Effects of DDT and DDE on placental cholinergic receptors.

The placental cholinergic system; known as an important factor in intracellular metabolic activities, regulation of placental vascular tone, placental development, and neurotransmission; can be affected by persistent organic pesticides, particularly organochlorine pesticides(OCPs), which can influence various epigenetic regulations and molecular pathways. Although OCPs are legally prohibited, trace amounts of the persistent dichlorodiphenyltrichloroethane(DDT) are still found in the environment, making prenatal exposure inevitable. In this study, the effects of 2,4'-DDT and 4,4'-DDT; and its breakdown product 4,4'-DDE in the environment on placental cholinergic system were evaluated with regards to cholinergic genes. 40 human placentas were screened, where 42,50% (17 samples) were found to be positive for the tested compounds. Average concentrations were 10.44 µg/kg; 15.07 µg/kg and 189,42 µg/kg for 4,4'-DDE; 2,4'-DDT and 4,4'-DDT respectively. RNA-Seq results revealed 2396 differentially expressed genes in positive samples; while an increase in CHRM1,CHRNA1,CHRNG and CHRNA2 genes at 1.28, 1.49, 1.59 and 0.4 fold change were found(p<0028). The increase for CHRM1 was also confirmed in tissue samples with immunohistochemistry. In vitro assays using HTR8/SVneo cells; revealed an increase in mRNA expression of CHRM1, CHRM3 and CHRN1 in DDT and DDE treated groups; which was also confirmed through western blot assays. An increase in the expression of CHRM1,CHRNA1, CHRNG(p<0001) and CHRNA2(p<0,05) were found from the OCPs exposed and non exposed groups.The present study reveals that intrauterine exposure to DDT affects the placental cholinergic system mainly through increased expression of muscarinic receptors. This increase in receptor expression is expected to enhance the sensitivity of the placental cholinergic system to acetylcholine.

The Relationship Between Cancer Patients' Supportive Care Needs and Their Attitudes Toward Complementary and Alternative Medicine.

BACKGROUND: Cancer patients have high supportive care needs related to the nature of the disease and treatment methods. To meet these needs or reduce symptoms, patients can be expected to resort to alternative treatment methods. AIM: To examine the relationship between the supportive care needs of cancer patients and their attitudes toward complementary and alternative medicine (CAM). METHODS: This was a cross-sectional study involving 289 cancer patients at the Oncology Hospital in east of Turkey. Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF 29) and Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) were standard instruments used for data collection. The association between supportive care needs and attitude toward CAM was determined. RESULTS: The mean age of the study participants was 56.7 ± 12.7 years. There were 180 females (62.3%) and 109 males (37.7%). The mean score of the SCNS-SF 29 of the study participant was 101.19 ± 33.97. It was found that the patients' psychological needs were the highest, followed by health services and information, daily life, and sexuality needs, respectively. The mean score of the HCAMQ was 27.16 ± 9.54. There was a weak, significant negative correlation between HCAM and psychological supportive care needs (r: -0.240, P: 0.003). However, there was no significant relationship between needs related to health services information, daily life sexuality, and attitudes toward CAM. CONCLUSIONS: Cancer patients have high supportive care requirements. Those with high psychological needs have a positive attitude toward HCAM. Incorporation of HCAM in the care of cancer patients may improve their quality of care.

Comparison of preoperative and postoperative serum thiol/disulfide levels in patients undergoing laparoscopic sleeve gastrectomy for morbid obesity.

OBJECTIVE: Obesity, a prevalent chronic disease, results from an imbalance between energy intake and expenditure. The oxidative stress associated with obesity stems from an imbalance between reactive oxygen species and the cell's antioxidant defense system. Oxidative stress can cause many diseases. The assessment of thiol/disulfide balance, a biochemical test, can be used to detect oxidative stress. The aim of this study is to determine the changes in oxidative stress associated with obesity after obesity surgery by assessing the thiol/disulfide levels. PATIENTS AND METHODS: The study was conducted with 40 volunteer patients with a body mass index (BMI) above 40 who underwent obesity surgery at Harran University Hospital General Surgery. Thiol and disulfide levels and other blood parameters were measured from the preoperative and postoperative 2nd and 6th-month blood samples of the patients. BMI was calculated by recording the weights and heights of the cases. Patients with diseases that could affect oxidative stress measurements and those using medication were excluded from the study, and the analyses were performed accordingly. RESULTS: The results showed a statistically significant decrease in native thiol, disulfide, reduced thiol, oxidized thiol, glucose, ALT (alanine aminotransferase), ALP (alkaline phosphatase), total cholesterol, HDL (high-density lipoprotein), triglyceride, and BMI values between the preoperative, 2-month postoperative, and 6-month postoperative measurements (p<0.05). CONCLUSIONS: Restrictive methods such as sleeve gastrectomy in individuals with morbid obesity led to weight control and a decrease in adipose tissue, reducing oxidative stress and increasing antioxidant response.

Evaluation of stress distribution on an endodontically treated maxillary central tooth with lesion restored with different crown materials: A finite element analysis.

Objectives: The biomechanical response of teeth with periapical lesions that have been restored using various substructure materials, as well as the stress mapping in the alveolar bone, has not been thoroughly described. In this context, the objective of this study is to investigate the structural stress distributions on root canal-treated maxillary right central incisors with lesions restored using different crown materials under linear static loading conditions through finite element analysis (FEA). Methods: In the study, five FEA models were utilised to represent healthy teeth and teeth restored with different substructure materials: (A) a healthy tooth, (B) a lesioned, root canal-treated, composite-filled tooth, (C) a lesioned, fiber-posted, zirconia-based crown, (D) a tooth with lesions, a fiber post, and Ni-Cr infrastructure crown, (E) a tooth with a lesion, a fiber post, and an IPS E-max infrastructure crown. A force of 100 N was applied at an angle of 45° to the long axis of the tooth from 2 mm cervical to the incisal line on the palatal surface. Deformation behaviour and maximum equivalent stress distributions on the tooth sub-components, including the bony structure for each model, were simulated. Results: Differences were observed in the stress distributions of the models. The maximum stress values of the models representing the restorations with different infrastructures varied, and the highest value was obtained in the model of the E-max crown (Model E: 136.050 MPa). The minimum stress magnitudes were obtained from Model B the composite-filled tooth (80.39 MPa); however, it was observed that the equivalent stresses in all the models showed a similar distribution for all components with varying magnitudes. In periapical lesion areas, low stresses were observed. In all models, the cervicobuccal collar region of the teeth had dense equivalent stresses. Conclusion: Different restorative treatment methods applied to root canal-treated teeth with periapical lesions can impact the stress in the alveolar bone and the biomechanical response of the tooth. Relatively high stress values in the cortical bone at the cervical line of the tooth have been observed to decrease towards the apical region. This observation may suggest a potential healing effect by reducing pressure in the periapical lesion area. Clinical significance: Composite resin restorations can be considered the first-choice treatment option for the restoration of root canal-treated teeth with lesions. In crown restorations, it would be advantageous to prefer zirconia or metal-supported prostheses in terms of biomechanics.

Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support.

AIM: To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. MATERIALS AND METHODS: A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival. RESULTS: The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047). CONCLUSIONS: Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.

Assessment of quantitative zonal parameters of prostate gland in discrimination of normal, benign, and malignant conditions: are these the more reliable parameters in the diagnosis of prostate cancer?

OBJECTIVE: Prostate cancer diagnosis and treatment are increasing in current public healthcare programs. An improved resolution multiparametric magnetic resonance imaging (MRI) has shown the potential to enhance the detection and differentiation of this medical condition. In this study, MR perfusion parameters were investigated in different ages and diseases to differentiate clinically significant prostate cancer. PATIENTS AND METHODS: From January 2017 to December 2022, 72 consecutive patients, who had undergone multiparametric MR imaging were enrolled in this study. Four different patient groups were formed: (1) those with prostate cancer, (2) those with prostatitis, (3) those with benign prostate hyperplasia (BPH), and (4) a control group. Quantitative dynamic contrast-enhanced (DCE)-MRI pharmacokinetic parameters included Ktrans, Kep, Ve, and iAUG. Different measurements were obtained from both the peripheral and transitional zones (PZ and TZ, respectively). Means values were compared between groups based on a univariate analysis. RESULTS: Ktrans and Kep values in the PZ were found to be statistically significantly lower in the control group (p = 0. 003 and p = 0. 011, respectively). It was seen that Ktrans and Ve measurements obtained from PZ had a statistically significant determinant in detecting malignancy (p = 0. 013 and p = 0. 036, respectively). It was seen that Ktrans, Ve, and iAUG obtained from the TZ showed a statistically significant difference in prostate cancer (p = 0.025, p = 0.005, and p = 0. 011, respectively) in contrast to other cases. Peripheral Ve values were statistically significantly lower than those measured Ve values from the TZ in prostate cancer cases (p = 0.002) in contrast to the other cases. CONCLUSIONS: Quantitative DCE-MRI parameters may vary according to age, disease, and zonal anatomy. These differences may contribute to the diagnosis of clinically relevant prostate cancer.

Outcomes of newborns with tracheostomy: single center experience.

BACKGROUND: Babies with severe bronchopulmonary dysplasia (BPD) are discharged with the support of a home-type mechanical ventilator, after opening a tracheostomy. In addition, although rare, tracheostomy is required in the neonatal period in congenital airway malformations. Early tracheostomy is appropriate to prevent complications due to prolonged intubation. We aimed to find the appropriate time for tracheostomy by examining the tracheostomy opening and closing times, complications and demographic characteristics of the patients, who were hospitalized and underwent tracheostomy in our neonatal intensive care unit. METHODS: This retrospective study involved infants admitted to the neonatal intensive care unit between January 2014 and 2019 and discharged following tracheostomy. Information acquired from hospital data was enrolled. The protocol was registered with ClinicalTrials.gov identifier NCT04497740. RESULTS: Twenty-six neonates with median 27.5 weeks gestational age and birth weight 885 gr were enrolled in the study. The mean opening time for tracheostomy was 54 ± 24 days, and the postmenstrual age (PMA) was 36 ± 3 weeks. The mean time to closure of tracheostomy in newborns with a tracheostomy was 387 ± 164 days. The duration of accidental decannulation developed as an early complication in 8 patients was mean 11 ± 8 days. Aspiration pneumonia in 2, subglottic stenosis in 5, accidental decannulation in 2, suprastomal collapse in 7, tracheocutaneous fistula in 8 and granulation tissue in 2 patients were found to be late complications, which occurred within median 90 days. CONCLUSIONS: If there is no evidence that breathing has improved and the patient is still using a mechanical ventilator at high pressures and high oxygen concentration, a tracheostomy placement should be considered within two months.

The state of additive manufacturing in dental research - A systematic scoping review of 2012-2022.

Background/purpose: Additive manufacturing (AM), also known as 3D printing, has the potential to transform the industry. While there have been advancements in using AM for dental restorations, there is still a need for further research to develop functional biomedical and dental materials. It's crucial to understand the current status of AM technology and research trends to advance dental research in this field. The aim of this study is to reveal the current status of international scientific publications in the field of dental research related to AM technologies. Materials and methods: In this study, a systematic scoping review was conducted using appropriate keywords within the scope of international scientific publishing databases (PubMed and Web of Science). The review included related clinical and laboratory research, including both human and animal studies, case reports, review articles, and questionnaire studies. A total of 187 research studies were evaluated for quantitative synthesis in this review. Results: The findings highlighted a rising trend in research numbers over the years (From 2012 to 2022). The most publications were produced in 2020 and 2021, with annual percentage increases of 25.7% and 26.2%, respectively. The majority of AM-related publications in dentistry research originate from Korea. The pioneer dental sub-fields with the ost publications in its category are prosthodontics and implantology, respectively. Conclusion: The final review result clearly stated an expectation for the future that the research in dentistry would concentrate on AM technologies in order to increase the new product and process development in dental materials, tools, implants and new generation modelling strategy related to AM. The results of this work can be used as indicators of trends related to AM research in dentistry and/or as prospects for future publication expectations in this field.

DNA damage and changes in oxidized biomolecules in COVID-19 patients treated in intensive care units: a single center experience.

OBJECTIVE: COVID-19 is a deadly disease. Investigations are being conducted on the underlying mechanisms to predict prognosis and reduce mortality rates. In this study, the extent of DNA damage and serum levels of oxidized biomolecules were investigated. We hypothesize that malondialdehyde (MDA) and protein carbonyl (PC) serum levels and DNA damage levels may be biomarkers that can be used in prognostic decision making and prediction of mortality in COVID-19 patients. PATIENTS AND METHODS: Patients included in the study were divided into two groups according to their survival. These groups were compared in terms of serum MDA, PC levels, DNA damage degrees and mortality on the 1st, 3rd, and 5th days of ICU admission. RESULTS: In patients who died, MDA levels increased over time (p=0.023), PC levels peaked on the third day of admission to the intensive care units (ICU), and then decreased, while DNA damage increased gradually (p=0.013). In surviving patients, MDA levels decreased over time (p=0.018); PC levels were at their peak on the first day of admission to the ICU and then decreased (p=0.018); DNA damage decreased initially, and then increased minimally compared to Day 1. CONCLUSIONS: For COVID-19 ICU patients, serum levels of MDA and PC and degrees of DNA damage can strengthen prognostic decision-making and contribute to reducing mortality.

Nitrosative stress-based specific evaluation of creatine use in combination with aerobic running exercise at different speeds: a preclinical study in mice.

OBJECTIVE: In acute and chronic aerobic exercise, skeletal muscle and liver are the main organs that adapt and regulate metabolic activity. The levels of nitrosative stress caused by exercise in these organs are extremely important in the continuity of exercise, its health-promoting benefits, and the evaluation of therapeutic efficacy. In this study, nitrosative stress levels were investigated in musculus quadriceps femoris tissue and liver tissue of mice that were given low and high-speed aerobic running exercise and also received Cr supplementation. MATERIALS AND METHODS: In this study, nitrosative stress levels were investigated in the muscle/liver tissue of 42 BALB/c mice that were given low and high-speed aerobic running exercise and creatine monohydrate (Cr) (40 mg/kg of diet daily) supplementation with exercise. The study included six groups with and without Cr supplementation, low-speed aerobic running, high-speed aerobic running, and no exercise. The mice in groups with low-speed and high-speed aerobic exercise with and without Cr supplementation were run on the treadmill for 8 weeks. Then, nitric oxide (NO·), nitric oxide synthase (NOS), and peroxynitrite (ONOO-) levels in muscle/liver tissue were measured by spectrophotometric method. RESULTS: It was found that the nitrosative stress level in the groups that did low and high-speed aerobic running exercises increased compared to the group that did not exercise. It was found that NO· decreased NOS activity and ONOO- level increased in muscle tissues of low and high-speed aerobic exercise groups that received Cr supplementation compared to those that did not. However, NO· and ONOO- levels in liver tissue decreased while NOS activity did not change. The lowest level of nitrosative stress in both muscle and liver tissue was found in the low-speed exercise group receiving Cr supplementation. CONCLUSIONS: Although supplements in exercise are an important component, the simultaneously measured nitrosative stress level is critical in determining the optimal exercise.

Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis.

BACKGROUND: Conventionally, two 4.5 mm cortical screws inserted toward the posterior tibial cortex are usually advocated for the fixation of Fulkerson osteotomy. This finite element analysis aimed to compare the biomechanical behavior of four different screw configurations to fix the Fulkerson osteotomy. MATERIALS AND METHODS: Fulkerson osteotomy was modeled using computerized tomography (CT) data of a patient with patellofemoral instability and fixed with four different screw configurations using two 4.5 mm cortical screws in the axial plane. The configurations were as follows: (1) two screws perpendicular to the osteotomy plane, (2) two screws perpendicular to the posterior cortex of the tibia, (3) the upper screw perpendicular to the osteotomy plane, but the lower screw is perpendicular to the posterior cortex of the tibia, and (4) the reverse position of the screw configuration in the third scenario. Gap formation, sliding, displacement, frictional stress, and deformation of the components were calculated and reported. RESULTS: The osteotomy fragment moved superiorly after loading the models with 1654 N patellar tendon traction force. Since the proximal cut is sloped (bevel-cut osteotomy), the osteotomy fragment slid and rested on the upper tibial surface. Afterward, the upper surface of the osteotomy fragment acted as a fulcrum, and the distal part of the fragment began to separate from the tibia while the screws resisted the displacement. The resultant total displacement was 0.319 mm, 0.307 mm, 0.333 mm, and 0.245 mm from the first scenario to the fourth scenario, respectively. The minimum displacement was detected in the fourth scenario (upper screw perpendicular to the osteotomy plane and lower screw perpendicular to the posterior tibial cortex). Maximum frictional stress and maximum pressure between components on both surfaces were highest in the first scenario (both screws perpendicular to the osteotomy plane). CONCLUSIONS: A divergent screw configuration in which the upper screw is inserted perpendicular to the osteotomy plane and the lower screw is inserted perpendicular to the posterior tibial cortex might be a better option for the fixation of Fulkerson osteotomy. Level of evidence Level V, mechanism-based reasoning.

Routine whole-body CT identifies clinically significant findings in patients supported with veno-venous extracorporeal membrane oxygenation.

AIM: To determine the yield of routine whole-body computed tomography (CT) following extracorporeal membrane oxygenation (ECMO) initiation and to assess the association of these findings with prognosis. MATERIALS AND METHODS: One hundred and ninety-eight consecutive patients with acute respiratory failure admitted for ECMO support between January 2015 and December 2019 who underwent whole-body CT performed within 48 h of ECMO initiation were examined in this single-institution retrospective study. CT findings were divided into three categories: clinically significant findings that may affect immediate management strategy or short-term outcomes; findings not related to hospital stay or outcome but require further workup; and benign findings that do not require further investigation. Logistic regression analysis was used to assess the association of CT findings with 7- and 30-day survival. RESULTS: Clinically significant findings were present in 147 (74%) patients, findings requiring further workup were found in 82 (41%) patients, and benign findings were identified in 180 (90%) of the patients. Patients with clinically significant neurological findings had an elevated risk of death at 7 days (odds ratio [OR] 3.58; 95% confidence interval [CI] 1.29; 9.93; p=0.01), but not 30 days. Increasing numbers of clinically significant findings were associated with greater odds of mortality at 7 days (OR 1.70; 95% CI 1.08; 2.67; p=0.02) and 30 days (OR 1.41; 95% CI 1.02; 1.96; p=0.04). CONCLUSIONS: Imaging patients at the point of admission for VV-ECMO with CT frequently identified clinically significant abnormalities with prognostic implications of these. These findings provide support for the use of more routine CT at the point of treatment escalation with prospective studies now required.

How to fix a tibial tubercle osteotomy with distalisation: A finite element analysis.

BACKGROUND: Antero-medialisation osteotomy combined with a distalisation procedure may require a more stable fixation as the osteotomy fragment loses both proximal and distal support. This finite element analysis aimed to compare the mechanical behaviour of different fixation techniques in tibial tubercle antero-medialisation osteotomy combined with distalisation procedure. METHODS: Tibial tubercle osteotomy combined with distalisation was modelled based on computerised tomography data, which were acquired from a patient with patellar instability requiring this procedure. Six different fixation configurations with two 3.5-mm cortical screws (1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and total deformation between the osteotomy components were analyzed. RESULTS: Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate fixation model. CONCLUSIONS: Plate fixation might be recommended for tibial tubercle antero-medialisation osteotomy combined with distalisation procedure because it might allow early active range of motion exercises and weight-bearing.

Micro-computed tomography assessment of triple antibiotic paste removal using different irrigation methods.

Purpose: The study aimed to compare four irrigation methods for triple antibiotic paste (TAP) removal using micro-computed tomography (micro-CT) analysis. Materials and methods: Forty bovine central incisor teeth were selected, and the root canals were prepared up to #6 Peeso reamer drills. Equal portions of metronidazole, ciprofloxacin, and minocycline were used for the TAP preparation. The TAP was prepared by mixing the powder with distilled water (with a powder to liquid ratio of 1 mg/1 mL). The TAP was introduced to the canals with a lentulo spiral; then, the access cavities were temporarily sealed. After 21 days of storage, the teeth were randomly divided into four equal groups according to irrigation techniques: open-ended, side-vented, double side-vented needle irrigations and EndoActivator irrigation device. The TAP was removed using 17% EDTA (20 mL) and distilled water (5 mL) for all of the groups. The volume of the intracanal medicament before and after the irrigation procedure was recorded by scanning the samples with micro-CT, and the TAP percentage was calculated. The percentages obtained from each group were compared using ANOVA. The significance level was set at p<0.05. Results: The results showed that there was no statistically significant difference among the TAP percentage volumes removed by the different irrigation techniques. Conclusion: The irrigation techniques used in this study showed similar TAP removal efficiency, however, they could not completely remove the TAP from the root canal systems.

Micro-ct findings of concentrated growth factors (cgf) on bone healing in masquelet's technique-an experimental study in rabbits.

INTRODUCTION: A recent histopathological and immunohistochemical study has proved that the addition of concentrated growth factors (CGF) to the Masquelet's technique contributes to the quality of the membrane formed, in respect of inducing inflammation and proliferation, maintaining vascularization on large diaphyseal bone defects, and increasing the number of stem cells. The aim of the study is comparison of radiological results of this combination treatment by micro-CT. MATERIALS AND METHODS: The study was planned on a critical bone defect model in rabbit radius. Group I and Group III were the control groups to which only the Masquelet's technique is applied. Group II and Group IV were CGF groups in addition to the Masquelet's technique. CGF was prepared by centrifugation of rabbit's own blood. For early phase, Groups I and II were evaluated in the 8th week, while for late phase, Group III and Group IV were evaluated in the 12th week. Groups were compared in terms of bony union radiologically by micro-CT(µCT) (New Bone Volume (NBV), Total Bone Volume (TBV) and NBV/TBV) and histopathologically. RESULTS: The structural parameters, including NBV, TBV, NBV/TBV were higher in the early- (8th week) and late-phase (12th week) CGF group. There was no statistically significant difference between CGF and control groups in early phase, (p = 0.153), while in late phase, CGF group was significantly higher of new bone volume than the control group, 246.3 mm3 (196.1-258) and 169.6 mm3 (154.3-235.9), respectively (p = 0.028). For early phase, control group was significantly lower than late-phase control group, 121.8 mm3 (88.8-144.4) and 169.6 mm3 (154.3-235.9), respectively (p = 0.006). The ratio of New Bone Volume to Total Bone Volume (NBV/TBV ratio) in CGF groups was significantly higher compared to the control groups 27.3% (24.7-29.6), 35.3% (32.1-38.6) (p = 0.032) and 39.7% (36.7-41.6), 55.3% (52-57.5) (p = 0.002), respectively. Histopathologically, Microscopic New Bone Formation had no statistically significant difference between control and CGF groups in early phase (8th week) (p = 0.153), while in late phase (12th week), CGF group had significantly higher amount of new bone formation than the control group, 0.29 µm2 (0.27-0.36), 0.51 µm2 (0.42-0.59), respectively (p = 0.008). CONCLUSION: The addition of CGF to the Masquelet's technique is an important method for supporting new bone formation in large diaphyseal bone defects. LEVEL EVIDENCE: Level III, therapeutic/care management.

Comparison of Fixation Techniques in Oblique and Biplanar Chevron Medial Malleolar Osteotomies; a Finite Element Analysis.

This study aimed to evaluate different fixation techniques and implants in oblique and biplanar chevron medial malleolar osteotomies using finite element analysis. Both oblique and biplanar chevron osteotomy models were created, and each osteotomy was fixed with 2 different screws (3.5 mm cortical screw and 4.0 mm malleolar screw) in 2 different configurations; (1) 2 perpendicular screws, and (2) an additional third transverse screw. Nine simulation scenarios were set up, including 8 osteotomy fixations and the intact ankle. A bodyweight of 810.44 N vertical loading was applied to simulate a single leg stand on a fixed ankle. Sliding, separation, frictional stress, contact pressures between the fragments were analyzed. Maximum sliding (58.347µm) was seen in oblique osteotomy fixed with 2 malleolar screws, and the minimum sliding (17.272 µm) was seen in chevron osteotomy fixed with 3 cortical screws. The maximum separation was seen in chevron osteotomy fixed with 2 malleolar screws, and the minimum separation was seen in oblique osteotomy fixed with 3 cortical screws. Maximum contact pressure and the frictional stress at the osteotomy plane were obtained in chevron osteotomy fixed with 3 cortical screws. The closest value to normal tibiotalar contact pressures was obtained in chevron osteotomy fixed with 3 cortical screws. This study revealed that cortical screws provided better stability compared to malleolar screws in each tested osteotomy and fixation configuration. The insertion of the third transverse screw decreased both sliding and separation. Biplanar chevron osteotomy fixed with 3 cortical screws was the most stable model.

The complex microbiome of caries-active and caries-free supragingival plaques in permanent dentition.

BACKGROUND AND AIM: Dental caries is one of the most common diseases seen in the oral cavity in all periods of deciduous, mixed, and permanent dentition. A comprehensive study of the oral microbiome is required to understand its polymicrobial etiology. The aim of this study was to reveal the plaque microbiome of caries-active and caries-free adults. MATERIALS AND METHODS: A total of 52 samples were collected from 26 caries-active patients and 26 caries-free controls. Dental supragingival plaque samples were collected from each subject and the bacterial 16S rDNA, expanded V3-V4 region, was amplified using next generation sequencing. RESULTS: The core microbiome was defined with 235 shared bacteria in genus level, and among all microbiome 14.8% of all bacteria showed significant difference (P < 0.05). The bacteria responsible of caries may be listed as Anaeroglobus, Atopobium, Bifidobacterium, Centipeda, Cryptobacterium, Desulfobulbus, Filifactor, Howardella, Lactobacillus, Leptotrichiaceae (unclassified), Megasphaera, Mycoplasma, Olsenella, Phocaeicola, Propionibacterium, Pseudoramibacter, Scardovia, Schwartzia, Treponema, and Veillonellaceae (unclassified). CONCLUSION: The present study provides comprehensive knowledge of the microbiological etiology of caries in permanent dentition.

The retreatment abilities of ProTaper Next and F6 Skytaper: a micro-computed tomography study.

PURPOSE: The aim of this study was to evaluate the retreatment abilities of the ProTaper Next (PTN) and F6 SkyTaper (F6) systems by using micro-computed tomography (microct), radiographic and microscopic imaging techniques. MATERIALS AND METHODS: The root canals of twenty-six extracted mandibular premolar teeth were prepared and obturated. For the retreatment procedure, the teeth were randomly divided into two equal groups according to endodontic instruments: PTN (X4) and F6 (#40/.06). Pre- and post-operative filling material volumes were measured with micro-ct, and areas were measured with radiographic and microscopic imaging techniques. The percentages of residual material were calculated, and then statistically compared. The significance level was set at p<0.05. RESULTS: There was no statistically significant difference between F6 and PTN for retreatment efficacy in the micro-ct and radiographic imaging techniques (p>0.05). PTN demonstrated better cleaning ability when evaluated by microscopic imaging. (p<0.05). The correlation was moderate between micro-ct and radiographic, and micro-ct and microscopic imaging groups; however, it was strong between radiographic and microscopic imaging methods. CONCLUSION: The PTN and F6 files had similar effects in the removal of filling material with microct evaluation. The radiographic imaging method gave similar results with micro-ct imaging.

Plate Positioning Affects the Pressure on the Axillary Nerve Following a Deltopectoral Approach.

PURPOSE OF THE STUDY To investigate the pressure levels on the axillary nerve at different plate positions after plate fixation of a proximal humerus fracture. MATERIAL AND METHODS Eight fresh-frozen cadaveric specimens were used. The plates were applied on the lateral side of the humerus. A FlexiForce pressure sensor was placed between the nerve and the plate, and the pressure on the nerve was measured (Group 1). The plates were then placed in two different positions such that distal portion of the plates would have 30° anterior and 30° posterior angles to the anatomical axis of the humerus (Group 2 and 3). The anterior of the distal attachment of the deltoid muscle was then elevated and the plates were placed in the middle of the anatomical axis of the humerus (Group 4). The position of the plates were controlled by fluoroscopy and the pressure was measured for each configuration sequentially. RESULTS The mean age of the cadavers was 70.5 ± 6.8 years (range: 61-80 years). Mean pressure values of the groups were 2.65 ± 0.8, 2.52 ± 0.8, 5.65 ± 1.4, and 2.56 ± 0.9 N, respectively. Group 3 had statistically highest-pressure values than the other groups, while no difference was found among groups 1, 2, and 4. DISCUSSION Numbness and weakness of the shoulder muscles are other clinical findings. If numbness on the deltoid muscle is reported, then atrophy is noted in the deltoid muscle in later stages. Persistent pain may be seen even if fracture union occurs after PHF surgery. Axillary nerve entrapment may be considered after the removal of common complications such as avascular necrosis due to fracture, screw migration, infection, and biceps tendon and rotator cuff problems. The sensory branch of the axillary nerve provides the sensation of the anterior joint capsule and lateral part of the deltoid muscle. CONCLUSIONS Proximal humerus plates, which are angled posteriorly along, lead to an increased pressure on the axillary nerve. Anterior orientation of the plate or elevation of deltoid insertion may be used to prevent the possible complications related to axillary nerve. Level of evidence Level II. Key words: proximal humerus fracture, Philos, axillary nerve, nerve injury.

The efficacy of the ON-Q elastomeric pump system in post-thoracotomy acute pain control.

OBJECTIVES: We aimed to evaluate the efficacy of continuous local anesthetic infusion to the incision site with the On-Q elastomeric pump system in postoperative acute pain control after thoracotomy. METHODS: A retrospective comparative analysis of of sixty patients who underwent thoracotomy for lung cancer by the same surgical team was performed between January 2016 and December 2017. The patients were divided into two groups according to postoperative pain management, those who were traditionally received tramadolol (15 mg/h) by intravenous continuous infusion (Group IVT, n = 30) and those who were administered continuous local anesthetic (0.5% bupivacaine, 4 ml/h) infusion to the incision site through an elastomeric pump in addition to the traditional treatment (Group LA, n = 30). The primary outcomes were postoperative acute pain scores on the numeric rating scale and postoperative rescue opioid consumption for 72 hours following surgery reported as pethidine equivalents. The secondary outcomes were frequency of analgesia related adverse events/complications, ICU and hospital stay, drug and total hospital cost. RESULTS: The mean pain scores at 2, 12, 24, 48 and 72th hours at rest and during coughing were found to be significantly lower in group LA (p < 0.05). Rescue opioid consumption on postoperative 0, 1, 2 and 3rd days and in total was found to be significantly lower in Group LA (p < 0.05). In Group LA, postoperative length of hospital stay was significantly shorter (5.8 ± 2.1 days vs. 8.0 ± 3.1 days; p = 0.034), drug costs (95.24 vs. 160.08 Euro; p = 0.023) and total hospital costs were lower (434.26 vs. 685.75 Euro; p = 0.014) than Group IVT. CONCLUSIONS: We believe that continuous local anesthetic infusion to the incision site in addition to systemic analgesic treatment for multimodal acute pain management after thoracotomy is an effective and safe method.