Evaluation of oxidative stress in degenerative rotator cuff tears

Background: Oxidative stress occurs as a result of the disruption of the balance between the formations of reactive oxygen species and antioxidant defense mechanisms during the conversion of nutrients into energy. Increased body oxidative stress has been reported to be involved in the etiology of several degenerative and chronic diseases. We hypothesized that the body oxidative stress level is higher in patients with atraumatic degenerative rotator cuff tear than that in healthy individuals. Methods: The patients who underwent arthroscopic repair for atraumatic, degenerative rotator cuff tear were prospectively evaluated. A total of 30 patients (group 1, 19 females and 11 males; mean age: 57.33 ± 6.96 years; range: 50-77 years) and 30 healthy individuals (group 2, 18 females and 12 males; mean age: 56.77 ± 6 years; range: 51-72 years) were included in the study. The Constant and American Shoulder and Elbow Surgeons scoring systems were used to evaluate the clinical outcomes. Serum oxidative stress parameters of the patients and the control group were biochemically evaluated. Accordingly, thiol/disulfide (DS) balance (DS/native thiol [NT], DS/total thiol [TT]), Total Oxidant Status (TOS), oxidative stress index, and nuclear factor erythroid-2–associated factor-2 values were used as the biochemical parameters indicating an increase in the serum oxidative stress level. Total antioxidant status and NT/TT values served as the biochemical parameters indicating a decrease in the serum oxidative stress level. Results: The study follow-up duration was 12 months. A statistically significant increase was observed in American Shoulder and Elbow Surgeons and Constant scores of patients who underwent arthroscopic rotator cuff repair relative to that during the preoperative period (P = .01). The values of biochemical parameters (DS/NT, DS/TT, TOS, oxidative stress index, and nuclear factor erythroid-2–associated factor-2), which indicated an increase in the serum oxidative stress, were significantly higher in preoperative patients than those in postoperative patients, albeit the control group values were significantly lower than those of the postoperative patients. The biochemical parameters (NT/TT and total antioxidant status) indicating a decrease in the serum oxidative stress levels were significantly higher in the postoperative patients than those in the preoperative patients and significantly lower than those in the control group. Conclusion: High levels of markers indicating an increase in the serum oxidative stress in patients with degenerative rotator cuff rupture suggested that TOS may be involved in the etiopathogenesis of rotator cuff degeneration. Although the oxidative load decreases during the postoperative period, the fact that it is still higher than that in healthy individuals supports this claim. © 2022 Journal of Shoulder and Elbow Surgery Board of Trustee

Biomechanical Evaluation of a Novel Apatite-Wollastonite Ceramic Cage Design for Lumbar Interbody Fusion: A Finite Element Model Study

Objectives. Cage design and material properties play a crucial role in the long-term results, since interbody fusions using intervertebral cages have become one of the basic procedures in spinal surgery. Our aim is to design a novel Apatite-Wollastonite interbody fusion cage and evaluate its biomechanical behavior in silico in a segmental spinal model. Materials and Methods. Mechanical properties for the Apatite-Wollastonite bioceramic cages were obtained by fitting finite element results to the experimental compression behavior of a cage prototype. The prototype was made from hydroxyapatite, pseudowollastonite, and frit by sintering. The elastic modulus of the material was found to be 32 GPa. Three intact lumbar vertebral segments were modelled with the ANSYS 12.0.1 software and this model was modified to simulate a Posterior Lumbar Interbody Fusion. Four cage designs in different geometries were analyzed in silico under axial loading, flexion, extension, and lateral bending. Results. The K2 design had the best overall biomechanical performance for the loads considered. Maximum cage stress recorded was 36.7 MPa in compression after a flexion load, which was within the biomechanical limits of the cage. Conclusion. Biomechanical analyses suggest that K2 bioceramic cage is an optimal design and reveals essential material properties for a stable interbody fusion

The effect of low-molecular-weight heparin on rat tendon healing

Objectives: We investigated the effect of low-molecular-weight heparin (LMWH) on the healing of tendons. Methods: Forty-five adult Wistar rats weighing 300 g were randomized into three groups equal in number. All the rats underwent full-thickness surgical incision of the Achilles tendon followed by primary repair. After the operation, two groups received daily subcutaneous LMWH injections (nadroparin calcium) for four weeks at high or low doses (group 1, 6 mg/kg, 170 IU AXa; group II, 3 mg/kg, 85 IU AXa). Group III remained untreated as the control group. Histologically, the specimens were examined under light and electron microscopy with regard to the amount of fibrillar collagen synthesis, mitochondrial degeneration, and the composition of the extracellular matrix collagen. Biomechanically, maximum load to failure and correspondent elongation of the tendons were measured. Results: Compared to the control group, histologically, both LMWH-treated Groups exhibited increased number of fibroblasts, increased fibrillar collagen formation in the extracellular matrix, and higher counts of granular endoplasmic reticula in cytoplasmic contents of fibroblasts as well as decreased mitochondrial vacuolization and degeneration. Biomechanical assessments showed that tendons in group I had significantly higher maximum load to failure and elongation values than group II and III (31 N vs. 24.6 N and 23.1 N; 25 mm vs. 19.6 mm and 17.3 mm, respectively; p0.05). Conclusion: Daily administration of single dose LMWH improves tendon healing through increasing the number of fibroblasts and fibrillar collagen synthesis and decreasing mitochondrial degeneration.Publisher's Versio

Results of expandable intramedullary nailing in femoral shaft fractures

Amaç: Çalışmamızda AO-32A ve 32B yetişkin femur cisim kırıklarında genişleyebilir intramedüller çivilerin kullanımı ve sonuçlarını değerlendirdik.Gereç ve Yöntem: En az 1 yıllık takipleri olan, AO-32A ve 32B yetişkin femur cisim kırığı nedeniyle genişleyebilir intramedüller çivi tedavisi uygulanmış 71 hasta (25 kadın, 46 erkek; ortalama yaş 37.2 yıl; aralık 17-83 yıl) retrospektif olarak çalışmaya alındı. Ameliyat süreleri ameliyat notlarından kayıt edildi. Hastalar son kontrollerinde klinik olarak Thoresen kriterlerine göre değerlendirildi ve alt ekstremite uzunluk farkları not edildi. Radyolojik olarak ise kırığın kaynamasına ve redüksiyonun devamlılığına bakıldı.Bulgular: 64 çivi açık cerrahi yaklaşımla, 7 çivi ise kapalı cerrahi yaklaşımla uygulandı ve ortalama ameliyat süresi 78 dakika (60-135 dakika) olarak bulundu. 63 (%88,7) olguda kaynama gerçekleşti ve ortalama kaynama süresi 18 hafta (13-32 hafta) idi. Son kontrollerde yapılan muayenede Thoresen kriterlerine göre 51 (%71,8) çok iyi, 12 (%16,9) iyi, 6 (%8,4) orta ve 2 (%2,8) olguda kötü sonuç alındı. 1 olguda 3 cm kısalık, 3 olguda 2 cm kısalık, bir olguda 1 cm kısalık ve 2 olguda ise < 1 cm kısalık vardı. 7 olguda diz ön ağrısı gelişti. 3 (%4,2) olguda uygulanan çivi şişirilemedi. 15 (%21,1) olguda çivi uygulandıktan sonra şişirilmeyi takiben kırık hattı etrafında femur medullasının genişleme, bir olguda lateral sirkumfleks femoral arter yaralanması oluştu. 4 (%5.6) olguda yüzeyel enfeksiyon görüldü ve antibiyotik tedavisi ile iyileşme sağlandı.Sonuç: Genişleyebilir intramedüller çiviler uygulama zorluğu ve sebep olabileceği komplikasyonlar nedeniyle sınırlı endikasyonlarla kullanılmalıdır.Aim: To evaluate the use and results of expandable intramedullary nails applied to adult AO -32A and 32B femoral shaft fractures.Material and Method: This retrospective study included 71 patients (25 females, 46 males; mean age 37.2 years, range 17-83 years) applied with expandable intramedullary nailing treatment for AO-32A and 32B femoral shaft fractures, with at least a 1-year follow-up period. Operating time was recorded from the operating notes. At the final follow-up examinations, patients were evaluated clinically according to the Thoresen criteria and lower limb length differences were recorded. Bone union and continuity of reduction were examined radiologically. Results: 64 nails were applied with an open surgical approach and 7 nails with a closed surgical approach. Operating time was mean 78 mins (range, 60-135 mins). In 63 (88.7%) cases, bone union was delayed and the mean time to union was 18 weeks (range, 13-32 weeks). According to the Thoresen criteria at the final follow-up examination, the results were very good in 51 (71.8%) cases, good in 12 (16.9%), fair in 6 (8.4%) and poor in 2 (2.8%). Shortness of 3cm was determined in 1 case, 2cm in 3 cases, 1cm in 1 case and <1cm in 2 cases. Anterior knee pain developed in 7 cases. The nail applied did not expand in 3 (4.2%) cases. In 15 (21.1%) cases, following inflation after application of the nail, expansion of the femur medulla developed around the fracture line and in 1 case this caused injury to the lateral circumflex femoral artery. Superficial infection was observed in 4 (5.6%) cases, which recovered with antibiotic treatment. Conclusion: As the application of expandable intramedullary nails is difficult and could cause complications, they should be used with limited indications

Hemodiyaliz ve Periton Diyalizi Hastalarında Tp-e/QT, ve Tp-e/QTc Oranı

Ani kardiyak ölüm ve aritmi riski son dönem böbrek yetmezliği hastalarında yüksektir. Tp-e/QT, ve Tp-e/QTc' nin ventriküler aritmogenezisi ve ani kardiyak ölümü göstermede QTc' den daha değerli olduğu gösterilmiştir. Çalışmada amacımız hemodiyaliz ve periton diyalizi hastalarında Tp-e intervali, Tp-e/QT ve Tp-e/QTc oranını kullanarak ventriküler repolarizasyonu değerlendirmektir.GEREÇ ve yÖNTEMLER: 35 sağlıklı kontrol, 92 hemodiyaliz hastası, ve 104 periton diyalizi hastası çalışmaya dahil edildi. Bütün hastaların elektrokardiyografileri çekildi. Tp-e interval, Tp-e/QT ve Tp-e/QTc oranı elektrokardiyografiden elde edilen verilerle hesaplandı ve gruplar arasında karşılaştırıldı. BULGULAR: QT hemodiyaliz hastalarında periton diyalizi hastalarına (p<0,001) ve sağlıklı kontrollere (p<0,001) göre yüksek saptandı. Ancak QT periton diyalizi hastalarında sağlıklı kontrollere göre anlamlı fark saptanmadı. QTc, Tp-e, Tp-e/QT, ve Tp-e/QTc hemodiyaliz ve periton diyalizi hastalarında sağlıklı kontrollere göre anlamlı yüksek tespit edildi. Bununla birlikte periton diyalizi ve kontrol grupları arasında QTc değerleri arasında farklılık tespit edilmedi (p:0,081). Diyabetik olmayan bütün son dönem böbrek yetmezliği hastaları sağlıklı kontrollerle karşılaştırıldığında QTc, Tp-e, Tp-e/QT, ve Tp-e/QTc sağlıklı kontrollere göre anlamlı yüksek tespit edildi. Tp-e/QT (p<0,001 r:0,314) ve Tp-e/QTc (p:0,018 r:0,187) arasında ortalama diyaliz süresi (ay) ile pozitifkorelasyon saptandı.SONUÇ: Çalışma Tp-e/QT, ve Tp-e/QTc' nin hemodiyaliz ve periton diyalizi hastalarında sağlıklı kontrollere göre yüksek olduğunu gösteren ilk araştırmadırSudden cardiac death and risk of arrhythmia are higher in patients with ESRD. Tp-e/QT, and Tp-e/QTc are novel and more reliable indexes of ventricular arrhythmogenesis and sudden cardiac death than QTc. The aim of this study was to assess ventricular repolarization in patients with hemodialysis and peritoneal dialysis by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. MATERIAL and METHODS: A total of 35 healthy controls, 92 hemodialysis patients, and 104 peritoneal dialysis patients were enrolled in the study. The Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio were calculated from the ECGs of the individuals and compared among groups. RESULTS: QT value was significantly higher in hemodialysis group compared with peritoneal dialysis group (p<0.001) and control group (p<0.001). However a difference was not found comparing QT values between peritoneal dialysis and control groups. Tp-e, Tp-e/QTc, Tp-e/QT, and QTc values were significantly higher in hemodialysis and peritoneal dialysis group comparing to control group. However a statistically significant difference was not found while comparing QTc values between peritoneal dialysis and control groups (p:0.081). When all patients of ESRD without DM were compared with the control group, Tp-e, Tp-e/QTc, Tp-e/QT, and QTc values were found significantly higher than the healthy control group. The values of Tp-e/QT (p<0.001 r:0.314) and Tp-e/QTc (p:0.018 r:0,187) in all patients with kidney disease were found to show positive correlation with duration of dialysis (month). CONCLUSION: This is the first known study that shows Tp-e/Q, and Tp-e/QTc are higher in hemodialysis and peritoneal dialysis patient

Red cell distribution width and mortality in patients with hip fracture treated with partial prosthesis

Objective: This study aimed to determine the relationship between red cell distribution width (RDW) and mortality in patients that received a partial hip prosthesis

Hemodiyaliz ve periton diyalizi hastalarında tp-e/qt, ve tp-e/qtc oranı

Narman, Serkan (Aksaray, Yazar)OBJECTIVE: Sudden cardiac death and risk of arrhythmia are higher in patients with ESRD. Tp-e/ QT, and Tp-e/QTc are novel and more reliable indexes of ventricular arrhythmogenesis and sudden cardiac death than QTc. The aim of this study was to assess ventricular repolarization in patients with hemodialysis and peritoneal dialysis by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. MATERIAL and METHODS: A total of 35 healthy controls, 92 hemodialysis patients, and 104 peritoneal dialysis patients were enrolled in the study. The Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio were calculated from the ECGs of the individuals and compared among groups. RESULTS: QT value was significantly higher in hemodialysis group compared with peritoneal dialysis group (p<0.001) and control group (p<0.001). However a difference was not found comparing QT values between peritoneal dialysis and control groups. Tp-e, Tp-e/QTc, Tp-e/QT, and QTc values were significantly higher in hemodialysis and peritoneal dialysis group comparing to control group. However a statistically significant difference was not found while comparing QTc values between peritoneal dialysis and control groups (p:0.081). When all patients of ESRD without DM were compared with the control group, Tp-e, Tp-e/QTc, Tp-e/QT, and QTc values were found significantly higher than the healthy control group. The values of Tp-e/QT (p<0.001 r:0.314) and Tp-e/QTc (p:0.018 r:0,187) in all patients with kidney disease were found to show positive correlation with duration of dialysis (month). CONCLUSION: This is the first known study that shows Tp-e/Q, and Tp-e/QTc are higher in hemodialysis and peritoneal dialysis patients.AMAÇ: Ani kardiyak ölüm ve aritmi riski son dönem böbrek yetmezliği hastalarında yüksektir. Tp-e/ QT, ve Tp-e/QTc’ nin ventriküler aritmogenezisi ve ani kardiyak ölümü göstermede QTc’ den daha değerli olduğu gösterilmiştir. Çalışmada amacımız hemodiyaliz ve periton diyalizi hastalarında Tp-e intervali, Tp-e/QT ve Tp-e/QTc oranını kullanarak ventriküler repolarizasyonu değerlendirmektir. GEREÇ ve YÖNTEMLER: 35 sağlıklı kontrol, 92 hemodiyaliz hastası, ve 104 periton diyalizi hastası çalışmaya dahil edildi. Bütün hastaların elektrokardiyografileri çekildi. Tp-e interval, Tp-e/QT ve Tp-e/ QTc oranı elektrokardiyografiden elde edilen verilerle hesaplandı ve gruplar arasında karşılaştırıldı. BULGULAR: QT hemodiyaliz hastalarında periton diyalizi hastalarına (p<0,001) ve sağlıklı kontrollere (p<0,001) göre yüksek saptandı. Ancak QT periton diyalizi hastalarında sağlıklı kontrollere göre anlamlı fark saptanmadı. QTc, Tp-e, Tp-e/QT, ve Tp-e/QTc hemodiyaliz ve periton diyalizi hastalarında sağlıklı kontrollere göre anlamlı yüksek tespit edildi. Bununla birlikte periton diyalizi ve kontrol grupları arasında QTc değerleri arasında farklılık tespit edilmedi (p:0,081). Diyabetik olmayan bütün son dönem böbrek yetmezliği hastaları sağlıklı kontrollerle karşılaştırıldığında QTc, Tp-e, Tp-e/ QT, ve Tp-e/QTc sağlıklı kontrollere göre anlamlı yüksek tespit edildi. Tp-e/QT (p<0,001 r:0,314) ve Tp-e/QTc (p:0,018 r:0,187) arasında ortalama diyaliz süresi (ay) ile pozitifkorelasyon saptandı. SONUÇ: Çalışma Tp-e/QT, ve Tp-e/QTc’ nin hemodiyaliz ve periton diyalizi hastalarında sağlıklı kontrollere göre yüksek olduğunu gösteren ilk araştırmadı

İzole Tip 2 Slap Lezyonu Nedeniyle Artroskopik Tamir Uygulanan Hastaların Kısa Dönem Klinik Sonuçlarının Değerlendirilmesi

Objective: The purpose of this study was to assess the clinical outcomes of isolated type IIsuperior labrum anteriorposterior (SLAP) lesions which were repaired arthroscopically Methods: The patientswho wereunderwent arthroscopic stabilization for isolated type IISLAP lesions werereviewed retrospectively. Shoulder function was evaluated according to the Constant-Murley score and visual analog scale (VAS) .Ranges of motion of the shoulders were evaluated both preoperatively and at the final follow-up. Results: A total of19 patients were evaluated. Of the patients; 15 were male and 4 were female and 31.5(23-45) was determined to be the mean age. Mean follow-up duration was 16.8 months (8-26). Preoperative mean Constant-Murley score was57 (40-71), whereas it was determined to be a mean of 81 (66- 98) at the final follow-up. VAS was determined to be 7(6-9) preoperatively, whereas it was determined to be 2 (0-5) at the final follow-up. Statistically significant differences were determined for both scoring systems at the final follow-up compared with the preoperative period(p<0.001). Conclusion: Arthroscopic repair ofisolated type II SLAP lesionsappeared as a reliable and effective procedure with respect to short-time clinical outcomes

Effects of thymoquinone in prevention of experimental contrast-induced nephropathy in rats.

Objective(s): This study aimed to show the effects of thymoquinone, which is known for its antioxidant, anti-inflammatory, and renal protective effects in contrast-induced nephropathy