[Show abstract][Hide abstract] ABSTRACT: Background
Implant-related osteomyelitis (IRO) is recently controlled with local antibiotic delivery systems to overcome conventional therapy disadvantages. In vivo evaluation of such systems is however too little.Questions/purposesWe asked whether vancomycin (V)-containing poly-l-lactic acid/ß-tricalcium phosphate (PLLA/ß-TCP) composites control experimental IRO and promote bone healing in vivo.Methods
Fifty-six rats were distributed to five groups in this longitudinal controlled study. Experimental IRO was established at tibiae by injecting methicillin-resistant Staphylococcus aureus (MRSA) suspensions with titanium particles in 32 rats. Vancomycin-free PLLA/ß-TCP composites were implanted into the normal and infected tibiae, whereas V-PLLA/ß-TCP composites and coated (C)-V-PLLA/ß-TCP composites were implanted into IRO sites. Sham-operated tibiae established the control group. Radiological and histological scores were quantified with microbiological findings on weeks 1 and 6.ResultsIRO is resolved in the CV- and the V-PLLA/ß-TCP groups but not in the PLLA/ß-TCP group. MRSA was not isolated in the CV- and the V-PLLA/ß-TCP groups at all times whereas the bacteria were present in the PLLA/ß-TCP group. Radiological signs secondary to infection are improved from 10.9¿±¿0.9 to 3.0¿±¿0.3 in the V-PLLA/ß-TCP group but remained constant in the PLLA/ß-TCP group. Histology scores are improved from 24.7¿±¿6.5 to 17.6¿±¿4.8 and from 27.6¿±¿7.9 to 32.4¿±¿8.9 in the CV-PLLA/ß-TCP and the V-PLLA/ß-TCP groups, respectively. New bone was formed in all the PLLA/ß-TCP group at weeks 1 and 6.ConclusionsCV- and V-PLLA/ß-TCP composites controlled experimental IRO and promoted bone healing.Clinical relevanceCV- and V-PLLA/ß-TCP composites have the potential of controlling experimental IRO and promoting bone healing.
Journal of Orthopaedic Surgery and Research 11/2014; 9(1):114. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine outcomes following arthroscopic Bankart repair with the focus on strength after the repair.
56 shoulders with Bankart lesion were operated on arthroscopically. Gender, mechanism of the first dislocation, number of dislocations, dominant side, operated side and the number of anchors used for surgery were recorded. DASH and Oxford instability scoring systems were applied preoperatively and compared to scores at the 24-month follow-up. The scoring systems were also applied to contralateral shoulders at the 24th month of follow-up. Range of motion was measured with a goniometer. Muscle strength was analyzed with a dynamometer simultaneously with the muscle activity of four perishoulder muscles. The data were recorded with surface EMG. Range of motion, muscle strength and activity were evaluated according to the contralateral shoulder at the 24th month of follow-up.
Male/female ratio was 42/14 with a mean age of 32 years. The mean number of dislocations was 3 ± 1 and all were traumatic dislocations. The number of mean anchors used was 3.1 and the mean follow-up period was 24 months. In clinical evaluation, the preoperative and postoperative results of the DASH and Oxford instability scores of the unstable shoulders were significantly different. In the comparison between the operated and contralateral shoulders, there was no significant difference in DASH and Oxford instability scores at the 24th month of follow-up. There was no significant loss of range of motion. Only internal rotation strength was significantly reduced and there was no significant change in the EMG patterns.
Although good clinical results can be achieved, internal rotation strength is reduced after arthroscopic surgery, but daily activities are not affected. There is no guarantee for patients of excellent recovery.
Level III cohort study.
Archives of Orthopaedic and Trauma Surgery 10/2013; 133(12). · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Aim. The purpose of this study was to investigate proliferation, morphology, mineralization and mRNA expressions of mineralized tissue associated proteins of PDL cells on smooth (S), sandblasted small-grit (SSG), sandblasted large-grit (SLG) and sodium titanate (NaTi) coated titanium alloys, in vitro. Methods and materials: PDL cells were cultured with DMEM media containing 10% FBS on the S, SSG, SLG and NaTi titanium surfaces. PDL cell proliferation, mineralization and immunohistochemistry experiments for Bone Sialoprotein (BSP) were performed. The morphology of the PDL cells was examined using confocal and scanning electron microscopy (SEM). Gene expression profiles of cells were evaluated using a quantitative-polymerase chain reaction (Q-PCR) for type I collagen (COL I), Osteocalcin (OCN), osteopontin (OPN) and Runt-related transcription factor-2 (Runx2) on days 7 and 14. Results. Proliferation results on days 6 and 10 were similar in groups, while those of day 13 revealed a decrease in the NaTi group when compared to the S group. NaTi surface induced BSP mRNA expression which was correlated with mineralization tests and BSP immunostaining results. Increased Runx2 mRNA expression was also noted in the NaTi surface when compared to other surfaces. Conclusions. This study considers the NaTi surface as a potential alternative to SSG and SLG surfaces. This surface might provide a promising environment for PDL ligament-anchored implants.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Acute effects of physical exercise on the deformational behaviour of articular cartilage and changes in cartilage oligomeric matrix protein (COMP) are definite. However, conclusive positive effects of fitness exercise on functional adaptation of articular cartilage have not been proved. AIM: Therefore, in this parallel-group randomised controlled trial, we tested the hypothesis that adequate amount of physical exercise with enough impact would be able to stimulate the functional behaviour of articular cartilage. METHODS: We evaluated 44 healthy males for their physical-fitness levels and their blood samples were obtained before, immediately after and 0.5h after a 30-min walking exercise. Thereafter, participants were assigned to the running, the cycling, the swimming and the control groups. At the end of 12weeks of intervention, the same measurement procedures were applied. Mixed repeated-measures analysis of variance (ANOVA) design was used for statistics. (Level of evidence: 2). RESULTS: Pre-test measurements showed that 30min of walking significantly increased serum-COMP levels in all groups. The post-tests revealed that the COMP level of all groups, except running, showed an increase after a 30-min walking activity. CONCLUSION: Overall, it was concluded that, 12weeks of regular, weight-bearing, high-impact physical exercise (i.e., running) decreases the deformational effect of walking activity. This finding is an evidence of functional adaptation of articular cartilage to specific environmental requirements.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Bioceramics are currently in use to cover bone defects in orthopedics and craniofacial surgery. But their compatibility and efficacy in cranium were not investigated in detail. The aims of this study were to produce, characterize, and assess the biocompatibility and osteointegration of Si-HA, Si-Sr-HA, HA-Wollastonite, and HA-Wollastonite-Frit bioceramics. Methods: Bioceramics were implanted into the burr holes of 14 craniotomy patients who were followed up from three to 24 months. Radiologic and scintigraphic examinations were performed. Results: Osteoblastic activity quantified by scintigraphy increased from 6.865 to 22.991±1.682 from four to eight months in the HA-Woll group. Adding fritt into HA-Woll decreased osteoblastic activity at 10 months. Si-Sr-HA displayed significantly higher osteoblastic activity when compared to the craniotomy site at 12 months. The scintigraphic ratio of the bioceramic implanted regions to the craniotomy sites varied between 1.10 and 1.57. Osteoblast formation and establishment of the trabecular pattern of bone was observed in the surroundings of bioceramics in two patients. Conclusion: These bioceramics can be safely used to cover the burr holes of craniotomy patients, as well as to close the cranial bone defects.
Journal of applied biomaterials & functional materials. 06/2012;
[Show abstract][Hide abstract] ABSTRACT: Rhythm training is an integral part of sports. The purposes of the study were to analyze the effects of rhythm training on tennis performance and rhytmic competence of tennis players, to compare the improvement levels of tennis specific and general rhythm training and to examine the effects of shorter and longer tempos on rhythmic competence. Thirty university students whose mean score of International Tennis Number (ITN) was 7.3 (±0.9) were divided randomly into three sub-groups: Tennis Group, General Rhythm Training Group and Tennis-Specific Rhythm Training Group. The experimental procedure lasted 8 weeks. During this period, all groups had the same tennis training twice a week. The Tennis Group had regular tennis training sessions. In addition to regular tennis training sessions, the General Rhythm Training Group followed the general rhythm training sessions and the Tennis-Specific Rhythm Training Group had tennis-specific rhythm training. The measurement instruments were ITN, Rhythmic Competence Analysis Test and Untimed Consecutive Rally Test. The results indicated that participation in tennis-specific or general rhythm training resulted in progress in tennis playing levels, forehand consistency performance and rhythmic competence of the participants. On the other hand, attendance to the regular 8-week tennis training was enough to solely increase the tennis playing level but not sufficient to develop forehand consistency performance and rhythmic competence. Although the participants in the TRTG had better improvement scores than the ones in the GRTG, no significant difference was found between the rhythm training groups. The results also revealed that participants exhibited higher rhythmic competence scores on fast tempo compared to slow tempo.
Journal of Human Kinetics 06/2012; 33:123-32. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: mRNA expressions related to osteogenic differentiation of MC3T3-E1 cells on electro-polished smooth (S), sandblasted small-grit (SSG) and sandblasted large-grit (SLG) surfaces of titanium alloys were investigated in vitro. Gene expression profiles of cells were evaluated using the RT2 Profiler PCR microarray on day 7. Mineralizing tissue-associated proteins, differentiation factors and extracellular matrix enzymes mRNA expressions were measured using Q-PCR. SLG surface upregulated 23 genes over twofolds and downregulated 3 genes when compared to the S surface. In comparison to the SSG surface, at least a twofold increase in 25 genes was observed in the SLG surface. BSP, OCN, OPN, COL I and ALP mRNA expressions increased in the SLG group when compared to the S and the SSG groups. BMP-2, BMP-6 and TGF-β mRNA expressions increased in both the SSG and the SLG surfaces. MMP-2 and MMP-9 mRNA expressions increased as the surface roughness increased. This study demonstrated that surface roughness of titanium implants has a significant effect on cellular behavior and SLG surface apparently increased gene expressions related to osteogenesis when compared to the S and the SSG surfaces.
[Show abstract][Hide abstract] ABSTRACT: Osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) often requires surgery and prolonged systemic antibiotic treatment. Local antibiotic delivery systems of bioceramics or polymers have been developed to treat osteomyelitis. A disadvantage of biodegradable polymers is the initial burst of antibiotics into the environment; one advantage of bioceramics is its osteoconductivity. We therefore developed a vancomycin-containing poly-l-lactic acid/β-tricalcium phosphate (PLLA/β-TCP) composite to control antibiotic release and stimulate bone formation.
We (1) characterized these composites, (2) assessed vancomycin release in inhibitory doses, and (3) determined whether they would permit cell adhesion, proliferation, and mineralization in vitro.
We molded 250 vancomycin-containing (VC) and 125 vancomycin-free (VUC) composites using PLLA, β-TCP, and chloroform. One hundred twenty-five VC composites were further dip-coated with PLLA (CVC) to delay antibiotic release. Composites were characterized according to their pore structure, size, volume, density, and surface area. Vancomycin release and bioactivity were determined. Adhesion, proliferation, and mineralization were assessed for two and three replicates on Days 3 and 7 with mesenchymal stem (MSC) and Saos type 2 cells.
Pore size, volume, apparent density, and surface area of the CVC were 3.5 ± 1.9 μm, 0.005 ± 0.002 cm(3)/g, 1.18 g/cm(3) and 3.68 m(2)/g, respectively. CVC released 1.71 ± 0.13 mg (63.1%) and 2.49 ± 0.64 mg (91.9%) of its vancomycin on Day 1 and Week 6, respectively. MSC and Saos type 2 cells attached and proliferated on composites on Days 3 and 7.
Vancomycin-containing PLLA/β-TCP composites release antibiotics in inhibitory doses after dip coating and appeared biocompatible based on adhesion, proliferation, and mineralization.
Vancomycin-containing PLLA/β-TCP composites may be useful for controlling MRSA but will require in vivo confirmation.
Clinical Orthopaedics and Related Research 09/2011; 469(11):3222-8. · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Skeletal muscles deteriorate after ovariectomy. Molecular pathway of this deterioration has not been defined. Tumor necrosis factor (TNF)-alpha activation is assumed to trigger muscle atrophy and administration of its antagonist is hypothesized to recover this atrophy in rats. Slow-twitch soleus and fast-twitch extensor digitorum longus muscle functions were investigated in intact, ovariectomized (OVX), and OVX plus 10 µg/g/week TNF-alpha antagonist administered female rats. Maximum isometric twitch and tetanic contraction responses were lower in the OVX groups. Maximum isometric twitch amplitudes recovered in the extensor digitorum longus but not in the soleus muscles after TNF-alpha antagonist administration. The decrease in responses to tetanic stimulations recovered in the OVX-TNF group at frequencies higher than 20 Hz in both muscle types. OVX animals body weight was 21% higher than intact animals. Muscle weight to body weight ratios of the OVX groups were higher than the control group which recovered after TNF-alpha antagonist administration. Findings suggest that the functional loss in OVX rat muscles is TNF-alpha pathway dependent. Skeletal muscle atrophy and function after OVX recovered by TNF-alpha antagonist administration.
Journal of Orthopaedic Research 02/2011; 29(2):275-80. · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Vibration analysis is a promising technique in diagnosing metabolic bone diseases such as osteoporosis and monitoring fracture healing. The aim of this study is to observe the structural dynamic property changes of the tibia extracted from the vibration analysis data.
In this study, bone mineral density and vibration measurements were made both in in vivo and in vitro conditions. The relationship between structural dynamic properties, obtained and bone mineral densities measured were investigated. Also, the effect of soft tissues on measured structural dynamic properties was analyzed.
Natural frequency of the tibia decreased with decreasing bone mineral density that presented a weak correlation with the bone mineral density values measured by dual energy X-ray densitometer of the femur. In the case of in vitro experiments, it was observed that the effect of muscles on measurement results is higher than that of the effect of the skin and the fibula which makes the modal identification procedure difficult. However, having very large percentage changes in the loss factors when mineral content and collagen are reduced is an encouraging result to believe that damping measurements may yield a promising technique in diagnosing progressing osteoporosis and monitoring fracture healing period.
The utilization of natural frequency alone as a diagnosing tool does not seem to be a sufficient method although there is a correlation between this parameter and bone mineral density. However, in vitro experiments showed that the identification of the loss factor is a promising technique in diagnosing progressing osteoporosis.
[Show abstract][Hide abstract] ABSTRACT: Fatigue is an indispensible part of a basketball game which may affect an athlete’s shooting kinematics. Although
kinematic analyses of various sports related movements were extensively done, this study is the first to consider the
effects of fatigue on the kinematics of free throw shooting. After measuring the resting heart rate, ten collegiate level,
male basketball players (21.8±1.6 y; 192.8±3.6 cm; 84.1±8.5 kg) were asked to perform free throws. Two successful
and two unsuccessful free throws were selected. Thereafter, participants were asked to complete the fatigue protocol,
which included 30m sprints and 5 vertical jumps at each end, until they reached volitional exhaustion. Additional
two successful and two unsuccessful free throws were collected. All shots were recorded by using two digital cameras operating at 60 Hz and placed in a stereoscopic view. The elbow, trunk, knee and ankle joint angles were measured before and after the ball release and at the ball release point. The selected joint angles were compared between
successful and unsuccessful free throws, as well as before and after the completion of fatigue protocol. The results
demonstrated that fatigue did not effect free throw shooting kinematics (p>0.05) and there was no significant joint
angle difference between successful and unsuccessful shots (p>0.05). This study suggested that high level athletes
are able to cope with the possible detrimental effects of fatigue while performing coordinated movements such as free
Journal of Human Kinetics 01/2010; 24:51-56. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With an aging population the frequency of postmenopausal fractures is increasing. Methods to enhance the repair of osteoporotic bone repair therefore become more important to reduce the society burden of care. We asked if absorbable collagen sponges containing recombinant human bone morphogenetic protein-2 (rhBMP-2) have the potential to enhance bone repair. We randomly assigned 40 rats into the ovariectomy and sham operation groups. A segmental defect was created in the right tibia 12 weeks after ovariectomy. rhBMP-2-containing absorbable collagen sponges were implanted into the defect in half of the animals in each group. We analyzed radiographs and histological sections and performed three-point bending tests to assess repair. Radiological scores in the rhBMP-2 applied rats were higher than those in controls at the end of 8 weeks after tibial osteotomy. The specimens failed under higher loads in the rhBMP-2-applied groups and histology revealed a higher fracture healing score, including callus formation, bone union, marrow changes, and cortex remodeling. We observed no adverse tissue responses such as fibrous connective tissue formation and inflammatory cellular infiltration. rhBMP-2 in absorbable collagen sponges enhanced bone repair in segmental tibial defects of ovariectomized rats. The sponges with rhBMP-2 appeared to enhance bone repair.
Clinical Orthopaedics and Related Research 09/2009; 467(12):3113-20. · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we compared the simple methods of skinfolds, ultrasound, and bioelectrical impedance analysis (BIA) against the standard of dual-energy X-ray absorptiometry (DEXA) in the assessment of body fat in normoactive Turkish male and female university students. We wished to develop new regression equations to more accurately predict percent body fat from skinfolds and ultrasound for this group of individuals. One hundred and four male (age 22.2±2.5 years; height 1.77±0.06 m; mass 74.9±10.4 kg) and one hundred and four female (age 21.9±1.9 years; height 1.65±0.06 m; mass 55.6±7.9 kg) students aged 18–26 years participated in the study. Analysis of variance and confidence intervals were used to compare mean percent body fat derived from skinfolds, ultrasound, BIA, and DEXA measurements, while intra-class correlation coefficients and Pearson correlation coefficients were used to evaluate the strength of the relationship between the methods. Bland and Altman plot analysis was used to evaluate the strength of agreement of the three methods with DEXA. Moreover, multiple regression analyses were conducted to develop new regression equations to predict percent body fat from subcutaneous fat thickness measured at three sites. The accuracy of the predictive equations was assessed by a cross-validation test. Mean percent body fat derived from DEXA (18.5±6.2% for males, 28.4±1.3% for females) was found to be significantly (p
European Journal of Sport Science 05/2009; 9(3):181-190. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: The purpose of this study was to investigate proliferation, morphology, mineralization and mRNA expression of mineralized tissue associated proteins of human periodontal ligament (PDL) cells on smooth (S), sandblasted small-grit (SSG), sanblasted large-grit (SLG) and sodium titanate (NaTi) coated titanium alloys in vitro.
Materials and Methods: PDL cells were obtained from premolar teeth extracted for orthodontic reasons. PDL cells were cultured with DMEM containing 10% FBS on the S, SSG, SLG, and NaTi titanium surfaces. PDL cell proliferation on days 2, 6, 10 and 13 and mineralization by von Kossa staining in vitro on day 30 were assessed comparatively for different surfaces. The morphology of the PDL cells was examined by using confocal and scanning electron microscopy (SEM). PDL cells on each surface were evaluated for gene expression profile using semi quantitative-Reverse Transcriptase Polymerase Chain Reaction for type I collagen (COL I), Bone sialoprotein (BSP), Osteocalcin (OCN), and osteopontin (OPN) on day 7.
Results: In the present study, we observed that all surfaces were biocompatible with PDL cells. More mineralized nodules were noted in NaTi group when compared to other groups. In proliferation experiments, while in a short time period (days 2 and 6) there was no apparent difference among the groups, in long time period (day 10 and 13) decreased proliferation rate was observed in NaTi group when compared to smooth surface. Correlating proliferation and mineralization results with mRNA expression for mineralized tissue-associated markers, NaTi surface induced BSP mRNA expression consistent with immuno-histochemical staining for BSP of PDL cells.
Conclusion: This study demonstrated that NaTi surface favors the attachment, and mineralization of PDL cells and this surface may provide a promising environment for the PDL cells by regulating proliferation rate, morphology and differentiation of PDL cells to osteoblasts( This study was supported by TUBITAK-SBAG/3130).