Muscle strength but not balance improves after arthroscopic biodegradable polyurethane meniscus scaffold application.

PURPOSE: This study aimed to assess the impact of biodegradable polyurethane meniscus scaffold implantation (BPMSI) on muscle strength and balance in comparison with the healthy contralateral knee in patients with irreparable medial meniscus defect. METHODS: This observational and prospective case-cohort study was conducted with patients who had irreparable meniscal defects and underwent arthroscopic meniscus scaffold implantation. Surgeries were carried out on the medial meniscus of 16 right and 4 left knees. Visual analog scale (VAS) was used to assess the degree of pain relief. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm (LYS) score were used to evaluate the functional improvement at weeks 12, 24 and 36. Concentric and eccentric quadriceps and hamstring peak torque (PT) as well as the peak torque-to-body weight (PTB) ratio, anterior-posterior, mediolateral and overall stability indexes were assessed at the same time points. RESULTS: Twenty male patients with a mean age and body mass index of 32.2 ± 8.8 years and 26.2 ± 4.2 kg/m2, respectively, were included in the study. The amount of pain decreased from 7.6 ± 1.5% to 2.9 ± 1.5% at postoperative week 36. Range of motion, Lysholm score and KOOS increased from 87.0ο ± 9.5ο to 115.0ο ± 15.1ο, 30.8 ± 4.3 to 81.5 ± 5.3 and 37.4 ± 5.3 to 74.1 ± 7.2, respectively. Concentric quadriceps and hamstring peak torque values and peak torque/body weight ratios were improved in the knees that received a meniscus scaffold implant. Anterior/posterior, medial/lateral, and overall stability indexes with or without biofeedback exhibited a slight improvement, which was not statistically significant. CONCLUSION: BPMSI led to decreased pain and improved function at postoperative week 36. Although muscle strength almost returned to normal, balance parameters did not recover within 36 weeks after the procedure.

Screening of 23 candidate genes by next-generation sequencing of patients with permanent congenital hypothyroidism: novel variants in TG, TSHR, DUOX2, FOXE1, and SLC26A7.

PURPOSE: To date, many genes have been associated with congenital hypothyroidism (CH). Our aim was to identify the mutational spectrum of 23 causative genes in Turkish patients with permanent CH, including thyroid dysgenesis (TD) and dyshormonogenesis (TDH) cases. METHODS: A total of 134 patients with permanent CH (130 primary, 4 central) were included. To identify the genetic etiology, we screened 23 candidate genes associated with CH by next-generation sequencing. For confirmation and to detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. RESULTS: Possible pathogenic variants were found in 5.2% of patients with TD and in 64.0% of the patients with normal-sized thyroid or goiter. In all patients, variants were most frequently found in TSHR, followed by TPO and TG. The same homozygous TSHB variant (c.162 + 5G > A) was identified in four patients with central CH. In addition, we detected novel variants in the TSHR, TG, SLC26A7, FOXE1, and DUOX2. CONCLUSION: Genetic causes were determined in the majority of CH patients with TDH, however, despite advances in genetics, we were unable to identify the genetic etiology of most CH patients with TD, suggesting the effect of unknown genes or environmental factors. The previous studies and our findings suggest that TSHR and TPO mutations is the main genetic defect of CH in the Turkish population.

A Prospective, randomized study comparing 7-day and 14-day quadruple therapies as first-line treatments for helicobacter pylori infection in patients with functional dyspepsia.

OBJECTIVE: Standard triple therapy for Helicobacter pylori has a low eradication rate in Turkey. The aim of this study was to evaluate and compare the effectiveness of 7-day and 14-day lansoprazole, amoxicillin, clarithromycin, and bismuth subsalicylate (LACB) treatment regimens as first-line H. pylori eradication therapies. MATERIALS AND METHODS: This study included 70 patients with symptoms of dyspepsia and a positive H. pylori stool antigen test (SAT). Thirty-five patients received the modified quadruple therapy regimen for 7 days (LACB-7) whereas the remaining 35 patients received the treatment for 14 days (LACB-14). Eradication was assessed by SAT 1 month after the end of therapy. RESULTS: A total of 64 patients completed the therapy. The cumulative per-protocol (PP) and intention-to-treat (ITT) eradication rates were 89% (n = 57/64) and 81.4% (n = 57/70), respectively. Both the PP and ITT eradication rates were superior in the LACB-14 group, compared with the LACB-7 group (PP: 90.6% vs. 87.5%; ITT: 81.4% vs. 80%, respectively), but these differences were not statistically significant (P = 0.689). CONCLUSIONS: Both the 7-day and 14-day first-line LACB therapies provided a high cure rate, were well tolerated, and were equally effective against H. pylori infection in Turkey.

Normalization of the psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in Turkey.

AIM: To construct normal values for the tests of the psychometric hepatic encephalopathy score (PHES) and evaluate the prevalence of minimal hepatic encephalopathy (MHE) among Turkish patients with liver cirrhosis. MATERIALS AND METHODS: One hundred and eighty-five healthy subjects and sixty patients with liver cirrhosis without overt hepatic encephalopathy were included in the study. All subjects underwent psychometric tests, which include number connection test-A and B (NCT-A/B), serial dotting test (DST), line drawing test (LDT), and digit symbol test (DST) in the same day. The variables that affected the results of the test were included in the multiple linear regression models and formulas were constructed to predict the expected results for each tests. RESULTS: The results of all PHES tests, except the LDT in the cirrhotic group were significantly different than center of gravity (CG) (P < 0,001). The score of PHES in the cirrhotic group was -2,18 ± 3,3 (median -2; range: 11 to +4), significantly lower than CG (-0.31 ± 2.18 [median, 0; range, -8 to +5]) (P < 0.001). the cutoff of PHES was set -4 point. Therefore, 19 of the 60 cirrhotic patients were diagnosed with MHE (31.6%). Among the patients with MHE, 11 (11/45, 24,4%) had Child-Pugh classification (CTP) A and 8 (8/15, 53.3%) had CTP B. No differences in age and education years were found between the MHE and non-MHE groups (P > 0.05). CONCLUSION: Turkish PHES normograms have been developed for detecting patients with MHE. Future multicenter national studies are needed to validate widely applicable norms.

The functional variants of endothelial nitric oxide synthase gene associated with rheumatoid arthritis in Turkish adults.

This study aimed to investigate whether functional variants of endothelial nitric oxide synthase (eNOS) gene play any role in rheumatoid arthritis (RA) ethiopathogenesis and treatment in the Turkish population. Because, eNOS variants are responsible for alteration of the NO level in plasma, by reducing/increasing the endothelial NO synthesis. In the study, two eNOS gene variants (G894T and intron 4 VNTR A/B) were examined at extracted DNAs from 65 peripheral blood cell of RA patients. For the control, blood samples obtained from 70 healthy persons were studied. Genotyping of molecular variants was performed by PCR-RFLP and/or PCR technique. The data obtained was compared in itself and response to therapy. We found that "TT genotypic frequency" for the G894T variant was significantly associated with RA with an overall risk of 8.3-fold (p 0.029). No association was identified between intron 4 VNTR A/B variant and RA. At the 6 months, the mean visual analog scale (VAS), health assessment questionnaire (HAQ), and disease activity score for 28 joints (DAS 28) improvement was not significant among groups. Improvement in DAS was significantly better in anti-TNF treatment than disease-modifying antirheumatic drugs (DMARD) treatment treated subgroup. We report for the first time that variants in the eNOS "TT" genotype might be contributed to the increased risk of RA in the Turkish population. These results imply that functional variants of eNOS gene might have an effect on RA patients and response to anti-TNF treatment. In addition, the results suggest that eNOS variants might be associated and affect host susceptibility and/or response to treatment in Turkish RA patients.

Microfracture technique versus carbon fibre rod implantation for treatment of knee articular cartilage lesions.

PURPOSE: To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions. METHODS: 10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score. Magnetic resonance imaging (MRI) outcome at 12 months was assessed by a radiologist. The modified magnetic resonance observation of cartilage repair tissue (MOCART) score was evaluated. RESULTS: The 2 groups were comparable in terms of age, body mass index, lesion location, lesion size, duration of symptoms, and coexisting pathology. The microfracture group had a higher preoperative Tegner-Lysholm score (39.4±7.3 vs. 34.4±4.9, p=0.015) and modified Cincinnati score (36.4±7.2 vs. 30.4±4.0, p=0.002) than the carbon fibre rod group. At 12 months, change in both scores was significant within each group (p<0.001) and was higher in the microfracture than carbon fibre rod group (p<0.001). MRI showed minimal regenerative tissue. Lobulation, oedema, and hypertrophy were more commonly found in the regeneration tissue after carbon fibre rod implantation than microfracture. At 12 months, the MOCART score was higher in the microfracture than carbon fibre rod group (59 vs. 47, p<0.001). CONCLUSION: Microfracture is superior to carbon fibre rod implantation in terms of clinical and radiological outcome.

Three novel mutations of CHD7 gene in two turkish patients with charge syndrome; A double point mutation and an insertion.

The CHARGE (coloboma, heart defects, atresia, retardation, genital, ear) syndrome is a genetic disease characterized by ocular coloboma, choanal atresia or stenosis and semicircular canal abnormalities. Most of the patients clinically diagnosed with CHARGE syndrome have mutations in chromodomain helicase DNA-binding protein 7 (CHD7) gene. The CHD7 gene is located on chromosome 8q12.1, and up to now, there are more than 500 pathogenic mutations identified in the literature. We report two patients diagnosed with CHARGE syndrome with two novel mutations in the CHD7 gene: the first patient has double consecutive novel mutations in three adjacent codons, and the other has a novel insertion.

Soluble guanylyl cyclase activators increase the expression of tolerance to morphine analgesic effect.

OBJECTIVES: It is aimed to investigate the effects of guanylyl cyclase activation and inhibition on acute morphine antinociception and the development of tolerance to its effect. BACKGROUND: Nitric oxide-soluble guanylyl cyclase signal transduction cascade suggested to play an important role in the development of tolerance to antinociceptive effects of morphine. METHODS: Nociception was evaluated by tail flick and hot plate tests in male Wistar rats. The analgesic effects of intraperitoneal protoporphyrin IX (PPIX; an activator of soluble guanylyl cyclase), 3-morpholinosydnonimine hydrochloride (SIN-1; NO donor and activator of guanylyl cyclase), S-Nitroso-N-acetylpenicillamine (SNAP; an activator of guanylyl cyclase), 3,3-Bis (amino ethyl)-1-hydroxy-2-oxo-1-triazene (NOC-18; NO donor activating guanylyl cyclase) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; an inhibitor of guanylyl cyclase) alone or in combination with subcutaneous morphine injection were evaluated. Their effects on morphine tolerance development were evaluated by giving these agents 20 minutes prior to twice daily morphine injection during tolerance development for 5 days. On day 6, the expression of morphine tolerance was determined. RESULTS: PPIX, SIN-1, SNAP and NOC-18 significantly increased expression of morphine tolerance while ODQ decreased. CONCLUSION: These data suggested that sGC activators have a significant role in tolerance to the analgesic effect of morphine (Tab. 1, Fig. 4, Ref. 29).

Outcomes of percutaneous endoscopic gastrostomy in hospitalized patients at a tertiary care center in Turkey.

BACKGROUND/OBJECTIVES: The aim of this study was to perform a retrospective analysis characterizing patients receiving tube feeding following percutaneous endoscopic gastrostomy (PEG) tube placement between 2004 and 2012 at Erciyes University Hospital in Turkey. SUBJECTS/METHODS: Patients above the age of 18 years who required long-term enteral tube feeding were studied. All PEGs were performed using the pull-through technique by one experienced endoscopist. Demographic, clinical outcomes and PEG-related complication data were collected. RESULTS: Of the 128 subjects studied, 91 were men (71%) and 37 were women (29%). The mean age of this patient population was 54 ± 19 years. The most common reason for PEG tube insertion was the inability to consume oral diet due to complications of cerebrovascular disease (27%), while cerebral hypoxia, occurring after nonneurological medical disorders, was the second most common indication (23%). A total of 70 patients (55%) had chronic comorbidities, with hypertension being the most common (20%). The most common procedure-related complication was insertion-site bleeding, which occurred in 4% of patients. Long-term complications during 1 year were insertion-site cellulitis, gastric contents leakage and peristomal ulceration, which occurred in 14%, 5% and 0.5% of patients, respectively. There were no PEG insertion-related mortalities; 1-year mortality was unrelated to the indication for PEG tube insertion. CONCLUSIONS: PEG tube insertion was a safe method to provide enteral access for nutrition support in this hospitalized patient population.

Thoracic paravertebral block for postoperative pain management in percutaneous nephrolithotomy patients: a randomized controlled clinical trial.

OBJECTIVE: To investigate the effect of thoracic paravertebral block (PVB) on pain control and morphine consumption in percutaneous nephrolithotomy operations. SUBJECTS AND METHODS: This randomized controlled clinical study was performed on 60 American Society of Anesthesiologists (ASA) I-II patients between the ages of 18 and 60 years who underwent percutaneous nephrolithotomy with approval of the ethical committee and written consent of the patients. Patients were randomly allocated into two groups: group P had 4 ml of 0.5% levobupivacaine injected at each of the T10, T11, and T12 paravertebral spaces and a standard PVB, and group C received 4 ml of 0.9% NaCl solution. All patients were given standard general anesthesia. The follow-up of saturation, heart rate, peripheral oxygen, and blood pressure values was recorded before induction, intraoperatively, and postoperatively. At postoperative 1, 2, 6, 12, and 24 h, the visual analog scale (VAS), Ramsey sedation score, respiratory rate, and 24-hour total morphine consumption were recorded. In addition, side effects and satisfaction of patients were recorded. RESULTS: VAS scores and total morphine consumption were lower in group P than in group C: 2.3 vs. 4.3 and 22.3 vs. 43.2 mg, respectively (p < 0.05). The level of satisfaction was higher in group P than group C. Differences between groups in other parameters were not significant. CONCLUSIONS: Thoracic PVB with levobupivacaine provided a good postoperative analgesia and increased patient satisfaction for those who underwent percutaneous nephrolithotomy.

Cerebral arterial air embolism associated with mechanical ventilation and deep tracheal aspiration.

Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8-10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

The effects of neoadjuvant chemotherapy on pulmonary structures: a quantitative analysis.

BACKGROUND: The effects of neoadjuvant therapy on perioperative and postoperative outcomes of patients with stage IIIA non-small cell lung cancer remain controversial. We investigated histopathological changes possibly caused by neoadjuvant chemotherapy and their effect on the tensile forces of pulmonary structures. METHODS: A prospective study of 30 patients who had undergone lung resection was performed. The patients were divided into two groups. Group 1 included those who received neoadjuvant chemotherapy, and Group 2 included those who underwent surgery alone. Tensile stress tests were performed on freshly excised vascular and bronchial strips after lung resection. The pulmonary artery, veins, and bronchi that had not been invaded by the tumor were histopathologically examined in both groups. Intraoperative and postoperative complications were recorded. RESULTS: This study showed that the tensile strength of pulmonary vessels and bronchi was less in the neoadjuvant group than in the control group. There were statistically significant differences in the tissue strips obtained from arteries, veins, and bronchi between the two groups. In the chemotherapy group, most cases exhibited extensive fibrosis. There was no statistically significant difference in complications between the groups. CONCLUSIONS: Neoadjuvant chemotherapy did not increase postoperative morbidity or mortality. The decreased tensile strength of pulmonary vessels and bronchi after neoadjuvant therapy should alert thoracic surgeons to possible surgical complications.

The antioxidant effects of dry apricot in the various tissues of rats with induced cold restraint stress.

α-Tocopherol and ß-carotene are the best known and most widely used natural antioxidant substances. Apricot contains ß-carotene, tocopherols and flavonoids. This experimental study was designed to investigate the protective effect of Malatya kabashi apricot in stress-induced injury in various tissues of rats. In total, 32 male Wistar albino rats were divided into four groups: control, apricot, stress and apricot-stress groups. Apricot was administrated to rats by gavage for 10 days in the apricot and apricot-stress groups. Then rats were kept at 4°C for 4 h in stress and apricot-stress groups. The rats were killed at the end of the experiment for biochemical and histological examinations. This study shows apricot supplementation decreased oxidative stress injury in both the stomach and intestine.

Effects of fluoxetine and LY 367265 on tolerance to the analgesic effect of morphine in rats.

Morphine is widely used to treat chronic pain, however its utility is hindered by the development of tolerance to its analgesic effects. The aim of this study was to investigate effects of fluoxetine, a specific serotonin (5-HT) reuptake inhibitor, and LY 367265, an inhibitor of the 5-HT transporter and 5-HT2A receptor antagonist, on tolerance induced to the analgesic effect of morphine in rats. The study was carried out on male Wistar Albino rats (weighing 170-190 g). To constitute morphine tolerance, animals received morphine (50 mg/kg; s.c.) once daily for 3 days. After last dose of morphine, injected on day 4, morphine tolerance was evaluated. The analgesic effects of fluoxetine (10 mg/ kg; i.p.), LY 367265 (3 mg/kg; i.p.) and morphine were considered at 30-min intervals by tail-flick and hot-plate tests. The results showed that fluoxetine and LY 367265 significantly attenuated the development and expression of morphine tolerance. The maximal antinociceptive effects were obtained 30 min after administration of fluoxetine and 60 min after administration of LY 367265. In conclusion, we observed that co-injection of morphine with fluoxetine and LY 367265 increased the analgesic effects of morphine and delayed development of tolerance to morphine analgesia.

The effects of Teucrium polium on ionizing radiation-induced intestinal damage in rats.

BACKGROUND AND STUDY AIMS: Oxidative stress plays an important role in development of intestinal injury after abdomino-pelvic radiation therapy. Teucrium polium (TP) is a medicinal plant which has antioxidant and anti-inflammatory properties. The aim of this study was to investigate the effect of TP on radiation-induced intestinal oxidative damage in rats. MATERIALS AND METHODS: Group 1 (n = 8), the control group; Group 2 (n = 8), the RAD (radiation) group in which each rat received a single whole-body 800 cGy radiation performed with a LINAC ; Group 3 (n = 8), the RAD + TP group in which rats were exposed to radiation as in Group 2, followed by intragastric administration of 0.5 g/kg/daily TP extract for 7 consecutive days; and Group 4 (n = 8), the TP group, rats received only intragastric TP for 7 days. RESULTS: Radiation led to intestinal damage, which was accompanied by an increase in intestinal thiobarbituric-acid-reactive substances (TBARS) and myeloperoxidase (MPO) levels, and a decrease in reduced glutathione (GSH) levels. Although TP significantly decreased intestinal MPO levels and inflammation scores, it neither reverted intestinal TBARS and GSH levels nor ameliorated other histological parameters of the disease. CONCLUSIONS: Our results suggest that TP reduces inflammation but does not ameliorate the increased oxidative stress conditions in radiation-induced intestinal damage in rats.

Comparison of clinical and pathological tumor, node and metastasis staging of lung cancer: 15-year experience with 530 patients.

AIM: The prognosis of patients with lung cancer depends on early diagnosis and accurate staging. The present staging system for lung cancer is tumor (T), node (N), and metastasis (M) staging (TNM). We compared the accuracy of preoperative (clinical) and postoperative (pathological) TNM staging of lung cancer in this study and emphasized the preoperative mediastinoscopy is useful in selected patients. METHODS: We performed a retrospective comparison of the clinical and pathological TNM staging of 530 patients with lung cancer treated surgically. The preoperative clinical TNM staging of all patients was based on physical examination, radiological investigations and bronchoscopy. Mediastinoscopy was used routinely for all patients with an indication since 2000. RESULTS: We found the agreement between clinical and pathological TNM staging to be only 46.4%. The comparison between clinical and pathological TNM staging was 6.2-5.3% at stage Ia, 37.9%-36% at stage Ib, 0.7-0.9% at stage IIa, 23-25% at stage IIb, 27.1-16.2% at stage IIIa, and 3.2-14% at stage IIIb respectively. The frequency rates of the different clinical and pathologic stages were 6.2% and 5.3%, for stage Ia, 37.9% and 36% for stage Ib, 0.7% and 0.9% for stage IIa, 23% and 25% for stage IIb, 27.1% and 16.2% for stage IIIa, 3.2% and 14% for stage IIIb respectively. CONCLUSION: We compared the clinical and pathological staging in patients with non small cell lung cancer submitted to surgical treatment to identify the causes of any discordance. The clinical TNM and staging based on computerized tomography was found to be inaccurate.

Evaluation of serum levels of interleukin-10, interleukin-11 and leukemia inhibitory factor in differentiation of eutopic and tubal ectopic pregnancies.

PURPOSE OF STUDY: To investigate whether serum levels of leukemia inhibitory factor (LIF), interleukin 10 (IL-10) and interleukin 11 (IL-11) are different in reference to the site of implantation. METHODS: Seventeen patients with laparoscopic diagnoses of tubal ectopic pregnancy (EP) and 19 patients with intrauterine pregnancy delivering healthy term neonates (IUP) were prospectively evaluated for LIF, IL-10 and IL-11 levels. The data were compared by using the Student's t-test, chi-square test, Kruskal-Wallis and the Mann-Whitney U test with Bonferroni's correction (p < 0.05) as appropriate. RESULTS: A statistically significant difference was observed in serum LIF levels between the EP and IUP groups (p = 0.002). Ranges of LIF were 15-300 and 70-1200 ng/ml for the IUP and EP groups, respectively. There were no significant differences between groups in terms of IL-10 and IL-11 levels. CONCLUSION: LIF, but not IL-10 or IL-11, levels may be increased in early tubal ectopic pregnancies when compared to normal intrauterine pregnancies.

Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding.

Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10-20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.