The effect of high tibial osteotomy and unicompartmental knee arthroplasty on patellofemoral joint in young patients with medial knee arthrosis.

INTRODUCTION: Osteoarthritis of the knee is a debilitating disease. In most cases, only the medial compartments are affected. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are the two main procedures commonly used in the surgical treatment of unicompartmental knee osteoarthritis patients not responding to conservative treatment. The aim of our study was to compare UKA and biplanar medial open-wedge HTO in terms of patellofemoral changes and functional score in patients under 60 years of age with medial compartment arthrosis. MATERIALS AND METHODS: A retrospective study. A total of 79 patients (37 HTO, 42 UKA) who received one of the two treatments in a single center were examined preoperatively and at a single postoperative follow-up. Posterior tibial slope, lateral patellofemoral angle (LPFA), Q-angle, patellar height, Cincinnati Rating System and Knee Injury and Osteoarthritis Outcome Score (KOOS) functional scores were evaluated in all patients preoperatively and at the 6-month follow-up examination. RESULTS: Insall-Salvati ratio remained stable in the HTO group, while there was a minor decrease in the UKA group and the changes between the groups were not statistically significant. Caton-Deschamps ratio increased in the UKA group and decreased in the HTO group, and this change was statistically significant (p < 0.001). LPFA did not change in the UKA group in the postoperative period, while it increased in the HTO group (p < 0.001). Changes in Q angle and Cincinnati Rating System scores were statistically similar between the UKA and HTO groups (p = 0.827 and p = 0.340). CONCLUSIONS: In our study, biplanar medial open-wedge HTO and UKA performed with appropriate surgical technique had no negative effect on patellofemoral joint. In patients under 60 years of age with medial compartment osteoarthritis of the knee, both surgical treatments can be performed with appropriate patient selection.

Investigation of the Effects of N-acetylcysteine and Selenium on Vesicoureteral Reflux Nephropathy: An Experimental Study.

INTRODUCTION: This study aimed to investigate the effects of N-acetylcysteine (NAC) and selenium (Se) on vesicoureteral reflux (VUR) nephropathy. METHODS: A total of 44 rabbits in 7 groups, namely group 1 (Control), group 2 (VUR + sterile urine), group 3 (VUR + sterile urine + NAC), group 4 (VUR + sterile urine + Se), group 5 (VUR + infected urine), group 6 (VUR + infected urine + NAC) and group 7 (VUR + infected urine + Se), were used. 99mTc Dimercaptosuccinic acid renal scan (DMSA), cystogram and urine culture were performed both at the beginning and end of the study. Left VUR was created surgically, and E. coli was inoculated in infected urine groups. NAC and Se were administered daily for 21 days. Malondialdehyde (MDA) measurement, inflammatory response scores (IRSs), and cicatrization response scores (CRSs) in renal tissues were evaluated. RESULTS: VUR did not reduce left renal uptake values in neither group 2 nor group 5. MDA levels of the left kidney were significantly higher in group 5 compared to group 1 (p = 0.001). There was no significant difference in MDA levels between group 5 and group 6, and between group 5 and group 7. Left kidney IRSs were found to be higher in all other groups except group 2 compared to the control group (p < 0.001). Left kidney CRSs were significantly higher in group 5 compared to group 2 (p = 0.026), group 6 (p < 0.001) and group 7 (p = 0.006). CONCLUSION: A decrease in renal functions was not observed in VUR, even if there was infection. When CRSs were evaluated, NAC and Se had protective effects in terms of scar formation in VUR nephropathy. TYPE OF STUDY: Experimental animal study. LEVELS OF EVIDENCE: N/A.

Therapeutic insights: Use of ceftazidime-avibactam in pediatric patients.

BACKGROUND: The increasing worldwide prevalence of multidrug-resistant (MDR) bacteria underscores the pressing demand for innovative therapeutic solutions. Ceftazidime-avibactam (CAZ-AVI) represents a promising new drug combination that has received approval for specific infection types. However, there is limited information regarding its application in pediatric patients. METHODS: This study investigates the effectiveness and adverse reactions associated with CAZ-AVI treatment in pediatric patients with life-threatening infections caused by MDR pathogens. The study was conducted at a tertiary children's hospital between December, 2021 and July, 2023. RESULTS: A total of 21 patients with life-threatening infections caused by MDR pathogens were enrolled in the study. All patients had underlying medical conditions: 10 had cerebral palsy, four had congenital neurometabolic disease, two had Nieman-Pick disease, two had cystic fibrosis, two had primary immunodeficiency, and one had leukemia. Among these, 12 patients had tracheostomies. Eight patients received CAZ- AVI monotherapy, and 13 patients received combination therapy. Microbiological eradication was achieved in 18 patients (85.7%), and a clinical response was observed in 20 patients (95.2%). Two patients (9.5%) experienced relapse with the same bacteria. One patient developed anaphylaxis, and one patient had elevated creatine phosphokinase levels that normalized following discontinuation of treatment. One patient died during the study period due to gastrointestinal bleeding. CONCLUSIONS: Ceftazidime-avibactam may be a promising new drug option for the treatment of life-threatening infections caused by MDR Gram-negative microorganisms in pediatric patients. However, further studies with larger case series are needed to further evaluate the efficacy and safety of CAZ-AVI in this population.

Mid-Term Clinical and Radiological Changes in the Ankle Joint in Varus Knee Osteoarthritis Following Total Knee Arthroplasty.

Background/Objectives: In patients with varus knee osteoarthritis, compensatory changes occur in the foot and ankle joints to compensate for the varus deformity of the knee. The aim of the study was to investigate the changes in the ankle of patients whose knee alignment was corrected with total knee arthroplasty (TKA) and to explore the clinical implications of these findings. Methods: In this retrospective observational study, we analyzed 204 knees of 179 patients who had regular follow-ups out of 431 patients who underwent TKA for varus knee osteoarthritis between January 2019 and July 2021. Patient demographics, body mass index, follow-up time, and radiographs were studied. The hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA), talar tilt (TT) angle, ground talar dome (GT) angle, ground tibia plafond (GP) angle, and the American Orthopaedic Foot & Ankle Society (AOFAS) score were assessed preoperatively and at the last follow-up. Results: A total of 204 knees of 179 patients with a mean follow-up time of 32.50 ± 6.68 months were evaluated. It was found that the change in the HKA had a positive effect on the AOFAS score and a negative effect on the TT, GT, and GP angles. While the clinical score improved in 82 patients, it worsened in 8 patients. The age difference between the groups whose AOFAS score improved and worsened was statistically significant. Conclusions: The correction of the varus malalignment in the knee was shown to also improve the compensatory valgus in the foot and ankle over the mid-term, with a statistically significant improvement in the patients' clinical ankle scores.

What Is the Rate of Antimicrobial Resistance of a Prosthetic Joint Infection in a Major Orthopaedic Centre?

Periprosthetic joint infections (PJIs) are important factors in decreasing the success of hip and knee arthroplasties. It is a necessity to explore the epidemiological data and develop applications for rational antibiotic use, to address future infection control concerns. We aimed to investigate the microorganisms that were responsible and the related antibiograms in 121 patients with PJI, who were managed by two-stage revision surgery. Patients' data records, demographics, comorbidities, sites of arthroplasty, synovial fluid and deep tissue culture results and antibiotic treatment were summarized on a standardized case report form. There were 43 (35.5%) culture-negative PJI cases and 12 (9.9%) polymicrobial growths. The causative pathogens included Gram-positive (50.4%) and Gram-negative microorganisms (23.1%) and fungi (0.8%). Methicillin resistance was 64.3% for S. aureus and 89.5% for coagulase-negative staphylococcus (CoNS). The extended spectrum beta lactamase (ESBL) rate for Enterobacteriaceae was 68.4%. This study shows that antibiotic resistance is encountered in more than half of the cases, which is valid for all microorganisms most common in PJI. The success of treatment decreases significantly in cases where antibiotic-resistant microorganisms are isolated or in cases where the culture is negative.

Is tranexamic acid safe for the hip joint?

To show the effects of tranexamic acid, which is a drug frequently used to control bleeding, on the hip joint and sciatic nerve in animal experiments. There were 15 rats in each of the 3 groups, with a total of 45 rats. Topical saline injections were applied to the first group, topical TXA injections to the second group, and intravenous (IV) TXA injections to the third group. In the samples taken from the hip joint 3 weeks later, femoral head cartilage, sciatic nerve, and joint capsule thicknesses were analyzed histologically. Statistically significantly more cartilage degradation was detected in the femoral head cartilage in both the IV and intraarticular TXA group when compared to the control group. The groups were also compared in terms of acetabular cartilage; however, no histological difference was found between the groups. It was seen that when the femoral head cartilage thickness (the average of the measurements made from 3 different points were used) was examined, the cartilage thickness in the topical TXA group was less when compared to the other 2 groups. However, this difference was determined to not be statistically significant. The data of the hip joint capsule thickness measurement, it was found that the capsule thickness in the topical TXA applied group was less when compared to the other 2 groups. However, this difference was not statistically significant. When the sciatic nerves in all 3 groups were compared, no different staining characteristics were found in the immunofluorescence examination. TXA, which is frequently used in orthopedic practice, shows negative effects on hip joint cartilage in both topical and intravenous application.

Tranexamic acid administered intraarticularly to the knee is safer for the articular cartilage and anterior cruciate ligament compared to intravenous administration: Histological analysis of an experimental rat model.

In this study, the effects of tranexamic acid (TXA) on the knee's articular cartilage, anterior cruciate ligament (ACL), and joint capsule were assessed histologically. There were 15 rats in each of the 3 groups, totaling 45 rats. Intraarticular (IA) saline injections were applied for the first group, IA TXA injections for the second group, and intravenous (IV) TXA injections for the third group. Using samples taken from the knee joint 3 weeks later, the medial/lateral femoral condyle and medial/lateral tibial plateau articular cartilages were evaluated with Osteoarthritis Research Society International (OARSI) scoring, while ACL diameter and joint capsule thickness were analyzed histologically. In comparisons of OARSI scores for the medial/lateral femoral condyle and medial/lateral tibial plateau cartilage regions, the scores obtained for the IV TXA group were significantly higher than those of the IA saline group (P < 0.001, P = 0.001, P = 0.003, P = 0.011). In comparisons of medial/lateral femoral condyle and medial/lateral tibial plateau OARSI scores, the scores obtained for the IV TXA group were again significantly higher than those of the IA TXA group (P < 0.001, P < 0.001, P < 0.001, P = 0.002). When ACL diameters were compared, a significant decrease was observed in the ACL diameters of the IV TXA group compared to the IA saline and IA TXA groups (P < 0.001, P = 0.039). Histologically, IV TXA damages the articular cartilage and ACL more than IA TXA. IA administration of TXA is more protective when the articular cartilage and ACL are preserved.

Does Morphology of the Shoulder Joint Play a Role in the Etiology of Rotator Cuff Tear?

BACKGROUND: The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs. AIM: Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters. METHOD: Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients. RESULTS: AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI. CONCLUSION: Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.

Is large unstained cell percentage (%LUC) a novel diagnostic marker for periprosthetic joint infections?

BACKROUND: Periprosthetic joint infection (PJI) is a very important complication that occurs after total joint replacement. Diagnosing PJI is at least as difficult as this disease. There is no biomarker that alone can diagnose PJI. OBJECTIVE: This study aimed to evaluate the effectiveness of large unstained cell percentage (%LUC) in diagnosing PJI and deciding on re-implantation in two stage septic exchange arthroplasty. METHODS: Patients who underwent revision arthroplasty between 2019 and 2023 were screened retrospectively. These patients were grouped as those who underwent two-stage septic exchange and those who underwent aseptic exchange. Prosthesis removal from the patients who underwent two-stage septic exchange, before spacer application, and on the 3rd post-operative day after spacer application, Blood parameters were collected at the 1st month and before the second stage after the spacer application, and before the revision surgery from the patients who underwent aseptic exchange. White blood cell, neutrophil percentage, %LUC, albumin, sedim and CRP values were checked and recorded one by one from all patients. RESULTS: The data of a total of 233 patients, including 133 patients in the two stage septic exchange group and 100 patients in the aseptic exchange group, were included in the study. When the predictive value of %LUC in PJI was accepted as cut-off 1.75, the sensitivity was 69.2% and the specificity was 73%. The change in %LUC over time in patients who underwent two-stage septic exchange was statistically significant (p= 0.0001). A positive correlation was found between the value of .%LUC after spacer application and the value of CRP before prosthesis protrusion/spacer application surgery, and the Spearman correlation coefficient was found to be 0.005. CONCLUSION: %LUC value can be a promising biomarker for the diagnosis of PJI by considering both sensitivity and specificity rates. Apart from this, it is an easily accessible and effective biomarker for re-implantation decision making and evaluation of response to treatment, especially in two-stage septic exchange surgeries.

Investigation of Morphometric Factors Associated With Adolescent ACL Rupture.

Background: There are no definitive anatomic morphometric risk factors for adolescent anterior cruciate ligament (ACL) injury. Purpose: To compare the parameters used to define the tibial and femoral morphometric structure of the knee between adolescent patients with and without ACL rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were magnetic resonance imaging (MRI) scans and radiographs of 115 patients aged 10 to 17 years who were evaluated for ACL rupture at a single institution between February 1, 2019, and January 31, 2022. Images from 115 patients with intact MRI scans were included as controls. We investigated the following imaging parameters: tibial slope (on lateral radiograph), lateral condylar height, tibial sulcus height, medial condylar height, condylar width, intercondylar notch with, intercondylar notch angle, notch index, eminence width, tibial plateau width, eminence width/tibial plateau width, medial/lateral/overall eminence height, medial plateau depth, and 2 different eminence angles. Parameters were compared between groups using the chi-square, Fisher exact, Student t, or Mann-Whitney U test, as appropriate. Receiver operating characteristic analysis was conducted for cutoff values of significant parameters. Results: There were no significant differences in age, sex, or side affected between groups. Only the medial plateau depth was found to be statistically significant between the ACL rupture and ACL intact groups (2.6 vs 2.2 mm; P = .015). A statistically significant cutoff value could not be obtained for the medial plateau depth. Conclusion: Medial plateau depth was found to be significantly greater in adolescent patients with ACL rupture compared with ACL-intact controls.

Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake.

OBJECTIVES: The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 20th, 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called 'Earthquake' created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. RESULTS: Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. CONCLUSION: Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Community-acquired S. aureus infection in childhood: a multi-center study.

BACKGROUND: The prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) has been increasing worldwide. We aimed to investigate the prevalence of MRSA in community-acquired S. aureus infections, the risk factors for CA-MRSA infection and the clinical features of CA-MRSA. METHODS: A multi-center study with prospective and retrospective sections was conducted. Patients ≥ 3 months old and ≤18 years of age who were diagnosed with community-acquired S. aureus infections were included in this study and the patients` information were reviewed from the medical and microbiological database of the hospital. A standard question form about living conditions and exposure risk factors was administered to the parents of patients. The CA-MRSA infections were compared with the methicillin-susceptible S. aureus (CAMSSA) infections in terms of the queried risk factors and clinical variables. RESULTS: We identified 334 pediatric patients with S. aureus infection, 58 (17.4%) had an infection with CAMRSA. The refugee rate was higher in the CA-MRSA group. There was no significant difference regarding the exposure risk. The treatment modalities and outcomes were similar. CONCLUSIONS: The study was not able to show reliable clinical variables or epidemiological risk factors except for being a refugee for CA-MRSA infections. Empirical antibiotic treatment should therefore be determined according to the local CA-MRSA prevalence in patients presenting with a possible staphylococcus infection.

Do age, gender, and region affect tibial slope? A multi-center study.

INTRODUCTION: Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. MATERIALS AND METHODS: A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60-69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. RESULTS: The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. CONCLUSIONS: Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope.

Pangolin-inspired untethered magnetic robot for on-demand biomedical heating applications.

Untethered magnetic miniature soft robots capable of accessing hard-to-reach regions can enable safe, disruptive, and minimally invasive medical procedures. However, the soft body limits the integration of non-magnetic external stimuli sources on the robot, thereby restricting the functionalities of such robots. One such functionality is localised heat generation, which requires solid metallic materials for increased efficiency. Yet, using these materials compromises the compliance and safety of using soft robots. To overcome these competing requirements, we propose a pangolin-inspired bi-layered soft robot design. We show that the reported design achieves heating > 70 °C at large distances > 5 cm within a short period of time <30 s, allowing users to realise on-demand localised heating in tandem with shape-morphing capabilities. We demonstrate advanced robotic functionalities, such as selective cargo release, in situ demagnetisation, hyperthermia and mitigation of bleeding, on tissue phantoms and ex vivo tissues.

Seroprevalence of Toxoplasma gondii in Different Patient Groups in Our Hospital

Objective: Toxoplasma gondii (T. gondii) is an obligate intracellular parasite. It is regarded as an important cause of morbidity and mortality in congenital contamination and immunosuppressive patients. This study aimed to determine the seropositivity of T. gondii in various ages and patient groups, as well as to reveal the current immune status, especially in risk groups. Methods: Results of T. gondii serology conducted between 2015 and 2019 in the medical microbiology laboratory in a university hospital were retrospectively analyzed. In the study, anti-T. gondii IgM, anti-T. gondii IgG antibodies, and anti-T. gondii IgG avidity test results were investigated by the enzyme-linked fluorescent assay method. Additionally, seropositivity rates among immunosuppressed patients and pregnant women, which are risk groups for toxoplasmosis, were revealed. In the identification of the immunosuppressed patients, groups with significant immunosuppression were retrospectively determined by examining their files. Results: The serology of T. gondii was investigated in serum samples of a total of 20.875 individuals, among which 6.220 (29.8%) are males and 14.655 (70.2%) are females. Anti-T. gondii IgM and IgG positivity rates were significantly higher in women than in men. When all years are evaluated, IgM positivity in 16.448 patients and IgG positivity in 4.427 patients were investigated. In the 5-year period, T. gondii IgM seropositivity and T. gondii IgG seropositivity was among all the patients was 2.4% and 24.1%, respectively. While the rate of T. gondii IgG seropositivity in women of childbearing age was 36.1%, it was 42.4% in pregnant women and 14.6% in immunosuppressed patients. Conclusion: T. gondii serology follow-up of pregnant women and immunosuppressed patients in terms of reactivity of latent infection should be advised and toxoplasmosis should be considered in suspicious clinical cases.

Radiological Evaluation of Femoral Intercondylar Notch and Tibial Intercondylar Eminence Morphometries in Anterior Cruciate Ligament Pathologies Using Magnetic Resonance Imaging.

PURPOSE: To determine the relationship between femoral-tibial morphometries and anterior cruciate ligament (ACL) pathologies using magnetic resonance imaging (MRI). METHODS: We retrospectively evaluated 455 patients (211 females and 244 males) who underwent knee MRI with suspected ACL pathology. Imaging findings were classified as normal ACL (n = 119), degeneration of the ACL (n = 116), partial ACL tear (n = 103), and complete ACL tear (n = 117). In all groups, the femoral intercondylar notch width (INW), intercondylar distance (CD), notch width index (NWI), and intercondylar notch angle (INA), the angles between the tibial plateau and tibial spines (MPA and LPA), intercondylar eminence peak angle (IEA), and tibial slope angles (MSA and LSA) were measured. RESULTS: Femoral INW and NWI were significantly lower in patients with ACL pathology (p < 0.05). They were also lower in patients with tear compared to degeneration. The INA was significantly smaller in patients with ACL pathology (p < 0.001) and the significance continued in both genders. The LSA was only increased in patients with complete tear (p < 0.01) and the difference seems existing in both genders. It was also found that the LPA and IEA demonstrated significant increases in patients with ACL pathology (p < 0.01 and < 0.05, respectively) and the significance in LPA continued in both genders. Significant differences between males and females were found for the INW and CD in all 4 groups (p < 0.001). In addition, the INA, LPA and LSA were independent predictors in determining the risk of ACL pathology. CONCLUSION: The ACL pathologies are associated with femoral-tibial morphometries and these associations exist in both genders. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00490-7.

Relationship between Selective IgA Deficiency and COVID-19 Prognosis.

The prevalence and mortality rates of coronavirus disease 2019 (COVID-19) widely vary among populations. Mucosal immunity is the first barrier to the pathogen's entry into the body. Immunoglobulin A (IgA) is the primary antibody responsible for mucosal immunity. We explored the relationship between selective IgA deficiency (SIgAD) and COVID-19 severity. We included 424 patients (203 women) with COVID-19. Eleven patients had SIgAD. Laboratory data of patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored using logistic regression analysis. In the univariate logistic regression analysis, the risk of severe COVID-19 disease in patients with SIgAD was approximately 7.7-fold higher than that in other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, P = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, P = 0.026) higher in the multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts and negatively correlated with C-reactive protein levels, which was a risk factor for severe COVID-19. In patients with SIgAD, the number of severe acute respiratory coronaviruses 2 that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.

Memory B cells and serum immunoglobulins are associated with disease severity and mortality in patients with COVID-19.

PURPOSE OF THE STUDY: The aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19. STUDY DESIGN: In this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined. RESULTS: The median age of the patients was 50 (35-63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6-8) in deceased patients and 1 (0-2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG1 and IgG2 than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG1 levels were independent risk factors for mortality in patients with COVID-19. CONCLUSION: In the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.

The Effect of Different Dental Implant Surface Characteristics on Bone Immunologic Biomarkers and Microbiologic Parameters: A Randomized Clinical Study.

This study assessed the levels of tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), receptor activator of nuclear factor kappa B (RANK), RANK ligand (RANKL), osteoprotegerin (OPG), and levels of Fusobacterium nucleatum, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, and Streptococcus oralis in areas where airborne particle-abraded, large-grit, acid-etched (SLA), fluorine-modified, and anodized implant surfaces are used. A total of 71 implants from 37 patients were assessed, grouped according to the surface characteristics of the implants: SLA surface (Group 1), fluorine-modified surface (Group 2), and anodized surface (Group 3). The following clinical indices were measured: Gingival Index (GI), probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), and keratinized tissue width (KTW). Peri-implant sulcus fluid and subgingival plaque samples were also collected. Commercial enzyme-linked immunosorbent assay (ELISA) kits were purchased for measuring TNF-α, PGE2, RANKL, RANK, and OPG. Real-time quantitative polymerase chain reaction (PCR) was used to detect P intermedia, T forsythia, T denticola, F nucleatum, P gingivalis, and S oralis levels in the subgingival biofilms. The groups showed no statistically significant differences in GI, PD, BOP, CAL, KTW, or peri-implant status. The total amounts of PGE2, TNF-α, RANKL, RANK, and OPG and the RANKL/OPG ratio were not significantly different between groups. F nucleatum, T forsythia, P intermedia, P gingivalis, and T denticola were significantly higher in Group 3 implants. DNA concentrations of S oralis were higher in Group 2. Within the limitations of this study, SLA and fluorine-modified implant surfaces may be more clinically successful than anodized-surface implants.

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.