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AimObesity and iron deficiency represent two of the most prevalent nutritional disorders worldwide. Obesity is accompanied by chronic low-grade inflammation, with elevated circulating levels of pro-inflammatory cytokines, particularly interleukin 6 (IL-6). Obesity-related inflammatory pathways promote hepatic hepcidin synthesis, with IL-6 serving as a central mediator of hepcidin transcription under inflammatory conditions. Hepcidin is the principal regulator of intestinal iron absorption, and its increased expression contributes to impaired iron availability in obese individuals. This study aimed to examine the association between obesity and iron deficiency and to clarify the role of hepcidin in iron homeostasis among obese children.Materials and MethodsThis case-control study enrolled 50 children with obesity [body mass index (BMI) >95th percentile] and 50 healthy non-obese children (BMI between the 5th and 95th percentiles), aged 8-18 years. The evaluated parameters included hemoglobin (Hb), mean corpuscular volume (MCV), serum iron, ferritin, total iron-binding capacity, transferrin saturation (TS), as well as serum hepcidin and IL-6 levels.ResultsObese children had significantly lower serum iron, Hb, MCV, ferritin, and TS (all p<0.05), and higher hepcidin and IL-6 levels (p=0.024 and p=0.032, respectively), compared to the controls. Hepcidin levels were directly correlated with IL-6 (p<0.001) and BMI standard deviation scores (p=0.019). Inverse correlations were observed between hepcidin and iron (p=0.024), hepcidin and Hb (p=0.001), and hepcidin and MCV (p=0.02).ConclusionChronic inflammation of obesity and elevated hepcidin levels result in the low iron states in obese children.

Background Subtrochanteric femur fractures are challenging to treat due to complex anatomy and high mechanical stresses. Cephalomedullary nailing is the standard treatment, often performed with the patient supine on a traction table, but this can prolong setup and cause complications (pressure or nerve injuries). Lateral decubitus positioning without a traction table may facilitate reduction and reduce traction-related risks, yet comparative data in subtrochanteric fractures are limited. This study compared outcomes of lateral decubitus versus traction table positioning for subtrochanteric fracture nailing. Methods A retrospective cohort study included 68 patients with subtrochanteric femur fractures treated with cephalomedullary nails. Patients underwent surgery supine on a traction table ( n  = 37) or in lateral decubitus without a traction table ( n  = 31). Operative metrics (entry point determination time, operative time, fluoroscopy duration, and blood loss) and postoperative outcomes (transfusion requirements, time to mobilization, complications, and final Harris Hip Score) were compared between groups. Results Lateral decubitus positioning was associated with shorter entry-point determination time (median 2 vs. 7 min; p  = 0.05), shorter operating-room time (80.3 ± 23.6 vs. 108.2 ± 23.2 min; p  = 0.03), reduced fluoroscopy time (151.2 ± 19.2 vs. 178.2 ± 16.1 s; p  = 0.03), and lower estimated blood loss (752 ± 346 vs. 1459 ± 611 mL; p  = 0.01) compared with traction-table positioning. No statistically significant differences were observed in transfusion requirements, time to mobilization, final Harris Hip Score, or complication rates (all p  > 0.05). Conclusion Compared with traction-table positioning, lateral decubitus cephalomedullary nailing was associated with better functional outcome, shorter operative and fluoroscopy times, and lower estimated blood loss, while union and complication rates were similar between groups. These findings suggest that lateral decubitus positioning is a viable alternative for subtrochanteric fracture fixation, particularly when traction-table setup may compromise operating-room efficiency. Given the observational design and potential confounding related to reduction techniques and surgeon factors, these findings should be interpreted as associations; prospective studies are warranted.

INTRODUCTION: Metacarpal fractures are one of the most common fractures. The primary goal in the post-operative rehabilitation of surgically treated metacarpal fractures is to bring the locomotor function of the relevant region closer to its pre-injury function. The aim of our study was to examine the effects of physical therapy and ergotherapy applications, which are initiated after the early period of plate osteosynthesis in metacarpal fractures, on the activity levels of daily life. METHODS: A post-operative rehabilitation program was started with 20 volunteers who had undergone an operation due to a metacarpal fracture. In the first stage, after pain control was achieved on the same post-operative day, patients were started with finger and wrist range of motion exercises. In the second stage, physical therapy exercises were given. In the third stage, the ergotherapy program was implemented. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Milliken Daily Living Activity, Assessment, and Hand Grip Strength Measurement Test were performed 3 times for each patient in the early post-operative period, after physical therapy, and after ergotherapy. RESULTS: In the evaluation of the DASH scores which were performed after the operation, after physical therapy, and after ergotherapy, the scores after ergotherapy were found to be statistically significant (p<0.001). In addition, when comparing the results of Milliken scoring and Hand Grip Strength Measurement Tests, the scores after ergotherapy were found to be statistically significant (p<0.001). DISCUSSION AND CONCLUSION: Three weeks of combined physical therapy and ergotherapy for surgically treated metacarpal fractures within 8–16 weeks post-operatively have been shown to have better functional outcomes, better grip strength, and higher efficacy compared to physiotherapy alone.

The detection of vital signs in complex environments using radar has a wide range of applications, from search and rescue to military purposes. Life detection can be achieved by detecting vital signs such as heartbeat, breathing, and movements of body parts. Because of the complex nature of the rubble environments, radar data contain clutter and noise that makes it difficult to detect signals with low amplitude levels, especially respiratory movements arised from breathing. In this study, data were collected with Stepped-Frequency Continuous Waveform (SFCW) radar for five scenarios in different environments. The method presented was used to determine whether living beings were in the environment. The data containing only vital signs was reconstructed using Singular Value Decomposition (SVD), and the range profile was obtained using the Multiple Signal Classification (MUSIC) algorithm. The range profiles of both the raw data and the data reconstructed with SVD were used to make the detections. The detections on the obtained range profile were later re-examined using Singular Spectrum Analysis to further reduce the false alarm rate. As a result of this process, data taken from different environments have shown that a decision can be made as to whether there is a vital sign in the environment.

This randomized controlled trial aimed to compare abdominal muscle thickness between intensive care patients and healthy controls, and to evaluate the impact of IMT on expiratory muscle thickness using ultrasound. In this single-blind randomized controlled trial, 20 post-extubation intensive care patients were randomly assigned to either an a conventional physiotherapy (CP) group or IMT + CP group. Both interventions were applied for five days. An additional 10 healthy individuals served as controls for comparison. Abdominal muscle thicknesses—including external oblique (EOA), internal oblique (IOA), transversus abdominis (TRA), and rectus abdominis (RA)—were measured using ultrasound. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were also recorded. At baseline, healthy controls had significantly higher MIP, MIP% predicted, MEP, MEP% predicted, and RA muscle thickness compared to both patient groups (p < 0.05). Following intervention, both IMT and CP groups showed significant improvements in MIP (p < 0.05), but only the IMT group demonstrated significant increases in MEP, MEP% predicted, IOA, and RA muscle thickness (p < 0.05). The IMT group showed significantly greater improvements in MIP, MEP, IOA, and RA muscle thickness compared to the CP group (p < 0.05). Post-extubation IMT may improve not only inspiratory but also expiratory muscle strength and abdominal wall thickness. These findings suggest that IMT could support weaning processes in intensive care, although larger studies are needed. •Rectus abdominis thickness, MIP, MIP% predicted, MEP and MEP% predicted are higher in the healthy individiuals than in ICU patients•IMT increasesinternal oblique and rectus abdominis thickness in respiratory ICU patients.•IMT improves both MIP,MEPand predict

Purpose Children under 3 years old represent a notable portion, about 25 to 30%, of all central nervous system tumor (CNS) cases. Their clinical course, prognosis, and treatment significantly differ from older children. This single-center retrospective study aims to comprehensively analyze survival factors in children under three diagnosed with CNS tumors. Methods Between April 2012 and December 2023, cases under 3 years of age with CNS tumors diagnosed at our center were retrospectively evaluated. Results Among 279 CNS tumor cases, 42 (15%) were evaluated. The 5-year overall and event-free survival rates were 67.4% (95% CI 47.5–81.1) and 39.8% (95% CI 24.2–55.0), respectively. Gender, symptom onset to diagnosis time, pathological neurological findings at diagnosis, and tumor location did not significantly impact survival ( p  > 0.05). However, cases with neurological symptoms showed significantly higher event-free survival rates ( p  < 0.05). Patients with embryonal tumors, metastases, inability for total surgical excision, relapsed/progressive diseases, and who under 1 year old had significantly lower survival rates ( p  < 0.05). Radiotherapy timing did not affect survival ( p  > 0.05). Event-free survival rates remained unchanged after the third year. Conclusion The current treatments have been observed to have a positive impact on survival rates. Nonetheless, there is a need for novel treatments for patients with embryonal tumors, metastases, aged under 1 year, and those where total surgical excision is not feasible or in cases with progressive/relapse disease. This study underscores the importance of the first 3 years regarding relapse, progression, or mortality risk.

Amaç: Bu çalışmanın amacı, erken post-travmatik nöbeti önlenmede levetirasetamın ve fenitoinin etkinliğini karşılaştırmak ve klinik nöbet insidansını belirlemektir. Gereç ve Yöntem: Çalışmaya orta-şiddetli travmatik beyin hasarı tanısı alan, nörogörüntülemede beyin hasarı ile uyumlu bulgusu olan erişkin hastalar dahil edildi. Hastalar nöbet profilaksisi için uygulanan antiepileptik ilaca göre fenitoin grubu ve levetirasetam grubu olmak üzere iki gruba ayrıldı. Bulgular: Ocak 2012 ile Haziran 2017 arasında 100 travmatik beyin hasarlı hasta bu çalışmaya dahil edilme kriterlerini karşıladı. Nöbet profilaksisi, bu hastaların 60’ında fenitoin ve 40’ında levetirasetam ile sağlandı. Erken post-travmatik nöbet insidansı ise %8 idi. Gruplar arasında erken post-travmatik nöbet oranı açısından anlamlı farklılık saptanmadı (p>0,05). Travmatik beyin hasarı sonrası klinik nöbet insidansı %10 idi. Sonuç: Bu rapor, post-travmatik nöbet profilaksisinde levetirasetamın ve fenitoinin benzer etkinliğe sahip olduğunu gösterdi. Çalışmamız retrospektif bir tasarımda olmasına rağmen iki grup yaş, cinsiyet, travma mekanizması, nörogörüntüleme bulguları, Glasgow koma skoru, Marshall skoru ve akut fizyoloji ve kronik sağlık değerlendirmesi-II skorunu açısından benzer özelliklere sahipti. Bu bulgular, nöbet açısından fenitoin ve levetirasetamı karşılaştırılmayı güvenilir kılmaktadır. Objective: This study aimed to compare the efficacy of levetiracetam versus phenytoin in early post-traumatic seizure prevention and ascertain the incidence of clinical seizures in traumatic brain injury (TBI). Materials and Methods: Adult patients with moderate to severe TBI in the neuroimaging consistent with brain injury were included in the study. Patients were categorized into two groups, the phenytoin or levetiracetam groups, based on the administration of antiepileptic drugs for seizure prophylaxis. Results: In this study, 100 patients with TBI met the inclusion criteria between January 2012 and June 2017, wherein 60 received seizure prophylaxis with phenytoin, and 40 with levetiracetam. The incidence of early post-traumatic seizure was 8%, without significant differences between groups (p>0.05). The incidence of clinical seizures after TBI was 10%. Conclusion: This report showed that levetiracetam and phenytoin had similar efficacy in posttraumatic seizure prophylaxis. This retrospective study design improved the reliability of comparison between phenytoin and levetiracetam for seizures in the two groups with similar features in terms of age, sex, injury mechanism, neuroimaging findings, and Glasgow coma, Marshall, and acute physiology and chronic health evaluation-II scores.

INTRODUCTION: We evaluated the functional results of open and mini open surgical approaches in carpal tunnel syndrome patients. METHODS: Group 1 was undergone open surgery while Group 2 patients were operated by mini open technique. Clinical results were evaluated with patient satisfaction questionnaire, daily activities and grip strength. RESULTS: Twenty-eight patients were male and 63 were female. There were 13 male and 29 female with a total of 42 patients in Group 1, whereas 15 male and 34 female with a total of 49 patients were present in Group 2. Daily activity score was 13.86±1.00 for open group and 13.61±0.98 for Group 2. Grip strength was 0.27±0.07 bar in Group 1 and 0.31±0.09 bar in Group 2. There was no significant difference between two groups regarding to age, sex, operation site, daily activity scores, and grip strength. Surgical time was 18.05±1.78 minutes in Group 1 and 13.18±1.52 min in Group 2. Return to daily activity was 16.17±2.07 day in Group 1 and 12.53±1.80 day in Group 2. Surgery time and time to activity return is statistically significantly higher in open surgery group compared to mini-open group. Patient satisfaction score was 87.60±2.63 in Group 1 and 87.60±2.63 in Group 2. Patient satisfaction questionnaire result was statistically higher for mini-open group compared to Group 1. DISCUSSION AND CONCLUSION: In tandem with similar functional results, mini-open surgery can be preferred in callous hand, while open surgery is more suitable to patients with serious thenar atrophy along with suspicion of median nerve compression.

INTRODUCTION: Malreduction of the syndesmosis is associated with a poor prognosis; recent studies have focused on identifying intraoperative radiological parameters to prevent this phenomenon. Our study aimed to determine easily applicable and reproducible radiological parameters from magnetic resonance image (MRI)-based cross-sectional image analysis in determining the ideal trans-syndesmotic angle (TSA) and syndesmotic fixation axis (SFA). METHODS: A total of 120 ankle MRI scans without osseous/ligamentous injury were performed blindly by an orthopedist and a radiologist. Talar anterior tangent and talar axis line (TAL) were determined by cross-sectional measurements. The bisector of the anterior and posterior tangents of the syndesmotic joint was determined by the SFA, and the TSA was determined by the intersection of SFA and TAL. RESULTS: The average TSA was 16–17°. The SFA was between 28%±6.6% and 30%±5.7% anterior to the anteroposterior distance of the tibia laterally and the fibular apex medially. The intraclass correlation coefficient (ICC) range for measurements obtained by observer 1 was 0.600–0.882, while that for those obtained by observer 2 was 0.565-0.904. Interobserver agreement was between 0.589 and 0.901; reliability was acceptable for this new set of measurements. DISCUSSION AND CONCLUSION: Our measurements showed that the ideal TSA was between 16° and 17°, and SFA was located between the fibular apex laterally and the anterior third of the tibia medially. All parameters to be applied should be evaluated on a true lateral radiograph of the ankle because rotation will affect the TSA and the appearance of the SFA in a two-dimensional image.

Purpose: The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman’s stage IIIB Kienböck’s disease. Methods: The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18–54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. Results: The mean follow-up period was 17.33 ± 4.69 months (range: 12–24 months), mean operation time was 56.67 ± 12.5 min (range: 45–75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2–6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28–37%) and mean VAS score was 7.6 (range: 7–8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63–81%) and mean VAS score was recorded as 1.4 (range: 1–2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. Conclusion: Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.