Efficacy of N-acetylcysteine in reducing inflammation and oxidative stress to prevent complex regional pain syndrome type 1.

This study aimed to evaluate the effectiveness of N-acetylcysteine (NAC) in preventing complex regional pain syndrome type 1 (CRPS-1) by reducing proinflammatory cytokines and oxidative stress markers in patients with distal radius fractures. A retrospective single-center study at Bursa City Hospital involves patients over 50 years of age with distal radius fractures treated between January 2021 and December 2023. A total of 60 patients (mean age, 62.8 ±â€…5.1 years; 26 males and 34 females) were analyzed. Patients were divided into 2 groups: the NAC group (31 patients receiving 600-mg NAC daily for 3 months) and the control group (29 patients with no prophylactic medication). CRPS-1 diagnosis was based on Budapest criteria during multiple follow-up visits. Serum levels of interleukin (IL)-1 beta, IL-6, tumor necrosis factor-alpha (TNF-α), total oxidant status (TOS), and total antioxidant status (TAS) were measured at baseline and study end point. CRPS-1 positive patients had significantly higher levels of IL-6, TNF-α, and IL-1 (P < .001 for all), higher TOS (P < .001) and oxidative stress index (P < .001), and lower TAS (P < .001) compared with CRPS-1 negatives. The incidence of CRPS-1 was significantly lower in the NAC group (9.7%) compared with the control group (31.0%; P = .039). Logistic regression indicated a 78% reduction in CRPS-1 odds ratio with NAC treatment (odds ratio, 0.219 [95% confidence interval, 0.053-0.895]; P = .0322). NAC significantly reduced end-point levels and changes in IL-6 (P < .001), TNF-α (P < .001), and IL-1 (P = .038) and improved oxidative stress markers, showing higher TAS (P < .001), lower TOS (P < .001), and oxidative stress index (P < .001) compared with controls. NAC significantly reduced the risk of developing CRPS-1 by decreasing levels of proinflammatory cytokines and oxidative stress. This study highlights NAC's potential as a preventive treatment for CRPS-1 and emphasizes the importance of early intervention.

The effect of plate location on radial nerve palsy recovery time associated with humeral shaft fractures.

BACKGROUND: This study aims to investigate the influence of plate placement on nerve regeneration in humerus fractures accompanied by radial nerve injury. METHODS: A retrospective analysis was conducted on a cohort of 94 patients with humerus fractures and concomitant radial nerve injury treated between January 2018 and November 2022. After applying exclusion criteria, 31 patients were included in the study. Clinical outcomes were assessed by comparing demographic data, surgical duration, radial nerve recovery time, the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm Shoulder and Hand (DASH), and the Medical Research Council (MRC) scale. RESULTS: Two distinct groups were established: lateral plating and anteromedial (AM) plating. These groups demonstrated comparability regarding age, gender, and body mass index (BMI). No statistically significant differences were observed between the groups concerning MEPS and MRC. The AM plating group notably exhibited shorter surgical durations, faster recovery times, and lower DASH scores. CONCLUSION: According to the findings of this investigation, in cases of humerus fractures accompanied by radial nerve injury, AM plating may be preferable over lateral plating due to its association with reduced surgical durations and expedited nerve recovery.

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making.

OBJECTIVES: In this study, we aimed to investigate the relationship between intraoperative thenar muscle neurostimulation responses and postoperative thumb function recovery in patients with severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Between January 2019 and December 2021, a total of 21 severe CTS cases in 20 patients (7 males, 13 females; mean age: 56.3±19.3 years; range, 52 to 76 years) based on clinical and electrophysiological findings were retrospectively analyzed. The median nerve motor branch (MNMB) was stimulated intraoperatively with a nerve stimulator. The patients were divided into two groups according to contraction response on abductor pollicis brevis (APB) muscle: Group C (contractile, n=13) and Group NR (non-responsive, n=7) with and without muscular contraction. The Levine Functional Severity Scale (LFSS) was used to measure the functional status of CTS patients. The Manual Muscle Testing (MMT) was used to assess muscle strength. Clinical outcomes were compared between the groups at one year of follow-up. RESULTS: The mean total preoperative LFSS score was significantly higher in Group NR than in Group C (p=0.010). The mean postoperative MMT score was significantly higher in Group C than in Group NR (p<0.001). There was no positive result in pick-up, button fastening, and needle pinch tests in Group NR (p<0.001). However, there were significant improvements in postoperative LFSS scores in Group C (p<0.05), while the scores remained unchanged in Group NR (p>0.05). CONCLUSION: Direct stimulation of the median nerve motor branch and observation of contraction response on APB muscle can be used to predict clinical recovery and facilitates making the decision for opponensplasty in severe CTS.

Visceral adiposity index and triglyceride/high-density lipoprotein cholesterol ratio in hypogonadism

ABSTRACT Background Cardiometabolic risk is high in patients with hypogonadism. Visceral adiposity index (VAI) and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio are the practical markers of atherosclerosis and insulin resistance and independent predictors of cardiaovascular risk. To date, no study has evaluated VAI levels and TG/HDL-C ratio in hypogonadism. Subjects and methods A total of 112 patients with congenital hypogonadotrophic hypogonadism (CHH) (mean age, 21.7 ± 2.06 years) and 124 healthy subjects (mean age, 21.5 ± 1.27 years) were enrolled. The demographic parameters, VAI, TG/HDL-C ratio, asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured for all participants. Results The patients had higher total cholesterol (p = 0.04), waist circumference, triglycerides, insulin, and HOMA-IR levels (p = 0.001 for all) than the healthy subjects. VAI and ADMA and TG/HDL-C levels were also higher in patients than in healthy subjects (p < 0.001 for all). VAI was weakly correlated with ADMA (r = 0.27, p = 0.015), HOMA-IR (r = 0.22, p = 0.006), hs-CRP (r = 0.19, p = 0.04), and total testosterone (r = −0.21, p = 0.009) levels, whereas TG/HDL-C ratio was weakly correlated weakly with ADMA (r = 0.30, p = 0.003), HOMA-IR (r = 0.22, p = 0.006), and total testosterone (r = −0.16, p = 0.03) levels. Neither VAI nor TG/HDL-C ratio determined ADMA, HOMA-IR, and hs-CRP levels. Conclusions The results of this study demonstrate that patients with hypogonadism have elevated VAI and TG/HDL-C ratio. These values are significantly correlated with the surrogate markers of endothelial dysfunction, inflammation, and insulin resistance. However, the predictive roles of VAI and TG/HDL-C ratio are not significant. Prospective follow-up studies are warranted to clarify the role of VAI and TG/HDL-C ratio in predicting cardiometabolic risk in patients with hypogonadism.

Add on Exenatide Treatment is Beneficial in Poorly Controlled Obese Type 2 Diabetics under Intensive Insulin Regimens.

Background: Intensive insulin treatment is bothersome in obese patients with type 2 diabetes mellitus. High insulin dosages further increase weight gain and the risk of hypoglycemia. Glucagon like peptide-1 receptor agonists decrease the insulin need, cause weight loss and reduce the risk of hypoglycemia. There is limited data about the effect of exenatide on obese diabetics under intensive insulin regimens. Methods: This retrospective case series report the clinical outcomes of 23 obese (13 morbidly obese) patients with uncontrolled type 2 diabetes mellitus (Age=59±10.44 years, body mass index 41.1±6.8 kg/m2, HbA1c 9.9±1.5%), under high dose (94.1±39.6 unit) intensive insulin. Exenatide twice daily was added for a mean follow-up period of 11.22±7.01 (3-30) months. Intensive insulin regimens were continued in 7 patients while the others were switched to basal insulin during the follow-up. Results: During the follow-up, mean HbA1c levels of the patients significantly improved (p=0.019), along with the significant decrease in body mass index and the total insulin need (p<0.001 for both). Baseline insulin dosages were significantly higher in the intensive regimen group (p=0.013) while other demographical and clinical characteristics were similar. No significant difference was present between the groups regarding the alterations of HbA1c, body mass index and the reduction in total insulin dosages. Conclusion: Add on exenatide appears to be a rational treatment modality in uncontrolled obese patients with type 2 diabetes mellitus despite intensive insulin regimens. Further prospective randomized studies with longer follow-up periods are recommended.

A 3-cm Single-port Video-assisted Thoracoscopic Lobectomy for Lung Cancer.

Video-assisted thoracoscopic surgery is advantageous over traditional surgical practices, because of a faster postoperative recovery period, less pain, and a shorter hospital length of stay. There is no single standard technique in the video-assisted thoracoscopic surgery approach. Although these "minimally invasive" resections are habitually performed through 3-port or 4-port incision, we performed a left lower lobectomy in a 54-year-old male patient for lung cancer, through a 3-cm single-port incision.

Endocan, a novel marker of endothelial dysfunction in patients with essential hypertension: comparative effects of amlodipine and valsartan.

Vascular inflammation plays an important role in the pathophysiology of hypertension and high levels of endocan may reflect ongoing vascular inflammation in hypertensive patients. In the present hypothesis-generating study, we aimed at investigating the comparative effects of amlodipine and valsartan on endocan levels in newly diagnosed hypertensive patients. The study population consisted of 37 untreated hypertensive patients who were randomized to the two treatment arms. After baseline assessment, each patient was randomly allocated to either 10 mg daily of amlodipine (n = 18, 7 males) or 160 mg daily of valsartan (n = 19, 3 males) and treated for a 3-month period. Sphygmomanometric blood pressure (BP) and serum endocan were measured before and every 2 weeks during drug treatment. There was no statistically significant difference between the two treatment arms as far as baseline socio-demographic and clinical characteristics are concerned. After a 3-month treatment period, systolic and diastolic BP values significantly reduced by antihypertensive treatment (p < 0.001). Furthermore, endocan levels were significantly decreased in both treatment arms (p < 0.05). However, amlodipine caused a greater percent decrease in circulating endocan levels compared with valsartan at the end of the treatment period. Both drugs reduced high sensitivity C-reactive protein values. However, the statistical significant difference vs baseline was achieved only in the group treated with amlodipine. No correlation was found between endocan plasma levels and BP reduction. The results of this hypothesis-generating study suggest that amlodipine and valsartan decrease endocan levels in newly diagnosed hypertensive patients. The effects, which are more evident with amlodipine, may contribute to the anti-inflammatory effects exerted by the two drugs on the vascular target.

[The effect of tibial lengthening on gastrosoleus muscle function: an electrophysiological study].

OBJECTIVES: We evaluated the changes in electrophysiological characteristics of the contraction forces of the gastrosoleus complex due to stretching in experimental tibial lengthening. METHODS: Distraction histiogenesis was performed in 22 guinea pigs weighing 600 to 800 g. Following the application of a semicircular external fixator and right tibial osteotomy, distraction was applied at a rate of 0.25 mm two times a day for 15 days without a latency period. The animals were randomized to two groups. In the study group, a foot plate preventing ankle plantar flexion was affixed to the external fixator, while ankle motions were unrestricted in the control group. On days 5, 10, and 15, the posterior tibial nerve was stimulated with a nerve stimulator at a constant frequency. Gastrosoleus muscle contractions were measured with a transducer and contraction forces were recorded. RESULTS: On day 5, muscle contraction forces measured in the study group were much higher than the control group (p<0.05). On day 10, however, muscle contraction forces showed a rapid decline in the study group and, at the end of the study, muscle contraction forces decreased by 81% compared to the baseline values (p<0.05). Yet, throughout the study period, muscle contraction forces were always higher than the control group (p<0.05). In addition, the rate of the decrease in muscle strength slowed down after day 10 in the study group, and gastrosoleus function and strength were much better preserved. Equinus deformity developed progressively in the ankles of the control animals whose muscle contraction forces also showed significant decreases during the experiment (p<0.05). CONCLUSION: In clinical applications of tibial lengthening, the strength of the gastrosoleus complex should be preserved to prevent equines deformity and maintain ankle functions. This can be achieved through gradual stretching of the muscle during distraction. If there is shortening before surgery or muscle stiffness is expected during lengthening, measures should be taken before distraction osteogenesis and muscle length should be preserved.