Effect of cilostazol on healing of achilles tendon ruptures: an experimental study on rats.

PURPOSE: This study aimed to evaluate whether cilostazol (phosphodiesterase III inhibitor) could enhance the healing of Achilles tendon ruptures in rats. MATERIALS AND METHODS: The Achilles tendons of 24 healthy male adult rats were incised and repaired. The rats were randomly allocated to cilostazol and control groups. The cilostazol group received daily intragastric administration of 50 mg/kg cilostazol for 28 days, while the control group did not receive any medication. The rats were sacrificed on the 30th day, and the Achilles tendon was evaluated for biomechanical properties, histopathological characteristics, and immunohistochemical analysis. RESULTS: All rats completed the experiment. The Movin sum score of the control group was significantly higher (p = 0.008) than that of the cilostazol group, with means of 11 ± 0.63 and 7.50 ± 1.15, respectively. Similarly, the mean Bonar score was significantly higher (p = 0.026) in the control group compared to the cilostazol group (8.33 ± 1.50 vs. 5.5 ± 0.54, respectively). Moreover, the Type I/Type III Collagen ratio was notably higher (p = 0.016) in the cilostazol group (52.2 ± 8.4) than in the control group (34.6 ± 10.2). The load to failure was substantially higher in the cilostazol group than in the control group (p = 0.034), suggesting that the tendons in the cilostazol group were stronger and exhibited greater resistance to failure. CONCLUSIONS: The results of this study suggest that cilostazol treatment significantly improves the biomechanical and histopathological parameters of the healing Achilles tendon in rats. Cilostazol might be a valuable supplementary therapy in treating Achilles tendon ruptures in humans. Additional clinical studies are, however, required to verify these outcomes.

Clinical factors, management, and outcomes of children under 3 years old with central nervous system tumors: single-center experience.

PURPOSE: Children under 3 years old represent a notable portion, about 25 to 30%, of all central nervous system tumor (CNS) cases. Their clinical course, prognosis, and treatment significantly differ from older children. This single-center retrospective study aims to comprehensively analyze survival factors in children under three diagnosed with CNS tumors. METHODS: Between April 2012 and December 2023, cases under 3 years of age with CNS tumors diagnosed at our center were retrospectively evaluated. RESULTS: Among 279 CNS tumor cases, 42 (15%) were evaluated. The 5-year overall and event-free survival rates were 67.4% (95% CI 47.5-81.1) and 39.8% (95% CI 24.2-55.0), respectively. Gender, symptom onset to diagnosis time, pathological neurological findings at diagnosis, and tumor location did not significantly impact survival (p > 0.05). However, cases with neurological symptoms showed significantly higher event-free survival rates (p < 0.05). Patients with embryonal tumors, metastases, inability for total surgical excision, relapsed/progressive diseases, and who under 1 year old had significantly lower survival rates (p < 0.05). Radiotherapy timing did not affect survival (p > 0.05). Event-free survival rates remained unchanged after the third year. CONCLUSION: The current treatments have been observed to have a positive impact on survival rates. Nonetheless, there is a need for novel treatments for patients with embryonal tumors, metastases, aged under 1 year, and those where total surgical excision is not feasible or in cases with progressive/relapse disease. This study underscores the importance of the first 3 years regarding relapse, progression, or mortality risk.

Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey.

OBJECTIVE: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear. METHODS: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality). RESULTS: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group. CONCLUSION: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Histopathological Evaluation of Mechanoreceptors in the Metatarsophalangeal Joint Capsule in Hallux Valgus.

To date, we could find no study concerning the relationship between mechanoreceptors in the joint capsule of the first metatarsophalangeal joint and hallux valgus deformity. We aimed to investigate the presence of mechanoreceptors in samples obtained from the first metatarsophalangeal joint capsules of patients with hallux valgus deformity to improve our understanding of the clinical and histopathological features of the disease. Samples were taken from the first metatarsophalangeal joint capsules of 13 fresh-frozen cadavers with normal anatomy (controls) and 29 patients undergoing surgery for hallux valgus (cases). For light microscopy, excised specimens were fixed in 10% formaldehyde and processed for routine histopathological investigation. All samples were dehydrated in a series of ethanol, cleared in xylene, and embedded in paraffin. Orientation of collagen fibers was determined on Masson's trichrome-stained sections, and mechanoreceptors were evaluated on S-100-immunostained sections. In the sections stained with Masson's trichrome, the orientation of collagen fibers was regular in the control group. However, coarse and disoriented collagen bundles were observed in the hallux valgus cases (P ≤ .05). S-100 immunostaining was positive in the sections of both the cases and controls. Finally, free nerve endings were more abundant in the samples obtained from the capsules of hallux valgus cases than from the control group (P ≤ .05). An increase in the number of free nerve endings within the capsules of the first metatarsophalangeal joints in feet with hallux valgus deformity might have a role in the development of clinically relevant joint pain and instability.

Homozygous c.130-131 ins A (pW44X) mutation in the HAX1 gene as the most common cause of congenital neutropenia in Turkey: Report from the Turkish Severe Congenital Neutropenia Registry.

BACKGROUND: Severe congenital neutropenia is a rare disease, and autosomal dominantly inherited ELANE mutation is the most frequently observed genetic defect in the registries from North America and Western Europe. However, in eastern countries where consanguineous marriages are common, autosomal recessive forms might be more frequent. METHOD: Two hundred and sixteen patients with severe congenital neutropenia from 28 different pediatric centers in Turkey were registered. RESULTS: The most frequently observed mutation was HAX1 mutation (n = 78, 36.1%). A heterozygous ELANE mutation was detected in 29 patients (13.4%) in our cohort. Biallelic mutations of G6PC3 (n = 9, 4.3%), CSF3R (n = 6, 2.9%), and JAGN1 (n = 2, 1%) were also observed. Granulocyte colony-stimulating factor treatment was given to 174 patients (80.6%). Two patients died with infectious complications, and five patients developed myelodysplastic syndrome/acute myeloblastic leukemia. The mean (± mean standard error) follow-up period was 129.7 ± 76.3 months, and overall survival was 96.8% (CI, 94.4-99.1%) at the age of 15 years. In Turkey, severe congenital neutropenia mostly resulted from the p W44X mutation in the HAX1 gene. CONCLUSION: In Turkey, mutation analysis should be started with HAX1, and if this is negative, ELANE and G6PC3 should be checked. Because of the very high percentage of consanguineous marriage, rare mutations should be tested in patients with a negative mutation screen.

Mid-Term Results of Two Different Fixation Methods for Chevron Osteotomy for Correction of Hallux Valgus.

We compared 2 different fixation methods (bioabsorbable pins and cannulated screws) after chevron osteotomy for the treatment of hallux valgus. We reviewed consecutive proximal chevron osteotomies in 80 patients (100 feet) performed by 2 surgeons. Of the 100 feet (80 patients), 48 feet (40 patients) were stabilized with bioabsorbable pins, and 52 feet (40 patients) were stabilized with cannulated screws. In the pin group, 8 patients were male (20%) and 32 were female (80%). In the screw group, 10 patients were male (25%) and 30 were female (75%). The mean patient age was 43.1 (range 24 to 60) years in the pin group and 43.5 (range 20 to 60) years in the cannulated screw group. The visual analog scale, intermetatarsal angle, and hallux valgus angle decreased significantly and the American Orthopaedic Foot and Ankle Society scores increased significantly in all patients in both groups after surgery (p < .05). No statistically significant differences were found between the 2 groups (p > .05). Both fixation methods were found to be safe and reliable under the appropriate conditions and when performed by an experienced surgeon.

Distal Oblique Metatarsal Osteotomy for Hallux Valgus Deformity: A Clinical Analysis.

We compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n = 30) or distal chevron osteotomy (n = 31) were evaluated retrospectively. The chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p < .001), hallux valgus angle (p < .001), distal metatarsal articular angle (p < .001), range of first metatarsophalangeal joint motion (p < .001), American Orthopaedic Foot and Ankle Society score (p < .001), and sesamoid position (p < .001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 ± 0.1 mm versus 1.0 ± 0.1 mm; p < .001) and absolute shortening of the first metatarsal (1.0 ± 0.4 mm versus 6.8 ± 1.0 mm; p < .001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus.

Middle and long term radiologic and functional results of childhood supracondylar humeral fractures operated in first 24 hours with limited medial approach.

OBJECTIVE: To investigate the middle- and long-term radiological and functional results of children with type III supracondylar humerus fractures treated with a limited medial approach and internal fixation. METHODS: The retrospective study was conducted at Department of Orthopaedics in Goztepe Training and Research Hospital, Istanbul, Turkey, and comprised data of children who underwent surgery between April 1991 and June 2009. Patients in group I underwent surgery within the first 8 hours after admission, and those in group II did so 8-24 hours after admission. Patients were evaluated according to the Flynn scoring system. RESULTS: Of the 79 patients, 52(65.8%) were male and 27(34.2%) were female. Fractures involved the left side in 49(62%) patients. Group I had 39(49.4%) patients and group II 40(50.6%). The overall mean age was 6.2±2.95 years (range: 2-13 years), and the mean follow-up was 53.2±14.9 months (range: 26-193 months). Functional scores were satisfactory (excellent, good and fair results) in all cases in both groups (100%), and the cosmetic results were satisfactory in 37(95%) in group I, and 39(97.5%) in group II (p>0.05). CONCLUSIONS: Limited medial approach to the treatment of supracondylar humerus fractures yielded successful functional and cosmetic results.

Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer.

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC.

M30 does not predict the severity of hepatosteatosis, whereas adiponectin level declined with increase of ALT and the severity of hepatic steatosis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an emerging problem all over the world. Because NAFLD and polycystic ovary syndrome (PCOS) are both closely related with insulin resistance, it would be necessary to determine the rate of presence of NAFLD in PCOS patients. So, this study aimed to investigate the utility of M30 in PCOS patients for the diagnosis of hepatic injury. METHODS: Eighty patients with PCOS were included in the study. Ultrasonographic examination for the presence of hepatic steatosis, M30 serum level for determining the severity of ongoing apoptotic cell death in liver, and BARD index for defining the hepatic injury were performed during the study. 25-OH vitamin D and adiponectin level in sera were studied using ELISA (Enzyme-Linked ImmunoSorbent Assay). RESULTS: M30 and vitamin D levels did not change significantly with the severity of hepatic steatosis. On the other hand, M30 levels showed a positive correlation with ALT and AST levels, and M30 level suddenly increased with the presence of hepatic steatosis from 159.7 to 170 U/l, however stabilized with the increasing severity of hepatic setatosis. Adiponectin levels decreased with the increasing severity of hepatic steatosis and significantly varied between ALT greater than 40 U/l and less than 40 U/l. CONCLUSIONS: M30 level in serum increased with the appearance of hepatic steatosis and had a positive correlation with a noninvasive hepatic injury test, BARD (BMI, aspartate aminotransferase [AST]/alanine aminotransferase [ALT] ratio [AAR], diabetes mellitus [DM]) index. Adiponectin level decreased with the increasing ALT level and severity of hepatic steatosis.

Effect of post-extubation inspiratory muscle training on diaphragmatic function in mechanically ventilated patients: A randomized controlled trial.

BACKGROUND: Diaphragmatic dysfunction is a common problem in patients who have been mechanically ventilated. OBJECTIVES: The study aimed to evaluate the effectiveness of inspiratory muscle training (IMT) on diaphragm muscle thickness and function in mechanically ventilated patients. MATERIAL AND METHODS: A single-blind trial was conducted. Twenty patients were randomly assigned to either the conventional physiotherapy (CP) group or to the IMT group for 5 days following extubation. The CP group received only CP, while the IMT group received CP in addition to IMT. Ten healthy controls (HCs) underwent IMT. Maximum inspiratory pressure (MIP) and physical function were recorded. Diaphragm excursion (DE), diaphragm thickness at the end of inspiration (Tdi), diaphragm thickness at the end of expiration (Tde), peak contraction velocity (PCV), and peak relaxation velocity (PRV) were evaluated with ultrasonography before and after the intervention. RESULTS: The IMT group and HCs showed significant improvements in DE (p = 0.005; p = 0.005, respectively), PCV (p = 0.028; p = 0.015, respectively) and PRV (p = 0.029; p = 0.020, respectively) after 5 days of IMT. A significant increase in MIP was recorded in all groups after the intervention (CP: p = 0.044; IMT: p = 0.005; HC: p < 0.001). There was a significant improvement in the Medical Research Council (MRC) and the Physical Function in Intensive Care Test (PFIT) scores in both the CP and IMT groups (p < 0.001 and p < 0.001, respectively). CONCLUSIONS: Inspiratory muscle training improves diaphragmatic functions, including MIP, diaphragm excursion, PCV, and PRV. We think that IMT applied after extubation may serve as a tool to prevent and facilitate the recovery of diaphragmatic function.

Investigation of the pressure value while performing biceps tenodesis for superior capsuler reconstruction.

BACKGROUND: To compare the histopathological results of biceps tenodesis (BT) performed with normal, low, and high pressures for superior capsule reconstruction (SCR) in rabbits with massive rotator cuff tears. MATERIALS AND METHODS: Thirty rabbits were divided into three groups. Rabbits 1-10 underwent SCR with BT at the same pressure (Group 1), value measured in the groove; 50% lower (Group 2); 50% higher (Group 3). After the 4-week follow-up, shoulder were en-bloc excised and histopathological evaluation was performed with modified Bonar's scale. Results were compared between the groups, statistically. RESULTS: Extracellular matrix were significantly lower in group 2 compared to the other groups (p < 0.05). Cellularity levels were significantly lower in group 2 compared to the other groups (p < 0.05). Group 2 had no difference between the sides (p > 0.05). Group 2 had lower vascularity levels compared to the other groups (p = 0.01). DICSUSSION: When the biceps tendon was in the bicipital groove and in a more mobile state with lower pressure exposure. BT performed with a tension that creates less pressure than the biceps in the groove is more successful in SCR.

Lamivudine treatment failure risks in chronic hepatitis B patients with low viral load.

AIM: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). MATERIAL AND METHODS: In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA <10 9 copies/ml and for HBeAg­patients HBV DNA <10 7 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. RESULTS: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with <100,000 copies/ml and ≥ 100,000 copies/ ml had 54.8 and 67.3% LTF rates at the end of the 5th year, respectively. Logistic regression analysis of risk factors showed HBeAg+, hepatic activity index, HBV DNA, virological response at 6 months and duration of follow-up were independent predictors for LTF (p values were 0.001, 0.008, 0.003, 0.020 and 0.003, respectively). CONCLUSION: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.

Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning.

BACKGROUND/AIMS: An unsuccessful colonoscopy procedure is often related to inadequate bowel cleansing. It is difficult for patients to finish the whole 4 liters of polyethylene glycol-electrolyte lavage (PEG-EL) because of its salty taste and the large quantity. Pineapple juice has been shown to be an effective agent in the dissolution of undigested food in the stomach. This study assessed the effectiveness of both 2 and 4 liters of PEG-EL in precolonoscopic bowel cleansing and the quality of colonoscopic cleaning by adding 1 liter of pineapple juice to a reduced-volume PEG-based regime. METHODS: The patients were chosen from those undergoing a colonoscopic procedure. A total of 126 patients were randomized into 3 groups receiving 3 different PEG-EL (Golytely®) regimes, i.e. 4 liters of PEG-EL (group 1, n = 44), 2 liters of PEG-EL (group 2, n = 39) or 2 liters of PEG-EL with 1 liter of pineapple juice (Dimes® 100%; group 3, n = 43). RESULTS: Both the 4- and 2-liter PEG-EL regimes resulted in similar bowel cleansing scores in all parts of the colonic segments. However, adding 1 liter of pineapple juice to the reduced-volume PEG-EL regime improved the quality of the cleansing on the right side of the colon and in the transverse colon. Adequate bowel cleansing was achieved in 68.1% of the patients in group 1, 63.9% in group 2 and 80% in group 3 (the lowest score in one of the segments). On the other hand, the tolerability of the regimes was similar in all 3 groups (p = 0.509). CONCLUSIONS: Reduced PEG-EL (2 rather than 4 liters) may be sufficient for precolonoscopic bowel cleansing in the Turkish population. Administration of pineapple juice in the reduced-dose preparation regime may improve the quality of the bowel cleaning.

The results of the modified St Jude Total Therapy XV Protocol in the treatment of low- and middle-income children with acute lymphoblastic leukemia.

The St Jude Total Therapy Study XV was the first clinical trial to prospectively use minimal residual disease levels during and after remission induction therapy to guide risk-directed treatment. We used the Total Therapy XV protocol with minimal modification in treating 115 newly diagnosed pediatric acute lymphoblastic leukemia patients from low- and middle-income groups from January 2011 to December 2017. The mean age at diagnosis was 5.97 ± 3.96 years. The median follow-up period was 88 months. Three (2.6%) patients had bone marrow relapse, and one (0.87%) had an isolated central nervous system relapse. Nineteen of the patients (16.52%) died due to infection-related complications, three (2.61%) died due to progressive disease, and one (0.87%) died due to hematopoietic stem cell transplant complications. Five-year overall survival was 80%, and event-free survival was 78.3%. Our results showed that the Total XV treatment protocol could be used successfully in patients with ALL from low- and middle-income populations. However, infection-related deaths remain a significant problem.

Investigation of the effects of subacromial bursal tissue preservation and microfracture procedure on healing after rotator cuff repair in a rat model.

INTRODUCTION: The aim of this study is to compare the preservation of bursal tissue and microfracture techniques and to examine the effectiveness of the combination of the two methods in rotator cuff tear healing in the rat shoulder. HYPOTHESIS: Bursal tissue preservation combined with microfracture is more effective in the rotator cuff repair. MATERIALS AND METHODS: Twenty-three male Sprague-Dawley rats were randomly divided into two groups. The bursal tissue was preserved in group 1 (n=11) and excised in group 2 (n=12). Groups were categorized into subgroups as L (left) and R (right) based on the shoulder side receiving microfracture (L received microfracture, R did not). Histopathological examination was performed using modified Bonar Score System. RESULTS: Cell morphology grades of group 1 were lower than group 2 (p<0.05). In terms of collagen measurements, the grade of group 1L (bursa preservation+microfracture) was lower than groups 1R, 2L, and 2R, and the grade of group 1R was lower than groups 2L and 2R. Cellularity grades of group 2 were higher than group 1 (p<0.05). Extracellular matrix grades of group 1 were lower than group 2 (p<0.05). The overall grades were lower in group 1 than in group 2 (p<0.05). DISCUSSION: Combined treatment of bursal tissue preservation and microfracture was the most efficient method as determined by healing findings in histopathological specimens. Preservation of bursal tissue was a more effective option in tendon healing than performing only microfracture. LEVEL OF PROOF: II, animal research.

Comparison of 4 surgical approaches in pediatric Gartland type 3 supracondylar humerus fractures treated by open reduction and pinning: A multicenter study.

OBJECTIVE: This study aimed to compare the outcomes of medial, lateral, posterior, and anterior approaches in pediatric Gartland type 3 supracondylar humerus fractures treated with open reduction and pinning. METHODS: Gartland type 3 supracondylar humeral fractures treated by open reduction and pinning in 4 different centers with different surgical approaches were divided into 4 groups according to the surgical approach. Each trauma center applied the surgical approaches with which it had the most experience. Specifically, patients treated with medial, lateral, posterior, and anterior approaches were classified as groups 1, 2, 3, and 4, respectively. The demographic characteristics of the patients and the complications were compared. The findings were evaluated according to the Flynn criteria. RESULTS: A total of 198 pediatric patients, 114 (57.6%) male and 84 (42.4%) female, with a mean age of 6.27 ± 2.03 (range = 1-12) years, were included in this study. They were all treated with open reduction and pinning, 51 (25.8%) by the medial approach, 49 (24.7%) by the lateral approach, 66 (33.3%) by the posterior approach, and 32 (16.2%) by the anterior approach. No significant differences in age, gender, side, or complication status were found between the groups (P > .05). There were also no significant differences between the groups regarding the Flynn cosmetic and functional criteria (P > .05). CONCLUSIONS: Superior functional and cosmetic results can be achieved with fewer complications with surgical techniques applied by experienced surgeons in the open reduction of supracondylar humeral fractures in children. It is recommended that surgeons choose the approach with which they have the most experience. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Is there an association between the measurement of qualitative HBsAg and virologic response in chronic HBV infection?

BACKGROUND: In the follow up of chronic hepatitis B infection (HBV), a significant correlation between quantitative HBsAg titer measurement and HBV DNA level, and moreover with intrahepatic covalently closed circular DNA was already shown. However, besides their impact on long-term follow up, they are really expensive methods, and not available widespread. We aimed to investigate the utility of qualitative measurement of HBsAg titer in prediction of virologic response at the end of the first year of anti-viral treatment in chronic HBV infection. MATERIAL AND METHODS: A total of 70 patients receiving anti-viral therapies for chronic HBV infection were included into the study. The patients were evaluated according to Hbe Ag status and response to treatment. The determinations used in the study (biochemical, virologic responses, primary non-response) were accepted as it was described in AASLD. RESULTS: Qualitative HBsAg titer increased significantly in both HBeAg positive and negative patients (p values 0.002 and < 0.000). Increasing of HBsAg titer in first three months is more dramatic in responder group, however the difference was disappeared at the sixth and twelve moths on follow up. Similarly, a fast increasing in anti-HBe titer in HBeAg negative chronic HBV patients was related with higher response at the end of first year therapy. However, the changings at the 12th month of anti-viral treatment were similar in both responder and non-responder groups. CONCLUSION: In conclusion, the fast increase in qualitative measurement of HBsAg titer seemed to be a predictor of higher anti-viral medication success in chronic HBV patients. However, this meaningful increasing was disappeared on the follow up, particularly after the six months examination.

Major extremity injuries associated with farmyard accidents.

BACKGROUND: The aim of the study is to analyze the major agricultural injuries related to the extremities. PATIENTS: We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. RESULTS: Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60-360). Mean length of stay was 24 days (4-150), and mean number of operations during hospitalization was 2.4 (1-30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). CONCLUSIONS: Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

Uncooled microwave ablation of osteoid osteoma: New approaches to an old problem.

OBJECTIVE: This study aims to evaluate the technical and clinical success of uncooled microwave ablation (MWA) in the treatment of osteoid osteoma with two-dimensional fluoroscopy guidance in the operating room. METHODS: The clinical and imaging data of 9 patients were retrospectively evaluated. Mean patient age was 14.55 years. The mean size and volume of the lesions were 17.2 × 10.8 × 8.0 mm and the mean nidus size was 6.86±2.05 mm on computed tomography. MWA was performed with uncooled probe in operating room and in sterile conditions. Numerical pain score was recorded before the procedure, the day after, and at 1, 3 months after the procedure. RESULTS: Clinical and technical success was achieved in 100% of patients. The mean volume of MWA-induced necrosis was 20.8 × 12.8 × 10.7 mm, peripheral scar thickness was 3.5±0.75 mm, and none of the patients had nidus enhancement on first month follow-up magnetic resonance imaging. Fluoroscopic guidance was conducted under digital c-arm. Patients received four to 12 spot films (mean: 6.6 kVp, 2.66 mAs) over the lower extremity. Mean radiation exposure to the skin due to imaging was 0.02 mGy per patient per procedure. The dose area product-the total amount of radiation deliverable to the patient was 0.75±0.32 Gy.cm2. CONCLUSION: This study demonstrated the effectiveness and the safety of the uncooled MWA in osteoid osteoma. The technique may effectively be used in operating room under c-arm fluoroscopy. Such hybrid approach may ensure sterility, anesthetic safety, and lower radiation dose to patients.