Evaluation of single and multiple hyaluronic acid injections at different concentrations with high molecular weight in the treatment of knee osteoarthritis.

BACKGROUND: Knee osteoarthritis is severe progressive and most commonly diagnosed articular disease and its incidence is increasing around the world depending on age. This pathologic condition which limits daily activity of patients can be characterized by degeneration of cartilage and inflammation. Although non-steroidal anti-inflammatory (NSAII) agents and other analgesics are routinely used treatment options, the potential effects of intraarticular injections including hyaluronic acid (HA) have also been demonstrated by various studies. However, few studies compare the efficacy of a single high molecular weight (HMW) high dose and a triple HMW low dose. This study aimed to compare the efficacy of single high molecular weight (HMW) high dose (2 mL / 60 mg) and triple HMW low dose (2 mL /30 mg) intra-articular injection of HA in knee osteoarthritis (OA) patients by evaluating function and pain parameters during 12 months. METHODS: This is a single-center, retrospective clinical study that included and involved 128 patients. Group I (n=64) patients received triple 30 mg HA injections (SEMICAL®) with one-week intervals, while Group II (n=64) patients received a single 60 mg HA injection (SEMICAL®). Lequesne Index, WOMAC and VAS scores were recorded to assess pain and function during a 12-month period. RESULTS: There was no significant difference in characteristics of patient demographics. Our finding indicate that WOMAC, VAS score, and Lequesne Index values during follow-up visits exhibited a decrease, signifying improvement in the clinical condition. Notably, scores were significantly more favorable with the 30 mg of HA injection compared to the 60 mg of HA injection. CONCLUSION: This study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.

Comparison of refugee patients with cystic fibrosis and their counterpart children from Turkey during the war.

Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1-258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1-12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3-258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization.  Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis. What is Known: • Children who have chronic diseases are the group that is most affected by wars. • The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF). What is New: • Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months. • Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.

The Impact of the Number of Sutures on Regeneration in Nerve Repair.

PURPOSE: The ideal number of sutures for epineural nerve repair is still unclear. Increased number of sutures increases secondary damage and inflammation to the nerve tissue, which negatively affects nerve regeneration. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed, which also negatively affects nerve regeneration. Therefore, each additional suture is not only beneficial but also detrimental. The aim of this study was to find out the ideal number of sutures for nerve repair. METHODS: Seventy rats were randomly divided into 5 groups. One of the groups was used as a control group, and right sciatic nerves of the rats in other 4 groups were repaired by using 2, 3, 4, or 6 epineural sutures, respectively, after nerve transection. Biomechanical assessment was performed on the nerves collected from these rats at 5 days of follow-up. Functional and histological analyses were evaluated after 12 weeks of follow-up. RESULTS: It was found that an increase in the number of sutures enhances resistance to tensile force in general. However, there was no significant biomechanical difference between the 6-sutured group in which the most sutures were used and the 4-sutured group. In functional examinations, overall successful results were obtained in the group with 4 sutures. In histological examinations, there was no statistical difference between the control group, 2-sutured groups, and 4-sutured groups in terms of connective tissue index. However, it was observed that the group with 6 sutures had a higher connective tissue index than the control group and groups with 2 and 4 sutures. In terms of regeneration index, it was found that repair with 4 sutures was superior to repair with 2 and 6 sutures. No difference was found between any of the suture groups according to the diameter change index. CONCLUSIONS: These results indicate that repair with 4 sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies.

Effect of pronator teres muscle botulinum neurotoxin type-A injection on proximal median nerve entrapment.

PURPOSE: We aimed to evaluate the effect of botulinum neurotoxin type-A (Btx-A) injection into the pronator teres muscle in proximal median nerve entrapment (PMNE). METHODS: Intramuscular injection of 30 IU Btx-A into the pronator teres muscle was performed in 12 patients (14 extremities) diagnosed with PMNE. The injection was made under nerve stimulator control. One patient with thoracic outlet syndrome was excluded from the study and not included in the clinical evaluation. Grip and pinch strength, 2-point discrimination, Q-DASH score, and pain on VAS were evaluated and compared before and 6-8 months after injection. The patients were contacted again by phone after the first and fifth years and asked about PMNE symptomatology. RESULTS: None of the patients had complications. No significant difference in pinch strength was observed following Btx-A injection, but there was significant improvement in grip strength, 2-point discrimination, and Q-DASH and VAS pain scores. CONCLUSION: The outcomes of our study were promising: Btx-A injection improved symptoms in patients with PMNE. LEVEL OF EVIDENCE: Level IV.

Volar buttress plate fixation: An effective and reliable option for Bennett's fractures.

OBJECTIVES: This study aimed to demonstrate the volar plate fixation technique for fixing Bennett's fractures due to its buttress effect. PATIENTS AND METHODS: The retrospective study included 10 patients (8 males, 2 females; mean age: 35.9±11.56 years; range, 17 to 51 years) who were treated using the volar plate fixation technique between January 2018 and August 2022. The postoperative functional scores of the patients were evaluated using the Q-DASH (Quick Disabilities of the Arm, Shoulder, and Hand) score, and their pain status was evaluated with the Visual Analog Scale (VAS). We also assessed fracture union and development of complications. We assessed opposition according to Kapandji grade and abduction of the thumb. RESULTS: The mean follow-up time was 16.6±2.91 (range, 12 to 21) months. The technique was performed on the right extremity in eight patients and on the left extremity in two patients. All patients were right-hand dominant. The VAS score was 1 in two cases and 0 in the other cases. The mean Q-DASH score was 1.36±2.44. The mean pinch strength was 6.4±0.89 kg, and the mean grasp strength was 18.8±3.52 kg on the injured side. The mean Kapandji grade of opposition was 9.3±0.82, while the mean abduction degree was 37.4±2.01. CONCLUSION: Based on the early results of this technique, we conclude that volar plate fixation for Bennett's fractures is reliable and allows for early motion, providing anatomical and stable joint reduction, and it does not have implant complications such as hardware irritation. However, fixation of small fragments may be particularly challenging.

Relationship Between the Type of Allergen and Night Sweat in Allergic Children.

BACKGROUND: Atopic diseases can accompany allergic sensitization. The amount of allergen is as important to know since allergen exposure affects sensitization development. Some allergic children complain of intense sweating during the first few hours of transition to sleep especially at night. This study was carried out to investigate the relationship between the type of allergen to which children are sensitized and night sweating. METHODS: Children aged two to 18 years old with single allergic sensitization were included. A specific immunoglobulin E (IgE) skin prick test results were obtained from the medical records of the patients. Then, the patients' families were asked to evaluate the levels of sweating from 0 to 10 with the Visual Analogue Scale (VAS) questionnaire and the Sleep Disturbance Scale for Children (SDSC). RESULTS: Sensitization to mites was more prevalent in the group of patients with night sweating (p<0.001), and pollen allergy was more prevalent in the group of patients without night sweating (p<0.001).  Conclusion: The amount of mites and wetness in bed sheets might be responsible for allergic sensitization. A change in clothes and bed sheets for those with intense sweating might ensure better sleep and reduce the severity of the atopic symptoms. Such a recommendation might provide a better clinical outcome in these patients.

Treatment of recalcitrant femur nonunion with pedicled corticoperiosteal medial femoral condyle flap.

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn't any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

Clinical differences between nasogastric tube and Hunter's rod for staged Zone II flexor tendon reconstruction.

OBJECTIVES: This study aims to compare the outcomes of two-stage flexor tendon reconstruction in Zone II of the hand and to evaluate the results of a nasogastric tube as a potential alternative to Hunter's rod. PATIENTS AND METHODS: Between November 2012 and January 2022, a total of 45 patients (26 males, 19 females; median age: 31 years; range, 12 to 61 years) who underwent two-stage flexor tendon reconstruction were retrospectively analyzed. Of the patients 24 underwent nasogastric tube reconstruction (NT group) and 21 underwent Hunter's rod reconstruction (HR group). Patients' demographic and clinical characteristics, the number of surgeries, the occurrence of complications, the presence of infection during the procedure, and the range of motion of the finger joints at the final follow-up examination were recorded. The assessment of the cases was conducted using the total active motion system. RESULTS: Twenty-four digits underwent two-stage flexor tendon reconstruction with the nasogastric tube. Among these, three index fingers, nine middle fingers, seven ring fingers, and five little fingers were operated. Twenty-one digits underwent two-stage flexor tendon reconstruction using Hunter's rod. Among these, two index fingers, eight middle fingers, six ring fingers, and five little fingers were operated. In the NT group, excellent results were observed in 58.3% (14 digits), good results in 25% (six digits), fair results in 8.3% (two digits), and poor results in 8.3% (two digits). In the HR group, excellent results were seen in 57.1% (12 digits), good results in 33.3% (seven digits), fair results in 4.7% (one digit), and poor results in 4.7% (one digit). CONCLUSION: The utilization of a nasogastric tube offers a convenient and cost-effective option to Hunter's rod in the two-stage flexor tendon reconstruction, leading to favorable outcomes characterized by high rates of excellence and improvement, while effectively minimizing the occurrence of complications.

The protective effects of ginseng on x-irradiation-induced intestinal damage in rats.

Although radiotherapy is widely employed in the treatment of various malignancies in oncology patients, its use is limited by the toxic effects it causes in surrounding tissues, including the gastrointestinal system. Korean Red Ginseng (KRG) is a traditional drug reported to possess antioxidant and restorative properties in various studies. The purpose of the present study was to investigate the protective effects of KRG against radiation-associated small intestinal damage. Twenty-four male Sprague Dawley rats were randomly assigned into three groups. No procedure was performed on Group 1 (control) during the experiment, while Group 2 (x-irradiation) was exposed to radiation only. Group 3 (x-irradiation + ginseng) received ginseng via the intraperitoneal route for a week prior to x-irradiation. The rats were killed 24 h after radiation. Small intestinal tissues were evaluated using histochemical and biochemical methods. An increase in malondialdehyde (MDA) levels and a decrease in glutathione (GSH) were observed in the x-irradiation group compared to the control group. KRG caused a decrease in MDA and caspase-3 activity and an increase in GSH. Our findings show that it can prevent damage and apoptotic cell death caused by x-irradiation in intestinal tissue and can therefore play a protective role against intestinal injury in patients receiving radiotherapy.

An overview of the orthopedic patient profile in the first five days following February 6th, 2023 Kahramanmaras earthquake: A single-center experience in the earthquake zone.

OBJECTIVES: This study aims to investigate the patient profile at a medium-volume hospital located in the earthquake zone among patients who received orthopedic treatment within the first five days after the natural disaster that was considered a major earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 10th, 2023, a total of 338 patients (156 males, 182 females; mean age: 42.2±9.7 years; range, 0 to 87 years) who received orthopedic treatment in our center were retrospectively analyzed. The patients were divided into four groups according to age as follows: infants (younger than one year of age), children (one to 13 years), adults (14 to 59 years), and elderly (60 years or older). RESULTS: Considering the age distribution, 291 (86%) patients were young adults. A total of 173 orthopedic surgeries were performed, including internal fixation in 63 patients, external fixation in 11 patients, upper/lower extremity fasciotomy in 47 patients, amputation in 39 patients, and soft tissue debridement in 13 patients. CONCLUSION: It is of utmost importance to recognize the principles of emergency fracture fixation and fasciotomy to successfully perform orthopedic surgeries after a natural disaster such as a major earthquake, particularly when the number of earthquake victims is considerably high.

The Effects of Laparoscopic Sleeve Gastrectomy (LSG) on Obesity-Related Type 2 Diabetes Mellitus: a Prospective Observational Study from a Single Center.

PURPOSE: The objective of the study is to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on mid- to long-term regulation of blood glucose in patients with obesity and type 2 diabetes mellitus (T2DM) MATERIALS AND METHODS : In this prospective and observational single-center study, a total of 234 patients with obesity and a diagnosis of T2DM who underwent LSG between 2015 and 2020 were evaluated. The demographics and laboratory data, consisting of body mass index (BMI), glycosylated hemoglobin (HbA1c%), and fasting plasma glucose (FPG) and total weight loss (TWL%), were compared preoperative and postoperative at 12th and 18th months and annual follow-up for seven consecutive years. RESULTS: The mean age of 234 patients (female(n)/male(n):191/43) included in the study was 44.69±9.72 years, while the preoperative mean BMI, FPG, and HbA1c values were 47.9±6.82, 132.09±42.84 mg/dl, and 7.02±1.35% respectively. The mean rate of weight loss (TWL%), which was 34.7 in the 18 months, decreased to 23.15 in the 7th year. While the HbA1c % value was 7.02±1.35 in the preoperative, it was found 5.71 ± 0.75 (p<0.001) and 6.30 ± 1.77 (p<0.05) at the 18th month and 7th year after the operation, respectively. While the DM remission rate was 71.1% at the postoperative 18th month, it was 45.4% at the 7th year, despite the patients regaining weight in the follow-ups. CONCLUSIONS: Our study revealed that LSG resulted in high remission rates that continued for 7 years after the surgery, although sustained improvement or remission of diabetes despite some weight regain after the first 18 months.

Examination of the relationship between basketball referee's mental well-being and emotional regulation levels.

This study utilized a relational screening model to examine the relationship between mental well-being and emotional regulation levels among basketball referees. The research sample consisted of 327 active field referees officiating in Turkish basketball leagues during the 2021-2022 season, selected using an accessible sampling method. The sample included 13.50% (n = 44) female referees and 86.50% (n = 283) male referees, with 67.30% (n = 220) holding national accreditation and 32.70% (n = 107) being regional referees. Data collection involved a personal information form, the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) and the Referee Emotion Regulation Scale (RERS). Statistical analyses, such as Pearson's correlation coefficient, regression analysis, t-tests, and ANOVA, were conducted using SPSS 21 software, with a significance level set at p < .05. The results of this study indicated that gender and educational status did not significantly influence mental well-being, Suppression, and Cognitive Reappraisal levels among basketball referees. However, the level of refereeing emerged as a significant variable impacting mental well-being, Suppression, and Cognitive Reappraisal levels. Notably, a positive and significant correlation was observed between mental well-being, Suppression, Cognitive Reappraisal levels, age, and experience of basketball referees. Furthermore, a positive correlation was found between referees' mental well-being and emotional regulation levels, highlighting the interplay between these factors. The findings underscore the importance of prioritizing mental well-being and emotional regulation for enhancing the performance of basketball referees. Furthermore, the study emphasizes the need to nurture these aspects to improve referees' psychological resilience and overall performance. Practical research on mental well-being and emotion regulation in refereeing can contribute significantly to the existing literature, providing valuable insights for referee training and support programs.

Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year?

BACKGROUND: Cystic fibrosis (CF) is an autosomal recessive disorder caused by CF transmembrane conductance regulator (CFTR) genetic variants. CFTR modulators improve pulmonary function and reduce respiratory infections in CF. This study investigated the clinical and laboratory follow-up parameters over 1 year in patients with CF who could not receive this treatment. METHODS: This retrospective cohort study included 2018 and 2019 CF patient data from the CF registry of Turkey. Demographic and clinical characteristics of 294 patients were assessed, who had modulator treatment indications in 2018 but could not reach the treatment. RESULTS: In 2019, patients younger than 18 years had significantly lower BMI z-scores than in 2018. During the 1-year follow-up, forced expiratory volumes (FEV1) and FEV1 z-scores a trend toward a decrease. In 2019, chronic Staphylococcus aureus colonization, inhaled antipseudomonal antibiotic use for more than 3 months, oral nutritional supplement requirements, and oxygen support need increased. CONCLUSIONS: Patients who had indications for modulator treatments but were unable to obtain them worsened even after a year of follow-up. This study emphasized the importance of using modulator treatments for patients with CF in our country, as well as in many countries worldwide.

Dynamic Effects on Hole Transport in Amorphous Organic Semiconductors: a Combined QM/MM and kMC Study.

Small-molecule-based amorphous organic semiconductors (OSCs) are essential components of organic photovoltaics and organic light-emitting diodes. The charge carrier mobility of these materials is an integral and limiting factor in regard to their performance. Integrated computational models for the hole mobility, taking into account structural disorder in systems of several thousand molecules, have been the object of research in the past. Due to static and dynamic contributions to the total structural disorder, efficient strategies to sample the charge transfer parameters become necessary. In this paper, we investigate the impact of structural disorder in amorphous OSCs on the transfer parameters and charge mobilities in different materials. We present a sampling strategy for incorporating static and dynamic structural disorder which are based on QM/MM methods using semiempirical Hamiltonians and extensive MD sampling. We show how the disorder affects the distributions of HOMO energies and intermolecular couplings and validate the results using kinetic Monte Carlo simulations of the mobility. We find that dynamic disorder causes an order of magnitude difference in the calculated mobility between morphologies of the same material. Our method allows the sampling of disorder in HOMO energies and couplings, and the statistical analysis enables us to characterize the relevant time scales on which charge transfer occurs in these complex materials. The findings presented here shed light on the interplay of the fluctuating amorphous matrix with charge carrier transport and aid in the development of a better understanding of these complex processes.

The role of ultrasound in determining the presence and severity of carpal tunnel syndrome in diabetic patients.

Carpal tunnel syndrome (CTS) is seen in 5% of the population and 14%-30% in diabetics. Although electrophysiological tests are used as the gold standard method in the diagnosis, alternative methods are being studying. We aimed to investigate whether the measurement of median nerve cross-sectional area (CSA) by ultrasound is associated with the presence and severity of CTS. This prospective, cross-sectional observational study includes 128 randomly selected T2DM patients. Electrodiagnostic study was performed for all patients to diagnose CTS. Median nerve CSA were measured with ultrasound examination. The severity of the CTS was determined by Padua method. Among 128 diabetes mellitus (DM) patients, 54 (28%) had CTS and 53 (41%) had diabetic peripheral polyneuropathy. The mean duration of DM was 11.55 years. Median nerve CSAs of the patients were significantly higher in patients with CTS (CTS (-): 10.47 ± 2.67 vs CTS: (+) 12.37 ± 3.17; p < 0.001). Median nerve CSA cutoff value of >10 mm2 predicts the diagnosis of CTS. However, minimal, mild, and moderate CTS groups had similar CSA according to Padua classification (p > 0.05 for all). CSA measurement with ultrasonography can be used as an effective method in diagnosing severe CTS disease. However, median nerve CSA values should not be used to reveal the severity of CTS, in order not to miss the demonstration of minimal, mild, and moderate groups, as well as being an indicator of only the severe CTS group.

Clinical characteristics of patients requiring lung transplantation referral in national cystic fibrosis registry data.

BACKGROUND: We aimed to determine the number of cystic fibrosis (CF) patients recorded in the Cystic Fibrosis Registry of Türkiye (CFRT) who were in need of lung transplantation (LT) referral and examine clinical differences between patients who were LT candidates due to rapid forced expiratory volume in one second (FEV1) decline and LT candidates without rapid FEV1 decline in the last year to identify a preventable cause in patients with such rapid FEV1 decline. METHODS: All CF patients recorded in the CFRT in 2018 were evaluated in terms of LT. Patients were divided into those with FEV1 below 50% and in need of LT due to a decrease of 20% or more in the previous year (Group 1) and those who did not have FEV1 decline of more than 20% in the previous year but had other indications for LT (Group 2). Demographic and clinical features were compared between the two groups. RESULTS: Of 1488 patients registered in CFRT, 58 had a need for LT. Twenty patients were included in Group 1 and others in Group 2. Our findings did not reveal any significant variations in treatment, chronic infection status, or complications between the two groups. The average weight z-score was significantly higher in Group 1. Positive correlations were detected between weight z-score and FEV1 in 2017 in Group 1 and between FEV1 values in 2017 and 2018 in Group 2. CONCLUSIONS: There appears to be a relationship between the nutritional status and weight z-scores of CF patients and pulmonary function, which may indirectly affect the need for lung transplantation referral.

Comparison of lateral arm flap and posterior interosseous artery flap for soft tissue reconstruction of the elbow.

BACKGROUND: The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap. METHODS: The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes. RESULTS: Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05). CONCLUSION: The study concludes that both flap techniques are easy to apply depending on the surgeon's experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Understanding the Families' Perceptions of Adapted Physical Activity for Individuals with Autism Spectrum Disorder through Metaphors.

The aim of this study was to understand the perceptions, understanding and experiences of the families of individuals with autism spectrum disorder (ASD) related to adapted physical activity (APA), and their educators, through their use of metaphors. The research was based on systematic content analysis in the qualitative research model. The data were collected based on metaphors. The participants included 85 families of individuals with ASD attending private institutions operating in Istanbul and Ankara. The metaphors used by the families were examined under two headings: adapted physical activities, and educators. When the metaphors used to describe APA were examined, four themes emerged, education, emotion, support and development, and these themes were divided into the categories of guidance, skill, affection, and care. When the metaphorical perceptions of educators were examined, three themes emerged: education, emotion, and social adaptation. These were further categorized as experience, knowledge, entertainment, independence, happiness, and treatment. The metaphors showed that experiences in APA support increased self-confidence for individuals with autism spectrum disorder and support the social adaptation of individuals who have the opportunity to apply knowledge and experience. This research shows that families have positive perceptions of APA educators and their lessons.

Treatment Outcomes of All Arthroscopic 4-Corner Arthrodesis Techniques With 2 Headless Screws.

PURPOSE: Scaphoid excision with 4-corner arthrodesis is a safe procedure that relieves pain while also preserving the functional movements of the wrist. Different techniques have been described with successful results. In this study, we present the midterm clinical outcomes of 17 patients who underwent treatment with our arthroscopic 4-corner arthrodesis technique. METHODS: Patients with at least 1 year of follow-up were included in our study. Preoperative and postoperative radiologic, functional, and clinical results were compared. Radiologic and clinical union were achieved in all patients. RESULTS: Significant improvement was observed in Quick Disabilities of the Arm, Shoulder, and Hand, Mayo Wrist Score, visual analog scale, and Patient-Rated Wrist Evaluation scores. Although wrist range of motion increased in the radioulnar plane, no clinically important change was observed in the flexion-extension arc. The patients were able to return to work in an average of 10 weeks. CONCLUSIONS: The arthroscopic 4-corner arthrodesis technique is a method with satisfactory outcomes. The main disadvantage of this procedure is that it requires a lengthy operative time, and both specific expertise and equipment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.