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Background: The term massive refers to a quantitative measure of the rotator cuff tears. Irreparable rotator cuff tear is indicated by ratings that qualitatively evaluate the repairability of the tendon. These two terms should be considered separately. Methods: Between 2016 and 2022, publications in the last about 5 years were searched from Pubmed and MEDLINE online databases. The search terms (irreparable OR massive) AND (rotator cuff tear), (repairable OR massive) AND (rotator cuff tear), (massive OR retracted) AND (rotator cuff tear), (irreparable OR retracted) AND (rotator cuff tear) ”were used. For each search term, it was checked whether the title of the search term was mentioned in the title of the article, and whether the title and the content were compatible in the studies in which the searched term was mentioned in the title. Results: Of the 934 scanned articles, 69 of them were evaluated in terms of study title and material-method compatibility. 22 articles with the term “massive rotator cuff tear” in the title were identified. It was seen that in 11 of these 22 articles (50%), the title and the material method were compatible and in 11 of them (50%) the title and the content were incompatible, and the term “massive” was used instead of the term “irreparable”. Conclusions: We see that most of the studies on massive tears were actually done to emphasize irreparable tears. Since most of the massive tears are repairable, the quality feature of massive tears, which are in the group that poses a problem, as irreparable rotator cuff tear or massive irreparable rotator cuff tear should be emphasized. Keywords: Rotator cuff tears, Shoulder, Arthroscopy, Ireparable, Massive

Ahmet Umit Sabancı,1,* Perihan Erkan Alkan,2,* Cem Mujde,3,* Hivda Ulbeği Polat,4,* Cemre Ornek Erguzeloglu,5,* Atil Bisgin,3,6,* Cuneyt Ozakin,7,* Sehime G Temel5,8,9,* 1Bursa Çekirge State Hospital, Orthopedics and Traumatology Clinic, Bursa, Turkey; 2Bursa Uludağ University, Vocational School of Health Services, Medical Laboratory Technician Department, Bursa, Turkey; 3Çukurova University AGENTEM (Adana Genetic Diseases and Treatment Center), Adana, Turkey; 4TUBITAK, Marmara Research Center, Genetic Engineering and Biotechnology Institute, Gebze, Kocaeli, Turkey; 5Bursa Uludag University, Institute of Health Sciences, Department of Translational Medicine, Bursa, Turkey; 6Çukurova University, Faculty of Medicine, Department of Medical Genetics, Adana, Turkey; 7Bursa Uludağ University, Faculty of Medicine, Department of Infectious Diseases and Microbiology, Bursa, Turkey; 8Bursa Uludağ University, Faculty of Medicine, Department of Medical Genetics, Bursa, Turkey; 9Bursa Uludag University, Health Sciences Institute, Department of Translational Medicine, Bursa, Turkey*These authors contributed equally to this workCorrespondence: Cuneyt OzakinBursa Uludağ University, Faculty of Medicine, Department of Infectious Diseases and Microbiology, Bursa, TurkeyEmail ozakin@uludag.edu.trSehime G TemelBursa Uludağ University, Faculty of Medicine, Department of Medical Genetics, Bursa, TurkeyEmail sehime@uludag.edu.trPurpose: SARS-CoV-2-infected individuals may be asymptomatic, and therefore, the virus is highly contagious. We aimed to develop an agent to control viral replication in the upper respiratory tract and to prevent progression of the disease into the lower airways as well as inter-individual transmission. For this purpose, we investigated the antibacterial and antiviral activities of our novel nanobubble ozonated hyaluronic acid-decorated liposomal (NOHAL) solution, developed by using nanotechnology.Methods: The MIC levels of NOHAL solution were determined on blood agar cultures of Staphylococcus aureus (ATCC 6538), Streptococcuspneumoniae (ATCC 49619) and Escherichia coli (ATCC 25922). The in vitro anti-viral activity of NOHAL solution was studied using recombinant SARS-CoV-2 copies of the original virus, grown in Vero cells generated by reverse genetic technology. Human primary lung epithelial cells obtained by bronchoscopy or lung resection were used for cell viability tests using flow cytometry analysis. The cytotoxicity testing was performed using the BALB/c 3T3 (CCL-163) cell line. Skin, oral, nasal and ocular irritation tests were performed using New Zealand albino rabbits, Syrian hamsters, BALB c mice and New Zealand albino rabbits of both sexes.Results: Bacterial growth was prevented by NOHAL solution in a time-/dose-dependent manner. In vivo or in vitro experiments did not show any toxicity of NOHAL solution. No cytotoxicity was recorded on cell viability. No skin, oral, nasal or ocular toxicities were recorded. In addition, in a SARS-CoV-2 mouse infection model, NOHAL solution diminished the viral RNA levels effectively in nasopharyngeal and lung samples after its prophylactic intranasal application.Conclusion: NOHAL solution has the potential to reduce or prevent the spread of SARS-CoV-2 through the nose and/or oral cavity. The clinical efficacy of this solution needs to be tested in order to determine its efficacy in the early phase of COVID-19.Keywords: nanobubble, ozone, hyaluronic acid, liposome, anti-microbial, anti-viral

Objective: In our study, a nanoparticle liposome molecule with patent application number TR201804452A2 was used, and the Minimum Inhibitor Concentration (MIC) was found to be 1562 ppm. According to the ASTM F 1980 standard, it has been determined that the nanoparticle liposome solution kept at 37 days and 55 oC in return for one-year stability preserves its effectiveness. Our study aimed to show that the newly developed solution maintains its effectiveness for a long time. Methods: CLSI M07-A10 (Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Tenth ed. Approved Standard) standard test method of the nanoparticle liposome solution developed with a technique different from the standard ozonation mechanisms, and antibacterial tests were performed by modifying the contact time and the MIC value of the solution, and its effect on time has been determined. For the stability test of the nanoparticle liposome solution, it was kept at 55 oC for 37 days in return for one-year stability according to the ASTM F 1980 standard. Results: MIC of nanoparticular ozone solution CLSI M07-A10 standard test method for S. aureus (ATCC 25923) and E. coli (ATCC 25922) strains by modifying contact time It was determined as 1.562 ppm. For S. aureus (ATCC 25923), at the end of the first hour, it was determined that the activity started at 2000 and 1750 ppm nanoparticle liposome solution concentration. For E. coli (ATCC 25922) it was determined that the activity started at the 10th minute at 2000 ppm nanoparticular ozone solution concentration. The solution was still effective at the end of one year according to the ASTM F 1980 standard in terms of effectiveness. Conclusions: As a result, the nanoparticle liposome solution, a new product, does not lose its stability and effectiveness for a long time, contrary to what is known. Although the half-life of gaseous ozone is as short as 20 minutes, the stability in the nanoparticle liposome solution has been determined as at least one year. Since nanoparticle liposome solution is a natural and slow-release product, it is thought that it can create a barrier in mucosal membranes in regions such as the nose, throat, eye and ear with solutions to be prepared in appropriate doses thus preventing bacteria from settling. Keywords: Nanoparticle liposomes, ozone, antibacterial efficiency, Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922)

Cognitive impairments are a core and persistent characteristic of schizophrenia with implications for daily functioning. These show only limited response to antipsychotic treatment and their neural basis is not well characterised. Previous studies point to relationships between cortical thickness and cognitive performance in fronto-temporal brain regions in schizophrenia patients (SZH). There is also evidence that these relationships might be independent of symptom severity, suggesting dissociable disease processes. We set out to explore these possibilities in a sample of 70 SZH and 72 age and gender-matched healthy controls (provided by the Center of Biomedical Research Excellence (COBRE)). Cortical thickness within fronto-temporal regions implicated by previous work was considered in relation to performance across various cognitive domains (from the MATRICS Cognitive Battery). Compared to controls, SZH had thinner cortices across most fronto-temporal regions and significantly lower performance on all cognitive domains. Robust relationships with cortical thickness were found: visual learning and attention performance correlated with bilateral superior and middle frontal thickness in SZH only. Correlations between attention performance and right transverse temporal thickness were also specific to SZH. Findings point to the importance of these regions for cognitive performance in SZH, possibly reflecting compensatory processes and/or aberrant connectivity. No links to symptom severity were observed in these regions, suggesting these relationships are dissociable from underlying psychotic symptomology. Findings enhance understanding of the brain structural underpinnings and possible aetiology of cognitive impairment in SZH.

Impairments in cognitive performance are common in schizophrenia, and these contribute to poor awareness of symptoms and treatment ('clinical insight'), which is an important predictor of functional outcome. Although relationships between cognitive impairment and reductions in regional brain volumes in patients are relatively well characterised, less is known about the brain structural correlates of clinical insight. To address this gap, we aimed to explore brain structural correlates of cognitive performance and clinical insight in the same sample. 108 patients with schizophrenia (SZH) and 94 age and gender-matched controls (CON) (from the Northwestern University Schizophrenia Data and Software Tool (NUSDAST) database) were included. SZH had smaller grey matter volume across most fronto-temporal regions and significantly poorer performance on all cognitive domains. Multiple regression showed that higher positive symptoms and poorer attention were significant predictors of insight in SZH; however, no significant correlations were seen between clinical insight and regional brain volumes. In contrast, symptomology did not contribute to cognitive performance, but robust positive relationships were found between regional grey matter volumes in fronto-temporal regions and cognitive performance (particularly executive function). Many of these appeared to be unique to SZH as they were not observed in CON. Findings suggest that while there exists a tight link between cognitive functioning and neuropathological processes affecting gross brain anatomy in SZH, this is not the case for clinical insight. Instead, clinical insight levels seem to be influenced by symptomology, attentional performance and other subject-specific variables.

Metacognition is impaired in schizophrenia and is an important predictor of functional outcome, but the underlying neuropathology is not clear. Studies have implicated frontal regions and there is also some evidence that the hippocampus might play a pivotal role, but findings are inconsistent. We set out to more comprehensively investigate the neural underpinnings of insight in first-episode psychosis (FEP) using 2 metacognitive measures (the Beck Cognitive Insight Scale [BCIS]) and a perceptual metacognitive accuracy task alongside structural magnetic resonance imaging (MRI). We measured cortical thickness in insula and frontal regions, hippocampal (including subfield) volumes, hippocampal microstructure (using neurite orientation dispersion and density imaging [NODDI]), and fractional anisotropy in fornix. Relative to controls, FEP showed poorer metacognitive accuracy, thinner cortex in frontal regions and lower fornix integrity. In healthy controls (but not FEP), metacognitive accuracy correlated with cortical thickness in frontal cortex and insula. Conversely, in FEP (but not controls), metacognitive accuracy correlated with hippocampal volume and microstructural indices. Subicular hippocampal subregions were particularly implicated. No structural correlates of BCIS were found. These findings suggest that the neural bases of metacognition might differ in FEP: hippocampal (rather than frontal) integrity seems to be critical. Further, the use of objectively measured metacognitive indices seems to be a more powerful method for understanding the neurocircuitry of metacognition in FEP, which has the potential to inform therapeutic strategies and improve outcome in these patients.

Bu çalışmada; insülin enjeksiyonu öncesienjeksiyon bölgesindeki mikrobiyal yük incelenerek deri antisepsisi için%70’lik etil alkol kullanımının gerekli olup olmadığını değerlendirmekamaçlandı. Araştırma, bir üniversite hastanesinin Endokrinoloji ve MetabolizmaHastalıkları Kliniğinde yürütüldü. Araştırmanın örneklemini; Tip 1 DiabetesMellitus (DM) tanısı alan, insülin tedavisi uygulanan, enjeksiyon bölgesibelirgin derecede kirli olmayan, enfeksiyon riski bulunmayan ve araştırmayakatılmayı gönüllü kabul eden 66 hasta oluşturdu. İnsülin enjeksiyonlarıabdominal bölgeye uygulandı ve her hastadan toplam iki kez cilt kültürü alındı.İnsülin enjeksiyonu öncesi hastanın enjeksiyon bölgesinde 10 cm2olarak belirlenmiş bir alan steril bir eküvyon ile deneyimli bir araştırmacıtarafından cilt üzerine sürtülerek ilk kültür örneği alındı. Daha sonra bölge%70’lik etil alkol emdirilmiş pamuk ile içten dışa doğru silindi ve alkolünkuruması için 30 saniye beklendi. Ardından hastaya insülin enjeksiyonu uygulandıve aynı bölgeden ikinci kültür örneği alındı. Araştırmaya katılan hastaların %95’indeenjeksiyon öncesi, %66.7’sinde ise enjeksiyon sonrası enjeksiyon bölgesindeüreme olduğu saptandı. Enjeksiyon öncesi enjeksiyon bölgesi üzerindeki cm2başına ortalama Colony Forming Unit (CFU) 60.13±51.65, %70’lik etil alkol kullandıktansonraki ortalama CFU 15.98±25.27 olarak belirlendi ve bu istatistiksel olarakanlamlı ölçüde yüksek bulundu (p=0.000). Araştırma sonucunda; Endokrinoloji veMetabolizma Hastalıkları Kliniğinde Tip 1 DM tanısı ile yatan hastalara insülinenjeksiyonu öncesi cilt antisepsisinin gerekli olduğu kanısına varıldı., Inthis study, it was aimed to evaluate whether the use of 70% ethyl alcohol forskin antisepsis is necessary by examining the microbial load at the injectionsite before the injection of insulin. The study was conducted at Clinic ofEndocrinology and Metabolic Diseases of an university hospital. The sample ofthe study consisted of 66 patients who were diagnosed with Type 1 DiabetesMellitus (DM), were treated with insulin, had no significant dirt at theinjection site, and had no risk of infection and who accepted voluntaryparticipation in the study. Insulin injections were applied to the abdominalregion and a total of two skin cultures were obtained from each patient. Thefirst culture sample was obtained by rubbing a 5-6 cm2 area on theskin which was determined before insulin injection with a sterile swab by anexperienced researcher. The area was then wiped out from inside with 70% ethylalcohol impregnated cotton, and the alcohol was allowed to dry for 30 seconds.The patient was then given insulin injection and a second culture sample wasobtained from the same site. Microbial growth was found in 95% of the patientsbefore injection and in 66.7% of the patients after the injection. The meanColony Forming Unit (CFU) was 60.13 ± 51.65 per cm2 on the injection sitebefore injection, the mean CFU 15.98 ± 25.27 after using 70% ethyl alcohol andthis was determined as statistically significantly higher (p = 0.000). As aresult of the research; for the patients with Type 1 DM in the Clinic ofEndocrinology and Metabolic Diseases, before the injection of insulin the skinantisepsis was considered to be necessary.

This study presents the pollen analysis of 16 chestnut honeys from the Black Sea Region of Turkey. Honey samples were collected from 12 different localities in 2018 around Samsun, Sinop, Kastamonu and Giresun. Honey samples were taken from a height of at least 10 and a height of 859 meters. The pollen analysis was carried out using microscopical analysis. All of the samples collected are unifloral honey.The highest number of pollen was observed in the samples from Bozkurt, Kastamonu in Turkey. ÖzetBu çalışma, Türkiye'nin Karadeniz Bölgesi'nde bulunan farklı şehirlerden 16 kestane balının polen analizini içermektedir. 2018 yılında Samsun, Sinop, Kastamonu ve Giresun çevresinde 12 farklı bölgeden bal örnekleri toplanmıştır. Bal örnekleri deniz seviyesinden en az 10 metre, en fazla 859 metre yükseklikten alınmıştır. Balların mikroskobik analizi Toplam Polen Sayısı (TPS) kullanılarak gerçekleştirildi. Toplanan örneklerin tamamı unifloral baldır. Çalışmada en fazla polen Bozkurt, Kastamonu'dan alınan örneklerde görülmüştür.

Impaired functional capacity is a core feature of schizophrenia and presents even in first-episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is less clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor, but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in FEP using MRI and a reliable objective measure of functioning [University of California, San Diego Performance-Based Skills Assessment (UPSA)]. In a sample of FEP (n = 39) and a well-matched control group (n = 21), we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) within brain regions implicated by previous work. The FEP group had thinner cortex in various frontal regions and fusiform, and reduced FA in inferior longitudinal fasciculus (ILF). In FEP, poorer functional capacity correlated with reduced superior frontal volume and lower FA in left ILF. Importantly, frontal brain volumes and integrity of the ILF were identified as the structural correlates of functional capacity in FEP, controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.

Cardiometabolic risk factors influence white matter hyperintensity (WMH) development: in metabolic syndrome (MetS), higher WMH load is often reported but the relationships between specific cardiometabolic variables, WMH load and cognitive performance are uncertain. We investigated these in a Brazilian sample (aged 50–85) with (N = 61) and without (N = 103) MetS. Stepwise regression models identified effects of cardiometabolic and demographic variables on WMH load (from FLAIR MRI) and verbal recall performance. WMH volume was greater in MetS, but verbal recall performance was not impaired. Age showed the strongest relationship with WMH load. Across all participants, systolic blood pressure (SBP) and fasting blood glucose were also contributors, and WMH volume was negatively associated with verbal recall performance. In non-MetS, higher HbA1c, SBP, and number of MetS components were linked to poorer recall performance while higher triglyceride levels appeared to be protective. In MetS only, these relationships were absent but education exerted a strongly protective effect on recall performance. Thus, results support MetS as a construct: the clustering of cardiometabolic variables in MetS alters their individual relationships with cognition; instead, MetS is characterised by a greater reliance on cognitive reserve mechanisms. In non-MetS, strategies to control HbA1c and SBP should be prioritised as these have the largest impact on cognition.

BACKGROUND: Metacognition is the ability to be aware of own mental activities. Metacognitive deficits are reliably reported in schizophrenia and metacognitive ability has been strongly linked to functional capacity. However, the neural correlates of metacognitive ability in schizophrenia is uncertain, although some evidence implicates the hippocampus as a critical structure in this group. We explored neural correlates of perceptual metacognitive accuracy in first episode psychosis (FEP) and healthy controls, hypothesizing that lower hippocampal volume would correlate with poorer metacognition in FEP only. METHODS: 31 patients with FEP (9 female, aged between 19 and 39, mean age 25.95) and eighteen age, gender and education matched healthy controls (6 female, aged between 18 and 38, mean age 24.43) took part in the study. Brain structural T1s were acquired using MRI and all participants completed a perceptual metacognitive accuracy task outside of the scanner. Gray matter volumes for cortical and subcortical regions were calculated using Freesurfer’s “recon-all” pipeline (http://surfer.nmr.mgh.harvard.edu). Regions of interest (ROI) included prefrontal and hippocampal structures, as implicated in previous studies on metacognition. Comparisons between FEP and control groups were performed using t-tests for continuous variables (ROI volumes, metacognitive accuracy). Correlational analyses than explored relationships between ROI and metacognitive accuracy, by group. RESULTS: In the FEP group, metacognitive accuracy was significantly impaired compared to controls. There was no difference between groups on any of the ROI volume measures. Metacognitive accuracy in the FEP group correlated with total hippocampal volumes both in left hemisphere (r=.429, p=.016), and right hemisphere r=.487, p=.005). These relationships were localized to specific hippocampal subfields (left hippocampal head; r=.376, p=.037, left hippocampal body; r=.462, p=.009; right hippocampal head; r=.475, p=.007, right hippocampal body; r=.516, p=.003). In contrast, there were no statistically significant relationships between metacognitive accuracy and hippocampal volume in the control group (left hippocampus: r=-0.046, p=0.855, right hippocampus: r=.056, p=.826). DISCUSSION: Results of this study provide evidence of a positive relationship between hippocampal volumes and metacognitive accuracy in FEP only. This points to possible differences in the neural substrates of metacognition in schizophrenia, with hippocampus contributing to the poorer metacognitive performance frequently observed in patients. Metacognitive ability has important consequences for functional capacity, and these results are consistent with the suggestion that hippocampal pathophysiology might be central to cognitive deficit in schizophrenia.

The COVID-19 pandemic and the consequent restrictions imposed by governments worldwide have had profound social and psychological effects, particularly for young adults. This study used longitudinal data to characterise effects on mental health and behaviour in a UK student sample, measuring sleep quality and diurnal preference, depression and anxiety symptoms, wellbeing and loneliness, and alcohol use. Self-report data was collected from 254 undergraduates (219 females) at a UK university at two-time points: autumn 2019 (baseline, pre-pandemic) and April/May 2020 (under 'lockdown' conditions). Longitudinal analyses showed a significant rise in depression symptoms and a reduction in wellbeing at lockdown. Over a third of the sample could be classed as clinically depressed at lockdown compared to 15% at baseline. Sleep quality was not affected across the sample as a whole. The increase in depression symptoms was highly correlated with worsened sleep quality. A reduction in alcohol use, and a significant shift towards an 'evening' diurnal preference, were also observed. Levels of worry surrounding contracting COVID-19 were high. Results highlight the urgent need for strategies to support young people's mental health: alleviating worries around contracting COVID, and supporting good sleep quality, could benefit young adults' mental health as the COVID-19 crisis unfolds.

Background Impaired functional capacity is a core feature of schizophrenia and present even in first episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is not clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in first episode psychosis using MRI and a reliable objective measure of functioning (University of California, San Diego Performance-Based Skills Assessment (UPSA)) Methods In FEP and a well-matched control group, we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) in specific regions implicated by previous work. Between-group differences in these parameters were assessed first. We then examined correlations between MRI measures and UPSA scores in the FEP group while controlling for negative symptomology and medication use. Results The FEP group had thinner cortex in various frontal regions, fusiform, and insula, and reduced FA in inferior longitudinal fasciculus. In FEP, poorer functioning (UPSA) correlated with reduced superior frontal volume and lower FA in inferior longitudinal fasciculus. Discussion In accordance with previous findings, FEP exhibited widespread brain structural differences compared to controls. Importantly, frontal brain volumes and integrity of the inferior longitudinal fasciculus were identified as the structural correlates of functional capacity in FEP, after controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes.Levels of Evidence: Level IV: Retrospective case series

Covering the reconstructed area with a healthy soft-tissue envelope is a major challenge after limb-sparing surgery in patients with malignant bone and soft-tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft-tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft-tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft-tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft-tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft-tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8-48) days and mean follow-up period was 57·3 (range 50-74) months. There was no tumour recurrence or skip metastasis in the follow-up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery.

Background An unfavorable condition for bone healing is the presence of bone defects. Under such conditions, a material can play a role to cover fractured or defective bone. Technological advances now allow for the use of such material. Hyalonect® (Fidia Advanced Biopolymers SLR, Italy), a novel membrane comprising knitted fibers of esterified hyaluronan (HYAFF11) can be used to cover fractured or grafted bone and can also serve as a scaffold to keep osteoprogenitor cells in place. The aim of this study was to compare osteoblastic activity by the use of scintigraphic methods in defective rabbit tibias during early-phase bone healing with or without a hyaluronan-based mesh. Methods Two groups (A and B) of New Zealand albino rabbits were used; each group included 10 animals. Operations on all rabbits were performed under general anesthesia. We also resected 10-mm bone segments from each animal’s tibial diaphysis. After resection, tibias with defects were fixed using Kirschner wires. In group A, no hyaluronan-based mesh was used. In group B, tibial segmental defects were enclosed with a hyaluronan-based mesh. The rabbits were followed up for 4 weeks postoperatively, after which bone scintigraphic studies were performed on each animal to detect and compare osteoblastic activity. Results The mean count in the fracture side of the hyaluronan-based mesh group was significantly higher compared to that of the group A (p = 0.019). However, there was no significant difference between group B and control rabbits with respect to the mean count on the intact bone side (p = 0.437). The bone defect (fracture)/intact bone mean count ratio was significantly higher in group B compared to group A (p = 0.008). Conclusions A hyaluronan-based mesh plays a role in promoting osteoblastic activity. Hyalonect® is suitable for restoring tissue continuity whenever the periosteal membrane is structurally impaired or inadequate. Our results demonstrated that, during early-phase bone healing, osteoblastic activity was increased in bone defect sites when a hyaluronan-based mesh was also used. The most important aspect of this study concerns its scintigraphy-based design. This study is the first to use a scintigraphic method to demonstrate the effectiveness of hyaluronic acid-based material for bone healing.

Bu arastirmanin amaci, kiz ve erkek ogrenciler arasinda hangi cinsiyetin daha iyimser olduguna iliskin algilarin belirlenmesi ve cinsiyete gore iyimserlik duzeylerinin farklilasip farklilasmadiginin incelenmesidir. Betimsel arastirma modelinde gerceklestirilen arastirmaya yaslari 18 ve 26 arasinda degisen, 266 (145 kiz, 121 erkek) universite ogrencisi katilmistir. Arastirmada ogrencilerin demografik ozelliklerinin belirlenmesi icin kisisel bilgi formu, iyimserlik duzeylerinin belirlenmesi icin Scheier ve Carver (1985) tarafindan gelistirilen, Aydin ve Tezer (1991) tarafindan Turkce uyarlamasi yapilan Yasam Yonelimi Testi kullanilmistir. Ogrencilerin cinsiyete gore iyimserlik algilarinin belirlenmesi icin ise 3 secenekli (Kizlar daha iyimserdir, Erkekler daha iyimserdir, Kiz ve erkekler arasinda fark yoktur.) cumlelerden birini secmeleri istenmistir. Verilerin analizinde Ki Kare testi ve t testi teknigi kullanilmistir. Arastirma sonucunda; kiz ve erkek ogrencilerin cogunlukla erkeklerin daha iyimser oldugu algisina sahip oldugu fakat bu sonucun istatistiksel olarak anlamli olmadigi, kiz ve erkek ogrenciler arasinda iyimserlik duzeyleri acisindan anlamli farklilik bulunmadigi sonucuna ulasilmistir. Elde edilen bulgular ilgili literatur isiginda tartisilmistir.

Achilles tendon ruptures commonly occur during sports activities and there is an increasing tendency in the incidence of these ruptures due to ‘weekend warriors' who are over 30 years of age. Achilles tendon ruptures are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures; however, there is no consensus on the treatment method, which is still determined by the surgeon and patient. Open surgical repair of the Achilles tendon carries specific risks, including adhesions between the tendon and the skin, infection and, in particular, wound breakdown. Thus, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia offers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique results in acceptable wound appearance that is able to endure early active mobilization and satisfactory clinical recovery without any severe complications. Furthermore, this procedure protects the paratenon, and thus blood supplies of the tendon, and enhances biologic recovery. Also, direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter the authors describe their own Achilles tendon repair technique under local anesthesia without a tourniquet and with cooperation of the patient, and the results of their clinical experiences as well as those in the literature. © Springer-Verlag Berlin Heidelberg 2012, 2015, All Rights Reserved.

Background: Intertrochanteric femur fractures are common in older people. In high-risk patients, especially American Society of Anesthesiologists (ASA) scores 3 and 4, surgery with internal fixation can cause excessive stresses. Therefore, external fixation is another option for treating these patients. Objective: To evaluate the results and complications of external fixation in elderly patients with intertrochanteric fractures. Methods: Twenty-six surgically high-risk patients with intertrochanteric fractures admitted to our clinic were treated with external fixation (January 2010- November 2011). Epidemiological and radiological data and also complications were recorded at each follow-up. Results: No complications occurred in 13 patients. The remaining 13 patients had complications after surgery: Of the patients, 10 had implant failure (6 pin migration and 4 pin cut-out) and 3 had pin tract infections. Six patients who had implant failure (2 pin migration and 4 pin cut-out) underwent revision. Unrevised complicated patients (4 pin migration) and 2 of 3 patients with pin tract infections had malunion and shortening. High risk older patients with external fixation had a high complication and morbidity rate. Conclusion: We do not recommend using pertrochanteric external fixators in high-risk patients due to the high revision rate and serious complications.

Isolated rupture of the vastus medialis muscle is rare, and surgical repair is recommended. The results of rehabilitation programme after the percutaneous intramuscular splintage of a nearly total vastus medialis muscle tear in a 52-year professional-master degree weight-lifter is presented in this report.

Objectives: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop (EndoButton-CL®) on the femoral side, and an IS/staple on the tibial side. Methods: We retrospectively reviewed data on 46 patients who underwent arthroscopic ACL reconstruction with Achilles tendon allografting. Fixation was performed with a bioabsorbable IS (the IS group) in 24 patients (mean age 26.5 years), and with the EndoButton-CL device (the EB group) in 22 patients (mean age 28.1 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. Results: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (p>0.05). Femoral TW at the proximal and middle levels (on both anteroposterior and lateral views) in the IS group was significantly greater than in the EB group (p0.050). Conclusion: Femoral ACL graft fixation using an EndoButton-CL reduced femoral TW compared to use of an IS.