Effect of Transcutaneous Electrical Nerve Stimulation on Patients with Total Knee Replacement: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to determine the effect of transcutaneous electrical nerve stimulation (TENS) on pain, functionality, quality of life, and analgesic consumption in patients undergoing TKR. DESIGN: A single center, randomized controlled trial. METHODS: A total of 52 participants were randomly assigned to the intervention (n = 26) and control (n = 26) groups. The intervention group was exposed to conventional TENS. Data were collected with a Patient Identification Form, the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Quality of Life Scale (SF-36), and the Analgesic Tracking Form. RESULTS: VAS and WOMAC scores significantly decreased in the intervention group, over time, while they increased in the control group. SF-36 scores significantly increased in the intervention group over time. It was determined that analgesic consumption was significantly lower in the intervention group than in the control group. CONCLUSIONS: TENS significantly reduced pain and increased functionality and quality of life. Our findings suggest that TENS may be an effective adjunctive analgesic therapy in patients receiving TKR; however, more testing is needed in larger and more heterogeneous populations. CLINICAL IMPLICATIONS: Nurses can provide effective postoperative pain control in patients undergoing TKR, increase functionality, accelerate the healing process, and improve their quality of life by using TENS, a non-pharmacological treatment method, in the perioperative period.

The effects of metformin, pioglitazone, exenatide and exercise on fatty liver in obese diabetic rats: the role of IRS-1 and SOCS-3 molecules.

BACKGROUND: Obesity-induced inflammation mechanism is seen as a mechanism that may be the cause of insulin resistance and non-alcoholic fatty liver disease (NAFLD). Pathological destruction of insulin signaling molecules such as insulin receptor substrate proteins (IRS), especially due to the increase of cytokine signal suppressors (SOCS), has been demonstrated in experimental diabetes. The aim of this study was to determine the effects of metformin, pioglitazone, exenatide and exercise treatments used in type 2 diabetes on fatty liver and the role of Irs-1 and Socs3 molecules in this process in obese diabetic rats. METHODS: The study was conducted on 48 Wistar albino adult male rats weighing 180-220 g and randomly divided into 6 groups. The obese rat model with fatty liver was formed with a 60% fat diet for 4 weeks. Afterwards, drug treatment with metformin (Ob + D + M), pioglitazone (Ob + D + P), exenatide (Ob + D + ExA)) or exercise (Ob + D + ExE) was applied for 4 weeks to these obese groups, in which diabetes was induced by streptozocin (STZ). At the end of the experimental protocol, liver tissue samples were taken from all rat groups and histopathological and genetic analyses were performed. RESULTS: The mean steatosis degrees of the Ob + D + ExA and Ob + D + ExE groups were statistically significantly decreased compared to the obese diabetic group (p < 0.001). The group with the lowest mean steatosis grade was the Ob + D + ExE. Decrease in SOCS-3 expression was significant in Ob + D + M and Ob + D + P groups than other groups (p < 0.05). Mean staining intensities of Ob + D + Ex group, Ob + D + ExE group and Ob + D + P group according to IRS-1 expression statistically significantly increased compared to obese diabetic group (p < 0.05). Average staining intensity of Ob + D + ExE group according to IRS-1 expression was significant than other groups. CONCLUSION: Exercise and exenatide treatments seemed to be the prominent treatment methods by showing a statistically significant effect in decreasing the degree of steatosis, decreasing the Socs3 expression level and increasing the Irs-1 expression level.

Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients.

BACKGROUND: We aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. MATERIALS AND METHODS: This was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease. RESULTS: Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively. CONCLUSIONS: Under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.

Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years' Results of 21 Patients.

BACKGROUND: Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS. METHODS: Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%. RESULTS: Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired. CONCLUSIONS: Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications. LEVEL OF EVIDENCE: Level IV.

Automatic Segmentation of Meniscus in Multispectral MRI Using Regions with Convolutional Neural Network (R-CNN).

The meniscus has a significant function in human anatomy, and Magnetic Resonance Imaging (MRI) has an essential role in meniscus examination. Due to a variety of MRI data, it is excessively difficult to segment the meniscus with image processing methods. An MRI data sequence contains multiple images, and the region features we are looking for may vary from each image in the sequence. Therefore, feature extraction becomes more difficult, and hence, explicitly programming for segmentation becomes more difficult. Convolutional Neural Network (CNN) extracts features directly from images and thus eliminates the need for manual feature extraction. Regions with Convolutional Neural Network (R-CNN) allow us to use CNN features in object detection problems by combining CNN features with Region Proposals. In this study, we designed and trained an R-CNN for detecting meniscus region in MRI data sequence. We used transfer learning for training R-CNN with a small amount of meniscus data. After detection of the meniscus region by R-CNN, we segmented meniscus by morphological image analysis using two different MRI sequences. Automatic detection of the meniscus region with R-CNN made the meniscus segmentation process easier, and the use of different contrast features of two different image sequences allowed us to differentiate the meniscus from its surroundings.

The Effect of Aromatherapy Massage on Knee Pain and Functional Status in Participants with Osteoarthritis.

This study was conducted to evaluate the effect of aromatherapy massage on knee pain and functional status in subjects with osteoarthritis. The study was designed as a non-randomized interventional study. The study was carried out on patients who referred to the outpatient clinics of the Department of Orthopedics, Physiotherapy and Rehabilitation at Bozok University Research and Application Hospital, and were diagnosed with osteoarthritis. A total number of 95 patients were included in the study, and of those, 33 were allocated to aromatherapy massage group, 30 were allocated to conventional massage group, and 32 were allocated to the control group. The study data were collected using the Patient Identification Form, visual analogue scale, the Western Ontario and McMaster University Osteoarthritis Index. Repeated measures analysis of variance test was used to analyze the outcomes in the aromatherapy, conventional massage and control groups, according to the weeks of follow-up. Bonferroni test was used for further analysis. Baseline mean visual analogue scale score and the Western Ontario and McMaster University Osteoarthritis Index were not significantly different between the groups (p > .05). Visual analogue scale (rest-activity) scores and the scores in the Western Ontario and McMaster University Osteoarthritis Index in the aromatherapy massage group were lower, and the difference compared to the control group was statistically significant (p < .001). Aromatherapy massage performed in patients with osteoarthritis reduced knee pain scores, decreased morning stiffness, and improved physical functioning status. Thus, as long as specific training is provided for aromatherapy massage, aromatherapy can be recommended for routine use in physical therapy units, hospitals and homes.

Postoperative changes in sacropelvic junction in short-segment angular kyphosis versus Scheuermann kyphosis.

PURPOSE: To comparatively evaluate the biomechanical alterations those occur in the sagittal plane of sacropelvic junction in angular kyphosis (AK) and Scheuermann kyphosis (SK) patients after surgery. METHODS: The spine radiographs of 52 patients operated for short-segment AK (n = 20) or SK (n = 32) were studied. Main outcome measures were sacral slope, pelvic incidence, pelvic tilt, lumbar lordosis, and thoracic kyphosis angles. RESULTS: In AK group, local and thoracic kyphosis angles, as well as lumbar lordosis angle, showed statistically significant reduction with surgery. Thoracic kyphosis and lumbar lordosis angles were reduced significantly in SK group. Postoperatively, there were significant differences between groups in lumbar lordosis, pelvic tilt angle, and sacral slope (p = 0.021, p = 0.001, and p = 0.027, respectively). Thoracic kyphosis angle and sacral slope were increased, and there was a remarkable correlation between thoracic kyphosis and lumbar lordosis values in the AK group. CONCLUSIONS: The results of this study suggest that a significant sacropelvic improvement can be achieved by balanced sagittal vertical axis and T1 spinopelvic leading to a good sagittal alignment of spine in patients with AK and SK. Changes seen in morphological parameters after surgery may be closely related with baseline biomechanics and structure of the spine and pelvis. Therefore, further clinical and scientific trials are necessary both to elucidate the biomechanics, their clinical implications, and to develop new techniques and models for spine and pelvis surgery.

Plasma urotensin-2 level and Thr21Met but not Ser89Asn polymorphisms of the urotensin-2 gene are associated with migraines.

BACKGROUND: Urotensin-II (U-II) is a peptide recognized by its potent vasoconstrictor activity in many vascular events, however the role of urotensin-II in migraine has not been considered yet. The molecular mechanisms and genetics of migraine have not been fully clarified yet, but it is well-known that vascular changes considerably contribute in pathophysiology of migraine and also its complications. The aim of this study was to analyze the plasma U-II levels along with genotype distributions and allele frequencies for UTS2 Thr21Met and Ser89Asn polymorphisms among the patients with migraine without aura (MWoA). METHODS: One hundred eighty-six patients with MWoA and 171 healthy individuals were included in this study. Plasma U-II levels were measured in attack free period. The genotype and allele frequencies for the Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms in the UTS2 gene were analyzed. RESULTS: Plasma U-II levels were significantly higher in MWoA patients (p = 0.002). We detected a significant association between the T21M polymorphism in the UTS2 gene and migraine (53.8 % in patients, 40.4 % in controls, p = 0.035), but not with S89N polymorphism (p = 0.620). A significant relationship was found between U-II levels and MIDAS score (ß = 0.508, p = 0.001). CONCLUSION: Our study suggests that U-II may play a role in migraine pathogenesis; also Thr21Met polymorphism was associated with the risk of migraine disease. Further studies are needed for considering the role of U-II in migraine pathophysiology and for deciding if UTS2 gene may be a novel candidate gene in migraine cases.

Weight bearing the same day versus non-weight bearing for 4 weeks in Achilles tendon rupture.

INTRODUCTION: Achilles tendon rupture (ATR) often occurs in 40- to 50-year-old men. Multiple studies discuss the correct treatment strategy based on surgical or nonsurgical intervention, including early mobilization. We aimed to compare the outcomes of bearing weight on the same day with non-weight bearing over a 4-week period of ATR patients. MATERIALS AND METHOD: Forty-seven ATR patients were conservatively treated and entered into our study. Group 1 consisted of 23 patients treated with partial weight bearing beginning the same day of conservative treatment; Group 2 consisted of 24 patients treated with non-weight bearing after a 4-week period. Patients were at least 18 years old and were followed for 12 months. Evaluation criteria were mechanism of injury, admission time to our clinic, complication rate, and time to return to work. Symptoms and physical activity levels of all patients were assessed on 6 and 12 months after treatment began, according to the Achilles Tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS: Rerupture rates were rate 17.4% (4 patients) in Group 1 and 12.5% (3 patients) in Group 2 (p = 0.81). Time to return to work was shorter in Group 1 compared with Group 2, but it was not statistically significant (p = 0.86). AOFAS, ATRS, and PAS scores at 6 and 12 months showed no significant differences between groups (p = 0.69, p = 0.59, p = 0.89, p = 0.77, p = 0.94, p = 0.66, respectively). CONCLUSION: This study showed that a well-conducted early-weight-bearing treatment has good clinical outcomes, with a complication rate no higher than non-weight-bearing treatment.

Evaluation of mean platelet volume (MPV) levels in patients with synovitis associated with knee osteoarthritis.

Platelet count, C-reactive protein (CRP) and neutrophile countings are markers those reflect the inflammatory response. Mean platelet volume (MPV) is a simple indicator of platelet size and has been known to be a marker of platelet activity. Some platelet markers, including MPV, have been investigated to have relation with inflammation. MPV is inversely correlated with inflammation in inflammatory bowel diseases, rheumatoid arthritis, and ankylosing spondylitis, as shown in the previous studies. In this study, we aimed to investigate the levels of MPV in patients with synovitis of knee osteoarthritis. 147 patients diagnosed with synovitis associated to osteoarthritis, 191 patients with knee osteoarthritis, and 121 patients between the same age range who did not have joint complaints (control group), totally 459 participants were included to our study. MPV results of these groups were compared. We found a significant difference between the patient group with synovitis associated with osteoarthritis of knee and patients with knee osteoarthritis in MPV blood level (p < 0.0001), similarly a significant difference was found between the patient group with synovitis associated with osteoarthritis of knee and the control group (p < 0.0001). There was no significant difference between the knee osteoarthritis patient group and the control group (p = 0.78). We found a significant relation between MPV and ESR in the patient group with synovitis of osteoarthritis (p = 0.004). According to the Pearson correlation, it is found that there is a negative relationship between CRP and MPV variables in those of knee osteoarthritis patients. This correlation coefficient is statistically significant at the 10% level (p = 0.058). We could not find a relation between CRP and MPV in patients with the osteoarthritis group, but we found negative correlation (p = 0.65). Significant relationship was not found between ESR and MPV variables at the 10% level; the p value is 0.34. In the control group no correlation was found between CRP-MPV (p = 0.69) and ESR-MPV (p = 0.798). MPV levels may be beneficial in osteoarthritis with synovitis patients. MPV levels may be considered as a marker of inflammation but further comprehensive prospective trials are needed in osteoarthritis associated with synovitis patients.

Is cervical sagittal alignment associated with pain and disability in myofascial pain syndrome?: A cross-sectional study.

OBJECTIVE: To elucidate the role of cervical sagittal alignment in the pathophysiology of cervical myofascial pain syndrome(MFPS) and its impact on pain levels and disability status among patients. METHODS: This prospective cross-sectional study included participants aged 18-64 years experiencing neck pain for more than 3 months and diagnosed with MFPS. Cervical sagittal parameters (C0-2 cervical lordosis(CL) angle, C2-7 CL angle, cervical sagittal vertical axis (cSVA), T1 slope, T1 slope minus CL mismatch(T1S-CL), and cervical tilt) were measured using Surgimap software by an expert physiatrist. Pain levels were assessed using the Numerical Pain Rating Scale(NRS), and neck disability was evaluated using the Neck Bournemouth Questionnaire(NBQ). RESULTS: Out of 200 initially assessed participants with cervical MFPS, 133 were included after excluding ineligible individuals. The mean age of the participants was 35.3±8.2 years. Participants categorized by pain severity (moderate vs. severe) showed no significant differences in cervical range of motion, C0-2 angle, cSVA, T1 slope and T1S-CL. However, significant differences were observed in C2-7 angle (p=0.008), cervical tilt (p=0.006), and NBQ scores (p<0.001) between the two pain severity groups. Grouping based on T1S-CL compliance showed no significant differences in pain and disability effects. Correlation analysis revealed weak negative correlations between pain levels and C2-7 Cobb angle (p=0.009, r=0.226) as well as cervical tilt (p=0.005, r=0.243). No correlations were found between cervical sagittal parameters and NBQ scores. CONCLUSIONS: Decreased C2-7 CL angle and cervical tilt angle are associated with increased pain levels; however, cervical sagittal alignment was not found to be associated with disability.

Computational Mechanical Analysis of AO 44A1, 44B1, and 44C1 Fractures with Finite Element Modeling: Evaluation of Screw, Plate, and Kirschner Wire Fixation.

BACKGROUND: The aim of this study was to create AO 44A1, 44B1, and 44C1 fractures using finite element analysis to determine the stability of Kirschner wire, intramedullary screw, and plate-screw fixation methods in fracture. METHODS: Using finite element analysis, the postreduction behavior of AO 44A1, 44B1, and 44C1 fractures with Kirschner wire, intramedullary screw, and plate-screw fixation methods was analyzed and compared in terms of displacement and stress. RESULTS: The lowest amount of displacement was provided with the intramedullary screw method in AO 44A1 and 44B1 fractures and with the 4-mm Kirschner wire method in AO 44C1 fractures. The total displacement of the intramedullary screw system used for fixation in AO 44A1, 44B1, and 44C1 fractures was lower. CONCLUSIONS: According to finite element analysis results, the lowest amount of displacement was obtained with intramedullary screw fixation in AO 44A1 and 44B1 fractures, and 4-mm Kirschner wire fixation was achieved in AO 44C1 fractures.

Is YouTube a Reliable and Quality Source on Unilateral Biportal Endoscopic Spine Surgery? A Cross-Sectional Study.

OBJECTIVE: This study aimed to evaluate the quality and reliability of YouTube videos focusing on unilateral biportal endoscopic spine surgery, a novel technique for spinal decompression in degenerative spinal disease. METHODS: This cross-sectional study, conducted in February 2023, involved an online search on YouTube using the term "unilateral biportal endoscopic spine surgery". Video popularity was assessed using the Video Power Index. Video reliability and quality were measured using the Global Quality Scale, the Journal of the American Medical Association benchmark criteria, and the modified DISCERN instrument. RESULTS: Ninety-three videos were included for evaluation. Uploader profiles were categorized by continent, with 61.3% from Asia, 35.5% from the United States, 2.2% from Africa, and 1.1% from Australia. When comparing 3 groups as South Korea, United States, and other countries, no significant differences were observed in the technical characteristics of the videos. However, the educational quality and reliability of the videos were higher in those uploaded from South Korea (P < 0.001).When the videos were divided into 2 groups according to their educational quality, significant difference were noted in video duration, loading time, video quality, and reliability (P < 0.001). CONCLUSIONS: The YouTube videos on unilateral biportal endoscopic spine surgery showed high quality and reliability. However, videos from South Korea were found to have higher educational quality and reliability, while other specifications were similar for all videos. Furthermore, it was determined that videos uploaded more recently and with longer duration were of higher quality.

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: New technique.

OBJECTIVE: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. METHODOLOGY: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. RESULTS: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn't observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. CONCLUSION: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention.

Efficacy of treatment with glucosamine sulfate in patients with knee effusion due to osteoarthritis.

OBJECTIVE: Evaluation of anti-inflammatory effect of Glucosamine sulfate (GS) versus diclofenac sodium (DS) in effusion of osteoarthritic knees. METHODOLOGY: In this study, patients were included in this study from 2007-2010 based on American College of Rheumatology criteria with OA and physical examination in effusion of osteoarthritic knees. The patients were divided into two groups. First group (27 patients) DS was given in doses 75 mg twice daily for ten day. In the group II (25 patients) GS was used in doses of 1500 mg two times daily over the first 12 weeks of the study. A closed aspiration was performed. The knee circumference was measured in patients before and 12 week after treatment. Before and after 12 weeks of treatments, both groups of patients were assessed according to the WOMAC questionnaire of knee pain and function scores. RESULTS: Comparison of knee mean circumference between the two groups was not statistically significant before treatment (p=0.938), but significant after treatment (p<0.001). At the end of the 12 week, there was 66.6% complete resolution of effusion in the DS group (18 patients) and 24.0% (6 patients) in the GS group, this was statistically significant (P<0.001). DS groups, results of the beginning and at the end of 12 week measurement showed significant differences in WOMAC pain mean score (P < 0.001) but GS groups not statistically significant (P=0.160). The WOMAC function mean scores in pre and post-treatment periods of follow-up showed significant variation between the two groups (P< 0.001, P<0.001). CONCLUSIONS: Our observations suggest that GS is not able to suppress the progression of adjuvant arthritis in OA with effusion of knee osteoarthritis. GS should not be expected as anti-inflammatory influence as DF in the treatment of OA-related effusion.

Effects of antidiabetics and exercise therapy on suppressors of cytokine signaling-1, suppressors of cytokine signaling-3, and insulin receptor substrate-1 molecules in diabetes and obesity.

OBJECTIVE: Pathological destruction of insulin signaling molecules such as insulin receptor substrate, especially due to the increase in suppressors of cytokine signaling molecules, has been demonstrated in experimental diabetes. The contribution of suppressors of cytokine signaling proteins to the development of insulin resistance and the effects of antidiabetic drugs and exercise on suppressors of cytokine signaling proteins are not clearly known. METHODS: A total of 48 Wistar albino adult male rats were divided into six groups: control group, obese group with diabetes, obese diabetic rats treated with metformin, obese diabetic rats treated with pioglitazone, obese diabetic rats treated with exenatide, and obese diabetic rats with applied exercise program. Immunohistochemical staining was performed in both the liver and adipose tissue. RESULTS: There was a statistically significant decrease in suppressors of cytokine signaling-1, a decrease in suppressors of cytokine signaling-3, an increase in insulin receptor substrate-1, and a decrease in immunohistochemical staining in the obese group treated with metformin and exenatide compared to the obese group without treatment in the liver tissue (p<0.05). A statistically significant decrease in immunohistochemical staining of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 was found in the obese group receiving exercise therapy compared to the obese group without treatment in visceral adipose tissue (p<0.05). Likewise, no significant immunohistochemistry staining was seen in diabetic obese groups. CONCLUSION: Metformin or exenatide treatment could prevent the degradation of insulin receptor substrate-1 protein by reducing the effect of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins, especially in the liver tissue. In addition, exercise can play a role as a complementary therapy by reducing suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins in visceral adipose tissue.

Okadaic Acid-Induced Alzheimer's in Rat Brain: Phytochemical Cucurbitacin E Contributes to Memory Gain by Reducing TAU Protein Accumulation.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory loss and cognitive decline, with hallmark pathologies related to amyloid beta (Aß) and TAU. Natural phytochemicals show promise for drug discovery to fill the current therapeutic innovation gap in AD. This study investigated the effect of cucurbitacin E (CuE), one of the bioactive components of Ecballium elaterium, on TAU fibril formation in okadaic acid-induced AD in rats. In a randomized design, we assigned 30 female Sprague Dawley rats to one of five experimental groups: (1) control, (2) stereotaxic surgery, (3) stereotaxic surgery + artificial cerebrospinal fluid, (4) stereotaxic surgery + okadaic acid (AD model), and (5) stereotaxic surgery + okadaic acid + CuE treatment. For experimental groups 4 and 5, rats were administered OKA-ICV (200 ng/kg) followed by CuE (4 mg/[kg·day], intraperitoneally) for 20 days. Expression of the MAPK1/3 and MAPK14 genes associated with TAU metabolism, hippocampal protein levels of these genes, cognitive functions of the rats, and histological accumulation of TAU in the brain were evaluated. Our findings in this preclinical model collectively suggest that phytochemical CuE contributes to memory gain by reducing TAU protein accumulation, which warrants further evaluation in future in vitro and in vivo studies.

Investigation of Possible Reasons of Failed Treatment of Conservative Thoracolumbar Osteoporotic Vertebral Fractures.

AIM: To investigate the possible reasons of failed conservative treatment of osteoporotic thoracolumbar vertebral compression fractures (VCFs). Sagittal balance impairment may weaken union by increasing the load on the fracture line. Most osteoporotic vertebral fractures occur in the thoracolumbar and mid-thoracic regions. MATERIAL AND METHODS: We investigated the records of patients aged > 60 years who underwent treatment for osteoporotic thoracolumbar VCFs between 2012 and 2020. The patients were divided into two groups: those who required surgical treatment due to the failure of conservative treatment and those who were successfully treated with conservative treatment. All the patients underwent lateral radiography and computer tomography of the whole spine at their initial and final visit. The radiographic parameters of spine and presence of sarcopenia, age, and gender were compared between the groups. RESULTS: Of the study subjects, the mean age of 13 females and 7 males in whom conservative treatment was successful was 67.4 years and the mean follow-up period was 23.5 months, while in 18 females and 5 males who underwent surgical treatment due to the failure of conservative treatment, the mean age was 68.7 years and the mean follow-up period was 22.1 months. No significant differences between the groups regarding age and gender were observed. However, significant differences were observed between the groups regarding the presence of sarcopenia and thoracic kyphosis, thoracolumbar kyphosis and distance from the center of the fractured vertebra to the plumb line (DSVA). CONCLUSION: Sarcopenia and DSVA were significantly higher in the surgical treatment group. Receiver operating characteristic analysis demonstrated that the sensitivity and specificity of DSVA for identifying high-risk patients for failed conservative treatment of osteoporotic thoracolumbar VCFs were 100% and 95%, respectively, with an optimum diagnostic cutoff value of 6.5 mm.

Contribution of Multilevel Transformainal Lumbar Interbody Fusion Surgery to Restoration of Lumbar Lordosis in Patients with Degenerative Spine: Comparison of Long and Short Level Fusion.

AIM: To investigate the effect of multilevel transforaminal lumbar interbody fusion (TLIF) procedures in lumbar degenerative spine conditions on the restoration of lumbar lordosis (LL) in patients with short- and long-level fusion, and to examine the associated radiological results. MATERIAL AND METHODS: This retrospective study reviewed patients with degenerative spinal diseases who underwent lumbar fusion using a multilevel TLIF procedure. Patients with three or fewer segments involved in fusion were assigned to the shortlevel fusion group and those with more than three segments involved in fusion were assigned to the long-level fusion group. The anteroposterior and lateral spine radiographs of the patients were used to measure LL, distal lumbar lordosis and radiological parameters. RESULTS: The study included 47 patients who met the inclusion criteria, with a mean age of 60.4 ± 12.2 years. The mean follow-up time of our patients was 18.3 ± 11 months. Thirty-five (74.5%) patients were women and 12 (25.5%) were men. Overall, 12 patients underwent 3-level and 35 patients underwent 2-level TLIF. Long-level fusion was performed in 24 patients and short-level fusion was performed in 23 patients. CONCLUSION: Multilevel TLIF can be used to correct spinopelvic alignment when applied with the appropriate indications and techniques in patients with degenerative spinal disorders. Multilevel TLIF is associated with substantial improvements in LL, distal lumbar lordosis, and SVA (sagittal vertical axis). It also helps to correct the correlation between PI and LL.