Mehmet Albayrak

Background: Intervertebral disc degeneration (IVDD) is a major contributor to low back pain and disability worldwide. Increasing evidence suggests that vascular insufficiency plays a critical role in its pathogenesis; however, existing experimental models inadequately reproduce vascular-driven disc degeneration. To develop and histopathologically validate a novel unilateral three-level lumbar artery ligation model capable of inducing progressive vascular insufficiency–related IVDD in rats. Methods: Fifty-two Sprague-Dawley rats (26 males and 26 females) were randomly assigned to a sham-operated control group or to three experimental groups representing the acute (day 3), subacute (day 15), and chronic (week 8) stages following unilateral ligation of three consecutive lumbar arteries. Intervertebral discs (L4–L5) were analyzed using histopathological staining (Hematoxylin–Eosin and Safranin O/Fast Green). Disc morphology, nucleus pulposus (NP) and annulus fibrosus (AF) integrity, extracellular matrix composition, and disc height parameters were evaluated using a standardized histological scoring system and comprehensive morphometric analyses. Radiological disc height measurements were performed at the chronic stage. Results: Unilateral three-level lumbar artery ligation induced a clear, progressive, and time-dependent pattern of IVDD. Histopathological scores increased significantly from the acute to the chronic phase (p < 0.001), demonstrating gradual disruption of NP and AF architecture, marked loss of proteoglycan content, and progressive structural deterioration. Sex-based analysis revealed no statistically significant differences across time points, although a trend toward higher degeneration scores in females was observed at Week 8. Morphometric evaluation demonstrated region-specific (midline, right, and left) and time-dependent alterations in NP and AF heights (all p < 0.05). Although no significant side-to-side differences were observed during the acute and subacute stages (Day 3 and Week 2; all p > 0.05), NP height showed a trend toward reduction on the ligated side at Week 8 without reaching statistical significance (p = 0.076), whereas AF height was significantly reduced compared with the contralateral side (p = 0.001). Radiological assessments failed to detect significant bilateral differences, emphasizing the superior sensitivity of histopathological and morphometric analyses in identifying early and progressive degenerative changes. Conclusion: The proposed unilateral three-level lumbar artery ligation model successfully reproduces the acute, subacute, and chronic stages of IVDD through controlled vascular insufficiency. By avoiding direct mechanical damage to the intervertebral disc, this approach more closely reflects the stepwise pathophysiological evolution of vascular-related IVDD than conventional mechanistically induced models. This model demonstrates consistent and progressive degeneration at histopathological and morphometric levels, providing a robust, reproducible, and clinically relevant platform for investigating vascular contributions to IVDD and for the preclinical evaluation of regenerative and therapeutic strategies.

This study aimed to evaluate global research trends in scoliosis between 2000 and 2024 using latent Dirichlet allocation (LDA) topic modeling. English-language, peer-reviewed journal articles indexed in Scopus were analyzed using their titles, abstracts and keywords to identify dominant and relatively underrepresented research themes. The findings showed that surgery-related topics accounted for the largest thematic proportion of the scoliosis literature, whereas etiopathogenesis and genetic factors had limited structural representation. Artificial intelligence-related studies increased in recent years but remained primarily focused on radiological assessment, Cobb angle measurement and diagnostic applications. These results demonstrate an imbalance in the thematic distribution of scoliosis research; however, bibliometric frequency and topic proportion should not be interpreted as direct indicators of scientific quality or clinical importance. The findings may help researchers recognize areas that warrant further investigation, particularly etiological and genetic mechanisms. The application of artificial intelligence in genetics, precision medicine and treatment planning should be regarded as a potential direction for future research rather than an outcome directly demonstrated by the present analysis.

This study evaluates the effects of exenatide (EXE), a glucagon-like peptide-1 (GLP-1) receptor agonist, on bone healing in rats using a single radius cortical defect model and histopathological, biochemical, and in silico methods. Forty-two male Sprague–Dawley rats, excluding controls, were divided into 7 groups after receiving a standard radius defect. The serum levels of total protein (TP), calcium (Ca2+), phosphorus (P), alkaline phosphatase (ALP), osteocalcin (OC), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in each specimen were measured. Radius samples were examined histopathologically using hematoxylin and eosin (H&E) and Masson’s trichrome staining. Molecular docking analyses were used to assess EXE interactions with the GLP-1 receptor and osteogenic transcription factors. Statistical significance was set at p < 0.05. Changes in the selected serum markers were observed in the blood samples obtained from the specimens; however, these changes may not have been due to EXE administration. No significant negative effect on bone healing was observed in the groups that received subcutaneous EXE after the bone defect was created. By contrast, it was observed that for the treatment group that received EXE for 7 consecutive days before the bone defect was created on Day 7, bone healing progressed more slowly than in the groups treated with saline. Regarding the binding of EXE to the other target receptors, root mean square deviation (RMSD) values were low, bruised surface area (BSA) was high, and electrostatic interactions were strong, indicating that the ligand (i.e., EXE) binds to the selected receptor surfaces. Although the data obtained from the in vitro analyses in this study were verified using molecular docking, it should be noted that its design is preclinical. Given the widespread clinical use of GLP-1 receptor agonists in the management of type 2 diabetes mellitus (T2DM), our research findings may have translational relevance. Although derived from an experimental animal model, these results suggest that GLP-1 agonists such as EXE can exert additional effects on bone healing and inflammatory processes, thus warranting further studies, including controlled clinical investigations, to elucidate the potential implications for patient care.

This study aimed to investigate the effects of Lopinavir/Ritonavir (Lop/r) on chondrocyte structure and extracellular matrix (ECM) integrity, as well as its impact on key proteins involved in anabolic and catabolic pathways, using both in vitro and in silico approaches. Drug-target interaction networks were constructed through bioinformatics analyses, and molecular docking was performed. Human primary chondrocytes were treated with Lop/r, and untreated cells served as controls. Cell viability, proliferation, and protein expression levels were assessed using standard in vitro techniques, including spectrophotometric assays and Western blotting. Molecular docking analyses revealed strong binding affinities between Lop/r and osteoarthritis-related targets such as HIF-1α, EP300, TNF, IL-6, KCNA5, and IL-1β, suggesting modulation of hypoxia, inflammatory, and epigenetic pathways. In vitro, Lop/r did not alter chondrocyte morphology or ECM structure and was not cytotoxic (p < 0.05). However, it significantly reduced the expression of critical proteins including HIF-1α, SOX9, and IL-1β (p < 0.05). These findings suggest that Lop/r may exert regulatory effects on cartilage-related molecular pathways and holds promise as a repurposed therapeutic agent for osteoarthritis. Further studies are warranted to confirm its potential in clinical applications.

Introduction: Total knee arthroplasty (TKA) is a commonly performed surgical procedure for the treatment of advanced-stage knee osteoarthritis. This study aims to compare perioperative blood loss between tourniquet-assisted and tourniquet-free TKA using the reference change value (RCV), a personalized analytical tool that accounts for both biological and analytical variability. Materials and methods: A retrospective analysis was conducted on 137 patients (tourniquet group ( n = 68) and non-tourniquet group ( n = 69) who underwent primary TKA. Hematological parameters—including red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT)—were evaluated preoperatively, on the day of surgery, and on postoperative day one. Blood loss was assessed using both conventional statistical methods and RCV-based analysis. Results: No statistically significant differences were observed between the two groups in terms of age and gender ( p > 0.05). Although preoperative hemoglobin levels were significantly different between groups ( p < 0.05), there were no significant intergroup differences in pre- or postoperative RBC and HCT values. Traditional statistical analysis showed no significant difference in blood loss ( p > 0.05). However, RCV analysis revealed that while bleeding had stabilized by the first postoperative day in the non-tourniquet group, it remained significantly elevated in the tourniquet group. Conclusions: The findings suggest that RCV offers a more individualized and sensitive approach to assessing perioperative blood loss in TKA. Although conventional methods did not demonstrate significant differences, RCV analysis indicated a more rapid hemostatic response in the non-tourniquet group. Incorporating RCV into routine clinical practice may enhance patient-specific blood management and support earlier postoperative decision making.

Hallux valgus is a deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal, causing difficulty in walking and requiring various treatments. Despite its multifactorial etiology, the role of the tibialis anterior tendon in hallux valgus and its variations in the morphology of tibialis anterior tendon distal insertion sites have not been fully explored. This study aimed to evaluate the effect of such variations on hallux valgus using magnetic resonance imaging. This was a retrospective study and included 115 individuals aged 18 years and older who underwent foot radiographs and MRI. The participants were divided into a hallux valgus group of 53 patients and a control group of 62 people based on radiographic measurements. Tibialis anterior tendon distal attachment was classified into five types according to the attachment morphology. Statistical analyses were performed to evaluate the relationship between the tibialis anterior tendon types and hallux valgus severity. Among the participants, patients who underwent foot radiography and MRI due to any medical indication 70.4% were female, with a mean age of 43.83 ± 15.25 years. In terms of tibialis anterior tendon distal attachment, the most common type was Type 5 (40.9%), followed by Type 2 (34.8%). Type 4 was not observed in any case. In all participants, the mean hallux valgus angle was 20.63 ± 8.42o, and the mean intermetatarsal angle was 9.69 ± 2.68o. Tibialis anterior tendon distal attachment Type 5 was significantly associated with an increased hallux valgus angle but not with the intermetatarsal angle. We found a significant relationship between the diameter of the tibialis anterior tendon and hallux valgus angle. This study revealed a significant association between hallux valgus and Type 5 tibialis anterior tendon distal attachment, suggesting that tibialis anterior tendon morphology influences hallux valgus severity. The findings underscore the importance of considering variations in tibialis anterior tendon distal attachment sites in the etiopathogenesis and treatment planning of hallux valgus.

Objective: This study delves into the implications of adenoidectomy for scoliosis progression, investigating the intricate nexus of hypoxia, spinal curvature, and surgical intervention. With adenoidectomy being a common procedure for addressing pediatric sleep-disordered breathing, this research study explores its potential impact on spinal health. Patients and Methods: Employing a retrospective cohort design, this study gathered data from patients who underwent adenoidectomy, including those with scoliosis, between January 2017 and March 2023. Initial and follow-up evaluations involved clinical and radiological assessments, notably measuring the Cobb angle to quantify spinal curvature. Results: This study enrolled 218 patients under 10 years old. Among them, 18 exhibited Cobb angles of 10° or more, with a mean Cobb angle of 12.8°. In the follow-up evaluation, 83% of patients with initial Cobb angles of 10° or more were reached out to, along with 84.6% of those with Cobb angles below 10°. The postoperative follow-up revealed a notable decrease in Cobb angles for most patients, particularly those with an initial Cobb angle exceeding 10°. Conclusions: This study underscores the potential connection between adenoidectomy, hypoxia, and scoliosis regression, highlighting the importance of early intervention for scoliosis management. Despite certain limitations, this investigation lays the foundation for future research involving larger patient cohorts and multifaceted analyses. The observed interactions between airway function, hypoxia, and spinal health open avenues for refining clinical strategies in scoliosis treatment.

Aims: To retrospectively demonstrate the effect of patellar resurfacing (PR) on the clinical and functional outcomes of total knee arthroplasty (TKA). Methods: The files of 257 patients who presented to our clinic between 2013 and 2022 and underwent TKA due to the diagnosis of grade IV gonarthrosis were screened retrospectively. Thirty-two patients were excluded due to not attending regular follow-up, receiving steroid treatment, or being morbidly obese. The sample consisted of 225 patients, of whom 123 underwent PR (Group A) and 102 did not undergo PR (Group B). The Sperner classification was used to evaluate the level of patellar arthrosis. The effect of PR on postoperative clinical and functional outcomes in patients undergoing TKA was investigated using the WOMAC knee functional scoring and Visual Analog Scale (VAS) for clinical and functional evaluation at six, 12, and 24 months postoperatively. Results: The presence of anterior knee pain wasstatistically significantly lower in Group A than in Group B (p=0.0001). There was no statistically significant difference between the comorbidity distributions of the groups. The preoperative-to-postoperative changes in the mean VAS and WOMAC scores were statistically significantly higher in Group A compared to Group B (p=0.0001 for both). Conclusion: The implementation of PR in TKA may vary depending on countries, clinics, and even surgeons. In the current study, PR was found to contribute positively to the clinical and functional outcomes of patients by preventing complications such as anterior knee pain that may develop due to patellar arthrosis in the postoperative period.

Aim: The objective of the study was to compare the outcomes and patient satisfaction of two different anesthesia techniques; wide-awake-local anesthesia-no tourniquet (WALANT) and sedation anesthesia with a tourniquet, in open carpal tunnel release surgery for bilateral cases. Material and Methods: The study included 57 patients (41 female, 16 male) who underwent carpal tunnel release surgery between January 2016 and September 2021. The files were retrospectively evaluated and included in the present study. Patient evaluations were conducted using QuickDASH and Michigan Hand Outcomes Questionnaire scores before surgery, on the 15th day after suture removal, and at six months postoperatively. Surgical duration and complications were also recorded. Statistical analyses were performed to compare the outcomes between the two groups. Results: Both QDash and MHQ scores were analyzed for anesthesia effects on hands. The study's reliability was ensured by an 85% statistical power, 95% confidence level, and p