Intramedullary locking mini-plate screw system in Lindgren osteotomy: a more effective fixation technique in mild and moderate hallux valgus cases.

OBJECTIVE: In the treatment of mild and moderate hallux valgus (HV) cases, the Lindgren distal osteotomy (LDO) technique has been one of the most frequently preferred methods, and screw fixation has been the most preferred material for surgery. However, considering the implant removal operations due to the reaction to the material,  the risk of unsteadiness, retarded union, and malunion has limited the amount of safe application of lateralization of the distal fragment in distal osteotomy surgery and has yielded the researchers for a better alternative. This study compared the results of the LDO cases using headless cannulated screws and intramedullary plate fixation materials. PATIENTS AND METHODS: The retrospective study included 31 files of patients operated for HV between January 1, 2018, and December 31, 2022, in Adana City Training and Research Hospital Orthopedics Clinic, Adana, Turkey. In the radiological evaluation, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the length of the first metatarsal (ML), and the distal metatarsal articular angle (DMAA) recorded preoperatively and postoperatively were analyzed. The functional results of the operations were evaluated by using the Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and EuroQol (EQ-5D) scores. RESULTS: Postop HVA, IMA, MU, and DMMA values were significantly higher in patients in Group 1 than in patients in Group 2 (p<0.001; p=0.004; p=0.004; p=0.049; p<0.001, respectively). The change in Delta (∆) HVA and EQ-5D values was significantly higher in patients in Group 2 compared to patients in Group 1 (p=0.020; p=0.016, respectively). CONCLUSIONS: The easily available and low-cost locking plates produced for mini-fractures may safely be used in distal osteotomy surgery of mild and moderate HV successfully combined with screws if intramedullary-placed, allowing accurate lateralization and improving overall outcome.

The experience of a tertiary level hospital in the 2023 Turkey double earthquake zone; management of 1,092 musculoskeletal injuries in the first week.

OBJECTIVE: The double earthquakes that occurred on February 6, 2023, are currently called the disaster of the century, in Turkey. This study is the first to report the experiences in the treatment of orthopedic emergency patients hospitalized in Adana City Training and Research Hospital (ACH), the largest tertiary hospital in the region. PATIENTS AND METHODS: The study included the retrospective analysis of the files of the victims of the earthquakes admitted to the ACH between February 6, 2023, and February 13, 2023. The age, gender, time of admission, types and localization of injuries, treatment modalities of earthquake victims, and orthopedic surgical treatment data were recorded. RESULTS: In the first week of the quakes, 3,699 patients were admitted to the ER with earthquake-related injuries. A total of 1,092 patients with musculoskeletal injuries were hospitalized, and 827 (75.7%) received orthopedic surgery. Surgical procedures included wound debridement under anesthesia (n=392, 47.4%), large bone fractures and/or pelvic ring fractures (n=224, 27.1%), fasciotomies (n=327, 69.1%), and amputations (n=121, 14.6%). CONCLUSIONS: Although Orthopedics and Traumatology Clinic staff have the highest workload, all hospital personnel should be equipped with basic orthopedic approaches related to the disaster. We believe that taking a more active role in the follow-up of orthopedic patients will help improve the management of the chaotic processes and increase overall treatment success.

microRNA-142-mediated repression of phosphodiesterase 3B critically regulates peripheral immune tolerance.

Tregs play a fundamental role in immune tolerance via control of self-reactive effector T cells (Teffs). This function is dependent on maintenance of a high intracellular cAMP concentration. A number of microRNAs are implicated in the maintenance of Tregs. In this study, we demonstrate that peripheral immune tolerance is critically dependent on posttranscriptional repression of the cAMP-hydrolyzing enzyme phosphodiesterase-3b (Pde3b) by microRNA-142-5p (miR-142-5p). In this manner, miR-142-5p acts as an immunometabolic regulator of intracellular cAMP, controlling Treg suppressive function. Mir142 was associated with a super enhancer bound by the Treg lineage-determining transcription factor forkhead box P3 (FOXP3), and Treg-specific deletion of miR-142 in mice (TregΔ142) resulted in spontaneous, lethal, multisystem autoimmunity, despite preserved numbers of phenotypically normal Tregs. Pharmacological inhibition and genetic ablation of PDE3B prevented autoimmune disease and reversed the impaired suppressive function of Tregs in TregΔ142 animals. These findings reveal a critical molecular switch, specifying Treg function through the modulation of a highly conserved, cell-intrinsic metabolic pathway. Modulation of this pathway has direct relevance to the pathogenesis and treatment of autoimmunity and cancer.

Evaluation of oxidative stress via total antioxidant status, sialic acid, malondialdehyde and RT-PCR findings in sheep affected with bluetongue.

INTRODUCTION: Bluetongue (BT) is a non-contagious infectious disease of ruminants. The disease agent bluetongue virus (BTV) is classified in the Reoviridae family Orbivirus. AIMS AND OBJECTIVES: The aim of this study was to determine serum malondialdehyde (MDA), total antioxidative stres (TAS), total sialic acid (TSA), ceruloplasmin, triglyceride, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), cholesterol, creatinine, albumin, and total protein levels in sheep with and without bluetongue (BT). MATERIALS AND METHODS: The study included 13 Sakiz crossbreed sheep, aged 1-4 years and usually in the last stage of pregnancy, as the BT group and a control group consisting of 10 healthy sheep. All sheep were clinically examined before collecting blood samples. Serum ALT, AST, cholesterol, triglyceride, albumin, GGT, total protein, creatinine and TAS levels were measured using commercially available kits as per manufacturer's recommendations using a Biochemistry Auto Analyzer (Sinnowa D280, China). Serum lipid peroxidation was estimated through a previously described method in which MDA reacts with thiobarbituric acid (TBA) to form a coloured complex at a maximum absorbance of 535 nm. The TSA value was measured at 549 nm using the method described by Warren (1959): sialic acid was oxidised to formyl-pyruvic acid, which reacts with TBA to form a pink product. The ceruloplasmin concentration was measured according to Sunderman and Nomoto (1970): ceruloplasmin and p-phenylenediamine formed a coloured oxidation product that was proportional to the concentration of serum ceruloplasmin. Real time RT-PCR and conventional RT-PCR were performed as described by Shaw and others (2007). RESULTS: Biochemistry analysis of serum showed that in the BT group, TSA, MDA, triglyceride and ALT and AST were higher and that ceruloplasmin and TAS were lower than in the control group. Serum albumin, cholesterol, creatinine, total protein and GGT did not differ significantly between the two groups. CONCLUSIONS: Serum triglyceride, ceruloplasmin, TSA, MDA and TAS concentrations may prove beneficial to the diagnosis, prognosis and biochemical analysis of BT.

Role and species-specific expression of colon T cell homing receptor GPR15 in colitis.

Lymphocyte recruitment maintains intestinal immune homeostasis but also contributes to inflammation. The orphan chemoattractant receptor GPR15 mediates regulatory T cell homing and immunosuppression in the mouse colon. We show that GPR15 is also expressed by mouse TH17 and TH1 effector cells and is required for colitis in a model that depends on the trafficking of these cells to the colon. In humans GPR15 is expressed by effector cells, including pathogenic TH2 cells in ulcerative colitis, but is expressed poorly or not at all by colon regulatory T (Treg) cells. The TH2 transcriptional activator GATA-3 and the Treg-associated transcriptional repressor FOXP3 robustly bind human, but not mouse, GPR15 enhancer sequences, correlating with receptor expression. Our results highlight species differences in GPR15 regulation and suggest it as a potential therapeutic target for colitis.

Genome-wide regulatory analysis reveals that T-bet controls Th17 lineage differentiation through direct suppression of IRF4.

The complex relationship between Th1 and Th17 cells is incompletely understood. The transcription factor T-bet is best known as the master regulator of Th1 lineage commitment. However, attention is now focused on the repression of alternate T cell subsets mediated by T-bet, particularly the Th17 lineage. It has recently been suggested that pathogenic Th17 cells express T-bet and are dependent on IL-23. However, T-bet has previously been shown to be a negative regulator of Th17 cells. We have taken an unbiased approach to determine the functional impact of T-bet on Th17 lineage commitment. Genome-wide analysis of functional T-bet binding sites provides an improved understanding of the transcriptional regulation mediated by T-bet, and suggests novel mechanisms by which T-bet regulates Th cell differentiation. Specifically, we show that T-bet negatively regulates Th17 lineage commitment via direct repression of the transcription factor IFN regulatory factor-4 (IRF4). An in vivo analysis of the pathogenicity of T-bet-deficient T cells demonstrated that mucosal Th17 responses were augmented in the absence of T-bet, and we have demonstrated that the roles of T-bet in enforcing Th1 responses and suppressing Th17 responses are separable. The interplay of the two key transcription factors T-bet and IRF4 during the determination of T cell fate choice significantly advances our understanding of the mechanisms underlying the development of pathogenic T cells.

The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review.

It has been 20 years since the first description of a rapidly progressive renal disease that is associated with the consumption of Chinese herbs containing aristolochic acid (AA) and is now termed aristolochic acid nephropathy (AAN). Recent data have shown that AA is also the primary causative agent in Balkan endemic nephropathy and associated urothelial cancer. Aristolochic acid nephropathy is associated with a high long-term risk for renal failure and urothelial cancer, and the potential worldwide population exposure is enormous. This evidence-based review of the diagnostic approach to and management of AAN draws on the authors' experience with the largest and longest-studied combined cohort of patients with this condition. It is hoped that a better understanding of the importance of this underrecognized and severe condition will improve epidemiologic, preventive, and therapeutic strategies to reduce the global burden of this disease.

Chemically orthogonal trifunctional Janus beads by photochemical "sandwich" microcontact printing.

The combination of topographic and chemical orthogonality on polymer particles by site selective immobilization of functional thiols via thiol-ene chemistry provides a trifunctional particle surface with azide and acid functionalities on opposing poles and alkenes in the equatorial area. These Janus beads are accessible for site selective orthogonal chemical reactions as well as biomolecular recognition on the same particle.

T-bet and GATA3 orchestrate Th1 and Th2 differentiation through lineage-specific targeting of distal regulatory elements.

T-bet and GATA3 regulate the CD4+ T cell Th1/Th2 cell fate decision but little is known about the interplay between these factors outside of the murine Ifng and Il4/Il5/Il13 loci. Here we show that T-bet and GATA3 bind to multiple distal sites at immune regulatory genes in human effector T cells. These sites display markers of functional elements, act as enhancers in reporter assays and are associated with a requirement for T-bet and GATA3. Furthermore, we demonstrate that both factors bind distal sites at Tbx21 and that T-bet directly activates its own expression. We also show that in Th1 cells, GATA3 is distributed away from Th2 genes, instead occupying T-bet binding sites at Th1 genes, and that T-bet is sufficient to induce GATA3 binding at these sites. We propose these aspects of T-bet and GATA3 function are important for Th1/Th2 differentiation and for understanding transcription factor interactions in other T cell lineage decisions.

The transcription factor T-bet regulates intestinal inflammation mediated by interleukin-7 receptor+ innate lymphoid cells.

Mice lacking the transcription factor T-bet in the innate immune system develop microbiota-dependent colitis. Here, we show that interleukin-17A (IL-17A)-producing IL-7Rα(+) innate lymphoid cells (ILCs) were potent promoters of disease in Tbx21(-/-)Rag2(-/-) ulcerative colitis (TRUC) mice. TNF-α produced by CD103(-)CD11b(+) dendritic cells synergized with IL-23 to drive IL-17A production by ILCs, demonstrating a previously unrecognized layer of cellular crosstalk between dendritic cells and ILCs. We have identified Helicobacter typhlonius as a key disease trigger driving excess TNF-α production and promoting colitis in TRUC mice. Crucially, T-bet also suppressed the expression of IL-7R, a key molecule involved in controlling intestinal ILC homeostasis. The importance of IL-7R signaling in TRUC disease was highlighted by the dramatic reduction in intestinal ILCs and attenuated colitis following IL-7R blockade. Taken together, these data demonstrate the mechanism by which T-bet regulates the complex interplay between mucosal dendritic cells, ILCs, and the intestinal microbiota.

Revealing the nature of thio-click reactions on the solid phase.

Thiol- and yne-functionalized beads were manufactured in a simple microfluidic setup. While CuAAC and thiol-yne reactions were performed on yne-functionalized beads, 9 different thiol-X reactions were compared, in terms of kinetics and conversion, on thiol-functionalized beads.

"Giant" hollow multilayer capsules by microfluidic templating.

Monodisperse microgels were synthesized by a microfluidic setup and used as a sacrificial template for the fabrication of "giant" hollow polyelectrolyte capsules with rigid walls consisting of covalently cross-linked polyelectrolytes and metal nanoparticles. First, a simple tubing-needle-based microfluidic system is utilized to produce size-monodisperse, degradable "giant" microgels consisting of dextran chains linked via carbonate esters. Second, these monodisperse microgels are subjected to a layer-by-layer coating of negatively charged platinum nanoparticles (Pt(NP)'s) and a positively charged diazoresin (DAR). Three bilayers of Pt(NP)'s and DAR are used to obtain a stable membrane on the microgels. Finally, the sacrificial dextran-based microgel cores are smoothly hydrolyzed and removed without rupture of the polyelectrolyte membrane due to the covalently linked hybrid polyelectrolyte/nanoparticle nature of the membrane. Scanning electron and confocal microscopy are used to characterize the capsules. The capability of encapsulating materials of interest is also shown by the addition of fluorescent polystyrene particles to the monomer mixture and subsequent visualization of embedded polystyrene particles in coated microgels after microfluidic polymerization and layer-by-layer coating. The obtained "giant" microcapsules are envisaged to be used as microreactors or drug-delivery systems.

Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas.

OBJECTIVE: Although there is a tendency to minimize the surgical procedures for chronic subdural hematomas, there is no agreement on the optimal treatment. In the literature there is only one published result of a randomized study comparing twist drill craniostomy with burr-hole craniostomy. We aimed to compare twist drill craniostomy with burr-hole craniostomy for the treatment of unilateral hemispheric chronic subdural hematomas in adults. MATERIAL AND METHODS: The study was planned as a prospective, randomized, controlled investigation. Between November 2002 and April 2006, 70 patients (54 male and 16 female) with unilateral hemispheric chronic subdural hematomas were operated. 32 patients underwent burr-hole craniostomy and 38 patients were treated by twist drill craniostomy. After discharge, the patients were followed up at 1, 3 and 6 months after operation. Mortality, morbidity, surgical complications requiring reoperation, duration of hospitalization, recurrence, total number of reoperations, and cure rates were compared. RESULTS: Two patients died and one patient developed 6th nerve paresis in the inpatient period. There were three recurrences (two in the burr-hole craniostomy group, one in the twist drill craniostomy group) and in one patient from the burr-hole craniostomy group a chronic subdural hematoma developed on the contralateral side postoperatively. There was no significant difference clinically and radiologically between the two groups at any time period. CONCLUSION: Both surgical methods seem effective for the treatment of unilateral chronic subdural hematomas.

The importance of the indirect pathway of allorecognition in clinical transplantation.

The immune system mounts a response to non-self transplanted tissue through a number of mechanisms. The indirect pathway of allorecognition, in which cells of the adaptive immune system recognize MHC alloantigen-derived peptide on self-MHC molecules, has emerged as a potent inducer of allograft rejection. In particular, recent evidence convincingly connects the indirect pathway with chronic rejection, including antibody-mediated and CD8(+) T cell-mediated rejection. However, the indirect pathway can also promote the generation of regulatory T cells, which have emerged as crucial suppressors of the alloresponse, and hold much promise in the quest for clinical tolerance. An improved understanding of the indirect pathway is likely to bring important benefits to transplant recipients.

Comparison of TEMPO EC and TBX medium for the enumeration of Escherichia coli in cheese.

AIMS: TEMPO EC (Escherichia coli) is based on glucuronidase activity and is a test for use with the TEMPO system for the automated 24 h enumeration of E. coli in food products. In this study, TEMPO EC was compared with TBX medium, the current standard plate method for the enumeration of E. coli in cheese. METHODS AND RESULTS: For comparative purposes, both naturally (92) and artificially contaminated (31) cheese samples were studied. Pearson correlation coefficients were determined as 0.954 and 0.978 between the two methods for naturally and artificially contaminated samples, respectively. Regression analysis yielded the following equations: log(10) TEMPO EC = 0.340 + 0.889 log(10) TBX medium and log(10) TEMPO EC = 0.174 + 0.899 log(10) TBX medium for naturally and artificially contaminated samples, respectively. In general, absolute differences did not exceed one log between results obtained by the two methods. CONCLUSIONS: Statistical analysis of the results showed good agreement between the two enumeration methods. SIGNIFICANCE AND IMPACT OF THE STUDY: TEMPO EC is a practical and reliable alternative to the current standard plate method for the enumeration of E. coli in foods.

Is there a way to avoid surgical complications of twist drill craniostomy for evacuation of a chronic subdural hematoma?

BACKGROUND: Although twist drill craniostomy for evacuation of a chronic subdural hematoma is a rapid and minimally invasive procedure, it carries the risk of complications because it is a 'blind' technique. Our aim was to analyse the complications in a series of patients treated by this technique in order to identify methods of avoidance by modifications in the surgical technique. METHOD: Thirty-nine patients with a chronic subdural hematoma underwent twist drill craniostomy between November 2002 and December 2005 in our clinic. When a surgical complication happened we modified our surgical technique to see if this avoided it in future patients. FINDINGS: Surgical complications happened in 7 patients (17.9%) including inadequate drainage, brain penetration, acute epidural hematoma and catheter folding. After preventive modifications these complications did not recur. CONCLUSIONS: Modifications in the technique of twist drill craniostomy are described in this paper which may minimise the occurrence of surgical complications.

Contralateral development of chronic subdural hematoma after evacuation of chronic subdural hematoma. A case report.

Contralateral acute complications such as acute epi/subdural hematomas can be encountered after evacuation of a chronic subdural hematoma, though they are rare. We found only one case of chronic subdural hematoma following the surgery for contralateral chronic subdural hematoma, have been published in English language literature. A 73-year-old male admitted to our hospital with a right-sided subdural hematoma. The subdural hematoma was evacuated through a burr-hole. A left-sided subdural higroma appeared after operation and turned into classical subdural hematoma in the course of time. After evacuation of contralateral chronic subdural hematoma, the patient recovered completely. All stages of the development of contralateral chronic subdural hematomas were shown by serial computed tomograms. It was suggested that traumatic chronic subdural hematomas develop from mostly subdural higromas. If contralateral subdural higroma is seen after surgical evacuation of a chronic subdural hematoma, the possibility of development of contralateral chronic subdural hematoma must be kept on mind.

Information preserving image compression for archiving NMR images.

This paper presents a result on information preserving compression of NMR images for the archiving purpose. Both Lynch-Davisson coding and linear predictive coding have been studied. For NMR images of 256 x 256 x 12 resolution, the Lynch-Davisson coding with a block size of 64 as applied to prediction error sequences in the Gray code bit planes of each image gave an average compression ratio of 2.3:1 for 14 testing images. The predictive coding with a third order linear predictor and the Huffman encoding of the prediction error gave an average compression ratio of 3.1:1 for 54 images under test, while the maximum compression ratio achieved was 3.8:1. This result is one step further toward the improvement, albeit small, of the information preserving image compression for medical applications.