 (range 12-53). The average postoperative follow-up period was 59.1 ± 28 (range 13-106) months. The functional and clinical scores were significantly improved at the final visit compared to the preoperative values. No differences were found between the operated and unaffected sides with respect to the radiological parameters. The preoperative alpha was significantly higher on the operated side than on the unaffected side (p = 0.007). Conclusion: In this study, within an average of 5 years after surgery, hip arthroscopy provided successful clinical outcomes in the treatment of OO of the hip joint without recurrence. The modified HHS, VAS, and HOS values improved significantly at the final follow-up; 14 of 15 patients had satisfactory outcomes after hip arthroscopy for hip OO. Level of Evidence: Prognostic Level IV study.

Differentially expressed genes related to lymph node metastasis in advanced laryngeal squamous cell cancers.

Understanding the molecular mechanisms and gene expression in laryngeal squamous cell carcinoma (LSCC) may explain its aggressive biological behavior and regional metastasis pathways. In the present study, patients with locally advanced LSCC tumors were examined for differential gene expression in the normal mucosa (non-tumoral mucosa), tumors and lymph node tissues. The aim was to identify possible predictive genes for lymph node metastasis. A total of 16 patients who had undergone total laryngectomy with neck dissection for advanced LSCC were randomly selected from a hospital database: Eight of the patients had lymph node metastasis (Group 1) and the other eight patients did not have metastasis (Group 2). Overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) were analyzed. For each patient, paraffin-embedded tissue samples were collected from non-tumoral mucosa, tumoral lesions and lymph node tissues. RNA was extracted from the tissue samples and used for complementary DNA synthesis, and microarray analysis was subsequently performed on each sample. Gene expression levels were determined in each specimen, and Groups 1 and 2 were compared and statistically analyzed. The microarray results for lymph node metastasis-positive and -negative groups, indicated the differential expression of 312 genes in the lymph nodes, 691 genes in the normal mucosal tissue and 93 genes in the tumor tissue. Transgelin (TAGLN) and cofilin 1 (CFL1) were identified as possible target genes and validated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The RT-qPCR results for TAGLN and CFL1 supported the microarray data. OS, DFS and DSS times were longer in Group 2 than in Group 1 (P=0.002, 0.015 and 0.009, respectively). In addition, TAGLN and CFL1 were associated with DFS and DSS. On the basis of these results, it is suggested that TAGLN and CFL1 expression may play an important role in the pathogenesis of regional metastasis and poor prognosis in advanced LSCC.

The load transfer effect of monopolar and bipolar radial head prosthesis designs on capitellar cartilage: A comparative biomechanical cadaver study.

OBJECTIVE: The aim of this study was to determine whether bipolar radial head arthroplasty may transfer less load to the capitellum than monopolar radial head arthroplasty and native radial heads. METHODS: Six human elbow joints were obtained from six fresh frozen cadavers (3 males, 3 females; mean age = 78 years, age range = 66-80). None of the elbow joints had a previous osseous injury, a chondral defect, osteoarthritis, or instability. In group 1, load transfer of the native radial head was measured in each specimen under 100 N of compression force using a custom-made load cell at 0°, 30°, 60°, 90°, and 120° flexion of the elbow in supination, neutral rotation, and pronation, respectively. After excision of the radial heads, the same testing protocol was first applied for monopolar radial head arthroplasty (Group 2) and then for bipolar radial head arthroplasty (Group 3). RESULTS: The mean load transfer on the capitellum was significantly higher in each forearm rotation and all angles of the elbow flexion in the arthroplasty groups than the native radial head group. Mean load transfer values of bipolar prostheses were between the values of native radial heads and monopolar prostheses in all positions. Bipolar prostheses showed similar load transfer characteristics compared to those of the native radial head in supination at 60° flexion; in neutral rotation at 0°, 30°, 60°, and 120° flexion; and in pronation at 90° and 120° flexion. CONCLUSION: The results of this study have revealed that bipolar radial head arthroplasty transfers similar loading as the native radial head on the capitellum in certain forearm positions and at elbow flexion angles. No significant differences could be found between load transfer values of bipolar head design and monopolar head design except in the pronation at full extension.

Fabrication of a multi-layered decellularized amniotic membranes as tissue engineering constructs.

As a promising approach in tissue engineering, decellularization has become one of the mostly-studied research areas in tissue engineering thanks to its potential to bring about several advantages over synthetic materials since it can provide a 3-dimensional ECM structure with matching biomechanical properties of the target tissue. Amniotic membranes are the tissues that nurture the embryos during labor. Similarly, these materials have also been proposed for tissue regeneration in several applications. The main drawback in using amniotic membranes is the limited thickness of these materials since most tissues require a 3D matrix for an enhance regeneration. In order to prevent this limitation, here we report a facile fabrication methodology for multilayered amniotic membrane-based tissue constructs. The amniotic membranes of Wistar albino rats were first decellularized with the physical and chemical methods and utilized as scaffolds. Secondly, the prepared decellularized membranes were sutured to form a multilayered 3D structure. Within the study, 7 groups including control (PBS), were prepared based on physical and chemical decellularization methods. UV exposure and freezing techniques were used as a physical decellularization methods while hypertonic medium and SDS (sodium dodecyl sulfate) protocols were used as chemical decellularization methods. The combinations of both protocols were also used. In groups, A was the control and group B was applied just UV. In group C was applied UV and freezing. In addition to UV and freezing, in group D was applied hypertonic solution while group E was applied SDS (0.03 %). In group F was applied UV, freezing, hypertonic solution and SDS (0.03 %). In group G was applied UV, hypertonic solution, SDS (0.03 %) and freezing, respectively. Based on the histological and quantitative analyses, F and G groups were found as the most efficient decellularization protocols in rat amniotic membranes. Then, group F and G decellularized amniotic membranes were used to form scaffolds and thus-formed matrices were further characterized in vitro cell culture studies and mechanical tests. Cytotoxicity analyses performed using MTT showed a good cell viability in F and G groups scaffolds. The percentage viability rate was higher in G group (81.3 %) compared to F (75.33 %) and also cell viability in G group was found more meaningful according to p value which was obtained 0.007. Cellular adhesions after in vitro cell culture and morphology of scaffolds were evaluated by scanning electron microscopy (SEM). It was observed that the cells cultivated in equal amounts of tissue scaffolds were higher in the F compared to that observed in group G. The mechanical testing with 40 N force revealed 0.77 mm displacement in group F while it was 0.75 mm in group G. Moreover, according to force-controlled test, 2.9 mm displacement of F group and 1.2 mm displacement of G group was measured. As a result, this study shows that the multilayered decellularized amniotic membrane scaffolds support cell survival and adhesion and can form a flexible biomaterial with desired handling properties.

Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures.

There are numerous surgical techniques described for treating acute quadriceps tendon rupture. We aim to evaluate the strength of the quadriceps tendon using isokinetic tests in hemodialysis patients treated with the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures. Additionally, functional and clinical results were investigated and compared with hemodialysis patients without a history of quadriceps tendon rupture. We retrospectively reviewed hemodialysis patients diagnosed with quadriceps tendon rupture who were operated between 2005 and 2015 at our institution. Eight patients with simultaneous bilateral quadriceps tendon rupture treated with the transpatellar tunnel technique (group 1; the operated group) and 10 patients with chronic renal failure without a history of quadriceps tendon rupture who underwent hemodialysis (group 2; the control group) were included in this study. The active range of motion (ROM), Lysholm and Tegner scores, knee flexor and extensor muscle strengths, and endurances were measured using an isokinetic dynamometer for each group and compared between the groups. The mean age was 44.6 and 40.2 years in groups 1 and 2, respectively. The mean follow-up was 58.6 (range, 24-140) months in group 1. The active ROM was 113.7 ± 9.7 degrees in group 1 and 130 ± 4.8 degrees in group 2 (p < 0.001). The mean Tegner score was not significantly different between the groups (1.87 ± 1.1 in group 1 vs. 2.6 ± 0.9 in group 2; p = 0.212). However, the Lysholm score was significantly higher in group 2 (93.2 ± 7.3 vs. 76.7 ± 13.8; p = 0.009). The mean extensor strength and endurance were significantly higher in group 2 than in group 1. The mean flexor strength and endurance were higher in group 1 than in group 2, but no significant difference was found. Although using the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures in hemodialysis patients can provide acceptable functional results, the ROM and strength particularly in extensor muscle might be significantly lower than control group. Level of evidence is Level III therapeutic case-control study.

Can Multi-Dimensional Voice Program (MDVP) Be Used as A Diagnostic Tool for Precocious Puberty?

OBJECTIVES: Voice is the one of the sexual maturation characteristics that differs between boys and girls. Voice analysis is a non-invasive diagnostic tool and well-tolerated by children. Our aim is to investigate the capability of MDVP to predict precocious puberty (PP). To our knowledge, this is the only study to assess the voice parameters in the diagnosis of PP. MATERIAL AND METHODS: The data of PP and control group were retrospectively reviewed. Voice parameters including fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR), age, and gender of subjects were noted. ROC curve was performed to the statistically significant parameters after double group comparisons and cut-off values were defined. 2 × 2 table were created and compared between the groups. RESULTS: A total of 54 children comprising 32 subjects (8 boys and 24 girls) in the PP group and 22 (10 boys and 12 girls) in the control group were included, and the mean age of girls were 8.17 and 7.92 years, and those of the boys were 8.83 and 7.90, respectively. Jitter and HNR values were statistically significant in the girls but not in boys between the 2 groups (P = 0.013, P = 0.032, respectively). The cut-off points were 1.31 for jitter, 6.39 for HNR. Univariate analysis according to cut-off values of jitter and HNR revealed a statistically significant difference between the 2 groups (P = 0.004, OR: 8.80 [1.26- 61,15] and P = 0.012, OR: 5.00 [1.27-19.68], respectively). CONCLUSIONS: Our findings suggest that, along with an evaluation of other secondary sexual maturation characteristics, voice analysis may be used by pediatric endocrinologists and otolaryngologists to diagnose PP in girls but not in boys.

Internal fixation for osteochondritis dissecans lesions of the knee in patients with physeal closure.

OBJECTIVE: The aim of this study was to present mid-term functional and radiological outcomes of patients with physeal closure who underwent arthroscopic or open internal fixation with headless cannulated compressive screws due to unstable Osteochondritis Dissecans (OCD) lesions of the knee. METHODS: With a diagnosis of unstable OCD of the knee, ten consecutive patients (seven male, three female) with physeal closure (mean age: 23 years; range: 17-40), underwent arthroscopic or open internal fixation with headless cannulated compressive screws. The patients were retrospectively reviewed based on functional and radiological data, with a mean follow-up of 42 months (range: 27-61). The average size of the defects was 4.2 cm2 with a range from 1.7 to 8 cm2 . The study protocol consisted of the Range of Motion (ROM), Tegner-Lysholm Score, Modified Cincinnati Rating System Questionnaire, Short Form-12 (SF-12) in addition to the plain radiograph and Computed Tomography (CT). Any development of arthrosis was assessed at the final follow-up according to the Internation Knee Documention Committee score (IKDC). RESULTS: At the final follow-up, control plain radiographs and CT showed complete union of the fragments in nine patients; however, CT imaging illustrated nonunion of the fragment in one patient. The main Tegner-Lysholm Score increased from 59 (range: 11-63) preoperatively to 97 (range: 88-100) at the final follow-up. Modified Cincinnati Rating System Questionnaire and IKDC score were 97 (range: 93-100) and 96 (range: 92-100), respectively, at the final follow-up. In addition, in terms of SF-12, the mean physical component score was 47.5 (range: 42-49), and the mean mental component score was 57.25 (range: 48-63). CONCLUSION: In patients with physeal closure, internal fixation using cannulated compressive screws may be an influential procedure for the OCD lesions of the knee ranging in size from medium to large. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

The Impact of the Ligamentous Injury Pattern and Associated Neurovascular Injury on Ultimate Knee Function in Patients with Traumatic Knee Dislocations.

The present study aims to investigate whether there is a relationship between the ligamentous injury pattern and concomitant neurovascular injury with long-term functional outcomes in patients with traumatic knee dislocations (TKDs). A total of 42 patients with TKDs were categorized according to the Schenck's classification based on the pattern of ligamentous injury. Concomitant vascular and neural injuries were recorded. Long-term functional outcomes were assessed using several objective and subjective outcome measures. This retrospective study was conducted in two phases: (1) to analyze the impact of ligamentous injury pattern on functional outcomes of patients with TKDs in the overall study population, by comparing all the variables among Schenck's grades; (2) to determine the impact of concomitant vascular and neural injury on ultimate knee function based on the subgroup analyses. In the overall study statistical differences were determined among each pattern of ligamentous injury in the total range of motion (ROM) and scoring systems (chi-squared test, p = 0.254). The overall rates of vascular and neural injury were 26 and 28%, respectively. In subgroup analyses, 40 patients were divided into three subgroups: group A (isolated concomitant neural injury), group B (isolated concomitant vascular injury), group C (without concomitant major vascular or neural injury). The analysis revealed a significant difference in the total ROM (p = 0.005), flexion measurements (p = 0.004), and the loss of extension (p = 0.003). Group A had the lowest total knee ROM and the mean flexion degrees, as well as the highest loss of extension. Concerning functional scoring systems including the combined Knee Society Score (knee score + function score), Lysholm knee scoring scale, and International Knee Documentation Committee score, subgroup analyses revealed significant differences among the groups (p = 0.001, p < 0.01 for all scores). All the scores were found to be lowest in group A. Evidence from the current study showed that the ligamentous pattern and concomitant neurovascular injury both may have a significant impact on ultimate knee function in patients with TKDs. This is a Level III-retrospective comparative study.

Abiotrophia defectiva as a Rare Causative Agent of Periprosthetic Total Knee Arthroplasty Infections: A Case Report and Literature Review.

We present a case of Abiotrophia defectiva in a prosthetic knee infection following total knee replacement for the first time. A 69-year-old female was prediagnosed with prosthetic knee infection, and a two-stage revision arthroplasty was applied. A. defectiva was cultured by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) from the synovial fluid aspirates. Penicillin G and gentamicin had been administered. One year postoperatively, a scintigraphy showed no recurrence. A. defectiva may be missed in culture negative patients with knee or hip arthroplasty. They should be carefully evaluated if they have undergone recent dental procedures.

Analysis of anatomical localization and severity of injury in patients with blood transfusion in urban terrain hospital.

BACKGROUND: Blood loss is the most significant cause of mortality in trauma cases. In injured patients, rapid evaluation and appropriate transfusion is lifesaving. The present study aims to analyze the blood/blood products requirement based on available data and find any associations between the transfusion requirements and injury severity scores (ISS) and anatomical locations of injuries of transfused patients. METHODS: Between 30 July 2014 and 30 July 2016, casualties admitted to the urban terrain hospital (UTH) and transfused at least one unit of red blood cell (RBC) were included. UTH Transfusion Record Notebook data included patients' age, mechanism and anatomical location(s) of the injury, admission hemoglobin (g/dL) level, injury severity score (ISS), transfused units of erythrocyte suspension (ES), warm fresh whole blood (WFWB), fresh frozen plasma (FFP), and massive transfusion (MT) rate. RESULTS: In this study, all patients were male; the mean age was 28.7±7.8 years. Overall, 59 of 579 (10%) patients were transfused 458 units of RBC (ES+WFWB). Torso (thorax ± abdomen) injury was present in 61% of the casualties who underwent transfusion, and 93% of these patients underwent massive transfusion. In 71% of patients, the ISS was >15, and there was statistically significant high blood/blood products use and MT rate in these patients, respectively (p=0.021, p=0.006). CONCLUSION: Anatomical location of injuries and ISS are valuable in the rapid determining of MT and survival rates of casualties. Especially in torso injuries, bleeding control is difficult and transfusion requirement and mortality rates are high. This study presents the trauma of urban terrain conflict-related transfusion data from a UTH.

Assessment of firearm injuries undergoing advanced airway management: Role II hospital experience.

BACKGROUND: Airway problems are one of the most important factors affecting mortality in firearm injuries. The present study aims to examine the data of patients who underwent advanced airway support due to explosion and bullet injuries in a Role II hospital. METHODS: Ninety three patients who underwent advanced airway support due to gunshot wounds in a Role II hospital between January 2015 and September 2016 were included in this study. The patients were divided into two groups as blast (Group A) (handmade explosives, rocket, and mine) and bullet (Group B) (rifle and pistol bullet) trauma injuries. The groups were compared regarding pre-hospital intubation, NISS (New Injury Severity Score), cardio-pulmonary resuscitation (CPR), emergency surgical intervention and mortality rates. RESULTS: There was no difference between the patient groups concerning demographic and clinical features. Thirty-six patients were included in group A, and 57 patients were included in group B. There was no statistically significant difference between the groups about emergency surgical intervention rates (p=0.42). However, a statistically significant difference was observed between the groups in terms of pre-hospital intubation (p=0.001), CPR application (p=0.001), mortality (p=0.001) rates and NISS (p=0.002) scores. CONCLUSION: Bullet injuries that require advanced airway are more destructive and more deadly than explosion injuries. This may be due to direct airway or organ damage in bullet gunshot wounds.

Microarray analysis of cartilage: comparison between damaged and non-weight-bearing healthy cartilage.

AIM: A limited healing response to focal cartilage lesions is frequently encountered in the clinical cartilage pathology. This study compares the gene expression patterns of damaged and undamaged regions of cartilage obtained from the same patient with focal cartilage lesions. The aim of this study is to provide new genes and proteins, which may be a potential future target of research. METHODS: During the autologous chondrocyte implantation (MACI) surgery, cartilage tissues (healthy non-weight bearing and Damaged-lesion side) were obtained from 10 patients with knee focal cartilage lesions. The degeneration status of the cartilage was characterized according to ICRS criteria. Whole genome microarray gene expression profiling was performed and some of the differentially regulated genes were validated with RT-PCR. RESULTS: Damaged and undamaged non-weight bearing cartilage showed distinct gene expression profiles. Genes involved in cell signaling, matrix degradation, hypoxia, and the inflammatory response showed significant up- or down-regulation. In the focal lesions, expression of genes such as HIF1α, TIMP-2, EID1, EID2, NCOA3, NBR1, SP100, and HSP90AA1 was significantly higher compared to healthy non-weight bearing cartilage from the same joint, whereas TIMP-4 was lower. CONCLUSION: The genes examined in this study differ distinctly between focal cartilage (ICRS 3-4) lesions and undamaged sites of the same joint. We believe that the data set forth in this study may be used for clinical purposes and be a guide in the development of new biological approaches for therapy.