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Background: Implant material may influence interfragmentary mechanics in medial malleolar (MM) fracture fixation. This study aimed to compare stainless steel, titanium, magnesium, and PLGA screws under identical conditions using finite element analysis (FEA). Methods: A CT-based ankle model with a unilateral oblique MM fracture (θ = 60° to the medial tibial plafond) was fixed with two parallel M4 × 35 mm screws placed perpendicular to the fracture plane (inter-axial distance 13 mm). Contacts were defined as nonlinear frictional, and each screw was assigned a pretension force of 2.5 N. Static single-leg stance was simulated with physiologic tibia/fibula load sharing. Four scenarios differed only by screw material. Primary outputs were interfragmentary micromotion (maximum sliding and gap). Secondary measures included fracture interface contact/frictional stresses, screw/bone von Mises stress, global construct displacement, and average tibiotalar cartilage contact pressure. Results: Interfragmentary micromotion increased as screw stiffness decreased. Maximum sliding was 32.2–33.8 µm with stainless steel/titanium, 40.4 µm with magnesium, and 65.0 µm with PLGA; corresponding gaps were 31.2–32.0 µm with stainless steel and titanium, 31.2 µm with magnesium, and 54.1 µm with PLGA, respectively. Interface stresses followed the same pattern: contact pressure (3.18–3.24 MPa for stainless steel/titanium/magnesium vs. 4.29 MPa for PLGA); frictional stress (1.46–1.49 MPa vs. 1.98 MPa). Peak screw von Mises stress was highest in stainless steel (104.1 MPa), then titanium (73.4 MPa), magnesium (47.4 MPa), and PLGA (17.9 MPa). Global axial displacement (0.26–0.27 mm) and average tibiotalar cartilage contact pressure (0.73–0.75 MPa) were essentially unchanged across materials. All conditions remained below commonly cited thresholds for primary bone healing (gap < 100 µm); however, PLGA exhibited a reduced safety margin. Conclusions: Under identical geometry and loading conditions, titanium and stainless steel yielded the most favorable interfragmentary mechanics for oblique MM fixation; magnesium showed intermediate performane, and PLGA produced substantially greater micromotion and interface stresses. These findings support the use of metallic screws when maximal initial stability is required and suggest that magnesium may be a selective alternative when reducing secondary implant removal is prioritized.

Generalized Anxiety Disorder (GAD) is a chronic disease persisting for at least 6 months, characterized by excessive and continuous anxiety, which leads to evident problems and functional disorders. S100B is a glial protein that plays a role in intercellular communication regulating cell growth and differentiation, and intracellular signal transmission. This study aimed to analyze the serum S100B, 8-OHdG, and oxidative stress levels of patients newly diagnosed with GAD who had not started treatment, to better understand the underlying neurobiological basis of the etiology of GAD. Forty-four patients diagnosed with GAD according to DSM-5 diagnostic criteria and 44 healthy controls were included in the study. The Beck Anxiety Inventory (BAI) was used to determine the anxiety levels of the GAD patients. The serum S100B, 8-OHdG, total oxidant status (TOS), and total antioxidant status (TAS) levels were measured in the patient and control groups. The 8-OHdG values of the GAD group were determined to be statistically significantly higher than those of the control group ( =0.028). No significant difference was determined between the GAD patients and the control group in respect of the TAS, TOS, and oxidative stress index (OSI) values ( >0.05). The S100B levels of the GAD group were found to be higher than those of the control group. The results of this study showed that there could be DNA damage because of oxidative stress in GAD patients. There is a need for further studies to confirm the role of S100B protein in GAD etiology and pathogenesis.

Conversion Disorder (CD) is a complex neuropsychiatric condition in which stress-related biological changes are thought to play a role. The present study sought to assess oxidative imbalance and inflammation in patients with conversion disorder by examining thiol/disulfide homeostasis and CRP levels as potential biomarkers. Ninety-six patients diagnosed with Conversion Disorder according to DSM-5 criteria and ninety-six age- and sex-matched healthy controls were included. Psychiatric symptom severity was assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Native thiol (SH), total thiol, disulphide levels, and ratios were measured spectrophotometrically. CRP levels were determined by immunoturbidimetry. Mann-Whitney -test was applied as appropriate. Effect size calculations were performed and a post-hoc observed power analysis was conducted. Native thiol and total thiol levels were significantly lower in CD patients compared with controls whereas disulphide levels and disulphide/thiol ratios were significantly higher (all p < 0.001). Effect sizes were large (Native thiol: d = 0.97), and post-hoc power was adequate (>0.95). No differences were observed in demographic parameters between groups. CRP levels were elevated in the CD group (2.61 ± 0.276 vs 1.34 ± 0.227 mg/L, p<0.001). Our findings indicate that patients with Conversion Disorder may show oxidative imbalance together with elevated CRP levels, supporting the notion that redox and inflammatory pathways could be involved in the disorder's pathophysiology. Thiol/disulfide homeostasis and CRP might therefore represent peripheral biomarkers of interest, although the cross-sectional, single-center design and the restricted set of biomarkers assessed call for cautious interpretation of these results. This is the first study to concurrently evaluate TDH and CRP in CD.

Background The correct identification of the knee joint line is essential for successful primary and revision total knee arthroplasty (TKA). Small misalignments can cause restricted range of motion, patellofemoral maltracking, and extensor mechanism imbalance leading to pain and functional impairment. This study aimed to evaluate the reliability of five radiographic anatomical landmarks — the fibular head, inferior patellar pole, tibial tubercle, and both femoral epicondyles — for estimating the joint line level in healthy Turkish adults. Methods A retrospective radiographic analysis was conducted on 100 healthy adults (61 male, 39 female; 18–50 years). Perpendicular distances from these five bony landmarks to the joint line were measured digitally by two independent observers using a PACS system under standardized calibration to minimize projection errors. Inter-observer reliability was assessed by the intraclass correlation coefficient (ICC). Power analysis was based on the fibular-head–joint-line (FH–JL) distance as the primary outcome measure. Results The FH–JL distance measured 11.4 ± 1.8 mm with a coefficient of variation of 15.8%, showing the highest reliability. Sex-based differences were significant (11.8 mm in men vs. 10.7 mm in women, p  = 0.002). ICC values for all measurements ranged from 0.91 to 0.96, indicating excellent agreement between observers. No age-related differences were found ( p  = 0.835). The fibular head showed strong correlations with both epicondyles ( r  = 0.724 and r  = 0.689). Conclusion In healthy adults, the fibular head serves as a reliable radiologic landmark that may assist in joint line restoration during revision TKA, pending validation in clinical settings. The study also acknowledges its limitations of using plain radiographs and excluding the adductor tubercle as a reference point.

Factors affecting pain sensation are still being investigated. In this study, we aimed to examine the effects of sex, age, body mass index (BMI), somatosensory amplification, anxiety, and depression on the perception of pain. Venipuncture was performed on 140 healthy individuals. All the cases completed a sociodemographic data form, visual analog scale (VAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory, and Somatosensory Amplification Scale. Height and weight were also measured. When both the sexes were compared, there was no difference in terms of VAS, BMI, age, and Beck Depression Inventory, but Somatosensory Amplification Scale and BAI were found to be higher in females. A correlation was found among VAS points, BAI, and BMI. The results of a regression analysis show that the BAI score is a predictor for the VAS score. These results indicate that anxiety may be a predictor of pain, whereas sex, depression, somatosensory amplification, age, and weight do not appear to influence the perception of pain.

Background Tendinopathy is a common musculoskeletal condition associated with persistent pain and functional limitation. Although vitamin D deficiency has been widely implicated in musculoskeletal disorders, its association with clinical outcomes in tendinopathy remains incompletely understood. This study investigated the association between serum vitamin D levels, clinical severity of tendinopathy, and the effects of vitamin D supplementation. Methods This retrospective observational study included 350 patients with tendinopathy treated at a tertiary referral center between 2023 and 2025. Patients were classified into a vitamin D supplementation group ( n  = 221), receiving 50,000 IU weekly for 4 weeks followed by 2000 IU daily for 8 weeks, and a nonsupplemented group ( n  = 129). Pain intensity (VAS), functional status (0–100 scale), disease duration, chronicity, and ultrasonographic inflammation severity were evaluated. Results Patients with serum vitamin D levels below 20 ng/mL exhibited significantly higher pain scores (7.3 ± 1.2 vs. 5.7 ± 1.3, p  < 0.001), longer disease duration (8.2 vs. 4.1 months, p  < 0.001), and a higher prevalence of chronic tendinopathy (79.6% vs. 24.0%, p  < 0.001). Following supplementation, serum vitamin D levels increased from 14.2 to 38.4 ng/mL ( p  < 0.001), accompanied by significant reductions in pain and improvements in functional status compared with the nonsupplemented group ( p  < 0.001). Severe vitamin D deficiency (< 10 ng/mL) was independently associated with a sevenfold increased likelihood of severe and chronic tendinopathy (OR: 7.2, p  < 0.001). Conclusions Vitamin D deficiency is strongly associated with greater clinical severity and chronicity of tendinopathy. Vitamin D supplementation is associated with meaningful improvements in pain and functional outcomes, suggesting that vitamin D status represents a clinically relevant and potentially modifiable factor in tendinopathy management. Clinical trial registration Clinical trial number: not applicable. This study was a retrospective observational study and was, therefore, not registered as a clinical trial.

Purpose This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. Materials and methods A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. Results Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. Conclusions The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate.

To evaluate whether performing laparoscopic endometrioma surgery in the follicular or luteal phase affects changes in ovarian reserve. This prospective cohort study was conducted in a university-affiliated hospital. A total of 55 women who underwent unilateral laparoscopic endometrioma removal were included in the study. Of these, 28 were in the follicular phase of the menstrual cycle (follicular group), and 27 were in the luteal phase (luteal group). The primary outcomes were the rates of decreased anti-Mullerian hormone (AMH) levels and antral follicle counts (AFC) 6 months after the surgery, which were compared between the groups. The groups were similar in patient characteristics and endometrioma sizes. AMH levels and AFCs were significantly lower in the post-operative 6th month compared with their pre-operative values (  < 0.05 for both groups). The rate of decrease in AMH levels 6 months after the surgery was not significantly different between the follicular and luteal groups (24.5 and 19.5%, respectively,  > 0.05). Similarly, the rate of decrease in AFCs 6 months after the surgery did not differ between the groups (13.4 and 14.3%, respectively,  > 0.05). Performing laparoscopic endometrioma surgery, whether in the follicular or luteal phase, does not seem to affect the changes in the ovarian reserve. https://clinicaltrials.gov/study/NCT03484546, identifier NCT034845.

As the relationship between psychological stress and platelet activation has been widely studied in recent years, activated platelets lead to certain biochemical changes, which occur in the brain in patients with mental disorders. However, data relating to the mean platelet volume (MPV) in patients with panic disorder (PD) are both limited and controversial. Herein, we aimed to evaluate, for the first time, the red cell distribution width (RDW) levels combined with MPV levels in patients with PD. Between January 2012 and June 2015, data of 30 treatment-naïve patients (16 females, 14 males; mean age: 37±10 years; range: 18-59 years) who were diagnosed with PD and 25 age- and sex-matched healthy volunteers (10 females, 15 males; mean age: 36±13 years; range: 18-59 years) (control group) were retrospectively analyzed. The white blood cell count (WBC), MPV, and RDW levels were measured in both groups. The mean WBC, MPV, and RDW levels were 9,173.03±2,400.31/mm , 8.19±1.13 fl, and 12.47±1.14%, respectively, in the PD group. These values were found to be 7,090.24±1,032.61, 6.85±0.67, and 11.63±0.85, respectively, in the healthy controls. The WBC, MPV, and RDW levels were significantly higher in the patients with PD compared to the healthy controls ( =0.001, =0.001, and =0.003, respectively). However, there was no significant difference in the platelet number between the patients with PD and healthy controls ( >0.05). Our study results are the first to demonstrate that the RDW levels combined with MPV levels significantly increase among patients with PD. We believe that increased RDW and MPV levels can be used as a novel marker for PD.

To compare the successes of clomiphene citrate (CC) alone, pure human urinary follicle-stimulating hormone (uFSH) alone, and both combined sequentially in patients with unexplained subfertility couples undergoing intrauterine insemination (IUI). Patients aged 18-38 years who had a normal uterine cavity, at least one normal fallopian tube, and regular menses and were unable to conceive despite unprotected intercourse for at least 12 months were randomized to receive CC alone, uFSH alone, or sequential CC and uFSH before a single IUI. The primary outcomes were clinical pregnancy and live birth rates. The study was approved by the ethics committee of our institution. A total of 135 patients were randomized, and 121 of these were able to complete the study. Of these, 30% (n=36) had CC alone, 34% (n=41) had uFSH alone, and 36% (n=44) had sequential CC and uFSH. The three groups did not significantly differ in terms of age, duration of infertility, hormone levels, and semen parameters. For CC alone, uFSH alone, and sequential CC plus uFSH groups, pregnancy rates were 8.3%, 17.1%, and 18.2%, respectively (p>0.05), and live birth rates were 8.3%, 12.1%, and 13.6%, respectively (p>0.05). In women with unexplained infertility, use of uFSH seemed to increase the success rate compared with CC alone. The sequential regime can significantly reduce the treatment cost if gonadotropin/IUI cycles are planned.