Safak Ekinci

Evaluation and Comparison of the Effects of Hyperbaric Oxygen and Ozonized Oxygen as Adjuvant Treatments in an Experimental Osteomyelitis Model

BACKGROUND We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis. MATERIALS AND METHODS Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses. RESULTS Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1β and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-β was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046). CONCLUSIONS O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

Comparison of four different reduction methods for anterior dislocation of the shoulder

BackgroundShoulder dislocations account for almost 50 % of all major joint dislocations and are mainly anterior.ObjectiveThe aim is a comparative retrospective study of different reduction maneuvers without anesthesia to reduce the dislocated shoulder.MethodsPatients were treated with different reduction maneuvers, including various forms of traction and external rotation, in the emergency departments of four training hospitals between 2009 and 2012. Each of the four hospitals had different treatment protocols for reduction and applying one of four maneuvers: Spaso, Chair, Kocher, and Matsen methods. Thirty-nine patients were treated by the Spaso method, 47 by the Chair reduction method, 40 by the Kocher method, and 27 patients by Matsen’s traction-countertraction method. All patients’ demographic data were recorded. Dislocation number, reduction time, time interval between dislocation and reduction, and associated complications, pre- and post-reduction period, were recorded prospectively. No anesthetic method was used for the reduction.ResultsAll of the methods used included traction and some external rotation. The Chair method had the shortest reduction time. All surgeons involved in the study agreed that the Kocher and Matsen methods needed more force for the reduction. Patients could contract their muscles because of the pain in these two methods. The Spaso method includes flexion of the shoulder and blocks muscle contraction somewhat. The Chair method was found to be the easiest because the patients could not contract their muscles while sitting on a chair with the affected arm at their side.ConclusionsWe suggest that the Chair method is an effective and fast reduction maneuver that may be an alternative for the treatment of anterior shoulder dislocations. Further prospective studies with larger sample size are needed to compare safety of different reduction techniques.

The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery

Context Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system. Evidence Acquisition The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues. Conclusions Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.

A New Treatment Option in Osteoarthritis: Prolotherapy Injections

Osteoarthritis is the most common degenerative disorder, and one of the major causes of physical disability in adults. Unfortunately many people experience arthroplasty or other major surgeries, in spite of improvements of the conservative options. There is a need for efficient treatment methods in this group of patients. Prolotherapy is one of the simple and safe injection-based complementary method and it’s efficiency was proved in the musculoskeletal problems. The aim of this article is to present current perspectives of prolotherapy in osteoarthritis.

Evaluation and comparison of the effect of hypothermia and ozone on ischemia–reperfusion injury of skeletal muscle in rats

BACKGROUND Tourniquet-induced ischemia-reperfusion, which affects local and distant organs, is very common in orthopedic surgery. Hypothermia is used in traumatic tissue during ischemic period commonly. Ozone (O3) has been recommended as a novel therapeutic agent in various medical conditions. The objective of the study was to evaluate and compare the effect of hypothermia (H) and O3 on ischemia-reperfusion injury of skeletal muscle in rats by measuring oxidative parameters and inducible nitric oxide synthase (iNOS) levels. MATERIALS AND METHODS Eighteen rats (Wistar albino) were separated into five groups randomly (sham, IR, IR + H, IR + O3, IR + H + O3; n = 6). The lower right extremity of all rats was subjected to 2 h of ischemia and 22 h of reperfusion clamping the common iliac artery and using the rubber-band technique at the level of the lesser trochanter under general anesthesia. Two hours of hypothermia were applied during the first 2 h of reperfusion in two groups. O3 was applied in two groups. All rats were sacrificed after the IR period with high dose of anesthesia. The tibialis anterior muscle and blood were saved. Levels of superoxide dismutase, glutathione peroxidase, MDA, NOx, and interleukin-1β were measured in the muscle. Creatinine kinase, lactate dehydrogenase, aspartate aminotransferase, urea, creatinine, and electrolytes were measured in serum. Immunohistochemical iNOS staining was performed on muscle samples. RESULTS The levels of MDA, NOx, and interleukin-1β in muscle were raised in the IR group compared with those in the sham group. The same parameters were lower in the groups of IR + H, IR + O3, and IR + H + O3 compared with those in the IR group. Superoxide dismutase and glutathione peroxidase activities in muscle were lower in the IR group compared with those in the sham group; however, same parameters were higher in the groups of IR + H, IR + O3, and IR + H + O3 compared with those in the IR group. Score and intensity of iNOS staining in skeletal muscle in the IR group was increased compared with that in the sham group and decreased in the groups of IR + H, IR + O3, and IR + H + O3 compared with that in the IR group. Levels of creatinine kinase, aspartate aminotransferase, and K in the three treatment groups decreased compared with those in the IR group. CONCLUSIONS These findings showed that hypothermia, which has more affect, and O3 decreased the tourniquet-induced IR injury in the rats muscle-skeletal system by reducing the levels of oxidative and nitrosative stress parameters and enhancing antioxidant enzymes. Hypothermia and O3 had no synergistic effect. Hypothermic reperfusion and O3 preconditioning might be beneficial in skeletal muscle IR injury-associated tourniquet.

An analysis of orthopaedic theses in Turkey: Evidence levels and publication rates

Background The aim of this study was to present characteristics and publication patterns of studies arise from orthopedic theses obtained from National Thesis Center; database in terms of publication years, study types, topics, level of evidence between 1974 and 2014. Methods Firstly, National Thesis Center database was searched for orthopedics and Traumatology theses. The theses, which their summary or full text were available were included in the study. The topics, study types and quality of study designs were reviewed. Then theses were searched in the PubMed database. Journals of published theses were classified according to category, scope and impact factors of the year 2014. Results 1508 theses were included into the study. Clinical studies comprised 71,7% of the theses, while 25,6% of the theses were non-clinical experimental and 2,7% of the theses were observational studies. Clinical studies were Level I in 8,6% (n = 93) and Level II in 5,8% of the theses (n = 63). A total of 224 theses (14,9%) were published in the journals indexed in PubMed database from 1974 to 2012. Fifty-two (23,2%) were published in SCI; 136 theses (60,7%) were published in SCI-E journals and 36 theses (16%) were published in other Journals indexed in PubMed. Conclusion The quantity and quality of published theses need to be improved and effective measures should be taken to promote quality of theses. Theses from universities and Training hospitals which did not allow open access, and; incomplete records of the National Thesis Center database were major limitations of this study.

Does enzyme replacement therapy enhance brain-derived neurotrophic factor expression in Gaucher disease?

We would like to thank Agilli et al. (2015a, 2015b) for their comments on our paper entitled “Brain-derived neurotrophic factor expression increases after enzyme replacement therapy in Gaucher disease” (Vairo et al., 2015). We certainly agree with their review on factors that can affect BDNF levels, although these factors are widely known and have even been repeatedly pointed out by the same authors in similar letters (Agilli and Aydin, 2015; Agilli et al., 2015a, 2015c). However, wewould like to point out thatwe did not report themenstrual status of our female patients becausewe have also analyzed the sample stratified by age and gender, and there was no statistical difference. Moreover, none of our patients had been using any medication nor had any condition that could be a confounding factor for the BDNF analysis. These data were confirmed by comparing the same patients under treatment and off treatment with healthy controls showing that BDNF increases after some months of enzyme replacement therapy but does not reach the levels found in controls. Our findings are very interesting since a decrease in BDNF levels has been previously reported in the brains of mice with Gaucher disease (Kim et al., 2006) but has never been reported in humans. We think neurotrophins, such as BDNF, should be further studied in Gaucher disease in order to determine if they could be phenotype modifiers or possible therapeutic targets, as they are in neuropsychiatric disorders (Fumagalli et al., 2006; Autry and Monteggia, 2012).

Article Commentary: Spinal Tuberculosis

Spinal tuberculosis (TB) is a significant form of TB, causing spinal deformity and paralysis. Early diagnosis and treatment are crucial for avoiding multivertebral destruction and are critical for improving outcomes in spinal TB. We believe that appropriate treatment method should be implemented at the early stage of this disease and that the Gulhane Askeri Tip Akademisi classification system can be considered a practical guide for spinal TB treatment planning in all countries.

Treatment of thoracic or lumbar spinal tuberculosis complicated by resultant listhesis at the involved segment.

(2014),http://dx.doi.org/10.1016/j.clineuro.2014.11.016This is a PDF file of an unedited manuscript that has been accepted for publication.As a service to our customers we are providing this early version of the manuscript.Themanuscriptwillundergocopyediting,typesetting,andreviewoftheresultingproofbefore it is published in its final form. Please note that during the production processerrors may be discovered which could affect the content, and all legal disclaimers thatapply to the journal pertain.

Response to ‘Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?’

We have read with a great interest the published article by Aoki and colleagues entitled ‘Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?’ [1]. The authors suggest that nerve growth factor (NGF) increases in herniated discs, and may play an important role in the generation of discogenic pain. However, we think some points should be discussed. NGF is a polypeptide that plays an important role for cells belonging to the nervous, endocrine, and immune systems [2]. We think the study group in which the authors evaluated tissue NGF levels is not well defined. Namely, they should state whether the patients have one of following diseases, which could probably affect NGF levels: neuropsychiatric diseases such as epilepsy, depression, schizophrenia, migraine and primary headache; and eating disorders or cardiometabolic diseases such as atherosclerosis, metabolic syndrome and type 2 diabetes mellitus [3]. In addition to these diseases, obesity is also shown to affect NGF levels [4]. In this regard, the above diseases should be taken into account while designing a study group, and the body mass index of participants has to be thought of as another confounding variable and included in multiple regression analysis like age and sex are. Besides the above confounders, supplements such as vitamin D analogs, zinc, vitamin B12, vitamin A, omega 3 fatty acid or herbal medicines and some drugs such as estrogen, glucocorticoids, acetyl-l-carnitine and antipsychotics also have to be denoted regarding whether the participants use these medications or not because they are affecting factors for NGF [5]. In conclusion, explanation of these concerns will certainly provide clearer information for the readers.