A Comparison of the Effects of Neuronal Nitric Oxide Synthase and Inducible Nitric Oxide Synthase Inhibition on Cartilage Damage.

The objective of this study was to investigate the effects of selective inducible nitric oxide synthase and neuronal nitric oxide synthase inhibitors on cartilage regeneration. The study involved 27 Wistar rats that were divided into five groups. On Day 1, both knees of 3 rats were resected and placed in a formalin solution as a control group. The remaining 24 rats were separated into 4 groups, and their right knees were surgically damaged. Depending on the groups, the rats were injected with intra-articular normal saline solution, neuronal nitric oxide synthase inhibitor 7-nitroindazole (50 mg/kg), inducible nitric oxide synthase inhibitor amino-guanidine (30 mg/kg), or nitric oxide precursor L-arginine (200 mg/kg). After 21 days, the right and left knees of the rats were resected and placed in formalin solution. The samples were histopathologically examined by a blinded evaluator and scored on 8 parameters. Although selective neuronal nitric oxide synthase inhibition exhibited significant (P = 0.044) positive effects on cartilage regeneration following cartilage damage, it was determined that inducible nitric oxide synthase inhibition had no statistically significant effect on cartilage regeneration. It was observed that the nitric oxide synthase activation triggered advanced arthrosis symptoms, such as osteophyte formation. The fact that selective neuronal nitric oxide synthase inhibitors were observed to have mitigating effects on the severity of the damage may, in the future, influence the development of new agents to be used in the treatment of cartilage disorders.

Does insulin, transferrin and selenous acid preparation effect chondrocyte proliferation?

OBJECTIVE: The aim of this study was to test the hypothesis that insulin, human transferrin, and selenous acid (ITS) preparation have positive effects on chondrocyte proliferation and morphology and investigate the biochemical and histological effects of these additive substances in different cell culture media. METHODS: Human cartilage-derived cells (hCDCs) were isolated from the cartilage tissue of a 57-year-old woman diagnosed with gonarthrosis. Tissue samples were cultured in Dulbecco's modified Eagle's medium (DMEM) and RPMI-1640. The cells' chondrogenic activities were observed. After serial passagings, cells were divided into 4 groups at the end of the 6th week. On the 14th day, proliferated cells were examined using an inverted microscope with x4, x10, x20 and x40 magnification and microphotographs were taken. Living cell quantity was determined on the first and 14th days using MTS-ELISA cell proliferation assay. RESULTS: DMEM (without adding ITS premix solution) and RPMI-1640 containing ITS premix solution provide proliferation of the chondrogenic cells. The proliferation and viability of chondrocytes were revealed in this study in the 3rd group (DMEM solution without additives). CONCLUSION: It is suggested that the culture medium ingredients play crucial roles on chondrogenic proliferation in osteochondral tissue cultures.

Patella infera or patellar tendon adherence after high tibial osteotomy.

PURPOSE: Alterations in patellar height after high tibial osteotomy are found in many instances. Fibrosis of the tendon is implicated as the cause of the mechanism of patella lowering. This study aimed to determine the relationship between the position of the patella and the histopathological findings at the patellar tendon after high tibial osteotomy. METHODS: Nineteen knees in seventeen patients who were consecutively hospitalised for implant extraction are studied. All of the patients had previously undergone closing wedge osteotomy by the same surgeon at the same department. The median follow-up time is 15 months (range: 11-35). Five patients who all underwent high tibial osteotomy at the same time are also included in the study as a control group for histopathological evaluation. All of the patients are evaluated radiologically, patellar tendon biopsies are taken during the operation, and histopathological analyses are performed. RESULTS: The shortening of the patellar tendon is statistically significant (P < 0.05). The severity of the vascularisation, inflammation, and fibrotic change observed at the distal part of the tendon is evident. However, there is no statistically significant correlation between these findings and the degree of shortening. CONCLUSIONS: The shortening of the tendon occurs as a result of adherence in the distal part of the tendon. It would appear that it is this shortening that causes the difficulties encountered during arthroplasty surgery of osteotomy patients, and not patella infera.

How different methodologies of harvesting and analysing the samples affect the test results in determining joint mediators.

Purpose. This study has researched the affect of different methodologies of harvesting and analysing the samples in determining the mediators emerging after the rat articular cartilage injury. Materials and Methods. One hundred and forty-four male wistar rats were divided into 2 groups. Synovial fluid samples were taken from all of the rats. We entered into the right knees of the rats in group I (n = 36) under anaesthesia and took cartilage tissue samples from their distal femur. Samples were taken as reference values for enzyme linked immunosorbent assay (ELISA) and histopathological evaluations. We entered into the right knees of the rats in group II (n = 108) and formed complete layer of cartilage injury in their medial femoral condyles. At the end of the 15th day, the rats were sacrificed after taking synovial fluid samples from their right knees creating defect in the rats in group II. The molecular markers in the synovial fluid and cartilage tissue samples which were taken from the experimental and control groups (MMP-9, MMP-13, TIMP-1, TNF- α , and NO) were analysed by direct or indirect methodologies. SPSS 18.0 Package program was used in the statistical evaluation. Students t-test where the measurement variables between the experimental and control groups were compared was applied. Receiver Operating Characteristics (ROC) curves were used in the determination of the diagnostic sufficiency from the tissue. Results. No difference was found between TIMP-1 (P = 0.67) and MMP-9 (P = 0.28) levels in synovial fluid and cartilage tissue. From the molecular markers, when MMP-9, MMP-13, NO, TIMP-1, TNF- α ', the area under ROC curve, and P values were examined, MMP-13 (P < 0.0001, 95% CI: 0.70-0.85), NO (P < 0.0001, 95% CI: 0.72-0.86), and TNF- α (P < 0.0001, 95% CI: 0.91-0.98) results were found to be statistically significant. Inferences. The indirect ELISA protocol which we apply for the cartilage tissue as an alternative to synovial lavage fluid is a reliable method which can be used in the determination of articular cartilage injury markers.

Clinical and radiological outcome of the growing rod technique in the management of scoliosis in young children.

OBJECTIVE: The aim of this study was to investigate the effects of growing rod treatment on the clinical and radiographic outcome and respiratory function of young children with scoliosis. METHODS: Data from 25 patients (24 females, 1 male) who underwent surgical treatment with growing rods for scoliosis between 1997 and 2007 were evaluated retrospectively. Dual growing rods were used in 16 patients and single growing rods in 9. Patients' average age was 7.38 ± 3.8 years at the initial surgery. Cobb angle, T1-S1 length, and instrumentation length were measured radiographically. Respiratory functions were evaluated at the final follow-up. RESULTS: Patients received an average of 4.2 lengthening treatments over an average period of 44.9 months. Cobb angles improved from 56.7° to 25.1° after final fusion. T1-S1 length increased from 27.2 ± 3.4 to 34.9 ± 3.6 cm after the initial surgery and 38.6 ± 3.7 cm post final fusion. Average growth was 1 ± 0.4 cm per year. Mean values of respiratory parameters at the last follow-up were FVC: 83.5 ± 3.5, FEV: 84.8 ± 5.3, and FVC/FEV1: 1 ± 0.046. Twelve patients experienced complications, of which eight were instrument-related and four medical. CONCLUSION: The growing rod technique is effective in the treatment of spinal deformity in young scoliosis patients and appropriate for improving both spinal column height and pulmonary function.

Subcutaneous anterior transposition of the ulnar nerve in cubital tunnel syndrome.

OBJECTIVE: The aim of this study was to present the mid-to long-term results of subcutaneous anterior transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. METHODS: The study retrospectively evaluated 33 patients (24 males, 9 females; mean age: 48 years; range: 26 to 59 years) who underwent subcutaneous transposition of the ulnar nerve. Mean follow-up period was 4 years 9 months (range: 2 years 6 months to 8 years). Modified McGowan's classification was used for preoperative scoring and the Wilson & Krout classification for postoperative clinical evaluation. Preoperatively 5 patients (15%) had Grade 1, 7 (21%) had Grade 2A, 9 (27%) had Grade 2B, and 12 (36%) had Grade 3 neuropathy. RESULTS: There were excellent results in 24 patients (73%), good in 7 (21%), fair in 1 (3%), and poor in one (3%). The patient with the poor result had developed neuropathy following a crush injury. There was a negative correlation between the preoperative McGowan grade and the postoperative Wilson & Krout score (p<0.05, r=-0.43). The success rate of the operation was significantly lower in patient groups as the time from symptom onset increased (p<0.05). There were no complications. CONCLUSION: Subcutaneous anterior transposition of the ulnar nerve is an effective and reliable surgical method with a low complication rate for the treatment of cubital tunnel syndrome.

Synergistic Effect of TGF-ß1 And BMP-7 on Chondrogenesis and Extracellular Matrix Synthesis: An In Vitro Study.

INTRODUCTION: The purpose of the present study seeks to determine the signal timing of BMP-7 and TGF-ß1 from a novel chitosan based hydrogel system that may affect chondrocyte proliferation resulting in the presence of a synergism seen conspicuously in consecutive controlled delivery. METHODS: Four groups of cultured chondrocytes were seeded on a novel designed chitosan based hydrogel. The hydrogel was left empty (control) in one group and loaded with BMP-7, TGF-ß1 and their combination in the other groups, respectively. Hydrogel structure was analyzed with scanning electron microscope. The release kinetics of Growth Factors (GFs) was determined with ELISA. Chondrocyte viability and toxicity after being tested with MTS and collagen type II synthesis, were quantified with western blotting. Canonical regression analysis was used for measuring statistical evaluation. RESULTS: Chitosan based hydrogel allowed controlled release of GFs in different time intervals for BMP-7 and TGF-ß1. Double peak concentration gradient was found to be present in the group loaded with both GFs. In this group, substantially higher chondrocyte growth and collagen synthesis were also detected. CONCLUSIONS: We concluded that, chitosan based hydrogel systems may be adjusted to release GFs consecutively during biodegradation at the layers of surface, which may increase the cell number and enhance collagen type II synthesis.

Anxiety and trauma perception and quality of life in patients who have undergone replantation.

The difficulty in keeping an amputated limb biologically alive is overcome day by day thanks to the successful replantation procedures applied in the early period. However, the reflections of this biological success on patients in functional and psychological terms may not be pleasing all the time. In our study, we aimed to evaluate the perceptual responses of patients to trauma after replantation and their possible effects on clinical results. We conducted a retrospective study of 43 patients who underwent replantation. The average age was 32.4 years and the average follow-up period was 38.6 months. When the results of the Short Form-36 (SF-36), Beck's Depression Inventory, and the assessment scores of the disabilities of the arm, shoulder, and hand survey were evaluated, there was a negative correlation between the patients diagnosed with depression and all SF-36 subunits. A negative correlation between the severity of trauma and the average physical and mental values included in the SF-36 evaluations was observed (R = 0.48, R = 0.51, respectively),. These results revealed that the psychology of the patient was one of the important factors that could not be ignored in the success of replantation.

Sonographically guided corticosteroid injection for treatment of plantar fasciosis.

OBJECTIVES: The purpose of this study was to prospectively investigate the effect of sonographically guided corticosteroid injection on the clinical and radiologic responses in patients with proximal plantar fasciosis. METHODS: Thirty-one consecutive patients with unilateral plantar fasciosis were enrolled. A 4-cm 21-gauge needle was positioned in a caudocranial oblique manner, and the needle was withdrawn to the near edge of the fascia so that the solution dispersed around the edge. Two milliliters (20 mg/mL) of lignocaine/prilocaine, 1%, and 0.5 mL (20 mg) of methylprednisolone acetate solutions were injected separately. The plantar fascia and fat pad thickness, fascial echogenicity, and perifascial edema were assessed with a 10-5 MHz linear array transducer. The American Orthopedic Foot and Ankle Society midfoot scale was used to assess function, alignment, and pain. The initial radiologic and clinical measurements were compared with data obtained not less than 6 weeks after the injections. RESULTS: A statistically significant decrease in the mean plantar fascia thickness was detected after treatment (P < .0001). There was no statistically significant difference in the plantar fascia echogenicity before and after treatment (P = .11). A statistically significant decrease was found for perifascial edema (P < .0001), and a statistically significant increase in American Orthopedic Foot and Ankle Society scores was detected (P = .0007). There was no decrease in fat pad thickness (P > .1). Plantar fascia rupture was detected in 1 patient. CONCLUSIONS: Sonographically guided corticosteroid injection enables real-time imaging of the plantar fascia during needle insertion. A caudocranial oblique injection beneath the fascia may have an incremental value in the treatment response in patients with plantar fasciosis.