Eklem Hastalıkları ve Cerrahisi Joint Diseases and Related Surgery Original Article / Özgün Makale Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults Erişkinlerde karışık tipteki femoroasetabüler sıkışmanın

ÖZ Amaç: Bu çalışmada tek bir merkezde güvenli cerrahi kalça dislokasyonu (GCKD) tekniği kullanılarak karışık tipteki femoroasetabüler sıkışma (FAS) tedavisinde edinilen deneyim değerlendirildi. Hastalar ve yöntemler: Çalışmada Ekim 2009 -Ekim 2014 tarihleri arasında kliniğimizde GCKD tekniği ile tedavi edilen 21 hastanın (7 erkek, 14 kadın; ort. yaş 33.8±10.6 yıl; dağılım 19-52 yıl) 22 kalçası geriye dönük olarak değerlendirildi. Ameliyat öncesi ve son Harris kalça skorları (HKS) ve alfa açıları karşılaştırıldı. Yaş, cinsiyet, taraf, sıkışma testleri, ameliyat öncesi HKS, tümsek ve kıskaç tip FAS radyografik göstergeleri ve ameliyat sırasındaki eklem bulguları en son işlevsel sonuçlar üzerindeki etkileri yönünden değerlendirildi. Bulgular: Semptomların ortalama süresi 29.5 aydı. Kalçanın fleksiyonu ve iç rotasyonu ile ortaya çıkan kasık ağrısı başlıca semptomdu. Tüm kalçalara radyografik olarak "karışık tipte FAS" tanısı konuldu. Yirmi iki kalçanın ortalama izlem süresi 48 aydı. Ameliyat öncesi ve en son ortalama HKS arasındaki farklılık istatistiksel olarak anlamlıydı (60.0'a karşın 87.6 puan, p<0.001). Yirmi iki kalçadan ortalama HKS'si 95.0 puan olan 17 kalçada (%77) tedavi yeterli olarak değerlendirildi. Ameliyat öncesi HKS'si 60 puanın altında olan kalçalar yetersiz sonuca biraz daha fazla yatkındı. Araştırılan hasta bağımlı, klinik, radyografik değişkenler ve ameliyat sırasındaki eklem bulguları içinde düz bir grafideki koksa profunda belirtisi daha yüksek bir yetersiz sonuç oranı ile ilişkili bulundu (p= 0.040). Sonuç: Güvenli cerrahi kalça dislokasyonu işlemi ortalama dört yıllık izlem sonrasında %77'lik bir başarı oranına sahiptir. Koksa profunda belirtisi yetersiz klinik sonuç ile bağlantılıdır. Ameliyat öncesi 60 puanın altındaki bir HKS klinik sonuç üzerinde negatif belirleyici bir değişken olarak görünmektedir. Anahtar sözcükler: Femoroasetabüler sıkışma; işlevsel sonuç; cerrahi kalça dislokasyonu; tedavi. ABSTRACT Objectives: This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. Patients and methods: In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Results: Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 87.6 points, p<0.001). The treatment was considered satisfactory in 17 of 22 hips (77%) having a mean HHS of 95.0 points. Hips having a preoperative HHS of less than 60 points were more prone to unsatisfactory outcome. Among the investigated patient-dependent, clinical, radiographic variables and intraoperative articular findings, coxa profunda sign in a plain radiograph was found correlated with a higher rate of unsatisfactory outcome (p= 0.040). Conclusion: Safe surgical hip dislocation procedure has a success rate of 77% after a mean follow-up of four years. Coxa profunda sign is associated with the unsatisfactory clinical outcome. Preoperative HHS of less than 60 points seems to be a negative predictive variable on the clinical outcome

Türk Biyokimya Dergisi

ABSTRACT Objective: The aim of this study was to investigate the laccase production of Trametes versicolor under submerged fermentation condition. Then, dye decolorization by laccase was optimized using Box-Behnken methodology. Methods: The optimal culture conditions for producing high amount of laccase were determined using Taguchi methodology. The experiments were designed with five factors (glucose, yeast extract, CuSO 4 , inoculum size and pH) at three levels with orthogonal array layout of L27 (3 5 ). Then, the optimum conditions for high decolorization activity of Reactive Blue 49 by obtained crude laccase were also investigated using Box-Behnken methodology. Results: The optimum culture conditions for production of high amounts of laccase were detected as 2 g L -1 of glucose, 5 g L -1 of yeast extract, 2mM of CuSO 4 , 4% of inoculum amount and pH 5.5. Yeast extract was the most effective factor, followed by CuSO 4 , inoculum, glucose and pH. Under these conditions, predicted values were in a good agreement with the actual experimental one. The predicted results showed that the maximum of Reactive Blue 49 decolorization as 98% could be obtained under the optimum conditions of pH 2.95, initial dye concentration 55.6 mg L -1 , enzyme amount 0.76 mL and reaction time 46.91 min. The validity and practicability of this statistical optimization strategy was confirmed with the relation between predicted and experimental values. Conclusion: The results suggested that Taguchi method can be used in the optimization of laccase production process. Production of laccase by Trametes versicolor 2008001 can be effectively used for enzymatic decolorization according to the results of decolorization experiments in optimal levels. Key Words: Laccase, Taguchi Method, Box-Behnken Methodology, dye decolorization. Conflict of Interest: The authors declare no conflict of interest. Materials and Methods Microorganism, culture conditions and dye Trametes versicolor ATCC (200801) originally isolated and cultured by Dr. O Yesilada was used in this study. This fungus was subcultured on Malt Extract Agar (MA) plates of 30 °C and stored at 4 °C. Laccase production of T. versicolor was tested under agitated culture conditions. To this end, firstly this fungus was cultured at 30 ˚C on slant MA for one week. Then, mycelial suspension was prepared and this suspension was inoculated into 250 mL Erlenmeyer flask containing 100 mL Potato Dextrose Broth (PDB). This culture was incubated at 30 °C and 150 rev min -1 for 4 days. After that, the culture was homogenized and determined culture of homogenized culture was transferred in 250 mL Erlenmeyer flasks with 100 mL Stock Basal Medium (SBM) that contain K 2 PO 4 : 0.2 g