Comparison of demographic, clinic and radiological features of patients with axial spondyloarthritis accompanying familial Mediterranean fever to patients with each condition alone.

OBJECTIVE: To compare the demographic, clinical, and radiological features of patients with axial spondyloarthritis (axSpA) accompanying familial Mediterranean fever (FMF) to patients with each condition alone. METHOD: Hacettepe University Hospital database was screened regarding ICD-10 codes for FMF (E85.0) and axSpA (M45). The diagnosis of FMF was confirmed by Tel-Hashomer criteria, and axSpA by the presence of sacroiliitis according to the modified New York criteria or active sacroiliitis on magnetic resonance imaging. As control groups, 136 gender-matched, consequent FMF patients without axSpA and 102 consequent axSpA patients without FMF previously treated with any biological agents were included in the analysis. RESULTS: In patients with FMF + axSpA compared to the axSpA group, age at axSpA symptom onset and age at diagnosis were lower [median with interquartile range (IQR): 21 (17-30) vs 27 (21-37), p < 0.001; 23 (21-38) vs 32 (24-43) years, p = 0.001], moderate to severe hip disease and total hip replacement were more prevalent (23.4% vs 4.7%, p < 0.001; 11.2% vs 2.8%, p = 0.016). In patients with FMF + axSpA compared to the FMF group, age at FMF symptom onset and age at diagnosis were higher [13 (6-30) vs 11 (5-18), p = 0.057; 23 (13-33) vs 18 (10-31) years, p = 0.033] and amyloidosis was more prevalent (6.6% vs 2.2%, p = 0.076). Although the M694V variant (in one or two alleles) was more prevalent in the FMF + axSpA group, the difference was not statistically significant. CONCLUSION: In patients with FMF + axSpA, the age of onset of axSpA was significantly earlier, moderate to severe hip involvement and amyloidosis were more common than in patients with each condition alone.

A Rare Cause of Lateral Snapping Knee in a 14-Year-Old Female Patient: Popliteus Tendon.

With this case report, we introduced a rare and commonly overlooked cause of lateral snapping knee, a snapping popliteus in a 14-year-old female patient. She was initially treated for a lateral discoid meniscus, a common diagnosis in this age group. Because of the non-resolving symptoms, a second-look arthroscopy was performed and showed a popliteus tendon snapping over a tubercle on the lateral femoral condyle. Resection of the tubercle resulted with a successful outcome. In evaluating the snapping knee in young children, popliteus tendon should be kept in mind. Key words: snapping popliteus, tubercle, knee, arthroscopy, popping.

Effects of mastoid and middle-ear volume on graft success and hearing outcomes in paediatric tympanoplasty.

OBJECTIVE: To examine the effects of mastoid and middle-ear volume on the anatomical and functional success of type 1 tympanoplasty in paediatric patients. METHODS: This study included 45 paediatric patients who underwent type 1 cartilage tympanoplasty. Patients' demographic data, pre- and post-operative audiological evaluation results, and post-operative graft status were evaluated. Middle-ear and mastoid cavity volumes were calculated (in cubic centimetres) using temporal bone high-resolution computed tomography. Middle-ear and mastoid cavity volume values were compared between patients with and without post-operative anatomical and functional success. RESULTS: Anatomical success was achieved in 82.2 per cent of patients (n = 37), and functional success in 68.9 per cent (n = 31). When anatomical success and failure groups were compared, a statistically significant difference was found in mean mastoid volume (p = 0.037), while there was no significant difference in relation to mean middle-ear volume (p = 0.827). The comparison of functional success and failure groups revealed no significant difference in mean mastoid volume (p = 0.492) or middle-ear volume (p = 0.941). CONCLUSION: The study showed that mastoid pneumatisation volume affects surgical success in paediatric tympanoplasty.

Reliability of Evaluation of the Surgeon-Dependent Factors Affecting Mechanical Failure after Intertrochanteric Femur Fracture Treatment.

PURPOSE OF THE STUDY The intertrochanteric femur fractures seen in the elderly population are usually treated surgically. Mechanical failure of this treatment is a serious complication and to prevent this, many assessment factors have been described such as tip-apex distance, reduction quality etc. The aim of this study is to evaluate the intra- and inter-observer reliability of modifiable factors evaluated after the treatment of intertrochanteric fractures. MATERIAL AND METHODS The early post-operative radiographs of sixty-two patients treated with PFN-A were evaluated. Six observers with 8 to 27 years of experience in hip trauma surgery were asked to measure tip apex distance (TAD), calcar referenced TAD (calTAD), collo-diaphyseal angle (CDA) and evaluate the position of helical blade and also fracture reductions according to Baumgaertner and Chang criteria on these radiographs. Fleiss kappa and intra-class correlation coefficient (ICC) values were calculated for inter-observer and intra-observer reliability assessment, respectively. RESULTS Inter-observer reliability values for both evaluations were moderate (fleiss κ: 0.417-0.455) for TAD measurements, moderate (fleiss κ: 0.418-0.458) for calTAD measurements, fair (fleiss κ: 0.302-0.288) for CDA measurements, substantial (fleiss κ: 0.606-0.631) for antero-posterior zone evaluation, moderate (fleiss κ: 0.550-0.546) for lateral zone assessment, fair-moderate (fleiss κ: 0.353-0.453) for Baumgaertner reduction quality assessment, and fair-moderate (fleiss κ: 0.365- 0.456) for Chang reduction quality assessment. Intra-observer reliabilities were found to be moderate to good for TAD and calTAD measurements, moderate for CDA measurements, good to excellent for AP and lateral zone and Baumgaertner reduction quality criteria assessments and good for Chang reduction quality criteria assessment. DISCUSSION There is no large data on the subject of the present study in the literature. There is a single article evaluating the reliability of more than one evaluation criteria in which only two observers' findings were evaluated in the literature. As in our study, more accurate inferences can be made with the increase in the number of observers. Unlike the literature, the inter-observer reliabilities of TAD and calTAD which have a very important place in the postoperative evaluation of these fractures were found as "moderate'' instead of "excellent'' in our study, CONCLUSIONS It was determined that only the inter-observer reliability of antero-posterior zone evaluation was substantial. The inter-observer reliability of all other measurements and evaluations were fair to moderate. Key words: Intertrochanteric fractures, reliability, measurements, reduction quality; TAD, calTAD.

PILE: a candidate prognostic score in cancer patients treated with immunotherapy

Background Although the immune checkpoint inhibitors (ICIs) became a vital part of cancer care, many patients do not respond to treatment, indicating need for biomarkers. The Pan-Immune-Inflammation Value (PIV) is a recently developed peripheral blood count-based biomarker. Herein, we evaluated a PIV-based candidate scoring system as a prognostic biomarker in ICI-treated patients. Methods A total of 120 advanced cancer patients treated with anti-PD-1 or anti-PD-L1 inhibitors for any cancer type were included in this study. The PILE scoring system incorporating the PIV (< median vs. ≥ median), lactate dehydrogenase levels (normal vs. > normal) and Eastern Cooperative Oncology Group performance status (0 vs. ≥ 1) was constructed from the multivariate analyses and used for stratification. The association between overall survival (OS), progression-free survival and PILE risk category was evaluated with multivariate analysis. Results The median follow-up was 9.62 months and the median OS of all cohort were 12.42 ± 2.75 months. Patients with higher PIV had significantly decreased OS (7.75 ± 1.64 vs. 18.63 ± 4.26 months, p = 0.037). The patients in the PILE high-risk group (PILE score 2–3) had decreased OS (18.63 ± 4.02 vs. 5.09 ± 1.23 months, HR: 2.317, 95% CI: 1.450–3.700, p < 0.001) and PFS (7.69 ± 1.30 vs. 2.69 ± 0.65 months, HR: 1.931, 95% CI: 1.263–2.954, p = 0.002) compared to PILE low-risk group (PILE score 0–1). The Harrell C-Index values were 0.65 and 0.61 for OS and PFS prediction, respectively. Conclusion In this study, we demonstrated a decreased overall survival in ICI-treated patients with a higher PILE score. If prospective studies validate our results, PILE score could be a biomarker for immunotherapy. (AU)

Clinical comparison of patients with angiography: Negative perimesencephalic and nonperimesencephalic subarachnoid hemorrhages.

AIMS: This study aimed to compare the clinical courses, complications, and clinical outcome scores of patients with perimesencephalic (PM) and nonperimesencephalic (n-PM) subarachnoid hemorrhage (SAH) with no vascular pathology observed on cerebral angiography. MATERIALS AND METHODS: This retrospective study included 52 of 310 patients who underwent cerebral digital subtraction angiography for SAH between October 2016 and April 2018. The patients were categorized into PM and n-PM groups based on the type of hemorrhage observed on brain CT. The patients Fischer's grades, Glasgow Coma Scale scores, and World Federation of Neurosurgical Societies SAH grades were recorded. Hydrocephalus, vasospasm findings in both groups, and modified Rankin scale (mRS) scores were assessed, and vascular pathology factors (diabetes mellitus, hypertension, and smoking) were compared between the patient groups. RESULTS: The PM group included 30 patients, the n-PM group 22 patients. Minimal hydrocephalus was observed in two patients in the PM group and six patients developed apparent hydrocephalus in the n-PM group. Angiographic vasospasm was observed in four patients in the n-PM group but none of the patients in the PM group. On discharge, all patients in the PM group had mRS scores of 0. One patient in the n-PM group become exitus and 18 patients were discharged mRS 0, 2 for two patients, and 3 for one patient. CONCLUSION: The patients with PM SAH experienced a benign course, whereas those with n-PM SAH showed a higher risk of vasospasm and hydrocephalus as well as worse exit scores.

Direct Radiography Following Fracture Reduction Improves the Reliability of Pauwels Classification.

PURPOSE OF THE STUDY Pauwels classification system is widely used to classify the femoral neck fractures. Even its widely usage there are severals debates about its reliability. After the femoral neck fracture occured the lower extremity rotates externally and this external rotation deformity could lead to misevaluation of Pauwels angle at the initial radiographs. The purpose of our study is to investigate whether the reliability of Pauwels classification increases after reduction of femoral neck fractures. MATERIAL AND METHODS Two power point presentation was prepared with 117 slides that include antero-posterior radiographs of each femoral neck fracture. The first one included preoperatively taken radiographs and the second one included early postoperatively taken radiographs. Eight observers evaluated these radiographs and they classified the fractures according to Pauwels classification system. After 3 months, the order of the slides were changed for each presentation and the observers were asked to evaluate the radiographs again. Intraclass correlation coefficient values were calculated for evaluation of inter- and intra-observer reliability. RESULTS The mean intra-observer agreement of preoperative evaluation was 0.406 (0.071-0.626) and the interobserver agreements were 0.263 (0.197-0.342) and 0.359 (0.287-0.447), respectively. The intra-observer agreement of postoperative evaluation was 0.508 (0.393-0.757), inter-observer agreements were 0.427 (0.353-0.509) and 0.431 (0.356-0.513), respectively. According to preoperative and postoperative evaluations, 6 of 8 observers' intra-observer agreements were found to be increased and the remaining 2 decreased. Interobserver reliability was improved from poor to fair-good values after evaluating the reducted fracture radiographs. DISCUSSION Femoral neck fractures(FNF) are common and anatomical reduction and internal fixation are preferred as a treatment option in young people and patients have good bone quality. Pauwels classification system is used for classify the FNF based on the shearing angle of the fracture line. As this angle increases, the fracture becomes unstable and nowadays stronger fixation devices are preferred for unstable fractures. Therefore, misevaluation of the fracture can lead to wrong treatment method selection. Non-optimal X-rays taken in the emergency rooms may cause misinterpretation of femoral neck fractures according to Pauwels classification system. We hypothized that the reliability of this classification system could be improved after reduction of the fracture. CONCLUSIONS Our study showed that classifying the femoral neck fracture according to Pauwels classification system is more confidential after the reduction, however we can not state that it's reliability is adequate. Key words: femoral neck fracture, Pauwels classification, reliability, inter-observer, intra-observer.

PILE: a candidate prognostic score in cancer patients treated with immunotherapy.

BACKGROUND: Although the immune checkpoint inhibitors (ICIs) became a vital part of cancer care, many patients do not respond to treatment, indicating need for biomarkers. The Pan-Immune-Inflammation Value (PIV) is a recently developed peripheral blood count-based biomarker. Herein, we evaluated a PIV-based candidate scoring system as a prognostic biomarker in ICI-treated patients. METHODS: A total of 120 advanced cancer patients treated with anti-PD-1 or anti-PD-L1 inhibitors for any cancer type were included in this study. The PILE scoring system incorporating the PIV (< median vs. ≥ median), lactate dehydrogenase levels (normal vs. > normal) and Eastern Cooperative Oncology Group performance status (0 vs. ≥ 1) was constructed from the multivariate analyses and used for stratification. The association between overall survival (OS), progression-free survival and PILE risk category was evaluated with multivariate analysis. RESULTS: The median follow-up was 9.62 months and the median OS of all cohort were 12.42 ± 2.75 months. Patients with higher PIV had significantly decreased OS (7.75 ± 1.64 vs. 18.63 ± 4.26 months, p = 0.037). The patients in the PILE high-risk group (PILE score 2-3) had decreased OS (18.63 ± 4.02 vs. 5.09 ± 1.23 months, HR: 2.317, 95% CI: 1.450-3.700, p < 0.001) and PFS (7.69 ± 1.30 vs. 2.69 ± 0.65 months, HR: 1.931, 95% CI: 1.263-2.954, p = 0.002) compared to PILE low-risk group (PILE score 0-1). The Harrell C-Index values were 0.65 and 0.61 for OS and PFS prediction, respectively. CONCLUSION: In this study, we demonstrated a decreased overall survival in ICI-treated patients with a higher PILE score. If prospective studies validate our results, PILE score could be a biomarker for immunotherapy.

Comparison of Clinical and Radiological Results of Two Fixation Materials after Distal Chevron Osteotomy for Hallux Valgus? - Two Kirschner Wires versus Single Screw Fixation.

PURPOSE OF THE STUDY Although distal chevron osteotomy (DCO) is considered as an intrinsically stable osteotomy, various fixation methods have been used to date. The purpose of this study was comparison of two commonly used methods in DCO, Kirschner (K)-wire and titanium fully threaded headless cannulated screw fixation, based on the clinical and radiological results, and their complications. MATERIAL AND METHODS Thirty patients were included in K-wire group and 36 patients were included in screw group. Mean age was 43.4 11.1 (rage; 19-65) years, and mean follow-up was 21.2 5.5 (range; 12-35) months. American Orthopaedic Foot Ankle Society (AOFAS) metatarsophalengeal-interphalangeal score was used for clinical evaluation. For radiological evaluation, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), medial sesamoid grade (MSG), and lateral sesamoid distance (LSD) to mid-axis of the second metatarsal were measured for all patients on both preoperative and postoperative final follow-up radiographs. RESULTS Mean AOFAS scores were significantly improved and radiographic measurements were significantly reduced at postoperatively in both groups (p< 0.01 for AOFAS, HVA, IMA, DMAA and MSG; p = 0.01 for LSD). Mean preoperative and mean postoperative, as well as the mean difference (difference between postoperative and preoperative) of the radiographic measurements, and AOFAS scores were not significantly different between two groups (p > 0.05). A total of 5 complications were observed (four in K-wire group, one in screw group). Complication rates between two groups was not statistically significant (p = 0.12). DISCUSSION Initial description of DCO did not include any fixation material. Afterwards, the procedure was modified by using single K wire in order to enhance the stability of the osteotomy. Previous studies were unable to demonstrate significant differences between K-wire fixation and cortical or Herbert type screw fixation based on clinical and radiological outcomes. Differently, in this study we compared two K-wire fixation with 3.5-mm titanium fully threaded headless cannulated screw fixation. Our results demonstrated that function and radiological measurements significantly improved after both fixation methods. Despite the increased complication rate in K-wire group, it was not statistically significant. Moreover, none of the complications was associated with unstable osteotomy, and required re-operation. CONCLUSIONS Both fixation methods provided comparable radiological and clinical outcomes with favourable results after DCO. Key words: hallux valgus, distal chevron osteotomy, Kirschner wire, headless cannulated screw, fixation method.

Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain.

AIMS: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. METHODS: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. RESULTS: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). CONCLUSION: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.

Clinical significance of serum protease activated receptor1 levels in patients with lung cancer.

OBJECTIVE: Protease-activated receptors (PAR) are G protein coupled receptors and they regulate many biological processes, including coagulation and cell survival and they might be good markers in some types of malignant tumors, providing useful information in diagnosis and prognosis. The objective of this study was to determine the clinical significance of the serum levels of PAR1 in lung cancer patients. PATIENTS AND METHODS: Eighty patients with lung cancer were enrolled into this study. Serum PAR1 levels were determined by the solid-phase sandwich ELISA method. Median age was 58.5-years old, range 36 to 80 years. RESULTS: The majority of the patients had NSCLC (85%) and stage IV disease (56%). The baseline serum PAR1 concentrations of the lung cancer patients were significantly higher than control group (median values 26.45 ng/mL v 0.07 ng/mL, p < 0.001). However, clinical variables including age, gender, histology, stage of disease, and response to chemotherapy were not found to be correlated with serum PAR1 levels (p > 0.05). Moreover, it failed to show any prognostic value on the survival of the lung cancer patients. CONCLUSIONS: The serum levels of PAR1 might have a diagnostic value in lung cancer patients. However, its predictive and prognostic values were not determined.

Effects of levosimendan on myocardial ischaemia-reperfusion injury.

BACKGROUND AND OBJECTIVE: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening KATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. METHODS: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n = 7) received no further treatment. In Group 2 (non-treated; n = 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n = 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. RESULTS: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P = 0.019). The tissue Na+-K+ ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P = 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P = 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. CONCLUSIONS: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

Could adding magnesium as adjuvant to ropivacaine in caudal anaesthesia improve postoperative pain control?

Recently, most studies reported magnesium as a N-methyl-D-aspartate receptor antagonist and its analgesic and perioperative anaesthetic effects have been discussed with central desensitization pathway. We investigated the effects of caudal ropivacaine plus magnesium and compared with ropivacaine alone on postoperative analgesia requirements. After hospital ethic committee's consent, 60 patients (ASA I-II, 2-10 years old) who had lower abdominal or penoscrotal surgery were enrolled in the study. After general anaesthesia induction, caudal blockage was applied. Patients were randomly assigned in two groups. Ropivacaine 0.25% was administered to Group R (n=37), ropivacaine 0.25% plus 50 mg magnesium to Group RM (n=23) in 0.5 ml kg-1 volume. Postoperative analgesia level was recorded at 15 min and 1, 2, 3, 4, 6 h by using Paediatric Objective Pain Scale (POPS) and The Children's Hospital of Eastern Ontoria Pain Scale (CHEOPS). Postoperative motor blocks were evaluated with Modified Bromage Motor Block Scale. According to demographic characteristics, there were no significant differences between the two groups (P>0.05). POPS, CHEOPS, Bromage Motor Scales, analgesia duration and adverse effects were similar in Group R and Group RM. It has been shown that addition of magnesium as an adjuvant agent to local anaesthetics for caudal analgesia has no effect on postoperative pain and analgesic need.

Morphological changes in diseased cementum layers: a scanning electron microscopy study.

The aim of this study was to compare the morphological changes that occurred in root cementum layers due to periodontal disease by using scanning electron microscopy (SEM). Ninety-two periodontally hopeless teeth extracted from 29 patients were studied. Measurements of probing depth (PD) and clinical attachment loss (CAL) were taken prior to extractions. After the longitudinal fracturing process of root specimens, healthy and diseased cementum layers of roots were evaluated by SEM for the thickness of the cementum and the morphological changes in collagen fibers. The result of SEM evaluation revealed a significant ( P < 0.001) decrease in the thickness of cementum layer on the diseased root surfaces compared to the healthy surfaces. There were denser and conspicuous collagen fibers with their interfibrillar matrix in cementum layers on the healthy root surfaces compared to the diseased surfaces. Within the limits of this study, the thickness of cementum layers in diseased areas was found to be significantly less than that in the healthy areas of root surfaces. However, there exist variations in the density and visibility of cemental fibers between individuals and within the individual.

Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy.

BACKGROUND AND OBJECTIVE: Adequate relief of pain after tonsillectomy is a common problem. We compared meperidine and tramadol when given at induction of anaesthesia with respect to their effects on postoperative pain relief and emergence characteristics after adenotonsillectomy in children. METHODS: Fifty children aged 4-7 yr undergoing tonsillectomy were randomly assigned to receive either tramadol 1 mg kg(-1) (n = 25) or meperidine 1 mg kg(-1) (n = 25) before commencement of the surgical procedure. Anaesthesia was induced with propofol (with cis-atracurium for muscle relaxation) and maintained with sevoflurane in oxygen and nitrous oxide. Postoperative pain was scored by a blinded observer using a facial pain scale in the recovery room at 0 (at arrival of the patient in the postoperative care unit) and at 10, 20 and 45 min thereafter. Agitation scores were also assessed by the same observer at 0 min. Heart rate and mean arterial pressure were recorded at regular intervals. The time to recovery to spontaneous respiration and the incidence of postoperative nausea and vomiting were noted. RESULTS: Facial pain scale scores were increased in the tramadol group at 0, 10 and 20 min (P < 0.05). No difference was observed in scores at the 45th min postoperation. Agitation scores were higher in the tramadol group than in the meperidine group. No statistical difference was found between the two groups. Heart rates and mean arterial pressures were similar in both groups. The time to recovery to spontaneous respiration was delayed with meperidine compared with tramadol (P < 0.05). The incidence of nausea and vomiting was not statistically different between groups. CONCLUSIONS: Meperidine was more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children.