The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial.

PURPOSE: To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. MATERIALS AND METHODS: Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. RESULTS: Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). CONCLUSIONS: FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure.HighlightsFES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP.The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.

Clarification of acid site location in MSE-type zeolites by spectroscopic approaches combined with catalytic activity: comparison between UZM-35 and MCM-68.

MSE-type zeolites synthesized by different organic structure-directing agents (OSDAs), UZM-35 and MCM-68, were prepared. The location of Brønsted acid sites derived from the framework Al atoms and acidic properties were investigated based on 27Al MQMAS NMR and in situ IR techniques combined with the evaluation of the catalytic activity. We have successfully found a significant difference in the location of Brønsted acid sites in the MSE-type framework; 61 and 33% of acid sites were located at the 12-ring channel for MCM-68 and UZM-35, respectively. The differences in the location of the acid sites yielded their unique catalytic activities for the hydrocarbon cracking reactions, indicating that a well-chosen type of OSDAs for the synthesis is one of the possibilities for controlling the distribution of the framework Al atoms in the MSE-type framework.

The Effect of Sham Controlled Continuous Theta Burst Stimulation and Low Frequency Repetitive Transcranial Magnetic Stimulation on Upper Extremity Spasticity and Functional Recovery in Chronic Ischemic Stroke Patients.

OBJECTIVE: This randomized controlled study examined the effect of continuous theta burst stimulation (cTBS) and low frequency repetitive transcranial magnetic stimulation (rTMS) on upper extremity spasticity and functional recovery in chronic ischemic stroke patients. MATERIALS AND METHODS: Twenty chronic ischemic stroke patients were randomized into three groups as real rTMS group (n = 7), real cTBS group (n = 7) and sham cTBS group (n = 6), in which real rTMS with physical therapy (PT), real cTBS with PT and sham cTBS with PT were applied in 10 sessions, respectively. The evaluation parameters were assessed at pre-treatment, post-treatment and follow up at 4 weeks. RESULTS: Ten sessions of real rTMS or real cTBS combined with PT were found beneficial in motor functional recovery and daily living activities both at post-treatment and follow up at 4 weeks (p Ë‚ 0.05). In the sham cTBS group, functional improvement was not significant (p > 0.05). In addition, in the real rTMS group, elbow flexor, pronator, wrist flexor and finger flexor spasticity were significantly decreased; in the real cTBS group, significant decrease was observed in the elbow flexor and wrist flexor spasticity (p Ë‚ 0.05). In comparison with sham cTBS group, only in the real cTBS group, significant improvement was observed in the level of wrist flexor spasticity at follow up at 4 weeks (p Ë‚ 0.017). CONCLUSIONS: In this study, it was observed that real cTBS or real rTMS combined with PT provided improvement on upper extremity motor functions and daily living activities in chronic ischemic stroke patients, but improvement in spasticity was limited.

Cardiopulmonary Exercise Testing, Impedance Cardiography, and Reclassification of Risk in Patients Referred for Heart Failure Evaluation.

BACKGROUND: An impaired cardiac output response to exercise is a hallmark of chronic heart failure (HF). We determined the extent to which impedance cardiography (ICG) during exercise in combination with cardiopulmonary exercise test (CPX) responses reclassified risk for adverse events in patients with HF. METHODS AND RESULTS: CPX and ICG were performed in 1236 consecutive patients (48±15 years) evaluated for HF. Clinical, ICG and CPX variables were acquired at baseline and subjects were followed for the composite outcome of cardiac-related death, hospitalization for worsening HF, cardiac transplantation, and left ventricular assist device implantation. Cox proportional hazards analyses including clinical, noninvasive hemodynamic, and CPX variables were performed to determine their association with the composite endpoint. Net reclassification improvement (NRI) was calculated to quantify the impact of adding hemodynamic responses to a model including established CPX risk markers on reclassifying risk. There were 422 events. Among CPX variables, peak VO2 and indices of ventilatory inefficiency (VE/VCO2 slope, oxygen uptake efficiency slope) were significant predictors of risk for adverse events. Among hemodynamic variables, change in cardiac index, peak cardiac time interval, and peak left cardiac work index were the strongest predictors of risk. Having 5 impaired CPX and ICG responses to exercise yielded a sevenfold higher risk for adverse events compared with having no abnormal responses. Combining ICG responses to CPX resulted in NRIs ranging between 0.34 and 0.89, attributable to better reclassification of events. CONCLUSION: Cardiac hemodynamics determined by ICG complement established CPX measures in reclassifying risk among patients with HF.

The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury.

STUDY DESIGN: A pre-post descriptive study. OBJECTIVES: To examine the immediate effects of ultrasound-guided femoral nerve block with phenol (UGFNBwP) in managing the lower limb spasticity of individuals with traumatic spinal cord injury (SCI). SETTING: Ankara, Turkey. METHODS: Nineteen patients with traumatic SCI presenting with lower extremity spasticity were treated with UGFNBwP. Modified Ashworth Scale of hip flexion and knee extension, functional independence measure motor subscale, difficulty of catheterization, hygiene score, spasm frequency, sleep quality, and patient satisfaction (PS) were measured in all patients prior to treatment, in the first week and second month. RESULTS: There was a statistically significant decrease in the Modified Ashworth Scale scores in the first week and second month compared to baseline (p < 0.017). Significant improvements were detected in functional independence measure motor subscale, DoC, HS, SF and PS at follow-up examinations compared to baseline (p < 0.017). No statistically significant difference in the SQ score was found. Patients reported no complications during the intervention and follow-up period. CONCLUSIONS: Ultrasound-guided femoral nerve block with phenol is an option worth considering to reduce spasticity and improve function in people with SCI.

Ultrasonographic evaluation of the femoral cartilage thickness in patients with chronic renal failure.

OBJECTIVE: To investigate the effects of chronic renal failure (CRF) on the distal femoral cartilage thickness by using ultrasonography and to determine the relationship between cartilage thickness and certain disease-related parameters. DESIGN: Fifty-seven CRF patients (41 male and 16 female) (mean [SD] age, 44.7 [12.1] years) and 60 healthy controls (41 male and 19 female) (mean [SD] age, 43.5 [13.3] years) were enrolled in this study. Demographic and clinical characteristics were recorded. Cartilage thickness measurements were taken from the medial and lateral condyles, and intercondylar areas of both knees. RESULTS: Groups were similar in terms of age, weight, height, body mass index and gender (all p>0.05). The mean cartilage thickness was found to be less in CRF patients than in controls (statistically significant for medial condyles and intercondylar areas both in right and the left knees [all p<0.05]). Cartilage thickness showed no correlation with eGFR, and with the levels of serum urea, creatinine, calcium, magnesium, phosphor, hemoglobin, uric acid and as well as steroid use (all p>0.05) in CRF patients. CONCLUSION: In the light of our findings, we imply that patients with CRF have thinner femoral cartilage than healthy controls. This result may support the view that patients with CRF are at increased risk for developing early knee osteoarthritis. Last but not least, clinicians should be aware of the importance of rehabilitation strategies aimed at decreasing onset and progression of knee osteoarthritis in patients with CRF.

Framework stability and Brønsted acidity of isomorphously substituted interlayer-expanded zeolite COE-4: a density functional theory study.

COE-4 zeolites possess a unique two-dimensional ten-ring pore structure with the Si(OH)2 hydroxyl groups attached to the linker position between the ferrierite-type layers, which has been demonstrated through the interlayer-expansion approach in our previous work (H. Gies et al. Chem. Mater. 2012, 24, 1536). Herein, density functional theory is used to study the framework stability and Brønsted acidity of the zeolite T-COE-4, in which the tetravalent Si is isomorphously substituted by a trivalent Fe, B, Ga, or Al heteroatom at the linker position. The influences of substitution energy and equilibrium geometry parameters on the stability of T-COE-4 are investigated in detail. The relative acid strength of the linker position is revealed by the proton affinity, charge analysis, and NH3 adsorption. It is found that the range of the ⟨T-O-Si⟩ angles is widened to maintain the stability of isomorphously substituted T-COE-4 zeolites. The smaller the ⟨O1-T-O2⟩ bond angle is, the more difficult is to form the regular tetrahedral unit. Thus, the substitution energies at the linker positions increase in the following sequence: Al-COE-4 < Ga-COE-4 < Fe-COE-4 < B-COE-4. The adsorption of NH3 as a probe molecule indicates that the acidity can affect the hydrogen-bonding interaction between (N-H⋅⋅⋅O2) and (N⋅⋅⋅H-O2). The relative Brønsted-acid strength of the interlayer-expanded T-COE-4 zeolite decreases in the order of Al-COE-4 > Ga-COE-4 > Fe-COE-4 > B-COE-4. These findings may be helpful for the structural design and functional modification of interlayer-expanded zeolites.

The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury.

OBJECTIVE: To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI). DESIGN: A single center, prospective, randomized, double-blinded, controlled study. SETTING: SCI rehabilitation unit of university rehabilitation center. PARTICIPANTS: Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012. INTERVENTIONS: Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a figure-of-8-shaped coil. OUTCOME MEASURES: Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients' satisfactions obtained using a 5-point Likert scale at 6 months. RESULTS: Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05). CONCLUSION: Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size.

Assessment of the reliability and usability of ChatGPT in response to spinal cord injury questions.

OBJECTIVE: The use of artificial intelligence chatbots to obtain information about patients' diseases is increasing. This study aimed to determine the reliability and usability of ChatGPT for spinal cord injury-related questions. METHODS: Three raters simultaneously evaluated a total of 47 questions on a 7-point Likert scale for reliability and usability, based on the three most frequently searched keywords in Google Trends ('general information', 'complications' and 'treatment'). RESULTS: Inter-rater Cronbach α scores indicated substantial agreement for both reliability and usability scores (α between 0.558 and 0.839, and α between 0.373 and 0.772, respectively). The highest mean reliability score was for 'complications' (mean 5.38). The lowest average was for the 'general information' section (mean 4.20). The 'treatment' had the highest mean scores for the usability (mean 5.87) and the lowest mean value was recorded in the 'general information' section (mean 4.80). CONCLUSION: The answers given by ChatGPT to questions related to spinal cord injury were reliable and useful. Nevertheless, it should be kept in mind that ChatGPT may provide incorrect or incomplete information, especially in the 'general information' section, which may mislead patients and their relatives.

Comprehensive analysis of publication of physical medicine and rehabilitation theses in Türkiye between years 2010 and 2020: Academic productivity and related factors.

Objectives: This study aimed to investigate the publication rates of physical medicine and rehabilitation specialty training theses, which are required to complete a residency in Türkiye, and determine the factors that affect publication. Materials and methods: Residency theses involved in this descriptive study were detected from the database of Higher Education Council Thesis Center (tez.yok.gov.tr) between January 2010 and December 2020. Publication of theses and date of publication were investigated by the writer's and supervisor's names on PubMed and Google Scholar. Results: Three hundred eighty-eight of 1,130 theses were turned into publications. Two hundred seventy-seven (24.5%) were published in SCI (Science Citation Index)/SCI Expanded indexed journals. The publication rates of residents were 47.1% in private universities, 34.2% in public universities, and 32.3% in training and research hospitals. The trainees who published their theses were more likely to become associate and assistant professors. Conclusion: Although approximately one-third of the theses defended were published, this rate is insufficient for sharing the knowledge. Considering that publishing their theses affected the residents' current academic careers positively, supervisors should provide the residents supportive facilitation to give the knowledge in research and publish their theses.

Shoulder disarticulation after clavicle fracture: a case report.

In this case report, we presented to a 90-year-old female with multiple comorbidities presented to the emergency department of our hospital three weeks following a fall from standing height. Upon arrival, the patient exhibited a Glasgow Coma Scale (GCS) 12, blood pressure of 100/60 mmHg, heart rate of 117 beats/min, respiratory rate of 24 breaths/min. Examination revealed atrophy, skin color change, sensory disturbance, or motor palsy in the left upper extremity. Chest X-ray showed a fractured left clavicle, with its free fragment dislocated toward the thorax. She was diagnosed with a displaced midshaft clavicle fracture, Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 15.2B2. On doppler ultrasound examination, flow loss secondary to compression was observed in the proximal left subclavian artery (SA). No flow was observed in the axillary, brachial, radial and ulnar arteries. Due to the patient's high number of comorbid diseases and poor general condition, disarticulation was performed from the shoulder joint, which is the proximal region of arterial occlusion. No other symptoms of circulatory dysfunction were observed at the 3 months follow-up. This case report emphasizes that delayed clavicle fracture can lead to catastrophic consequences. Trauma surgeons should also consider surgical treatment of clavicle fractures, depending on the patient's condition.

The use of standing powered wheelchairs from the perspective of individuals with spinal cord injury.

PURPOSE: The aim of this study was to investigate the experiences of standing powered wheelchair (SPWC) users with spinal cord injury (SCI). MATERIALS AND METHODS: This cross-sectional study included 20 participants with SCI. SPWC daily usage time (total, in sitting position and standing position) and the frequency of using the SPWC's standing feature were recorded. Participants' level of satisfaction and comfort associated with the SPWC were assessed on a five-point Likert scale. If there was a dissatisfaction reason with the SPWC, the issues related to it were recorded. Participants were asked about their positive and adverse experiences with the use of SPWC. RESULTS: Mean age of the participants was 41.65 (± 9.35) years. Eighty percent were tetraplegic. Ninety percent of the participants stood for at least 30 minutes at least one day a week, and 55% stood for at least 30 minutes at least four days a week. The most commonly reported perceived benefits were improvement in activities of daily living, bowel movements, and blood pressure regulation, better perception of body image, and feeling better. The most frequently identified reasons for dissatisfaction with the SPWC were its big dimensions, heavy weight, and difficulty of use in indoor environment and on uneven surfaces. CONCLUSIONS: The findings show positive perceived experiences for SPWC users with SCI in terms of physical, social, and psychological aspects. Prospective controlled studies are needed to explore the benefits of SPWC use regarding secondary complications of SCI.

This paper shows that participants with spinal cord injury (SCI) report numerous perceived physical, social, and psychological benefits of using standing powered wheelchair (SPWC).Individual adjustments must be made for SPWCs. Before prescribing SPWC, the physician and physical or occupational therapist who specialises in wheelchairs should make the necessary evaluations based on the individual's abilities and needs. The necessity for special SPWC equipment and orthoses during standing should be evaluated.In SPWC users with SCI, neck discomfort may occur due to the contraction of non-postural innervated muscles such as the neck due to inadequate trunk control. In addition to the adjustable chest support in SPWC, equipment that provides additional chest support can be used for better control of the trunk. Better control of the trunk can contribute to improved neck comfort.

Investigation of the efficacy of epidermal growth factor, boric acid and their combination in cartilage injury in rats: An experimental study.

OBJECTIVES: In this study, we aimed to determine the bioefficacy of epidermal growth factor (EGF), boric acid (BA), and their combination on cartilage injury in rats. MATERIALS AND METHODS: In in vitro setting, the cytotoxic effects of BA, EGF, and their combinations using mouse fibroblast cell (L929), human bone osteosarcoma cell (Saos-2), and human adipose derived mesenchymal stem cells (hAD-MSCs) were determined by applying MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] test. In in vivo setting, 72 rats were randomly divided into four groups. A standard chondral defect was created and microfracture was performed in all groups. Group A was determined as the control group. In addition to the standard procedure, Group B received 100 ng/mL of EGF, Group C received a combination of 100 ng/mL of EGF and 10 µg/mL of BA combination, and Group D 20 µg/mL of BA. RESULTS: The cytotoxic effect of the combinations of EGF dilutions (1, 5, 10, 25, 50, 100, 200 ng/mL) with BA (100, 300, 500 µg/mL) was observed only in the 72-h application period and in Saos-2. The cytotoxic effect of BA was reduced when combined with EGF. There was no significant difference in the histopathological scores among the groups (p=0.13). CONCLUSION: Our study showed that EGF and low-dose BA application had a positive effect on cartilage healing in rats. Significant decreases in recovery scores were observed in the other groups. The combination of EGF and BA promoted osteoblast growth. Detection of lytic lesions in the group treated with 20 µg/mL of BA indicates that BA may have a cytotoxic effect.

A Case Series of Deep Subgluteal Block: A New Block Targeting the Missed Portion of the Hip for Analgesia After Total Hip Replacement.

The study aimed to evaluate the effectiveness of deep subgluteal block (DSGB) for pain relief after posterolateral-approached total hip replacement. The cadaver study and observational case series assessed the spread and outcomes of ultrasound-guided DSGB. Results showed low postoperative pain scores, minimal opioid requirements, and no complications related to DSGB. Anatomical dissection revealed effective spread of the injected substance. These findings suggest that DSGB could be a promising regional analgesic technique for postoperative pain management after posterolateral-approached total hip replacement.

Knowledge of pelvic floor muscles in community-dwelling women aged over 60: its relationship with urinary incontinence.

PURPOSE: To investigate the awareness of the pelvic floor muscles (PFMs) and PFM exercises (PFME) knowledge, training and experience in community-dwelling women aged 60 and over and its relationship with urinary incontinence (UI). METHODS: This is a questionnaire based study which was carried out in 9 Physical Medicine and Rehabilitation Centers, including a total of 500 women aged 60 and over and living in the community. The questionnaire included questions about awareness of PFMs, UI complaints and PFME knowledge, training and experience. Knowledge and awareness of PFMs and PFME knowledge, training and experience were compared in subgroups with or without urinary incontinence. RESULTS: The mean age of the women included in the study was 67.8 ± 6.1 (60-88). Knowledge and awareness of PFMs and PFME knowledge, training and experience were low in the study population. Knowledge and awareness of PFMs were significantly low in the subgroup with urinary incontinence (p < 0.05). Kegel exercise training and experience were significantly low in the subgroup without urinary incontinence (p = 0.01, p < 0.01). CONCLUSION: Knowledge and awareness of PFMs and PFME knowledge, training and experience are low in community-dwelling women aged 60 and over and training programs should be organized to teach the function of the PFMs and to perform PFME correctly in this population.

Behcet's disease presenting with sudden-onset paraplegia due to anterior spinal artery involvement: 1-year follow-up of rehabilitation in conjunction with medication.

A 26-year-old male patient with sudden-onset paraplegia was presented. Clinical and imaging evaluation revealed isolated spinal cord lesions at thoracal levels and anterior spinal arterial involvement. Diagnosis of Behcet's disease was established with associating clinical findings with medical history. Vigorous medication and rehabilitation program were performed. Through the 1-year rehabilitation period in conjunction with medication, strength and functions improved gradually. A satisfactory functional gain as a rehabilitative goal in independence in activities of daily living and long-distance ambulation achieved around 4 months. The patient reached full independence after 1-year. As conclusion, Behcet's disease can present with sudden-onset paraplegia. In case of no evident etiology for paraplegia in young male, neuro-Behcet's disease also should be kept in mind. Contrary to assumption, early aggressive treatment and continuous rehabilitation in conjunction with medication might provide good prognosis with excellent clinical outcome in spinal cord involvement. Satisfactory functional recovery should be expected only after 3-4 months, and complete independence can be achieved after 1 year.

Atypical compartment syndrome of the forearm due to mixed infection with Proteus mirabilis and Morganella morganii after a penetrating injury: A limb-saving approach.

Compartment syndrome is a well-described clinical condition and is considered an orthopedic emergency affecting individuals of all ages. A typical scenario for acute compartment syndrome involves lower limb fractures or crush injuries. However, physicians may occasionally encounter atypical presentations, defined as atypical compartment syndrome (ACS). A 38-year-old, left-handed male patient without any comorbidities developed ACS of the forearm and clinical presentation of sepsis after a small penetrating injury to his right forearm. He developed ACS secondary to infected hematoma and subsequent soft tissue infection caused by Proteus mirabilis and Morganella morganii. Both bacteria infected the patient by direct contamination after injury with a knife, resulting in multifloral contamination. The patient was successfully treated with reconstructive surgery. In conclusion, ACS secondary to this type of penetrating injury shows a subtle clinical course at the time of hospital admission and can insidiously progress from an infected hematoma, posing a serious threat to the limb or even cause mortality. Good extremity function without any disability can be achieved with an accurate diagnosis during the initial evaluation of the patient in the emergency department and prompt surgical intervention followed by appropriate reconstructive methods.

The effect of high-frequency repetitive transcranial magnetic stimulation on motor recovery and gait parameters in chronic incomplete spinal cord injury: A randomized-controlled study.

Objectives: This study aims to examine the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on gait parameters and lower extremity motor recovery in a more specific sample of individuals with chronic and traumatic incomplete spinal cord injury (iSCI). Patients and methods: This double-blind, sham-controlled, randomized study included a total of 28 individuals (20 males, 8 females; mean age: 35.7±12.1 years; range, 18 to 45 years) with chronic (>1 year) traumatic iSCI. The participants were randomly allocated to either sham rTMS group (n=14) or real rTMS group (n=14). We compared the groups based on the lower extremity motor scores (LEMS), the temporal-spatial gait measurements using three-dimensional gait analysis, the Walking Index for SCI-II (WISCI-II), and 10-m walking test at baseline, three weeks (post-treatment) and five weeks (follow-up) after the treatment. Results: The real rTMS group revealed a significant improvement in walking speed, LEMS score, and 10-m walking test after the treatment compared to baseline (p=0.001, p=0.002, and p=0.023, respectively). Changes in the LEMS score were significantly increased in the real rTMS group compared to the sham group at both three and five weeks (p=0.001 and p=0.001, respectively). No significant difference was observed in the other variables between the groups (p>0.05). Conclusion: Our study findings support the therapeutic effectiveness of rTMS on motor recovery in chronic iSCI. The rTMS can be used as an adjuvant therapy to conventional physiotherapy in the rehabilitation of patients with iSCI.

Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue.

Background Local antibiotic applications have been used in chronic osteomyelitis and have been defined as an adjunctive treatment method. Biodegradable materials are also used for the same purpose by adding antibiotics. The fact that it does not require additional surgery to be removed is an important advantage. In this study, we intended to develop a new biodegradable drug-loaded polymeric scaffold with good antibiotic release and compare the microbiological results with antibiotic-impregnated bone cement. Methodology A tissue scaffold containing poly(2-hydroxyethyl methacrylate) (PHEMA) was prepared in our laboratory and loaded with ertapenem and daptomycin antibiotics. The surface morphology and pore geometries of drug-loaded and unloaded scaffolds were analyzed by a scanning electron microscope under vacuum. The dose-dependent antiproliferative effects of PHEMA scaffold, drug-loaded scaffold, cement, and drug-loaded cement on osteoblast cells were investigated. To evaluate drug release kinetics, the absorbance values of the scaffold loaded with ertapenem and daptomycin were measured with the spectrometer. For microbiological tests, ertapenem and daptomycin-impregnated cement and scaffold, as well as the control scaffold and cement samples, were investigated for their antibacterial activities on Staphylococcus aureus and Klebsiella pneumoniae strains using the disc diffusion method. These microorganisms are one of the most common microorganisms in osteomyelitis. Results The efficacy of antibiotic-impregnated scaffold and cement on both gram-negative and gram-positive microorganisms was investigated. The daptomycin zone diameter in S. aureus ATCC 29233 strain was 17 mm, whereas it was 24 mm for scaffold and 22 mm for cement. Scaffold was found to be more effective than cement against S. aureus strain. The K. pneumoniae ATCC BAA-2814 strain was found to be resistant to ertapenem, but the zone diameter was 21 mm for scaffold and 20 mm for cement. Ertapenem-loaded scaffold was found to be more effective than cement. It was found that the antimicrobial activity of the scaffold was higher than cement. When we evaluated the release profiles, for the daptomycin-loaded cement group, 98% of daptomycin was cumulatively released within 30 minutes, and for the daptomycin-loaded scaffold group, 100% of daptomycin was cumulatively released in six days. To compare ertapenem-loaded cement and scaffold, 98% of ertapenem was cumulatively released within 10 minutes in the cement group. For the scaffold group, 100% of ertapenem was cumulatively released in 17 days. We found that the scaffold released the antibiotic more slowly and for a longer duration. Therefore, it was thought that the scaffold would be more effective on biofilm and the treatment of osteomyelitis would be more successful. Conclusions The produced scaffold was compared with cement, and it was concluded that the scaffold had better release and antimicrobial efficacy. Scaffold is more advantageous than cement because it is bioeliminable. Thus, there is no need for a second surgical intervention with the likely prevention of mortality and morbidity. Because of all these features, the scaffold seems promising in the local treatment of osteomyelitis.