Mustafa Ozsahin

Leptin induces ADAMTS-4, ADAMTS-5, and ADAMTS-9 genes expression by mitogen-activated protein kinases and NF-ĸB signaling pathways in human chondrocytes.

Elucidation of the causes of inflammation has vital importance in the development of new approaches for the treatment of arthritic diseases. The degradation of aggrecan by upregulated disintegrin and metalloproteinase with trombospondin motifs (ADAMTSs) is the key event in the development of both rheumatoid arthritis (RA) and osteoarthritis (OA). Increased levels of leptin in both RA and OA have been demonstrated, thus linking leptin to arthritic diseases, but the mechanism has not been clarified. This study investigated the putative role of signaling pathways (p38, JNK, MEK1, NF‐ĸB, and PI3) involved in leptin‐induced cartilage destruction. Normal human articular chondrocytes were cultured with recombinant human leptin at 100, 250, 500, and 1000 ng/mL doses for 6, 12, 24, and 48 h, after which ADAMTS‐4, ‐5, and ‐9 genes expression were determined by real time‐polymerase chain reaction (RT‐PCR) and Western Blot methods. The signaling pathways involved in leptin‐induced ADAMTSs upregulation were also investigated by using inhibitors of signaling pathways. It was demonstrated that ADAMTSs expression level was peaked at 1000 ng/mL doses for 48 hours, and MAPKs (p38, JNK, and MEK) and NF‐ĸB signaling pathways involving in leptin triggered ADAMTSs upregulation. Obesity as a risk for RA and OA may contribute to the inflammation of both RA and OA diseases by secreting adipokines like leptin. We hypothesize that leptin is involved in the development of RA and OA accompanied with obesity by increasing ADAMTS‐4, ‐5, and ‐9 genes expression via MAPKs and NF‐ĸB signaling pathways.

Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals.

BackgroundFew studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. Patients and methodsAfter applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. ResultsIn the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P=0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio=0.43, 95% confidence interval=0.21–0.83; P=0.013) and the nondipping BP patterns (odds ratio=1.96, 95% confidence interval=1.05–3.67; P=0.035). ConclusionWe have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk.

Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model.

BACKGROUND Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. HYPOTHESIS The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. MATERIALS AND METHODS Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. RESULTS Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. CONCLUSION Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures.

Does MBL2 codon 54 polymorphism play a role in the pathogenesis of psoriasis

Background  Psoriasis is a T cell‐mediated immune disease in which various cytokines, primarily tumor necrosis factor‐α (TNF‐α), are complexly involved. Mannose‐binding lectin (MBL) gene polymorphisms decrease MBL serum levels, thereby increasing the synthesis of proinflammatory cytokines such as TNF‐α.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

Abstract Purpose: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. Methods: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV–EDV)/PSV]. Results: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. Conclusion: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Avulsion Fracture of the Anterior Inferior Iliac Spine in a Soccer Player

A 14-year-old male soccer player presented with left groin pain that had started suddenly after kicking the ball during a soccer game the day before. His pain was aggravated during the swing phase of walking and active flexion of the hip. Inspection revealed no swelling or erythema in the inguinal area. Moderate tenderness was noted upon palpation of the right inguinal region. Passive range of motion of the right hip was normal except for limited hip extension. Weakness in hip flexion was attributed to pain. An anteroposterior radiograph of the pelvis showed a displaced avulsion fracture of the anterior inferior iliac spine (AIIS; Figure 1). This finding was confirmed by a pelvic computed tomography scan that revealed a crescent-shaped bone fragment displaced inferiorly about 1.5 cm from the right AIIS (Figure 2). Avulsion fractures of the pelvic apophyses are very uncommon and almost always occur in adolescents before their growth plates close [1]. The most typical locations are the anterior superior iliac spine, AIIS, and ischial tuberosity [2]. These fractures may be overlooked and can be easily confused with an insertional tendinitis or musculotendinous tear. Patient history, as in this case, demonstrates the typical mechanism of injury involving a sudden and forceful muscular contraction during sport activities. The avulsion of the AIIS occurs after forceful contraction of the rectus femoris muscle. The most commonly reported mechanisms are kicking and running [2,3]. Treatment of avulsion fractures of the pelvic apophyses includes surgical and nonsurgical interventions. Surgical treatment, primary open reduction, and internal fixation may be warranted when the fragment is displaced greater than 2 cm or the ischial tuberosity is involved [3]. This young athlete was treated conservatively with 3 weeks of non–weightbearing activity, 3 weeks of partial weight-bearing activity, and then a gradual return to full

Cohesive Taping and Short-Leg Casting in Acute Low-Type Ankle Sprains in Physically Active Patients

BACKGROUND Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. METHODS Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. RESULTS In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. CONCLUSIONS Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.

Dual diagnosis: rheumatoid arthritis and multiple sclerosis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children. Moreover, multiple sclerosis (MS) is the most frequent demyelinating disease and has been associated with various chronic inflammatory diseases. However, its association with JRA has not been frequently described. Autoimmunity in both JRA and MS has been documented in the scientific literature, although there has been no definitive finding that patients with JRA are prone to the development of MS. An increasing frequency of MS resulting from an increased use of antitumor necrosis factor agents in the treatment of rheumatoid arthritis and other chronic inflammatory diseases has been reported recently. In this study, we report on the development of MS in a patient with JRA who did not have a history of antitumor necrosis factor use.

Fibromyalgia Syndrome in Patients with Nasal Septum Deviation

Abstract Objectives: Some studies conducted with patients with obstructive sleep apnea syndrome [OSAS] have suggested an association between sleep-disordered breathing [SDB] and fibromyalgia syndrome [FMS]. Nasal septum deviation [NSD] is a common physical disorder of the nose and it manifests itself with similar complaints, like respiratory distress and headache, as in patients with OSAS. The aim of this study was to determine the frequency of FMS in patients with NSD. Methods: Consecutive patients, 18 to 60 years old, evaluated in an academic otorhinolaryngology outpatient clinic were prospectively recruited for this study. Patients with nasal septal deviation were included in the nasal septum deviation group. Patients without nasal symptom deviation were recruited to serve as controls. All recruited cases were assessed by a single physiatrist for FMS. The FMS diagnosis was made on the basis of the 1990 American College of Rheumatology Research Classification Criteria. Results: One hundred ninety-nine consecutive patients, 18 to 60 years old, were enrolled in the study. Patients were divided into two groups as those with nasal symptom deviation [n = 115] and those without nasal symptom deviation [control group, n = 84]. Fibromyalgia syndrome was diagnosed in six NSD patients [5.2%] and in four [4.8%] control patients. No differences were noted in the prevalence of FMS between the two groups [p = 0.578]. Conclusion: In this study, we demonstrated a normal prevalence of FMS among patients with NSD. Although some studies suggest a relation between sleep disordered breathing and FMS, we could not find any relationship between NSD and FMS. This result may be associated with the fact that patients with OSAS and morbid obesity were excluded from our study. Future studies are warranted to clarify the association between obstructive sleep-disordered breathing and FMS.

Behçet hastalarında serum TNF- α ve osteoprotegerin düzeyi ve kemik kitle yoğunluğu

Objectives: Osteoporosis is commonly developed due to natural course of Behcet’s disease (BD) and therapeutic agents. It was aimed to investigate levels of osteoprotegerin and TNF-α (tumor necrosis factor), and bone mineral density (BMD) and correlation between them in BD. Materials and methods: The study included two groups as the study and the control group. Serum levels of TNF-α, osteoprotegerin, osteocalcine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and urinary creatinine and deoxypyridinoline along with BMD level were evaluated and compared. Correlation between TNF-α and osteoprotegerin level was investigated. Results: The study enrolled 41 BD patients and 36 agedmatched control subjects. Mean age was 42.26±11.64 and 41.66±70.99, in the study and control groups, respectively. There was no significant difference in body mass index (BMI) of subjects between groups (p>0.05). Level of TNF-α (p 0.05). Urinary deoxypyridinoline/ urinary creatinine ratio in patients with BD was significantly higher than those in control group (p=0.030). Patients had significantly lower BMD comparfed to the control group, except L2-L4 vertebral area (p<0.001, p<0.001, p=0.035, p<0.001, p=0.012, p<0.001, p<0.001 and p=0.111, respectively). No correlation was found between TNF-α and osteoprotegerin. Conclusions: The present study indicated that TNF-α and BMD was negatively correlated with each other and TNF-α had an effect on osteoporotic process in patients with BD. Osteoprotegerin level was not decreased, and not correlated with TNF-α.