Adult Separation Anxiety and Childhood Traumas: The Mediating Role of Cognitive Distortions

While there are many studies on the relationship between anxiety disorders and childhood traumas in the literature, there are limited studies on the relationship between separation anxiety disorders and traumatic experiences in early life. It is widely known that trauma and negative cognitive processes are important factors in the etiology and prognosis of psychiatric disorders. In this study, it was aimed to determine the relationship between adult separation anxiety levels and childhood traumas and cognitive distortions, and to examine the mediating role of cognitive distortions in the relationship between childhood traumas and separation anxiety. A total of 366 students attending a private university were included in the study. The scales, which were converted into online questionnaires by the researchers, were sent to the students via e-mail, and were administered online. The participants were evaluated using "Adult Separation Anxiety Questionnaire", "Childhood Trauma Questionnaire", and "Cognitive Distortions Scale". The results of the study indicated that there was a positive and significant relationship between adult separation anxiety levels and childhood sexual abuse while there was no statistically significant correlation between adult separation anxiety levels and physical and emotional abuse, or physical and emotional neglect. A positive and significant relationship was found between separation anxiety levels and the sub-dimensions of cognitive distortions' self-image, self-blame, helplessness, hopelessness, and preoccupation with danger. In addition, it was determined that the helplessness and preoccupation with danger sub-dimensions of cognitive distortions had a full mediator effect on the relationship between sexual abuse and separation anxiety. Our results show that there is a positive relationship between separation anxiety disorder and childhood sexual abuse, and cognitive distortions play a mediating role between both variables.

The mediating role of cognitive distortions in the relationship between problematic social media use and self-esteem in youth

Self-esteem expresses the individual's approach to himself and affects the whole life in terms of mental health. Another important factor affecting self-esteem, which has a critical importance for the youth period, is social media. In the literature, there are many studies examining the relationship between social media use and self-esteem of young people. In this study, it was aimed to investigate the relationship between problematic social media use and self-esteem in university students and to test the mediating role of cognitive distortions in the relationship between these two variables. The sample of the study consisted of 239 young individuals, 197 (82.4%) female, and 42 (17.6%) males, with a mean age of 20.62 ± 1.92 years, studying at a private university. Participants were evaluated by administering the "Rosenberg Self-Esteem Scale (RSES)", "Social Media Disorder Scale (SMD-9)", and "Cognitive Distortions Scale (CDS)". The scales were administered via an online survey. Results revealed that there was a negative significant relationship between the problematic social media use levels of the participants and their self-esteem. In the model established to evaluate the mediating role of cognitive distortions in the relationship between problematic social media use and self-esteem levels, in the first step, it was found that problematic social media use directly predicted self-esteem negatively. In the second step, it was determined that the use of problematic social media negatively predicted the mediating variable cognitive distortions. In the third step, when cognitive distortions, which are mediator variables, are added to the model in the relationship between problematic social media use and self-esteem; it was determined that cognitive distortions played a partial mediating role in the sub-dimensions of "self-perception", "self-blame", "hopelessness" and "seeing life as dangerous", while the sub-dimensions of "helplessness" and "total scale scores" played a full mediator role. Our findings show that there is a negative relationship between the problematic social media use of young people and their self-esteem levels, and cognitive distortions play a mediating role in the relationship between both variables.

Therapeutic effects of cinnamon bark oil on sciatic nerve injury in rats

OBJECTIVE

The aim of this study was to investigate the effects of cinnamon bark essential oil (CBO) on analgesia, motor activity, balance, and coordination in rats with sciatic nerve damage.

MATERIALS AND METHODS

Rats were divided into three groups as simply randomized. The right sciatic nerve (RSN) of the Sham group was explored. Only vehicle solution was applied for 28 days. The RSN of the sciatic nerve injury (SNI) group was explored. Damage was created by unilateral clamping, and vehicle solution was applied for 28 days. The RSN of the sciatic nerve injury+cinnamon bark essential oil (SNI+CBO) group was explored. SNI was created by unilateral clamping and CBO was applied for 28 days. In the experiment study, motor activity, balance, and coordination measurements were made with rotarod and accelerod tests. A hot plate test was performed for analgesia measurements. Histopathology studies were carried out with the sciatic nerve tissues.

RESULTS

In the rotarod test, there was a statistically significant difference between the SNI group and the SNI+CBO group (p<0.05). According to the accelerod test findings, there was a statistically significant difference between the SNI group with the Sham and SNI+CBO groups. In the hot plate test, there was a statistically significant difference between the SNI group with the Sham and SNI+CBO groups (p<0.05). In comparison to the Sham group and the SNI group, the SNI+CBO group was shown to have the greatest expression level of vimentin.

CONCLUSIONS

We have concluded that CBO can be used as an adjuvant treatment in cases of SNI, increased pain, nociception, impaired balance, motor activity, and coordination. Our results will be supported by further studies.

Self-esteem and social media addiction level in adolescents: The mediating role of body image

Background

There are many studies examining the relationship between social media and self-esteem. Studies examining the relationships between the self-esteem, social media use, and body image of adolescents are limited in the literature.

Aim

This study aimed to examine the relationship between self-esteem and social media addiction levels in adolescents and the mediating role of body image in the relationship between these two variables.

Methods

The sample of the study consisted of 204 adolescents, 67 (32.8%) girls and 137 (67.2%) boys, with a mean age of 15.90 ± 1.20 years, who were high school students. The self-esteem levels of the participants were evaluated with the "Rosenberg Self-Esteem Scale", their social media dependency levels were measured with the "Social Media Use Disorder Scale", and their body images were measured using the "Multidimensional Body-Self Relations Questionnaire".

Results

No significant relationship was found between the self-esteem levels of the participants and their ages or the education levels of their parents. There was a negative moderate significant relationship between the self-esteem levels of the participants and their social media addiction levels, and a positive moderate significant correlation was found between their self-esteem levels and body images. It was found that the social media addiction levels of the participants negatively predicted their self-esteem and body image levels. It was determined that body image had a partial mediator effect on the relationship between the social media addiction and self-esteem levels of the participants.

Conclusion

Our results revealed that there is a negative correlation between self-esteem and social media addiction levels in adolescents. Body image has a partial mediating role in the relationship between social media addiction and self-esteem levels.

Effects of rivaroxaban on myocardial ischemia-reperfusion injury in rats

Myocardial infarction and further ischemia-reperfusion injury is a life-threatening conditions in humans. In this study, the effects of rivaroxaban, an anticoagulant agent, were aimed to be studied in a myocardial ischemia-reperfusion (I/R) injury model in rats. Male Wistar-albino rats were allocated into three groups; Rivaroxaban (n=15), control (n=15) and sham (n=10). Myocardial ischemia (30 minutes) and then reperfusion (120 minutes) were surgically performed in the rivaroxaban given (3mg/kg/day by gavage for 10 days before surgical procedures) and the control groups. Electrocardiography changes, blood pressure and heart rate were recorded before ischemia, and during the periods of ischemia and the reperfusion. Hemodynamic and blood parameters were recorded. Necrotic tissue in the myocardium was determined by the triphenyl tetrazolium chloride dye method. The extent of myocardial necrosis and risk area was calculated using a computer-assisted image program. In the rivaroxaban administered group, the size of necrotic area in the myocardium decreased significantly, however, mean heart rate and mean arterial blood pressure did not change. K+ and CK levels in serum, which are indicative of tissue necrosis, were significantly lower in the rivaroxaban group compared to the control group (p<0.05). Rivaroxaban use, compared to the control group, effectively reduced the extent of myocardial injury as assessed by less necrotic myocardial tissue in rats. This protective effect of rivaroxaban may be attributed to its less thrombus formation in the coronary arteries during ischemia and less acidosis during tissue damage.

Quality of Life in Children Diagnosed with Epilepsy: An Analysis of Comorbid Psychiatric Disorders, Psychiatric Symptoms of Parents and Family Functionality

Objective: The aim of this study is to evaluate the comorbid psychiatric disorders, psychiatric signs and symptoms of the mother and family functionality in children with epilepsy, as well as to examine the relationship between the mentioned variables and quality of life. Methods: The study was conducted with 31 children between the ages 8-11 with a diagnosis of epilepsy for at least 6 months and their mothers; and 30 healthy children of the similar age group and their mothers as the control group. Childhood Depression Inventory (CDI), Children State-Trait Anxiety Inventory (STAI-CH), Pediatric Quality of Life Inventory (PedsQL) was used for children in the Epilepsy and control groups, State-Trait Anxiety Inventory (STAI), Symptom Checklist-90-Revised (SCL-90-R) and Family Assessment Device (FAD) was used for mothers in both groups. Results: According to the results of our study the CDI scores of children in the epilepsy group were found to be significantly higher than of those in the control group. No significant difference was found between both groups in terms of their STAI-CH scores, as well as in terms of total STAI and SCL-90-R scores of mothers in both groups. However, the Ange and Hostility subscale scores of mothers in the epilepsy group were found to be significantly higher than of those in the control group. In addition, the PedsQL total and subscale points of children in the epilepsy group were found to be significantly lower than of those in the control group. Finally, a negative correlation has been detected between the PedsQL scores of the epilepsy group and the children's CDI and STAI-CH scores, the STAI and SCL-90-R scores of the mothers and the FAD scores. Moreover, it was determined that the depression level of the children in the epilepsy group had a significant effect on the quality of life. Conclusion: Our findings suggest a correlation between the quality of life in children with epilepsy and the psychiatric symptoms of children and mothers as well as family functionality.

Monitoring of near-infrared spectrum values during packed red blood cell transfusion in pediatric intensive care unit

OBJECTIVES

Packed red blood cell (PRBC) transfusion is one of the most common treatment options in pediatric intensive care unit (PICU) which targets a better cerebral oxygenation. This study aimed to show the cerebral near-infrared spectroscopy (cNIRS) changes during PRBC transfusions in PICU.

MATERIAL AND METHODS

In this prospective observational study, changes in regional cerebral tissue oxygen saturation (rSO2) in pediatric patients, who required PRBC transfusion were monitored. All the cNIRS and related values were classified as baseline values. The same values were measured and calculated at the end of transfusion and named as 4th-hour values. Further measurements and calculations were made three hours later and named as 7th-hour values. Changes in cNIRS, cerebral tissue fractional oxygen extraction (CTFOE), cNIRS variability index (cNIRS-VI) were compared using Friedman test.

RESULTS

A total of 53 PRBC transfusions were monitored. Baseline haemoglobin increased from 6.3 (5.9, 6.7) gr/dL to 8.6 (8.4, 9) gr/dL at the 7th-hour. cNIRS values improved during transfusion (P=0.012), with a concomitant decrease in cNIRS-VI and CTFOE values (P<0.001 and P=0.017 consecutively) CONCLUSION: Our study revealed that there is an increase in cNIRS and related values after transfusion compared to baseline values in critically ill children admitted to a PICU. Age of PRBC did not have an effect on delta-cNIRS or post-transfusion hemoglobin values. There is a moderate correlation between the baseline cNIRS values and delta-cNIRS value after the transfusion.

SIRT4 prevents excitotoxicity via modulating glutamate metabolism in glioma cells

Excitotoxicity is the presence of excessive glutamate, which is normally taken up by glutamate transporters on astrocytes. Glutamate transporter 1 (GLT-1) is the major transporter on glia cells clearing more than 90% of the glutamate. Sirtuin 4 (SIRT4) is a mitochondrial sirtuin which is expressed in the brain. Previously, it was shown that loss of SIRT4 leads to a more severe reaction to kainic acid, an excitotoxic agent, and also decreased GLT-1 expression in the brain. In this study, we aimed to investigate whether overexpression of SIRT4 is protective against excitotoxicity in glia cells. We overexpressed SIRT4 in A172 glioma cell line and treated with kainic acid in order to induce excitotoxicity. We observed that SIRT4 overexpression increased the cell viability after kainic acid treatment. In addition, reduced glutamate was detected in glutamate assay with overexpression of SIRT4 after kainic acid treatment since SIRT4 decreased cell death by preventing excitotoxicity. Our results show that overexpression of SIRT4 increased the protein levels of GLT-1 and glutamate dehydrogenase (GDH) after kainic acid (KA) treatment so that excess glutamate can be absorbed. However, overexpression of SIRT4 decreased glutamine synthetase (GS) levels. These results demonstrate that, by inhibiting GS, SIRT4 prevents glutamine formation, which will be converted to glutamate in neurons. SIRT4 prevents excitotoxicity via upregulating glutamate metabolism. Finally, our results may show that SIRT4 might prevent excitotoxicity and related cell death via reducing GS expression and upregulating GLT-1 and GDH levels. Therefore, it is important to develop therapeutics against excitotoxicity through SIRT4-related pathways in the cell.

Design of l-Lysine-Based Organogelators and Their Applications in Drug Release Processes

This work reports on the synthesis of three new l-lysine-based organogelators bis(N²-alkanoyl-N⁶-l-lysyl ethylester)oxalylamides, where alkanoyls are lauroyl, myristoyl, and palmitoyl. The gels of these gelators were prepared with high yields in eco-friendly solvents commonly used in cosmetics such as ethyl and isopropyl esters of lauric and myristic acids, liquid paraffin, 1-decanol, and 1,2-propanediol. Fourier transform infrared measurements revealed the involvement of intermolecular hydrogen bonds in the gelation. Scanning electron microscopy images of xerogels indicated different morphologic patterns with regard to the alkanoyl chain length and the solvent employed in their preparation. The gel formation was supported by rheological measurements. Three gels prepared in liquid paraffin were loaded with naproxen (Npx) with a quite high loading capacity (up to 166.6% as percentage of gelator) without gel disruption. The release of Npx from the gel matrix into the buffered solution at physiologic pH was evaluated using UV-vis spectroscopy. The results revealed that the release rate of Npx from the organogels significantly retarded with increasing organogelator concentration, whereas it enhanced with increasing Npx concentration. The rate was also found to be pH-dependent; the lower the pH, the lower the rate. Furthermore, molecular dynamic calculations performed on the octamer of myristoyl-bearing gelator (N ² M/N ⁶ Lys) in 1,2-propanediol provided useful information regarding the structural properties of the gels, which may be of interest to interpret the structure of the gel matrix. Altogether, this work provided valuable outcomes, which may be relevant to the pharmaceutical industry. It may be suggested that l-lysine-based gels have potentials in the delivery of nonsteroidal anti-inflammatory drug molecules. Besides, the release of the drug can be fine-tuned by the correct choice of gelator-solvent combination.

Three-dimensional evaluation of maxillary sinus volume in different age and sex groups using CBCT

AIM

Sinus maxillaris is an important anatomical formation in many branches of dentistry due to its proximity to the field of work. Various methods have been used in literature to measure the maxillary sinus volume (MSV) such as cadavers, stereology, two-dimensional conventional radiographs, computed tomography (CT), magnetic resonance imaging (MRI). The aim of this study is to evaluate the change of maxillary sinus volume according to age and gender with MIMICS 19.0 (Materialise HQ Technologielaan, Leuven, Belgium) which is one of three-dimensional modeling software.

MATERIALS AND METHODS

This study was performed in 200 patients selected by a retrospective review of the archives of the Dicle University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology. Patients were divided into five age groups (18-24 years, 25-34 years, 35-44 years, 45-54 years, and ≥ 55 years) and by sex. Cone-beam computed tomography (CBCT) images of the patients were transferred to the MIMICS software and the MSV was measured. All statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 21) software.

RESULTS

There was no statistically significant difference between the right and left maxillary sinus volume according to the findings obtained from our study, and maxillary sinus volume in males was found to be significantly higher than that of females. Another finding of our study is that the maxillary sinus volume decreases with age increase. Especially it was also found that the sinus volume in males in the 18-24 age group was statistically significantly higher than females.

CONCLUSION

Consequently, maxillary sinus volume measurements can be made on CT, CBCT, MRI scans using reconstruction software.

Alterations in energy consumption and plantar pressure distribution during walking in young adults with patellofemoral pain syndrome

OBJECTIVE

The aim of this study was to determine the alterations of walking energy expenditure and plantar pressure distribution in young adults with patellofemoral pain syndrome (PFPS).

METHODS

Thirty five individuals (mean age: 21.31 ± 1.76) with PFPS constituted the patient group and forty healthy participants (mean age: 21.40 ± 2.11) the control group. Preferred walking speeds (PWS) were determined on the over ground. Individuals walked on a treadmill for 7 min at their PWS and 30% above PWS and oxygen consumption was recorded via a metabolic analyzer. Net oxygen consumption was calculated for each walking trial. Borg scale was applied to assess perceived exertion during walking trial. Plantar pressure distributions were measured by a pedobarography device. Plantar area was subdivided into six zones to evaluate the dynamic plantar pressure data.

RESULTS

The mean PWS of PFPS and control groups were 4.69 ± 0.51 and 4.52 ± 0.60 km/h, respectively (p > .09). No significant difference was observed in energy expenditure during walking at PWS between 2 groups while oxygen consumption during 30% above PWS was higher in patient group (18.72 ± 3.75 and 16.64 ± 3.27) (p = .007). Net oxygen consumption was also found to be higher in PFPS group (15.12 ± 3.62 and 13.04 ± 3.24) (p = .005). The mean Borg scores were significantly higher in PFPS group at each walking trials (p < .001). No statistically significant difference was found between weight distribution (%) of symptomatic and nonsymptomatic extremity (50.45 ± 3.92% and 49.56 ± 3.93%, respectively) (p = .509). Dynamic pedobarography parameters were not different between 2 groups, and also between symptomatic and nonsymptomatic extremities (p > .05).

CONCLUSION

Although, rate of perceived exertion and energy expenditure during walking at 30% above PWS are affected negatively in young adults with PFPS, we may speculate that energy consumption and plantar pressure distribution can be compensated by a physiologic adaptation mechanism during walking at PWS.

LEVEL OF EVIDENCE

Level III, Therapeutic Study.

The Relationship between Maxillary Sinus Lateral Wall Thickness, Alveolar Bone Loss, and Demographic Variables: A Cross-Sectional Cone-Beam Computerized Tomography Study

OBJECTIVES

Sinus floor elevation and augmentation surgery is widely used as a reliable procedure to increase insufficient bone height in the posterior maxillary area. The purpose of the present clinical study was to determine the associations between periodontal bone loss (PBL), maxillary sinus lateral bone wall thickness, age, and gender using cone-beam computerized tomography (CBCT).

MATERIALS AND METHODS

The current retrospective study consists of 716 maxillary sinus CBCT images of 358 patients. The CBCT scans were assessed to detect the relationship between lateral wall thickness and PBL. ANOVA and Student t test analysis were used to determine the influence of PBL on sinus lateral wall thickness.

RESULTS

Sinus lateral wall thickness was significantly associated with PBL (p < 0.05) at 3, 13, and 15 mm height. There was no significant association between lateral wall thickness and gender (p > 0.05). However, there was a significant association between lateral wall thickness at 3 and 13 mm and age (p < 0.05). There were significant associations between PBL and age (p < 0.001), and PBL and gender (p < 0.05).

CONCLUSIONS

PBL might have an association with maxillary sinus lateral bone wall thickness. Further studies are needed to confirm this possible relationship.

Evaluation of maxillary sinus septa: a retrospective clinical study with cone beam computerized tomography (CBCT)

OBJECTIVE

To determine the prevalence, height, location, orientation, and type of maxillary sinus septa in atrophic, non-atrophic, and partially atrophic maxillary segments using cone beam computerized tomography (CBCT).

PATIENTS AND METHODS

This cross-sectional study was conducted on a retrospective evaluation of CBCT images of 1000 maxillary sinus with 500 subjects from December 2009 to December 2012. The differences among gender, left and right side of maxillary sinus, type of crest and feature of septa were statistically analyzed.

RESULTS

A total of 297 septa was recorded in 1000 maxillary sinuses (29.7%) with a mean height was 4.62±2.50 mm. Forty-four (8.7%) septa were located in the anterior area, 123 (24.5%) in the middle area, and 131 (26.4%) in the posterior area. Seventy maxillary sinus septa (26.1%) were observed with a mediolateral type orientation. There were no significant differences between all features of maxillary sinus septa and gender or type of crest. The only significant association identified was between type of crest and type of septa.

CONCLUSIONS

The maxillary sinus septa exhibited variable characteristics according to orientation and type of crest. CBCT analysis is very important and should be performed before maxillary sinus surgery to prevent possible complications.

Associations of alveolar bone loss and interleukin-1β levels in one- and two-stage surgical procedures: a randomized prospective trial

OBJECTIVE

Dental implants have been widely and successfully used in recent years as an alternative treatment for removable and fixed dental prostheses. The aim of this randomized prospective study was to determine the alveolar bone loss rate (ABLR) and IL-1β levels in one- and two-stage surgical procedures.

MATERIALS AND METHODS

This study included 40 patients with a single missing tooth in the posterior mandible; dental implants were inserted using a one-stage surgical procedure (Group I) or a two-stage surgical procedure (Group II). All clinical periodontal parameters were recorded; peri-implant crevicular fluid (PICF) samples were collected before loading (T0) and during the third (T1) and sixth (T2) months after loading. ABLR values were evaluated at T0 and T2 by using dental tomography. PICF was analysed after T2 samples were collected. The study was registered through clinicaltrials.gov; identifier NCT03045458.

RESULTS

This study found that, the probing pocket depth was found to be significantly higher in Group I than Group II at both T1 and T2 (p < .05). There was no significant difference in other clinical parameters between the groups (p > .05). There was a significant difference between Group I ABLR values at T0 and T2 (p < .05). The PICF IL-1β levels were not significantly different between groups (p > .05).

CONCLUSIONS

Within the limitations of the short observational period and small sample size of this study, two-stage implant placement shows comparable clinical outcomes to implants placed using a one-stage placement protocol.

PLA2G6 mutations associated with a continuous clinical spectrum from neuroaxonal dystrophy to hereditary spastic paraplegia

PLA2G6-associated neurodegeneration (PLAN) and hereditary spastic paraplegia (HSP) are 2 groups of heterogeneous neurodegenerative diseases. In this study, we report PLA2G6 gene mutations in 3 families from Turkey, Morocco, and Romania. Two affected Turkish siblings presenting HSP adds the disease to PLAN phenotypes. They were homozygous for the PLA2G6 missense c.2239C>T, p.Arg747Trp variant and the ages of onset were 9 and 21. Parkinsonism, dystonia or cognitive decline were not the clinical elements in these patients contrary to the cases that has been previously reported with the same variant, however, iron accumulation was evident in their cranial magnetic resonance imaging. The Moroccan patient was homozygous for a novel missense c.1786C>T, p.Leu596Phe variant and the Romanian patient had 2 novel mutations; c.1898C>T, p.Ala633Val and c.1765_1768del, p.Ser589ThrfsTer76. Both of these patients conformed better to childhood onset PLAN with the age of onset at 4 and 7 years, respectively. Interestingly, all identified mutations were affecting the highly conserved patatin-like phospholipase domain of the PLA2G6 protein.

A cone-beam computed tomography study of the root canal morphology of anterior teeth in a Turkish population

Objective:

The aim of this study was to determine the root and canal morphology of the maxillary and mandibular anterior teeth in a Turkish population by analyzing cone-beam computed tomography (CBCT) images.

Materials and Methods:

CBCT images of 417 females and 410 males with a mean age of ranging from 14 to 70 years were examined in this study. A total of 1453 maxillary central incisors, 1504 maxillary lateral incisors, 1523 maxillary canines, 1582 mandibular central incisors, 1603 mandibular lateral incisors, and 1604 mandibular canines were analyzed. The number of root canals and the canal configurations were investigated and then were classified according to Vertucci's classification. The data were analyzed with the Pearson Chi-square test.

Results:

The Type 1 canal configuration was most prevalent in the maxillary anterior teeth (96.8-99.7%). The Types 2, 3, 4, and 5 canal configurations were observed within the range of 0-1.3%, 0-0.8%, 0-0.7%, and 0-1.8%, respectively. In the mandibular anterior teeth, the Type 1 canal configuration was most prevalent (77-95%). The Types 2, 3, 4, and 5 canal configurations were observed within a range of 0.2-2.7%, 0.2-1.6%, 0.9-5.9%, and 1.8-14.4%, respectively. The prevalence of two canals was higher in males than in females both in the maxillary and mandibular anterior teeth (P < 0.05).

Conclusions:

Type 1 was the most prevalent canal configuration of maxillary and mandibular anterior teeth in the Turkish population. Type 5 was the most frequently observed canal configuration of the two canalled teeth. The incidence of root canal numbers and configurations differed with sex.

Evaluation of the root and canal morphology of mandibular permanent molars in a south-eastern Turkish population using cone-beam computed tomography

Objective:

The aim of this retrospective study was to determine the root and canal morphology of the mandibular first and second permanent molars in a Turkish population using cone-beam computed tomography (CBCT).

Materials and Methods:

CBCT images of mandibular first (n = 966) and second molar (n = 1165) teeth from 850 Turkish patients were evaluated. The root canal configurations were classified according to the method of Vertucci. The data were analyzed by Pearson's Chi-square test.

Results:

The majority of mandibular molars were two rooted with three canals; however, three roots were identified in 0.05% of the first molars and 0.01% of the second molars, and 100% of the additional root canals were of type I configuration. Mesial roots had more complex canal systems with more than one canal, whereas most distal roots had a type I configuration.

Conclusions:

Within the limitations of this study, it can be concluded that CBCT scanning provides supplemental information about the root canal configurations of mandibular molars in a Turkish population. This study may help clinicians in the root canal treatment of mandibular molars.

Evaluation of the relationship between the maxillary posterior teeth and the sinus floor using cone-beam computed tomography

AIM

The aim of this study was to evaluate the relationship between each root of maxillary premolars and molars and the maxillary sinus floor according to sex, sinus position, and age by decade in a Turkish population by using cone-beam computed tomography (CBCT) scanning.

METHODOLOGY

We evaluated a database of 5,166 (2,680 maxillary premolars and 2,486 maxillary molars) CBCT scans obtained from 849 patients. The vertical relationship between each root of the molar and premolar teeth to the sinus floor was classified into three types: type 1, the roots penetrated into the sinus floor; type 2, the roots contacted the sinus floor; and type 3, the roots extended below the sinus floor.

RESULTS

The results of the classification of each root in relationship to the sinus floor were as follows: type 3 occurred most frequently in the first (92.4 %) and second (71.6 %) premolar teeth, type 1 (34.2 %) occurred most frequently in the palatinal roots of the first molar teeth, type 3 occurred most frequently in the mesiobuccal (39.9 %) and distobuccal (39.7 %) roots of the first molar teeth, and type 2 (36.7 %) occurred most frequently in the mesiobuccal roots of the second molar teeth. No significant differences were found between the left and right sides, but several differences were found between males and females. The relationship between the posterior teeth and the sinus floor differed according to the age decade interval (p < 0.05).

CONCLUSIONS

The maxillary first premolars have no relationship with the maxillary sinus floor, but the maxillary second molars are closer to the sinus floor. Also the second decade and males were most susceptible to undesirable results.

Bacteriophage therapy in implant-related infections: an experimental study

BACKGROUND

Implant-related infections with bacteria resistant to multiple antibiotics represent one of the major problems in orthopaedic surgery. It was our hypothesis that local application of bacteriophages, which are bacteria-destroying viruses, would be effective against biofilm-forming bacteria.

METHODS

An implant-related infection model was created using methicillin-resistant Staphylococcus aureus (MRSA) in forty-eight rats and Pseudomonas aeruginosa in another forty-eight rats. Each group was divided into four subgroups; one subgroup received a bacterium-specific bacteriophage (Sb-1 in the MRSA group and PAT14 in the Pseudomonas aeruginosa group), one received antibiotic for fourteen days (20 mg/kg/day teicoplanin in the MRSA group, and 120 mg/kg/day imipenem + cilastatin and 25 mg/kg/day amikacin in the Pseudomonas group), one received antibiotic and bacteriophage, and one received no treatment. Animals receiving bacteriophage therapy were injected locally with 107 bacteriophages in a 0.1-mL suspension on three consecutive days. All animals were killed on the fifteenth day after initiation of treatment, and the tibia was excised. Results were assessed with use of microbiology, light microscopy, and electron microscopy.

RESULTS

In the MRSA group, the antibiotic administration significantly decreased the number of colony-forming units per subject in quantitative cultures (control subgroup, 50,586; bacteriophage, 30,788; antibiotic, 17,165; antibiotic + bacteriophage, 5000; p = 0.004 for the comparison of the latter group with the control). Biofilm was absent only in the antibiotic + bacteriophage subgroup. In the Pseudomonas group, the number of colony-forming units per subject in quantitative cultures was significantly lower in each treatment subgroup compared with the control subgroup (control subgroup, 14,749; bacteriophage, 6484 [p = 0.016]; antibiotic, 2619 [p = 0.01]; antibiotic + bacteriophage, 1705 [p < 0.001]). The value in the antibiotic + bacteriophage subgroup was also significantly lower than the values in the other subgroups (p = 0.006). Biofilm thickness did not differ significantly among the subgroups in the Pseudomonas group.

CONCLUSIONS

The addition of bacteriophage treatment to an appropriate antibiotic regimen helped to dissolve the biofilm of both types of bacteria studied. This effect on MRSA was more pronounced than that on Pseudomonas aeruginosa.

Underinvolved relationship disorder and related factors in a sample of young children

BACKGROUND AND AIMS

The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diagnosed with Underinvolved Relationship Disorder according to the DC:0-3R classification system.

STUDY DESIGN AND METHODS

Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0-3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder between the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent-Infant Relationship Global Assessment Scale (PIRGAS) scores of children.

RESULTS

Language delay, insufficient social interaction and aggression were found to be significantly more frequent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive Developmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psychosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent-infant relationship is poorer.

CONCLUSIONS

The diagnosis of Underinvolved Relationship Disorder according to the DC:0-3R classification system is related to some developmental and psychosocial problems.

Identifying and verifying causes of death in Turkey: National verbal autopsy survey

OBJECTIVES

The aim of this study was to identify the national, rural, and urban mortality rates, and to define the medical causes of death for the 0-28 days and 29 days-5 years age groups, as well as adult mortality in Turkey.

STUDY DESIGN

A cross-sectional survey, which identified the causes of death using the verbal autopsy(VA) method, and a methodological study, which determined the validity of the verbal autopsy method was used in conjunction with each other.

METHODS

The verbal autopsy method, based on a representative sampling according to age and gender in Turkey, was used. A methodological study was additionally used, which determined the validity of the VA method.

RESULTS

The crude death rate calculated from the VA survey was 0.51% with rates of 0.60% in males, 0.42% in females, 0.48% in urban areas, and 0.56% in rural areas. Life expectancy at birth was 72.6 years for males and 77.2 years for females. The mean life expectancy at birth for both sexes together was 74.8 years. The VA form has a high degree of validity although no study or form can take the place of a records-based surveillance system with accurate information; the VA form is a useful tool for collecting data during certain periods or specific areas. However, healthcare providers must work towards establishing a well-designed, routine surveillance system in the long term.

CONCLUSIONS

The mortality rates and life expectancies were consistent with other similar studies in the country and the Turkish VA method may be safely used to determine causes of death in countries with inadequate record and registry systems.

Anterior cruciate ligament reconstruction improves the metabolic energy cost of level walking at customary speeds

PURPOSE

The metabolic energy cost of walking is altered by pathological changes in gait. It is thought that anterior cruciate ligament (ACL) deficiency alters the energy requirement for level walking through its effect on gait pattern. In this study, it is hypothesised that the metabolic energy cost of walking would improve after ACL reconstruction.

METHODS

Eight patients who were undergoing ACL reconstruction for an isolated rupture were included in this prospective study. Clinical examinations, Lysholm scores and metabolic tests were performed preoperatively and at 3, 6 and 12 months after ACL reconstruction using autologous quadruple hamstring tendons. For the metabolic evaluation, net oxygen cost was calculated while walking on a treadmill at 50-, 70- and 90-m/min velocities. A two-way factorial ANOVA was performed in order to evaluate the primary effects and interactions of the time point and velocity variables on net oxygen cost.

RESULTS

All patients had positive Lachman and anterior drawer tests preoperatively that became negative postoperatively and remained negative until the last follow-up point. The mean preoperative Lysholm score was 66, whereas the mean postoperative follow-up scores were 85, 91 and 94, respectively. The interaction between follow-up time point and velocity was not significant. Regardless of the selected velocity, the net oxygen cost was lower than that at preoperative levels at each postoperative time point (p < 0.05).

CONCLUSION

The results of the present study indicate that the energy cost of level walking in chronic ACL-deficient patients improves after ACL reconstruction. Cause-effect-based studies with correlation evaluations that compare kinetic, kinematic and electromyographic data and metabolic cost calculations should facilitate more accurate analyses.

LEVEL OF EVIDENCE

Therapeutic study, Level 4.

Unilateral ptosis associated with paramedian thalamiic infarction

The paramedian artery arises from P1 segment of posterior cerebral artery and supplies a variable extent of thalamus but usually the dorsomedian, median, internal medullary lamina and the intralaminar nuclei. The typical clinical picture of unilateral paramedian thalamic infarctions consist of arousal and memory disorders, language or visuospatial disorders depending on the side of the lesion accompanied with gaze palsies and sensory-motor deficits. Ipsilateral ptosis associated with paramedian thalamic infarctions has been rarely reported. We report a 31 years old patient presenting with unilateral ptosis and right sided facial numbness associated with right paramedian thalamic infarction.

Forty-five-degree or higher insertion angles are required to penetrate the opposite cortex in bicortical applications of Kirschner wires: an in vitro study on sheep bones

PURPOSE

Slippage of the wires over the opposite cortex from the endosteal side is frequent and can lead to insufficient stability. This in vitro biomechanical study was planned to investigate the angle of wire insertion that leads to trans cortex perforation.

METHODS

Long bones of sheep were cut longitudinally into two pieces and half bones were stabilised on a frame. Three orthopaedic surgeons performed the experiment using ten wires of four different diameters at two different drilling speeds. Each wire was introduced from the endosteal side at angles starting at 30° in 5° increments until perforation. When perforation was achieved, the angle was recorded. To determinate the critical angle of perforation, receiver operating characteristic (ROC) curve analyses was performed. Two-way factorial analysis of variance (ANOVA) and Kruskal-Wallis tests were used for statistical comparisons.

RESULTS

Kirschner-wire insertion angles of ≥ 45° provided perforation with a percentage of 83.9 %. Wire diameter, drilling speed and surgeon variables had no effect on perforation angles (p > 0.05).

CONCLUSION

If preoperative evaluation of fractures to be fixed by K wires reveals the need for oblique wire insertion angle < 45°, a standard trocar-tip K wire application would lead to slippage of the wire tip on the endosteal surface of the opposite cortex. According to this study, the operative plan should be changed if such obliquity of the K wire is mandatory during bicortical applications.

A new upper extremity sparing non-weight bearing orthosis

OBJECTIVES

Axillary and forearm crutches are commonly utilized in the treatment of foot and ankle injuries. In order to decrease the energy expenditure during mobilization, to prevent upper extremity complications, and to let the upper extremity free for other usages, we designed a new orthosis. The study is conducted to compare walking energy parameters of this newly designed orthosis with the axillary and forearm crutches.

MATERIALS AND METHODS

10 healthy young male volunteers walked on treadmill with three different orthoses in randomized order. Oxygen expenditure, oxygen cost, rate of perceived exertion (Borg scale), and observer stability assessment were analyzed.

RESULTS

Concerning oxygen consumption, perceived exertion, and observer stability assessment, the new device was found superior to the other devices (P<0.05). The new orthosis was superior to forearm crutches concerning oxygen cost (P=0.027) but not significantly different from the axillary crutches (P=0.062).

DISCUSSION

Compared to frequently used orthoses, the developed device provides mobilization using less or similar amount of energy. Additionally it spares one upper extremity to be used for other activities.

Intrapelvic mass causing femoral compression neuropathy in a patient with Gaucher disease: a case report

Gaucher disease is a lysosomal storage disorder in which glucocerebroside accumulates within the macrophages in any part of the body. Varying degrees of skeletal involvement may occur besides anemia, coagulation abnormalities and hepatosplenomegaly. Most of the factors influencing the quality of life in a patient with Gaucher disease are related to bone involvement. Gaucher cell deposits may extrude through cortical erosions and cause soft tissue masses around bones which are involved by the disease. We present a 38-year-old female patient with Gaucher disease who had a large intrapelvic mass originating from left iliac bone causing femoral compression neuropathy. The classification of disease is based on neurological involvement and if symptoms exist whether the symptoms are acute or subacute. The neurological impairment caused by compression by a tumor should be distinguished from the ones reported in neurogenic forms of the disease.

Comparison of the efficacy of tigecycline and teicoplanin in an experimental methicillin-resistant Staphylococcus aureus osteomyelitis model

We evaluated the efficacy of tigecycline and teicoplanin in a rat model of MRSA osteomyelitis. Osteomyelitis was induced with an intramedullary injection of 10(8 )colony-forming units (cfu) of MRSA. After osteomyelitis formation was confirmed on Day 14, infected rats were randomly divided into three groups: tigecycline (n=13), teicoplanin (n=13), and no-treatment control (n=14). A 28-day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily) or intramuscular administration of teicoplanin (20 mg/kg daily) was administered. Rats were then sacrificed, and the tibias were harvested. The bones were weighed and then cultured. Our results indicated that bacterial growth was significantly reduced in teicoplanin and tigecycline groups, compared to the control group (p=0.019 and p=0.006, respectively). However, no difference was detected between the two antibiotic groups (p=1.000). No bacterial growth was detected in 7 out of 13 and 9 out of 13 specimens of the teicoplanin and tigecycline treated groups, respectively. Although this result was numerically in favor of tigecycline, the difference was not statistically significant (p=0.427). In conclusion, tigecycline, a novel antibiotic, appears as an effective alternative to teicoplanin in the treatment of osteomyelitis caused by MRSA.

A household study to determine attitudes and beliefs related to organ transplantation and donation: a pilot study in Yapracik Village, Ankara, Turkey

Rural areas display adverse attitudes toward organ donation. Through a population-based cross-sectional study of people 18 years of age or older in the rural area of Ankara, Yapracik Village, Turkey, we identified the attitudes and beliefs of people related to organ transplantation and organ donation. The research universe included 87 people in 75 households. The research instrument was a questionnaire. None of the respondents had been involved in organ donation. The percentage of willingness to donate an organ was 47% which was significantly associated with younger age, including 34.4% who expressed willingness while alive. Twenty-five percent believed that their religion is adverse to transplantation, 28% thought it would create pain in death, 20% were afraid, and 83% believed in life afterwards, 15% said that their custom and usage were adverse to organ donation, 50% stated that they can accept organ donation from other races, and 65% stated that they can request organs from their friends. Eighty percent thought that organ donation is a gift given to a human; 34% of them stated that they can be a donor while they are alive. Fifty-four percent of respondents stated that they wanted to get information about organ donation and transplantation. Therefore basic educational campaigns targeting the increase of knowledge about organ donation are warranted in the rural population. There is a need to increase awareness about organ donation and transplantation. Findings like those in this study will help campaigns conducted for organ donation.

Misoprostol enhances early fracture healing: a preliminary biochemical study on rats

The purpose of this study was to demonstrate if misoprostol, a methyl derivative of prostaglandin E1, enhanced fracture healing in 54 male adult Sprague-Dawley rats. The base level of serum alkaline phosphatase (ALP) in 6 randomly selected rats was measured. Rats were then randomly separated into 3 groups and their tibias fractured. First and second groups received misoprostol for 4 weeks, 100 and 300 microg/kg/day respectively via oral route. The third group had no misoprostol. p<0.05 was considered significant. Elevation of ALP level in the 2nd week was significant in group 1, it was not in group 2 or 3; in the 4th week it was significant in all groups. In conclusion dosage dependent osteoinductive effect of misoprostol was shown in the early bone healing period. Biochemical findings in the latter period did not show any inhibitory effect of misoprostol on bone healing. Further studies, probably biomechanical, may be required for the final verdict.

Fire resistance of Douglas fir (Pseudotsuga menzieesi) treated with borates and natural extractives

The objective of this study was to determine fire resistance of Douglas fir (Pseudotsuga menzieesi (Mirb.) Franco) specimens treated with borate supplemented aqueous solutions of brutia pine bark powder, acorn powder, sumach leaf powder, and gall-nut powder. Boric acid (BA) and borax (BX) were used as borates which are the most commonly used fire retardants in wood preservation industry. Natural extractives (brutia pine bark powder, sumach leaf powder, acorn powder, and gall-nut powder) were also used which have toxic efficiency against insects and fungi due to their tannin contents. A commercial treatment compound Tanalith-CBC (copper-borate-chromate), which is an impregnation chemical, is used for comparison. The fire test method was performed in three stages: flame stage, without flame stage, and glowing stage. Results indicated that the lowest temperature for flame stage, without flame stage, and glowing stage were obtained for specimens treated with BA and BX mixture (7:3; weight:weight). The lowest mass loss was found for the specimens treated with a mixture of BA and BX. Natural extractives did not improve fire resistance of the samples. However, boric acid and borax had excellent fire retardant effectiveness over untreated and treated samples with natural extractives.

Solid phase extractive preconcentration of trace metals using p-tert-butylcalix[4]arene-1,2-crown-4-anchored chloromethylated polymeric resin beads

5,11,17,23-Tetrakis(1,1-dimethylethyl)-25,26-dihydroxy-27,28-crown-4-calix[4]arene in the cone conformation was synthesized. This p-tert-butylcalix[4]arene-1,2-crown-4 compound was then anchored with Merrifield chloromethylated resin beads. The modified polymeric resin was characterized by (1)H NMR, FT-IR and elemental analysis and used successfully for the separation and preconcentration of Cu(II), Cd(II), Co(II), Ni(II) and Zn(II) prior to their determination by FAAS. Effective extraction conditions were optimized in both batch and column methods. The resin exhibits good separating ability with maximum between pH 6.0-7.0 for Cu(II), pH 6.0 for Cd(II), pH 5.0 for Co(II), pH 4.0-4.5 for Ni(II), and pH 4.5 for Zn(II). The elution studies were carried out with 0.5 mol L(-1) HCl for Cu(II), Co(II) and Co(II), 1.0 mol L(-1) HCl for Cd(II) and Zn(II). The sorption capacity, preconcentration factor and distribution coefficient of each metal ion were determined. The detection limits were 1.10, 1.25, 1.83, 1.68 and 2.01 microg L(-1) for Cu(II), Cd(II), Co(II), Ni(II) and Zn(II). The influence of several ions on the resin performance was also investigated. The validity of the proposed method was checked for these metal ions in NIST standard reference material 2709 (San Joaquin Soil) and 2711 (Montana Soil).

Amount of leachant and water absorption levels of wood treated with borates and water repellents

Wood protection efficacy of borates against biological agents, flame retardancy, and suitability to the environment is well known. Since borates can be applied to timber as water based solutions, they are preferred economically as well. Even though they are highly mobile in wood, boron compounds are widely used in timber preservation. Borates migrate in liquid and increase the hygroscopicity of wood in damp conditions. This study deals with the physical restriction of water access in wood by impregnating water repellent agents into wood to limit amount of leachant and water absorption levels of wood after boron treatment. Borates were incorporated with polyethylene glycol-400 (PEG-400) their bulking effect in wood was considered. Results indicated that the amount of leachates from wood treated with borates in PEG-400 was remarkably higher compared to those of wood treated with the aqueous solutions of borates. Water absorption (WA) levels of wood treated with aqueous solutions of borates were higher than those of their treated samples with the solutions in PEG-400. Secondary treatments of wood with the water repellent (WR) chemicals following borate impregnation reduced the leaching of chemicals from wood in water and also WA of the specimens were less than those of the wood treated with only borates from aqueous and PEG solutions. Styrene (St) was the most effective monomer among the other agents used in terms of immobility effect on borates and WA.

The effect of pentoxifylline in treatment of skin degloving injuries: an experimental study

BACKGROUND

Management of skin degloving injuries is still a problematic issue and the avulsed part of the skin may become necrotic. In this pilot study, we attempted to develop an experimental model for degloving injuries and investigated the efficacy of pentoxifylline, a well-known potent agent in enhancement of erythrocyte flexibility and tissue vascularization, in treatment of this injury model.

METHODS

Degloving injuries were created in 15 rats' tails by circular puncturing of the skin at the middle of the tail and then applying moderate force to avulse the skin from the underlying tissue. Then, the skin was repaired back to its original position. No treatment was given in the first group (n=6). In the second group (n=3), 0.4cm(3) physiological serum was administered intraperitoneally for 10 days. In the third group (n=6), intraperitoneal 25mg/kg pentoxifylline was administered for 10 days. Tails were observed daily for 21 days and then examined histopathologically.

RESULTS

At the end of the study, the avulsed segment of the skin became cyanotic and ulcerated in the first and the second group, and in the third group, the skin was intact. In histopathological examination, loss of superficial ephitelium and dense infiltration of inflammatory cells were seen in groups 1 and 2, and the skin layers were normal in the group 3.

CONCLUSION

Pentoxifylline improved tissue preservation and was proved to be highly beneficial in treatment of skin degloving injuries.

Histoacryl glue in meniscal repairs (a biomechanical study)

The purpose of this study was to investigate the biomechanical efficacy of Histoacryl (cyanoacrylate, N-asetil 2 butyl sistein) in meniscal tear repair. In our study, the primary stability of three different repair techniques in delaying the formation of a gap of 2 mm was investigated. A meniscal tear was repaired with two vertical sutures and Histoacryl in the first group; it was repaired only with Histoacryl in the second group, and with only two vertical sutures in the third group. Menisci were then placed in a tensile loading machine, and the primary stability of the repair zones was measured until a displacement of 2 mm occurred. Biomechanical force was significantly (P<0.05) high (112.0+/-17.20 N) in all groups when vertical suture and Histoacryl glue were used together during displacements of 0.5, 1.0, 1.5 and 2.0 mm. We believe that Histoacryl is superior to vertical sutures regarding gap delaying. It potentiates the effect of vertical suture strength, permits early motion and thus merits an in vivo study.

Early internal fracture fixation prevents bacterial translocation

The aim of our study was to determine whether early internal fixation of major bone fractures helps prevent bacterial translocation in patients with multitrauma. Thirty-seven Sprague-Dawley rats were divided into three groups: (1) anesthesia only (n = 12); (2) the trauma group: tibia and femur fractures and moderate head trauma under anesthesia (n = 14); and (3) the fixation group: fixation of tibia and femur fractures and moderate head trauma under anesthesia (n = 11). After 24 hours, mesenteric lymph nodes, liver, spleen, and systemic blood samples were quantitatively cultured. The terminal ileum was assessed histopathologically. The incidence of bacterial translocation was less in the anesthesia group (two of 12 rats) and the fixation group (two of 11 rats) than in the trauma group (10 of 14 rats). The number of organs containing viable bacteria was significantly lower in the fixation group than in the trauma group. Histopathologically, villous architecture was preserved mostly in the fixation group; however, marked mucosal damage was detected in the trauma group. Our data suggest early internal fixation of long bone fractures in polytraumatized experimental animals with head injury results in preservation of the intestinal mucosal barrier and decreased bacterial translocation from the gut.

Traumatic musculocutaneous neuropathy: a case report

Isolated injury of the musculocutaneous nerve is a rare disorder. Reported cases are claimed to present with loss of biceps and brachialis power without a disturbing pain. The injury generally occurs after strenuous exercise and could be demonstrated by electrophysiological examination. We report a case of musculocutaneous nerve injury which occurred after a vigorous push and which presented with unusual symptoms and findings. The patient complained of episodic severe pain attacks which started from the axilla and radiated over the musculocutaneous nerve distribution including the lateral antebrachial cutaneous nerve area. He did not respond to 3 months of conservative treatment including multiple corticosteroid injections and finally required surgical release. Surgical epineurotomy resulted in immediate relief. This is the first reported case of acute musculocutaneous nerve injury presenting with unusual symptoms and findings. The operative release procedure performed was also not required in any of the other reported cases. An excellent result was obtained with epineurotomy.

Effect of patient age and symptom duration on subjective and objective outcomes of carpal tunnel surgery

This study prospectively examined the relationship between patient age and symptom duration on surgical outcome of carpal tunnel syndrome. Surgical outcomes were evaluated using both subjective and objective measures and statistical analysis was performed using canonical analysis. The result revealed patient age and symptom duration have significant effects on bot subjective and objective outcomes of carpal tunnel surgery.

Nerve entrapment in painful heel syndrome

Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Nerve entrapment has been suggested as one of the possible causes of this painful condition in recalcitrant cases. The purpose of this study is to determine the role of nerve entrapment in painful heels. Twenty patients with heel pain (25 heels) were compared with an age and body mass index-matched control population using electrodiagnostic methods. The results of the study revealed 22 heels (88%) with heel pain had lateral plantar nerve entrapment signs with or without medial plantar nerve findings on EMG. There were no abnormal values in the control group. Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but this study suggests that it may play a role the early phases of painful heel syndrome.

The addition of sodium bicarbonate to prilocaine solution during i.v. regional anesthesia

A comparison of plain prilocaine and bicarbonated prilocaine in intravenous regional anesthesia was studied in 30 patients undergoing upper extremity surgery. The patients were divided into two groups: one group was given anesthesia in the form of 1% prilocaine and the other group was given 1% prilocaine plus sodium bicarbonate. The onset of analgesia and anesthesia and recovery from analgesia and anesthesia were investigated in both groups. Bicarbonated prilocaine produced faster onset of analgesia when compared with plain prilocaine (P less than 0.01). The onset of anesthesia and recovery from analgesia and anesthesia were not statistically different between the two groups. Clinically, the intensity of anesthesia was better when bicarbonated prilocaine solution was used instead of plain prilocaine. We conclude that bicarbonated prilocaine is better than plain prilocaine during IVRA.