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Şimşek AT, Baysal B, Adam BE, Çalış F, Topçam A, Demirkol M, Doğan MB, Binguler AHE, Karaarslan N, Balak N. Morphological changes after open lumbar microdiscectomy at 2-year follow-up. J Back Musculoskelet Rehabil 2024; 37:75-87. [PMID: 37599519 DOI: 10.3233/bmr-220371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. OBJECTIVE The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. METHODS In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. RESULTS A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3 mm and 15.7 mm before and after surgery, respectively (p= 0.062), while the left FHs were 14.8 mm and 15.8 mm before and after surgery (p= 0.271). The mean right SFW was 5.4 mm before surgery and 5.7 mm after surgery, while the mean right IFW ranged from 3.6 mm to 3.9 mm. The mean left SFW was 4.8 mm before surgery and 5.2 mm after surgery, while the mean left IFW ranged from 3.5 mm to 3.9 mm. Before surgery, the FAs were, on average, 77.1 mm2 and 75.6 mm2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0 mm2 and 80.2 mm2 on the right and left sides, respectively. CONCLUSIONS Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups.
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Affiliation(s)
- Abdullah Talha Şimşek
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Begümhan Baysal
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Baha Eldin Adam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatih Çalış
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Arda Topçam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Demirkol
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Bilal Doğan
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Hande Erol Binguler
- Department of Industrial Engineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Istanbul Haliç University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Yilmaz I, Akalan H, Karaarslan N, Yasar Sirin D, Kaplan N, Dogan M, Ozbek H, Ates O. Can transcription factors in the intervertebral disc of lopinavir/ritonavir prevent degeneration in the nucleus pulposus by mediating the regulation of inflammation through signaling pathways? Eur Rev Med Pharmacol Sci 2022; 26:6845-6855. [PMID: 36196733 DOI: 10.26355/eurrev_202209_29788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study was conducted to examine whether lopinavir/ritonavir (Lop/r), an HIV protease inhibitor, can improve disc physiology and slow down intervertebral disc (IVD) degeneration through in vitro experimental methods, as well as whether it can suppress inflammation with interleukin-1 beta (IL-1β) and sex-determining region Y (SRY) protein-related high-mobility group box genes-9 (SOX9) through hypoxia-inducible factor 1-alpha (HIF-1α) and the nuclear factor kappa B (NF-κB) signaling pathway. The aim was to investigate whether Lop/r application is toxic to IVD cells and the microenvironment simultaneously. PATIENTS AND METHODS Human primary cell cultures were prepared using herniated IVD tissues obtained from patients with lumbar disc hernia who were unresponsive to conservative and medical treatment, and thereby, were operated on. The untreated culture samples served as control group, and the samples treated with Lop/r served as study group. Microscopic evaluations were performed simultaneously using fluorescent and supravital dyes in all groups. In addition to cell viability, toxicity, and proliferation analysis through a commercial kit, IL-1β, SOX9, HIF-1α, and NF-κB protein expressions were evaluated using Western blotting. In the statistical comparison of the obtained data, an alpha value less than 0.05 was considered significant. RESULTS Cell proliferation decreased in the Lop/r group, but no cell death was observed (p < 0.05). Moreover, at the end of 72 hours after Lop/r application, IL-1β and NF-kB protein expressions decreased by 40% and 52%, respectively, while HIF-1α and SOX9 protein expressions increased by 4% and 59%, respectively (p< 0.05). CONCLUSIONS Although these data were obtained from an in vitro experimental study, it is believed that these findings could make significant contributions to the pharmaco-regenerative treatment modalities of IVD degeneration. Lop/r suppresses the IL-1β and NF-κB and induces SOX9 and HIF-1α, since these signaling pathways may be related to human IVD degeneration.
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Affiliation(s)
- I Yilmaz
- Unit of Pharmacovigilance and Rational Use of Drugs, Republic of Turkey, Ministry of Health, Dr. Ismail Fehmi Cumalıoglu City Hospital, Tekirdag, Turkey.
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Yilmaz İ, Karaarslan N, Somay H, Ozbek H, Ates O. Curcumin-Impregnated Drug Delivery Systems May Show Promise in the Treatment of Diseases Secondary to Traumatic Brain Injury: Systematic Review. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221112479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a major social health problem, especially in young adults, and progresses with advanced functional losses. In this study, curcumin was directed to the damaged brain tissue by crossing the blood–brain barrier through drug delivery systems. Thus, the study asked whether it can be effective in the treatment of TBI, which has not had a radical treatment method in clinics yet. Methods A comprehensive and systematic literature search in the PubMed electronic database was performed. Descriptive statistics were used to evaluate the data obtained. The results were presented as frequency and percentage (%) or amount. Results Two clinical trials investigated curcumin for the treatment of TBI. One study tested curcumin in living mammalian subjects using an amyloLipid nanovesicle. In three studies, curcumin was investigated together with the drug delivery system for the treatment of TBI. Conclusion Drug delivery systems prepared with nanomaterials may have a potential therapeutic effect in treating TBI by increasing neuroprotection because they can penetrate the central nervous system more rapidly.
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Affiliation(s)
- İbrahim Yilmaz
- Ministry of Health, Dr Ismail Fehmi Cumalioglu City Hospital, Unit of Pharmacovigilance and Rational Use of Drugs, Tekirdag, Turkey
- Department of Medical Services and Techniques, Vocational School of Health Services, Istanbul Rumeli University, Istanbul, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Halic University School of Medicine, Istanbul, Istanbul, Turkey
| | - Hakan Somay
- Department of Neurosurgery, Kadikoy Medicana Hospital, Istanbul, Istanbul, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, İzmir Bakırçay University School of Medicine, Izmir, Izmir, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Istanbul Koc University School of Medicine, Istanbul, Istanbul, Turkey
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Yilmaz I, Akalan H, Oznam K, Karaarslan N, Yasar Sirin D, Ozbek H. Does oseltamivir protect human chondrocyte and nucleus pulposus cells from degeneration by inhibiting senescence and proinflammation mediated by the NLRP3 inflammasome and NF-κB? Eur Rev Med Pharmacol Sci 2022; 26:4816-4827. [PMID: 35856374 DOI: 10.26355/eurrev_202207_29207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Recent drug design studies suggest that inflammation is among the most important factors in the development of both intervertebral disc (IVD) degeneration (IVDD) and osteoarthritis (OA) due to cartilage damage. This study aimed to investigate whether the anti-inflammatory drug oseltamivir has a toxic effect on IVD and cartilage tissue cells. It assessed what effect oseltamivir has on hypoxia-inducible factor (HIF)-1 alpha (HIF1α), which plays an important role in anabolic pathways in IVD and cartilage tissue. In addition, the study analyzed whether oseltamivir could inhibit the release of inflammatory interleukin-1 beta (IL-1β) via the nuclear factor kappa-B (NF-κB) signaling pathway by activating the nucleotide-binding oligomerization domain and leucine-rich repeat protein-3 (NLRP3) inflammasome. MATERIALS AND METHODS Human lumbar IVD (n = 8) tissues were isolated for annulus fibrosus (AF) and nucleus pulposus (NP) primary cell cultures, and human tibial and femoral cartilage tissues (n = 8) were isolated for primary chondrocyte cultures. Untreated groups served as the control and oseltamivir-treated groups as the study sample. Cell viability and cytotoxicity were evaluated at 0, 24, 48, and 72 h in all groups for changes in HIF-1α, IL-1β, NF-κB, and the NLRP3-inflammasome protein expressions using Western blotting. The α significance value was < 0.05. RESULTS In the oseltamivir-treated groups, cell proliferation decreased in both AF/NP cell and chondrocyte cultures obtained from IVD cartilage tissues. After Western blotting analysis, changes were observed in the protein expressions of HIF-1α, IL-1β, NF-κB, and the NLRP3 inflammasome in both AF/NP cells and chondrocytes. The results were statistically significant (p < 0.05). CONCLUSIONS Oseltamivir treatment may be a promising regenerative strategy to manage IVDD and osteoarthritic cartilage tissues.
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Affiliation(s)
- I Yilmaz
- Department of Pharmacovigilance, Republic of Turkey, Ministry of Health, Doctor Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey.
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Ates O, Yilmaz I, Karaarslan N, Ersoz E, Hacioglu Kasim FB, Dogan M, Ozbek H. Coexistence of SARS-CoV-2 and cerebrovascular diseases: does COVID-19 positivity trigger cerebrovascular pathologies? J Infect Dev Ctries 2022; 16:981-992. [PMID: 35797292 DOI: 10.3855/jidc.15800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/27/2022] [Indexed: 10/31/2022] Open
Abstract
The objectives of this study were to determine the prevalence of cerebrovascular diseases caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to assess the pharmacological agents used in such cases as reported in the literature. Patient files were retrospectively scanned to determine the prevalence of neurological symptoms of the central nervous system (headache, dizziness, lack of smell and taste, numbness in arms and legs, change in consciousness, muscle weakness, loss of urine and stool control) and cerebrovascular diseases (ischemic cerebrovascular diseases, cerebral venous sinus thrombosis, intracerebral hemorrhage, subarachnoid/subdural hemorrhage) in 2019 novel coronavirus (2019-nCoV) disease (COVID-19) cases (n = 20,099). The diagnostic laboratory, radiology examinations and treatments applied to these cases were recorded. The data from studies presenting cerebrovascular diseases associated with SARS-Cov-2, which constituted 0.035% of all cases, were systematically evaluated from electronic databases. During the treatment of cerebrovascular diseases, it was discovered that high doses of enoxaparin sodium anti-Xa are combined with apixaban or acetylsalicylic acid or clopidogrel or piracetam, and mannitol, in addition to SARS-CoV-2 treatment modalities. While neurological symptoms of the central nervous system are uncommon in cases of SARS-CoV-2 infection, cerebrovascular diseases are far less common, according to the findings of this study. Acute cerebral ischemia was discovered to be the most common cerebrovascular disease associated with SARS-CoV-2. The mortality rate increases with the association between SARS-CoV-2 and cerebrovascular disease.
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Affiliation(s)
- Ozkan Ates
- Department of Neurosurgery, Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Ibrahim Yilmaz
- Unit of Pharmacovigilance, Republic of Turkey, Ministry of Health, City Hospital, Tekirdag, Turkey.
| | - Numan Karaarslan
- Department of Neurosurgery, Halic University School of Medicine, Istanbul, Turkey
| | - Emel Ersoz
- Clinics of Neurology, Republic of Turkey, Ministry of Health, Doctor Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Fatma Bahar Hacioglu Kasim
- Clinics of Radiology, Republic of Turkey, Ministry of Health, Doctor Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
| | - Mustafa Dogan
- Department of Infection Diseases, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Izmir Bakircay University School of Medicine, Izmir, Turkey
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Yilmaz I, Akalan H, Yasar Sirin D, Karaarslan N, Kaplan N, Ozbek H. Effects of an acetylcholinesterase inhibitor and an N-methyl-D-aspartate receptor antagonist on inflammation and degeneration of the nucleus pulposus. Eur Rev Med Pharmacol Sci 2022; 26:4409-4419. [PMID: 35776042 DOI: 10.26355/eurrev_202206_29080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The study aimed to examine the effects of two drugs, an acetylcholinesterase inhibitor (AChEI) and an N-methyl-D-aspartate receptor (NMDAR) antagonist, on degenerated annulus fibrosus (AF) and nucleus pulposus (NP) cells and the extracellular matrix (ECM) structure in vitro. PATIENTS AND METHODS Tissue samples were obtained from patients with intervertebral disc herniation (four males and four females; classified as Pfirmann stage IV) and used to prepare cell cultures. Untreated cell culture samples served as the control group. Study group samples were treated with donepezil, memantine or a combination of the two drugs. Cell viability, toxicity and proliferation were evaluated in all groups. Western blotting was used to examine changes in protein expression of signal transducer and activator of transcription 3 (STAT3), phospho-STAT3 (ser727), hypoxia-inducible factor (HIF)-1 alpha (HIF-1α) and nucleotide-binding oligomerisation domain (NOD) leucine-rich repeat (LRR)-containing proteins (NLR) family pyrin domain containing 3 (NLRP3) inflammasome. The alpha significance value was < 0.05. RESULTS Analysis of the microscopy and commercial kit results revealed that cell proliferation was suppressed, and no cell death was observed. The protein expression levels of NLRP3, STAT3, ser727 and HIF-1α were lower in the samples treated with donepezil and memantine at 72 h (p < 0.05). The protein expression levels of NLRP3, STAT3, ser727 and HIF-1α were higher in the samples treated with the combination of donepezil and memantine (p < 0.05). CONCLUSIONS The combined administration of memantine a NMDAR antagonist which can prevent neurodegeneration and donepezil an AChEI used for pain relief increased the protein expression levels in the anabolic pathway. However, it did not reduce the protein expression levels in the catabolic pathway. Therefore, further studies are needed to provide extensive insight into whether it may be among the potential targets for the therapy of intervertebral disc (IVD) diseases.
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Affiliation(s)
- I Yilmaz
- Republic of Turkey, Ministry of Health, Dr. Ismail Fehmi Cumalioglu City Hospital, Unit of Pharmacovigilance and Rational Use of Drugs, Tekirdag, Turkey.
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Yilmaz I, Karaarslan N. Examining the effects of HMG-CoA reductase inhibitors on anabolic and catabolic signaling pathway proteins associated with degenerative disc disease. Eur Rev Med Pharmacol Sci 2022; 26:2990-3000. [PMID: 35503599 DOI: 10.26355/eurrev_202204_28630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recent evidence suggests that statins, among lipid-lowering drugs, can be used to lower serum cholesterol levels for reducing the risk of cardiovascular disease in individuals with high cholesterol, as well as reducing DNA damage and having anti-ageing and pleiotropic effects. Additionally, nuclear factor kappa B (NF-κB) is reported to be suppressed in statin-administered nucleus pulposus (NP) cells for the prevention of interleukin (IL) -1 beta (IL-1β)-induced apoptosis and extracellular matrix (ECM) degradation. The purpose of this study is the examine whether it is possible for pharmacological synthetic statin agents added into primary cell cultures obtained from human intervertebral disc tissue (IVD) to stop and eliminate tissue degeneration through the anabolic/catabolic signaling pathways associated with inflammation. MATERIALS AND METHODS Pitavastatin and rosuvastatin were added to monolayer grown human primary annulus fibrosus (AF)/NP cells. Cytotoxicity and proliferation analyses were carried out. AF/NP cells and ECM structure were also examined microscopically. In addition, changes in transcription factors and protein expressions of proinflammatory cytokines, which play important roles in anabolic and catabolic pathways associated with inflammation, were analyzed. RESULTS Decreased proliferation and cell necrosis were observed at the end of 72 hours in the samples, in which statins were added, compared to the samples in the control group to which no pharmacological agent was administered. In addition to this, changes were observed in the expressions of proteins. All results were statistically significant (p<0.05). CONCLUSIONS To better understand the regenerative effects of these two pharmacological agents on degenerated AF/NP cells, there is an urgent need for prospective studies in which different signaling pathways and receptors on these pathways are investigated, apart from IL-1β; NF-κB signaling pathway and SOX9.
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Affiliation(s)
- I Yilmaz
- Unit of Pharmacovigilance, and Rational Use of Drugs, Republic of Turkey, Ministry of Health, Dr. Ismail Fehmi Cumalioglu Hospital, Tekirdag, Turkey.
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Yilmaz I, Akalan H, Sirin Yasar D, Karaarslan N, Ozbek H, Ates O. Is favipiravir a potential therapeutic agent in the treatment of intervertebral disc degeneration by suppressing autophagy and apoptosis? Turk Neurosurg 2022; 32:680-687. [DOI: 10.5137/1019-5149.jtn.38252-22.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Caliskan T, Akalan H, Yilmaz I, Karaarslan N, Sirin DY, Ozbek H. The effects of rivaroxaban, an oral anticoagulant, on human IVD primary cultures. Arch Med Sci 2022; 18:1062-1070. [PMID: 35832710 PMCID: PMC9266726 DOI: 10.5114/aoms/136323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/02/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The present study aimed to investigate the potential effects of rivaroxaban, an oral anticoagulant that inhibits the effects of factor Xa, on intact intervertebral disc tissue cells and the extracellular matrix (ECM). MATERIAL AND METHODS Rivaroxaban was applied to primary human cell cultures prepared from tissues of the intervertebral disc. Comparative molecular analyses were performed on non-drug-treated control group samples. Descriptive statistics were presented as the mean ± standard deviation. An analysis of variance test was performed to determine whether there were significant differences in the mean across the groups. When differences across groups were observed, Tukey's honestly significant difference post-hoc test was used for multiple pairwise comparisons. The significance of the obtained data was determined statistically. The α significance value was < 0.05. RESULTS The cells in the control group and in the rivaroxaban-treated group were viable, healthy, and proliferated (p < 0.05). However, the expression levels of the chondroadherin gene (CHAD), cartilage oligo matrix protein (COMP), matrix metalloproteinase (MMP)-13, and MMP-19 genes were changed (p < 0.05). CONCLUSIONS Although rivaroxaban does not suppress cell proliferation due to morphological, biological, and biochemical changes in the intervertebral disc tissue, it may change the expression of genes that are related to ECM maintenance.
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Affiliation(s)
- Tezcan Caliskan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Hande Akalan
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Halic University, Istanbul, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Bakircay University School of Medicine, Izmir, Turkey
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Aydin I, Yasar Sirin D, Karaarslan N, Ozbek H. Investigation of the Potential Effects of Alpha-Lipoic Acid on Human Degenerated Intervertebral Disc Tissue Primary Cell Cultures. Turk Neurosurg 2021; 32:420-429. [PMID: 35147963 DOI: 10.5137/1019-5149.jtn.34917-21.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM In this study, alpha-lipoic acid (ALA) supplementation was investigated at the molecular level to determine its effect on primary cell cultures prepared from human intervertebral disc (IVD) tissue in an in vitro environment. MATERIAL AND METHODS Human primary cell cultures were prepared from IVD tissue resected during surgery. While cell cultures without ALA supplementation formed the control group, those with ALA supplementation formed the study group. All cell groups were stained using acridine orange/propidium iodide (AO/PI), and the incidence of apoptotic cell death was determined under a fluorescent microscope. Cell surface morphology and extracellular matrix (ECM) structures were evaluated under an invert light microscope. Simultaneously, cell proliferation was evaluated by MTT-ELISA analysis, and the expressions of chondroadherin (CHAD), cartilage oligomeric protein (COMP), interleukin-1 beta (IL-1β), and matrix metalloproteinase (MMP)-7 and-19, which are genes associated with ECM regulation, were tested using qRT-PCR. The data obtained were evaluated statistically using Tukey's honestly significant difference (HSD) test after analysis of variance (ANOVA) was performed. The alpha significance value was accepted as .05. RESULTS Compared to the cells in the control group, it was observed that both proliferation was suppressed and ECM structures deteriorated in the cells in the study group. CONCLUSION Also, it was reported that the all-gene expression levels changed. ALA supplementation can negatively affect human IVD primary cell cultures in an in vitro environment.
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Affiliation(s)
- Irfan Aydin
- Istanbul Medipol University School of Medicine, Medical Pharmacology, Istanbul, Turkey
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Somay H, Bolukbasi AB, Karaarslan N, Berkman ZM. A Study on Assessment of the Effectiveness of the Surgical Methods Used for the Treatment of Patients with Cervical Spondylosis. Turk Neurosurg 2021; 32:261-270. [PMID: 34859830 DOI: 10.5137/1019-5149.jtn.33981-21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The present study retrospectively evaluated the preoperative and postoperative clinical and radiological findings of patients (n = 32) treated surgically for cervical spondylosis (n = 32). The factors affecting early postoperative recovery rates and the preferred surgical approach's effects on early recovery rates and lordosis angles were examined in light of the literature. MATERIAL AND METHODS The patients included in the study (n = 32) were divided into three groups according to their preferred surgical approach. These surgical approaches are posterior cervical laminectomy, posterior cervical laminectomy plus fusion, and anterior approach. Then, pre-and postoperative modified Japanese Orthopaedic Association Myelopathy (mJOA) scores, Torg-Pavlov ratios measured on direct cervical radiography, and pre-and postoperative lordosis angles were recorded. The data obtained were evaluated statistically. RESULTS The radiological examinations revealed that the average preoperative Torg-Pavlov ratio was 1 in 29 patients. The average sagittal spinal canal diameter was 9 mm, and myelomalacia was detected in 25 patients. Postoperative mJOA scores in patients who underwent anterior corpectomy and fusion and posterior laminectomy were statistically significant (P 0.05). The highest symptomatic recovery rate was found in patients with preoperative neck pain. This finding was not statistically significant (P 0.05). Changes in the postoperative lordosis angles and recovery rates were also observed, depending on the preferred surgical approach. CONCLUSION If there is no kyphotic deformity or straightening of the cervical lordosis, a posterior laminectomy can be performed to avoid the long-term complications caused by an anterior corpectomy. It should be kept in mind that multi-segment and wide laminectomies may cause instability problems.
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Affiliation(s)
- Hakan Somay
- Kadikoy Medicana Hospital, Clinics of Neurosurgery, Istanbul, Turkey
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Karaarslan N, Yilmaz I, Akgun FS, Caliskan T, Ozbek H, Ates O. Systematic Evaluation of Desmopressin Administered to Patients with Aneurysmal Subarachnoid Hemorrhage in the Light of the Literature. Turk Neurosurg 2021; 30:787-792. [PMID: 29694665 DOI: 10.5137/1019-5149.jtn.23064-18.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To discuss the management of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) developing after subarachnoid hemorrhage, in a comparative manner in the light of the literature. MATERIAL AND METHODS Without country or language restrictions, articles with high evidential value found in electronic databases were compared to our patients? DATA RESULTS After the literature review, three articles were included for systematic evaluation. Desmopressin was administered to the patients for the treatment of hyponatremia, volume contraction, and negative sodium balance caused by SIADH. However, it was not used for preventing re-bleeding. CONCLUSION To prevent the development of this complication (SIADH), the use of desmopressin, an analogue of vasopressin, is important in routine clinical practice.
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Affiliation(s)
- Numan Karaarslan
- Namık Kemal University, Scholl of Medicine, Department of Neurosurgery, Tekirdağ, Turkey
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Yilmaz I, Karaarslan N, Ozbek H. Practical Performance of Hippocampal Tissue Resection in Rats in Pharmacomolecular Research. Turk Neurosurg 2021; 31:112-118. [PMID: 33216343 DOI: 10.5137/1019-5149.jtn.31730-20.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To explain how to resect hippocampal tissue in rats used as live mammalian subjects for the resection of fresh cerebral tissue in laboratories. MATERIAL AND METHODS Adult male Wistar-Albino rats (n=50) were used for this purpose. RESULTS The average bodyweight of the rats was 316.4 ± 11.71 g, and the average weight of the resected hippocampal tissues was 1.01 ± 0.03 g; however, there were no statistically significant differences between the body weights and the hippocampal tissue weights (p > 0.05). The hippocampal tissues to be used in the study were excised practically by preserving the original anatomical configuration without injury to the tissue. CONCLUSION This paper elucidates a simple, step-by-step methodology for performance in the laboratory in order to improve the standardization of hippocampal tissue dissection.
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Affiliation(s)
- Ibrahim Yilmaz
- Istanbul Medipol University, School of Medicine, Department of Medical Pharmacology, Istanbul, Turkey
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Karaarslan N, Yilmaz I, Sirin DY. Toxicity of the acetyl-para-aminophenol group of medicines to intact intervertebral disc tissue cells. Exp Ther Med 2020; 21:147. [PMID: 33456514 PMCID: PMC7791924 DOI: 10.3892/etm.2020.9578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to investigate the effects of paracetamol, an analgesic and antipyretic that is used in emergency departments and neurosurgery departments for postoperative pain management on intervertebral disc tissue. Paracetamol-treated human primary cell cultures and untreated cell cultures were compared using molecular analyses. Cell proliferation and gene expression were statistically analyzed. Cell proliferation was suppressed on days 10 (P=0.05) and 20 (P<0.05) in the paracetamol-treated groups. Gene expression of chondroadherin, matrix metalloproteinase (MMP)-7, MMP-13 and MMP-19 was higher in the paracetamol-treated samples while gene expression of Cartilage Oligomeric Matrix Protein and interleukin-1β was lower (P<0.05). Paracetamol, which appears innocuous compared with many analgesics, may increase the expression of MMPs, which serve a significant role in catabolic reactions and suppress the proliferation of intact intervertebral disc tissue cells.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59100, Turkey
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Yilmaz I, Karaarslan N, Yasar Sirin D, Ozbek H. Pharmaco-molecular assessment of the effects of anandamide and its antagonists on hippocampal tissue in Wistar albino rats. Eur Rev Med Pharmacol Sci 2020; 24:11871-11882. [PMID: 33275258 DOI: 10.26355/eurrev_202011_23845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The members of the matrix metalloproteinase (MMP) family and cannabinoids (CBs) are reportedly associated with hippocampus-dependent memory functions. However, the effects of endogenously formed CBs on hippocampal long-term potentiation remain unknown. The present study aimed to investigate the changes in the gene and protein expression levels of matrix metallopeptidase 9 (MMP-9), phosphatase and tensin homolog (PTEN), and NOTCH receptor 1 (NOTCH1) in rat hippocampal tissues treated with anandamide (AEA), AM251, 6-iodopravadolin (AM630), and N-[4-{[(3,4-Dimethyl-5-isoxazolyl)amino]sulfonyl}phenyl] (ML193). MATERIALS AND METHODS The subjects were divided into 10 groups (n = five per group). The pharmaceuticals were administered via intraperitoneal injection once a day for seven days, except for the control group. The resected hippocampal tissues were then evaluated using a quantitative real-time polymerase chain reaction (RT-qPCR) and Western blot analysis. The data obtained were statistically analyzed, and p < 0.01 was considered statistically significant. RESULTS Contrary to the literature, the changes in MMP-9 expression were not statistically significant, but the changes in PTEN and NOTCH1 were. The findings of this in vivo experimental study revealed that the agonists and antagonists acting on the CB system have significant molecular effects on hippocampal tissue. CONCLUSIONS The changes in gene and protein expressions may be one of the reasons for the neurodegenerative processes observed in patients using these agonists and antagonists, whose effects on the CB system have not been fully explained yet. Our study can contribute to the literature as it is the first study investigating the MMP-9, PTEN and NOTCH1 gene and protein expression.
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Affiliation(s)
- I Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Turkey.
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Karaarslan A, Kasim FBH, Karaarslan N, Ates O. A study on legal and medical dimensions of radiation exposure in neurosurgery clinics in Turkish practice. Surg Neurol Int 2020; 11:397. [PMID: 33274112 PMCID: PMC7708964 DOI: 10.25259/sni_703_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background:
In the present study, the first aim was to address the detrimental effects of the fluoroscopy procedure performed by physicians and other health-care professionals in neurosurgery clinics, then to examine precautions that should be taken to avoid harmful effects of radiation and radioactive substances during this process. The second aim was to handle the rights provided for health-care professionals exposed to the radiation in workplaces.
Methods:
A standardized questionnaire was used for a multicenter survey. Volunteer, intellectual, and cooperative participants (n = 41) were randomly chosen. The survey was prepared considering reports drawn up by the International Atomic Energy Agency. The questions concerning safe and effective fluoroscopy procedure were asked to the participants. The answers received were statistically evaluated. The alpha significance value was accepted as 0.05.
Results:
Two neurosurgeons only knew the legal rights that they might possess due to the exposure to the radiation or radioactive substances.
Conclusion:
The survey conducted among the health-care professionals revealed the insufficiency of knowledge about the protection from the radiation exposure or radioactive substances in workplaces. Furthermore, both health-care professionals working in radiology clinics, and those in neurosurgery and other clinics who are likely to be exposed to the radiation or radioactive substances have the rights afforded by the law.
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Affiliation(s)
| | - Fatma Bahar Hacioğlu Kasim
- Department of Radiology, Republic of Turkey, Ministry of Health, State Hospital, Clinics of Radiology, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital and Spine Center, Clinics of Neurosurgery, Istanbul, Turkey
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Kaya YE, Karaarslan N, Yilmaz I, Sirin DY, Akalan H, Ozbek H. A Study of the Effects of Metformin, a Biguanide Derivative, on Annulus Fibrosus and Nucleus Pulposus Cells. Turk Neurosurg 2020; 30:434-441. [PMID: 32239484 DOI: 10.5137/1019-5149.jtn.27785-19.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To investigate the effects of metformin, a drug used widely for the treatment of type 2 diabetes mellitus, on human primary cell cultures prepared from uninjured segment of disc material intervertebral disk tissues. MATERIAL AND METHODS Primary cell cultures were prepared using the tissues of six patients (three males and three females) who had undergone lumbar microdiscectomy and sequestrectomy. Untreated samples served as the control group, and metformintreated samples served as the experimental group. All the samples were evaluated using an inverted light microscope, acridine orange/propidium iodide staining (AO/PI), and a fluorescence microscope. The cytostatic and cytotoxic effects of metformin, which was administered to the samples using a commercial MTT assay kit, were also evaluated. The data obtained were statistically assessed, and the alpha significance value was accepted as less than 0.05. In addition, for the groups’ changes in the expressions of chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), interleukin-1β (IL-1β) matrix metalloproteinase 7 (MMP-7), and matrix metalloproteinase 19 (MMP-19), genes related to the extracellular matrix synthesis and degradation were determined using gene-specific TaqMan Gene Expression Assays. RESULTS The administration of the drug adversely affected nucleus pulposus (NP)/annulus fibrosus (AF) cells and extracellular matrixâ€"like structures. This was statistically significant (p < 0.05). CONCLUSION Clinicians should not disregard the adverse effects of metformin, which is used widely in clinical practice, on the components of intervertebral disk tissues.
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Affiliation(s)
- Yasin Emre Kaya
- Abant Izzet Basal University School of Medicine, Department of Orthopaedics and Traumatology, Bolu, Turkey
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18
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Karaarslan N, Şimşek AT, Öznam K, Bülbül AM. Do Endocrinopathies Cause Changes in Transverse Carpal Ligament Thickness and Carpal Tunnel Area in Carpal Tunnel Syndrome? eamr 2020; 36:45-51. [DOI: 10.4274/eamr.galenos.2019.35762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Dogan M, Simsek AT, Yilmaz I, Karaarslan N. Evaluation of Empirical Antibiotic Treatment in Culture Negative Pyogenic Vertebral Osteomyelitis. Turk Neurosurg 2020; 29:816-822. [PMID: 31049918 DOI: 10.5137/1019-5149.jtn.25018-18.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To investigate the efficacy of empirical antibiotic treatment in culture-negative pyogenic vertebral osteomyelitis (PVO) cases. MATERIAL AND METHODS The records of patients with culture-negative PVO who were treated at infectious diseases and neurosurgery outpatient clinics in the past four years were examined retrospectively. The control group comprised healthy subjects with similar age, gender, and body mass index but without pathology. The comparison of the groups was performed by analysis of variance. Statistical significance was accepted as p < 0.05. RESULTS No statistically significant difference in the white blood cell count and erythrocyte sedimentation rate was found between the spondylodiscitis and the healthy subject groups when the blood parameters obtained before and after the treatment (p > 0.05). However, a statistical significance was assessed in the results of the comparison for C-reactive protein (p < 0.05). CONCLUSION In the context of evidence-based medicine and the rational use of antibiotics, it is clear that antibiotics should be preferred according to the culture antibiogram results in the treatment of infectious diseases.
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Affiliation(s)
- Mustafa Dogan
- Namik Kemal University School of Medicine, Department of Infectious Diseases, Tekirdag, Turkey
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Kaya YE, Karaarslan N, Sirin DY, Ozbek H, Kaplan N, Yilmaz I. Investigation of the Effects of Methylphenidate, an Amphetamine Derivative, on Intervertebral Disc Tissue Cell Cultures and Matrix Structures. Turk Neurosurg 2019; 29:734-742. [PMID: 31353439 DOI: 10.5137/1019-5149.jtn.26339-19.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To investigate the effects of methylphenidate (MPH), on intervertebral disc tissue (IVD) cell cultures and extracellular matrix structures. Changes in the expression of some important marker genes involved in anabolic and catabolic mechanisms of IVD extracellular matrix formation were also evaluated. MATERIAL AND METHODS Primary cultures of nucleus pulposus cells (NPCs) and annulus fibrosus cells (AFCs) were isolated from tissues obtained from the operated patients. Cell viability and proliferation were tested, and the cell surface morphologies were evaluated by microscopy. The expressions of the chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), interleukin-1 beta (IL-1β) and matrix metalloproteinase (MMP) -7 and MMP-19 genes were evaluated using the quantitative real-time polymerase chain reaction (qRT-PCR). A value of p < 0.05 was considered statistically significant. RESULTS The viability and proliferation of intervertebral disc tissue cells decreased in response to MPH treatment and the expression of the investigated genes also changed. CONCLUSION The data obtained from in-vitro studies may not directly adaptable to clinical applications. However, the fact that the central nervous system stimulant MPH can suppress proliferation of cells derived from IVD tissue should be considered carefully by clinicians.
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Affiliation(s)
- Yasin Emre Kaya
- Bolu Abant Izzet Baysal University, School of Medicine, Department of Orthopaedics and Traumatology, Bolu, Turkey
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Kaplan N, Karaarslan N, Yilmaz I, Sirin DY, Akgun FS, Caliskan T, Simsek AT, Ozbek H. Are Intervertebral Disc Tissue Cells Damaged When Attempting to Prevent Thrombus Formation Using Dabigatran, A New Oral Anticoagulant? Turk Neurosurg 2019; 29:470-477. [PMID: 31124572 DOI: 10.5137/1019-5149.jtn.24336-18.0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM To investigate the effect of dabigatran, a new oral anticoagulant, on human primary cell cultures isolated from intact intervertebral disc tissue. MATERIAL AND METHODS Cell cultures were prepared from tissues obtained from six cases who had undergone surgery due to spinal trauma. Dabigatran, an active pharmacological agent, was applied to intact annulus fibrosus (AF)/nucleus pulposus (NP) primary cell cultures from the study group. After performing cell viability, toxicity, and proliferation tests on all cultures in the control and study groups, the surface morphologies of the samples were evaluated. Subsequently, chondroadherin (CHAD), cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-13 and -19 expressions were measured via a real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically. RESULTS In the proliferation assays performed on the 20th day of the study, cells in the dabigatran-supplemented group were reported to have lost 46.37% more viability than those in the control group. Expressions of all genes examined except MMP-13 were evaluated in the control group by time, but in contrast to the control group results, COMP and MMP-19 gene expressions decreased in the dabigatran-treated group. No CHAD or MMP-13 expression was noted in these cultures. CONCLUSION The potential for a systemically applied drug to accumulate in tissue and negatively affect surrounding tissues and microstructures must be emphasized.
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Affiliation(s)
- Necati Kaplan
- Istanbul Rumeli University, Corlu Reyap Hospital, Department of Neurosurgery, Tekirdag, Turkey
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Kaplan N, Yilmaz I, Karaarslan N, Sirin DY, Simsek AT, Caliskan T, Bircan R, Ozbek H. Evaluation of the Effect of Daptomycin, a Glycopeptide Agent, on Intact Intervertebral Disc Tissue. Turk Neurosurg 2019; 29:522-529. [PMID: 30829382 DOI: 10.5137/1019-5149.jtn.24447-18.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the effects of pre- and intra-operatively administered daptomycin (DAP) on the intact human primary intervertebral disc tissue cells. MATERIAL AND METHODS Primary cell cultures were established using tissues obtained through decompressive laminectomy, traumatic intervertebral disc herniation excision, and posterior transpedicular stabilization. Non-drug-administered samples were used as a control group. The samples treated with DAP formed the study group. Molecular assays for proliferation and gene expression were performed. The obtained data were evaluated statistically, and results with a value of p < 0.05 were accepted as significant. RESULTS While no reduction was observed in the proliferation, the gene expression of intact intervertebral disc tissue cells was time-dependently decreased compared to the control group, and these results were reported to be statistically significant. CONCLUSION This study observed the effect that a pharmaceutical preparation, which was used on intervertebral disc tissue before and after the operation, had on normal, healthy, and intact tissue. It concludes that alterations in the expression of genes involved in the anabolic and/or catabolic process, even in adjacent healthy tissue, may slow down the healing process of the damaged tissue or cause undesired cell differentiation.
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Affiliation(s)
- Necati Kaplan
- Istanbul Rumeli University, Corlu Reyap Hospital, Department of Neurosurgery, Tekirdag, Turkey
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Kaplan N, Yilmaz I, Karaarslan N, Kaya YE, Sirin DY, Ozbek H. Does Nimodipine, a Selective Calcium Channel Blocker, Impair Chondrocyte Proliferation or Damage Extracellular Matrix Structures? Curr Pharm Biotechnol 2019; 20:517-524. [PMID: 31057106 PMCID: PMC6751346 DOI: 10.2174/1389201020666190506124548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 12/18/2022]
Abstract
Background: The study aimed to investigate the effects of the active ingredient, nimodipine, on chondrocyte proliferation and extracellular matrix (ECM) structures in cartilage tissue cells. Methods: Chondrocyte cultures were prepared from tissues resected via surgical operations. Nimodipine was then applied to these cultures and molecular analysis was performed. The data obtained were statisti-cally calculated. Results: Both, the results of the (3-(4,5 dimethylthiazol2-yl)-2,5-diphenyltetrazolium (MTT) assay and the fluorescence microscope analysis [a membrane permeability test carried out with acridine or-ange/propidium iodide staining (AO/PI)] confirmed that the active ingredient, nimodipine, negatively af-fects the cell cultures. Conclusion: Nimodipine was reported to suppress cellular proliferation; chondroadherin (CHAD) and hypoxia-inducible factor-1 alpha (HIF-1α) expression thus decreased by 2.4 and 1.7 times, respectively, at 24 hrs when compared to the control group (p < 0.05). Furthermore, type II collagen (COL2A1) ex-pression was not detected (p < 0.05). The risk that a drug prescribed by a clinician in an innocuous man-ner to treat a patient by relieving the symptoms of a disease may affect the proliferation, differentiation, and viability of other cells and/or tissues at the molecular level, beyond its known side effects or adverse events, should not be forgotten.
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Affiliation(s)
- Necati Kaplan
- Department of Neurosurgery, Corlu Reyap Hospital, Istanbul Rumeli University, 59680, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, 59100, Tekirdag, Turkey
| | - Yasin E Kaya
- Department of Orthopedic and Traumatology, Abant Izzet Basal University School of Medicine, 14000, Bolu, Turkey
| | - Duygu Y Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, 59100, Tekirdag, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey
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Yüksel MO, Gürbüz MS, Gök Ş, Karaarslan N, İş M, Berkman MZ. The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures. J Neurosci Rural Pract 2019; 7:S57-S61. [PMID: 28163505 PMCID: PMC5244062 DOI: 10.4103/0976-3147.196466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. Materials and Methods: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. Results: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. Conclusion: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.
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Affiliation(s)
- Mehmet Onur Yüksel
- Department of Neurosurgery, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | | | - Şevki Gök
- Department of Neurosurgery, Kars Public Hospital, Kars, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Merih İş
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Akgun FS, Sirin DY, Yilmaz I, Karaarslan N, Ozbek H, Simsek AT, Kaya YE, Kaplan N, Akyuva Y, Caliskan T, Ates O. Investigation of the effect of dipyrone on cells isolated from intervertebral disc tissue. Exp Ther Med 2019; 18:216-224. [PMID: 31258656 PMCID: PMC6566084 DOI: 10.3892/etm.2019.7576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
The present study aimed to evaluate the effects of dipyrone, an indispensable analgesic, anti-pyretic and anti-spasmodic used in emergency departments, on nucleus pulposus and annulus fibrosus cells in vitro. After surgical biopsy, primary cell cultures were prepared from intact intervertebral disc tissues. Dipyrone was administered to the cultures in the experimental groups except for the control group. The data obtained were statistically evaluated. The proliferation was identified to be suppressed via MTT analysis. The gene expression profile of the intervertebral disc cells in the dipyrone-treated groups was significantly changed. The expression of chondroadherin, cartilage oligo matrix protein, interleukin-1β and metalloproteinase (MMP)-19 genes were decreased, but MMP-13 and MMP-7 genes expressions were increased, as determined via reverse transcription-quantitative PCR. AO/PI staining revealed that no apoptotic or other type of cell death was detectable after administration of dipyrone does not mean that the drug is innocuous. The occurrence of cellular senescence and/or the halt of cell proliferation may also be important mechanisms underlying the adverse inhibitory effects of dipyrone. Therefore, prior to administering dipyrone in clinical practice, all possible adverse effects of this drug should be considered.
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Affiliation(s)
- Feride Sinem Akgun
- Department of Emergency Medicine, School of Medicine, Istanbul Maltepe University, Istanbul 34843, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Abdullah Talha Simsek
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Yasin Emre Kaya
- Department of Orthopedics and Traumatology, School of Medicine, Abant Izzet Baysal University, Bolu 14000, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Corlu Reyap Hospital, Istanbul Rumeli University, Tekirdag 59680, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul 34433, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Istanbul Koc University Hospital, Istanbul Koc University, Istanbul 34010, Turkey
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Caliskan T, Sirin DY, Karaarslan N, Yilmaz I, Ozbek H, Akyuva Y, Kaplan N, Kaya YE, Simsek AT, Guzelant AY, Ates O. Effects of etanercept, a tumor necrosis factor receptor fusion protein, on primary cell cultures prepared from intact human intervertebral disc tissue. Exp Ther Med 2019; 18:69-76. [PMID: 31258639 PMCID: PMC6566078 DOI: 10.3892/etm.2019.7559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/06/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to investigate the effects of etanercept (ETA), a tumor necrosis factor (TNF) inhibitor, on human cell cultures prepared from intact intervertebral disc tissue. ETA is used as a treatment for cases of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and ankylosing spondylitis accompanied by moderate or severe joint pain. ETA was applied to primary cell cultures [annulus fibrosus and nucleus pulposus (NP) from intact intervertebral disc tissue]. Cell cultures without ETA treatment served as the control group. Morphological and quantitative molecular analyses of the two groups were performed. The number of viable cells and cell proliferation decreased in the ETA-treated cultures as compared with those in the control group. Furthermore, in the treatment group, the chondroadherin gene, an NP-specific marker, was not expressed after 24 h. By contrast, the cartilage oligo matrix protein was expressed 24, 48 and 72 h post-ETA treatment, while its expression was significantly lower than that in the control group. In addition, the expression of interleukin-1β, as well as matrix metallopeptidase-7 and −19, was markedly decreased. Overall, the cell proliferation and gene expression in the ETA-treated cells were significantly different from those in the control group (P<0.05). These results suggest that the treatment duration and dosage of TNF inhibitors, which are used to suppress active inflammation, should be considered in the clinical setting. These biological agents may delay the healing of intervertebral disc tissue damage by slowing cell proliferation and altering gene expression via anabolic and catabolic pathways.
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Affiliation(s)
- Tezcan Caliskan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59100, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59100, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul 34433, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Corlu Reyap Hospital, Istanbul Rumeli University, Tekirdag 59680, Turkey
| | - Yasin Emre Kaya
- Department of Orthopedic and Traumatology, Abant Izzet Basal University School of Medicine, Bolu 14000, Turkey
| | - Abdullah Talha Simsek
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59100, Turkey
| | - Aliye Yildirim Guzelant
- Department of Physical Medicine and Rehabilitation, Corlu Reyap Hospital, Istanbul Rumeli University, Tekirdag 59680, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Esencan Hospital, Istanbul Esenyurt University, Istanbul 34570, Turkey
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Karaarslan N, Yilmaz I, Ozbek H, Sirin DY, Kaplan N, Akyuva Y, Gonultas A, Ates O. Are Specific Gene Expressions of Extracellular Matrix and Nucleus Pulposus Affected by Primary Cell Cultures Prepared from Intact or Degenerative Intervertebral Disc Tissues? Turk Neurosurg 2019; 29:43-52. [PMID: 29484626 DOI: 10.5137/1019-5149.jtn.22210-17.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To determine the gene expression patterns of nucleus pulposus (NP) in cell cultures obtained from degenerated or intact tissues. MATERIAL AND METHODS Whereas 12 of the cases were diagnosed with lumbar disc herniation and had undergone lumbar microdiscectomy, 12 cases had undergone traumatic intervertebral discectomy and corpectomy, along with discectomy after spinal trauma. NP-specific markers and gene expressions of the reagents of the extracellular matrix in the experimental setup were tested at the 0th, 24th, and 48th hours by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Visual evaluations were simultaneously made in all samples using invert and fluorescence microscopy. Vitality and proliferation analyses were evaluated by UV spectrophotometer. As a method of statistical evaluation, Spearman was used for categorical variants, and the Pearson correlation was used for variants with numerical and plain distribution. RESULTS No association was found either between the tissue type and times (r=0.000; p=1.000) or between the region that the tissue was obtained from and hypoxia transcription factor-1 alpha (HIF-1α) gene expression (r=0.098; p=0.245). There was no correlation between cell proliferation and chondroadherin (CHAD) expression or between type II collagen (COL2A1) and CHAD gene expressions. It was found that CHAD and HIF-1α gene expressions and HIF-1α and COL2A1 gene expressions affected cell proliferation. CONCLUSION Cell culture setups are of paramount importance because they may influence the pattern of changes in the gene expressions of the cells used in these setups.
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Affiliation(s)
- Numan Karaarslan
- Namik Kemal University, School of Medicine, Department of Neurosurgery, Tekirdag, Turkey
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Karaarslan N, Yilmaz I, Ozbek H, Oznam K, Ates O, Erdem I. Is Implant Washing and Wound Irrigation with Rifampicin Effective for Preventing Surgical Site Infections in Lumbar Instrumentation? Turk Neurosurg 2019; 28:904-909. [PMID: 29368319 DOI: 10.5137/1019-5149.jtn.21341-17.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To determine whether the washing of implants and autogenous bone grafts with rifampicin, and the irrigation of the surgical field using diluted rifampicin, have any significant effect on the prevention of spinal implant infections. MATERIAL AND METHODS A total of 166 consecutive lumbar stenosis and spondylolisthesis patients undergoing lumbar instrumentation between 2012 and 2016 were analyzed retrospectively. The patients were divided into two groups. Group I (n=85) included patients whose implants were washed with rifampicin immediately before insertion and whose surgical fields were irrigated with diluted rifampicin immediately after insertion. Group II (n=81) included the cases without rifampicin application. Both groups were matched for age, sex, body mass index, and surgical indication. The infection rates of the groups were compared during the first 2 postoperative years. RESULTS No significant difference was found between the infection rate in Group I and Group II. Only 1 case had surgical site infection (SSI) in Group I, a rate of 1.17% (1 of 85 patients), whereas 2 patients had SSI in Group II, a rate of 2.46% (2 of 81 patients). CONCLUSION Peroperative washing of implants with rifampicin and irrigation of the surgical field using diluted rifampicin have not been found to be significantly effective in preventing or reducing spinal implant infections. However, further studies with larger series need to be carried out to verify these results.
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Affiliation(s)
- Numan Karaarslan
- Namık Kemal University, School of Medicine, Department of Neurosurgery, Tekirdag, Turkey
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Sirin DY, Karaarslan N. Evaluation of the effects of pregabalin on chondrocyte proliferation and CHAD, HIF-1α, and COL2A1 gene expression. Arch Med Sci 2018; 14:1340-1347. [PMID: 30393488 PMCID: PMC6209709 DOI: 10.5114/aoms.2018.73134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/03/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The aim of the present study is to investigate the effects of pregabalin (PGB) on chondrocyte proliferation and collagen type II (COL2A1), hypoxia-inducible factor 1-α (HIF-1α), and chondroadherin (CHAD) gene expression in osteoarthritic chondrocytes. MATERIAL AND METHODS Standard primary chondrocyte cultures were prepared using osteochondral tissues that were surgically obtained from 6 patients with gonarthrosis. Cell morphology was evaluated using an inverted microscope, and cell death and proliferation were determined through MTT analysis, which was confirmed by AO/PI staining and statistically evaluated. The expression levels of CHAD, COL2A1, and HIF-1α genes were assessed using gene-specific TaqMan Gene Expression Assays. RESULTS MTT analyses showed that PGB administration did not have a negative or toxic effect on cell viability and proliferation in cultured chondrocytes (p < 0.001), but in our morphological evaluation extracellular matrix development was observed to be weaker in cultures treated with PGB. After 24 h of treatment, COL2A1, HIF-1α, and CHAD gene expression decreased in the groups to which PGB was applied compared to gene expression before the experiment (at 0 h); at 48 h, CHAD and HIF-1α expression increased to the same level as the control group, but the expression of COL2A1 continued to decrease. CONCLUSIONS Further studies need to be conducted with more participants to prove that there is a negative correlation between extracellular matrix formation and PGB administration. Our preliminary data show that even at low doses and over short-term administration, PGB may affect chondrocyte cells at the gene-expression level.
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Affiliation(s)
- Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag, Turkey
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Karaarslan N, Yilmaz I, Ozbek H, Yasar Sirin D, Kaplan N, Caliskan T, Ozdemir C, Akyuva Y, Ates O. Are radio-contrast agents commonly used in discography toxic to the intact intervertebral disc tissue cells? Basic Clin Pharmacol Toxicol 2018; 124:181-189. [PMID: 30120906 DOI: 10.1111/bcpt.13112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Abstract
In the literature, there have been no studies showing clear results on how radio-contrast pharmaceuticals would affect intact disc tissue cells. In this context, it was aimed to evaluate the effects of iopromide and gadoxetic acid, frequently used in the discography, on intact lumbar disc tissue in pharmaco-molecular and histopathological level. Primary cell cultures were prepared from the healthy disc tissue of the patients operated in the neurosurgery clinic. Except for the control group, the cultures were incubated with the indicated radio-contrast agents. Cell viability, toxicity and proliferation indices were tested at specific time intervals. The cell viability was quantitatively analysed. It was also visually rechecked under a fluorescence microscope with acridine orange/propidium iodide staining. Simultaneously, cell surface morphology was analysed with an inverted light microscope, while haematoxylin and eosin (H&E) staining methodology was used in the histopathological evaluations. The obtained data were evaluated statistically. Unlike the literature, iopromide or gadoxetic acid did not have any adverse effects on the cell viability, proliferation and toxicity (P < 0.05). Although this study reveals that radio-contrast pharmaceuticals used in the discography, often used in neurosurgical practice, can be safely used, it should be remembered that this study was performed in an in vitro environment.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Corlu Reyap Hospital, Istanbul Rumeli University, Tekirdag, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Cigdem Ozdemir
- Department of Pathology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Esencan Hospital, Istanbul Esenyurt University, Istanbul, Turkey
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Karaarslan N, Batmaz AG, Yilmaz I, Ozbek H, Caliskan T, Yasar Sirin D, Kaplan N, Oznam K, Ates O. Effect of naproxen on proliferation and differentiation of primary cell cultures isolated from human cartilage tissue. Exp Ther Med 2018; 16:1647-1654. [PMID: 30186383 PMCID: PMC6122143 DOI: 10.3892/etm.2018.6351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) that are applied through oral, injectable or topical routes have been widely used in painful and inflammatory musculoskeletal diseases. The current study aimed to determine whether naproxen, an aryl acetic acid derivative with analgesic and anti-inflammatory effects, has a toxic effect on human chondrocytes. Samples containing monolayer primary chondrocyte cultures were prepared following resection from osteochondral tissues obtained from patients with gonarthrosis. Cell viability, toxicity and proliferation and levels of stage-specific embryonic antigen-1, a precursor to human prechondrocytes, were evaluated spectrophotometrically. The results from the untreated control group were compared with those of the study groups, where naproxen was administered in varying doses (1-1,000 µM). Surface morphologies of the cells were compared using inverted light and environmental scanning electron microscopy. Treatment groups were compared by analysis of variance with Tukey's honest difference post hoc test. P<0.01 was considered to indicate a statistically significant difference. The research revealed significant changes to proliferation and differentiation of chondrocytes in all treatment groups (P<0.01). Naproxen was demonstrated to suppress chondrocyte proliferation and differentiation, which may be an important factor to consider when prescribing this medication to patients.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Ahmet Guray Batmaz
- Department of Orthopaedics and Traumatology, Atasehir Hospital, Istanbul 34384, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59100, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Istanbul Rumeli University, Corlu Reyap Hospital, Tekirdag 59100, Turkey
| | - Kadir Oznam
- Department of Orthopaedics and Traumatology, School of Medicine, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Istanbul Esenyurt University, Esencan Hospital, Istanbul 34510, Turkey
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Karaarslan N, Yilmaz I, Sirin DY, Ozbek H, Kaplan N, Kaya YE, Akyuva Y, Gurbuz MS, Oznam K, Ates O. Pregabalin treatment for neuropathic pain may damage intervertebral disc tissue. Exp Ther Med 2018; 16:1259-1265. [PMID: 30112057 PMCID: PMC6090477 DOI: 10.3892/etm.2018.6289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/23/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine whether pharmaceutical preparations with pregabalin (PGB) as an active ingredient, which are widely prescribed by clinicians, exert toxic effects on human primary nucleus pulposus (NP) and annulus fibrosis (AF). Primary human cell cultures were obtained from intact (n=6) and degenerated (n=6) tissues resected from the two groups of patients. Different doses of PGB were applied to these cultures and cells were subjected to molecular analyses at 0, 24 and 48 h. Cell vitality, toxicity and proliferation were assessed using a spectrophotometer. The expression of chondroadherin (CHAD), a (member of the NP-specific protein family), hypoxia-inducible factor-1α (HIF-1α) and type II collagen (COL2A1) was measured using reverse transcription-quantitative polymerase chain reaction. The results revealed that cell intensity increased in a time-dependent manner and cell vitality continued in the cultures without pharmaceuticals. Cell proliferation was suppressed in the PGB-treated cultures independent from the dose and duration of application. PGB was demonstrated to suppress the expression of CHAD and HIF-1α. In contrast, COL2A1 gene expression was not revealed in any experimental group. The present study utilized an in vitro model and the PGB active ingredient used herein may not be representative of clinical applications; however, the results demonstrated that PGB has a toxic effect on NP/AF cell cultures containing primary human intervertebral disc tissue. In summary, the use of pharmacological agents containing PGB may suppress the proliferation and differentiation of NP/AF cells and/or tissues, which should be considered when deciding on an appropriate treatment regime.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59030, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Istanbul Rumeli University, Corlu Reyap Hospital, Tekirdag 59860, Turkey
| | - Yasin Emre Kaya
- Department of Orthopedic and Traumatology, Abant Izzet Basal University School of Medicine, Bolu 14000, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul 34433, Turkey
| | - Mehmet Sabri Gurbuz
- Department of Neurosurgery, Istanbul Medeniyet University School of Medicine, Istanbul 34730, Turkey
| | - Kadir Oznam
- Department of Orthopedic and Traumatology, Istanbul Medipol University School of Medicine, Istanbul 34214, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Istanbul Esenyurt University, Esencan Hospital, Istanbul 34517, Turkey
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Karaarslan N, Yilmaz I, Ozbek H, Caliskan T, Topuk S, Sirin DY, Ates O. Systematic Evaluation of Promising Clinical Trials-Gene Silencing for the Treatment of Glioblastoma. Turk Neurosurg 2018; 29:328-334. [PMID: 29694664 DOI: 10.5137/1019-5149.jtn.22467-18.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To systematically investigate the role of artificial small interfering RNA (siRNA) molecules in glioblastoma treatment and to give a detailed overview of the literature concerning studies performed in this field worldwide in the last 31 years. MATERIAL AND METHODS Articles about clinical trials conducted between December 1, 1949 and November 8, 2017, were identified from the Cochrane Collaboration, the Cochrane Library, Ovid MEDLINE, ProQuest, the National Library of Medicine, and PubMed electronic databases, using the terms "post transcriptional gene silencing," "small interfering RNA," "siRNA," and “glioblastoma," either individually or combined ("OR" and "AND"), without language and country restrictions. Articles that met the examination criteria were included in the study. After descriptive statistical evaluation, the results were reported in frequency (%). RESULTS After scanning 2.752 articles, five articles were found that met the research criteria. Examination of full texts of the five identified articles provided no sufficient evidence for research conducted with regard to the use of gene silencing via siRNAs in glioblastoma treatment. CONCLUSION To be able to evaluate the clinical use of siRNAs, there is an urgent need for in vivo studies and for trials with randomized, controlled, and clinical designs that provide long-term functional outcomes.
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Affiliation(s)
- Numan Karaarslan
- Namik Kemal University, School of Medicine, Department of Neurosurgery, Tekirdag, Turkey
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Sirin DY, Kaplan N, Yilmaz I, Karaarslan N, Ozbek H, Akyuva Y, Kaya YE, Oznam K, Akkaya N, Guler O, Akkaya S, Mahirogullari M. The association between different molecular weights of hyaluronic acid and CHAD, HIF-1α, COL2A1 expression in chondrocyte cultures. Exp Ther Med 2018; 15:4205-4212. [PMID: 29849772 PMCID: PMC5962858 DOI: 10.3892/etm.2018.5943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/10/2018] [Indexed: 01/06/2023] Open
Abstract
The aim of the present study was to investigate the effects of three different formulations of hyaluronic acid (HA): Low molecular weight (MW) Sinovial One®, medium MW Viscoplus® and high MW Durolane®, on chondrocyte proliferation and collagen type II (COL2A1), hypoxia-inducible factor 1α (HIF-1α) and chondroadherin (CHAD) expression in primary chondrocyte cultures. Standard primary chondrocyte cultures were established from osteochondral tissues surgically obtained from 6 patients with gonarthrosis. Cell morphology was evaluated using an inverted light microscope; cell proliferation was determined with a MTT assay and confirmed with acridine orange/propidium iodide staining. Levels of CHAD, COL2A1 and HIF-1α expression were assessed using specific TaqMan gene expression assays. The results demonstrated the positive effect of HA treatment on cell proliferation, which was independent from the MW. COL2A1 expression increased in the medium and high MW HA treated groups. It was observed that HIF-1α expression increased in the high MW treated group alone. CHAD expression increased only in the medium MW HA treated group. Evaluation of gene expression revealed that levels of expression increased as the duration of HA application increased, in the medium and high MW HA treated groups. In terms of increased viability and proliferation, a longer duration of HA application was more effective. Taken together, it may be concluded that the administration of medium and high MW HA may be a successful way of treating diseases affecting chondrocytes in a clinical setting.
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Affiliation(s)
- Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59030, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Istanbul Rumeli University, Tekirdag 59680, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag 59060, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul 34810, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul 34433, Turkey
| | - Yasin Emre Kaya
- Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu 14000, Turkey
| | - Kadir Oznam
- Department of Orthopedics and Traumatology, Istanbul Medipol University School of Medicine, Istanbul 34214, Turkey
| | - Nuray Akkaya
- Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli 20070, Turkey
| | - Olcay Guler
- Department of Orthopedics and Traumatology, Medical Park Health Group, Istanbul 34180, Turkey
| | - Semih Akkaya
- Department of Orthopedics and Traumatology, Denizli Private Hospital, Denizli 20070, Turkey
| | - Mahir Mahirogullari
- Department of Orthopedics and Traumatology, Memorial Health Group, Istanbul 34758, Turkey
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Erşahin M, Gürbüz MS, Karaarslan N, Gezen AF. CT-guided Stereotactic Microsurgical Resection of Cerebral Mass Lesions. Medeni Med J 2018. [DOI: 10.5222/mmj.2018.87259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Karaarslan N, Gürbüz MS, Şimşek AT, Erşahin M, Berkman MZ. Evaluation of Biopathogenesis of Meningioma Cases in the Light of Literature. Medeni Med J 2018. [DOI: 10.5222/mmj.2018.77905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Karaarslan N, Gürbüz MS, Çalışkan T, Simsek AT. Forestier syndrome presenting with dysphagia: case report of a rare presentation. J Spine Surg 2017; 3:723-726. [PMID: 29354755 DOI: 10.21037/jss.2017.11.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) (Forestier syndrome) is a rheumatologic disease, the etiology of which is not exactly known. It is characterized by spinal osteophyte formations resulting from the ossification of the paravertebral ligaments and muscles. Anterior longitudinal ligament is the usual site of involvement and the frequency of the disease increases after the 5th decade. Lower cervical segments are the most frequently involved regions whereas the upper cervical involvement leading to dysphagia is very rare. In this report, a 77-year-old patient with Forestier syndrome in upper cervical region presenting with dysphagia was presented. Anterior cervical osteophyte resection was performed with no need for discectomy, fusion or stabilization. The patient showed a significant improvement in his all preoperative symptoms, and no recurrence was detected at 1-year follow-up.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University Faculty of Medicine, Tekirdag, Turkey
| | | | - Tezcan Çalışkan
- Department of Neurosurgery, Namik Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Abdullah Talha Simsek
- Department of Neurosurgery, Namik Kemal University Faculty of Medicine, Tekirdag, Turkey
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Karaarslan N, Gürbüz MS, Caliskan T, Tunckale T. Remote Cerebellar Haemorrhage Occurring after Transcranial Pituitary Surgery. J Clin Diagn Res 2017; 11:PD15-PD16. [PMID: 28969203 DOI: 10.7860/jcdr/2017/29152.10465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/17/2017] [Indexed: 11/24/2022]
Abstract
Post supratentorial and spinal surgeries, in rare cases, Remote Cerebellar Haemorrhage (RCH) develops as a complication. Although the exact aetiology of RCH remains uncertain, excessive drainage of the Cerebrospinal Fluid (CSF) is accepted as the most possible cause. It has been suggested that overdrainage of CSF leads to stretching and resultantly tearing of the cerebellar veins. Early diagnosis and appropriate management decrease mortality and morbidity significantly. In this report, we present a case of RCH encountered on the third postoperative day of transcranial pituitary surgery and discuss the possible causative factors. Excessive loss of CSF is considered to be the major cause of RCH. To our knowledge this is the first case of RCH seen after transcranial macroadenoma surgery reported in the literature so far.
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Affiliation(s)
- Numan Karaarslan
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
| | - Mehmet Sabri Gürbüz
- Specialist Neurosurgeon, Department of Neurosurgery, Elaziğ Training and Research Hospital, Elaziğ, Turkey
| | - Tezcan Caliskan
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
| | - Tamer Tunckale
- Assistant Professor, Department of Neurosurgery, Namık Kemal University, Medical Faculty, Tekirdağ, Turkey
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Karaarslan N, Gurbuz MS, Caliskan T, Ayan E, Aker FV, Berkman MZ. The Effect of Matrix Metalloproteinase-3 on the Prognosis and Biological Behaviour of Meningiomas. Turk Neurosurg 2017; 26:678-83. [PMID: 27438616 DOI: 10.5137/1019-5149.jtn.12807-14.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To analyse the effect of MMP-3 (Matrix Metalloproteinase Enzyme-3)-one of the extracellular matrix proteins- on the prognosis and biological behaviour of meningiomas. MATERIAL AND METHODS 79 cases of meningioma that were operated in our clinic between 2005 and 2010 were retrospectively analysed. Age, sex, preoperative peritumoral edema, histological subtype, grade, Ki-67 expression, MMP-3 staining pattern and recurrence rate were analysed. Pathological preparations were graded according to the WHO (World Health Organisation) 2007 grading system. RESULTS Of the MMP-III positive cases; 24 cases (60%) were grade I, 16 cases were grade II. The MMP-3 staining pattern was significantly positive (80%) in grade II meningioma. 14 of the MMP-3 positive cases were atypical meningiomas. Of the 20 cases with high Ki-67 proliferation index (PI), 12 cases (60%) were MMP-3 positive and 8 cases (40%) were MMP-3 negative. Rates of recurrence and preoperative peritumoral edema were high in cases with MMP-3 positivity. CONCLUSION In this study it was determined that MMP-3 positivity has a strong relationship with meningiomas having an aggressive character. MMP-3 may be used as a proliferation marker for biological behaviour, recurrence rate and prognosis of meningiomas.
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Affiliation(s)
- Numan Karaarslan
- Namık Kemal University, Faculty of Medicine, Department of Neurosurgery, Tekirdağ, Turkey
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Karaarslan N, Kutluay H, Çalışkan T, Tunçkale T, Ayan E, Şimşek AT. Cauda Equina Syndrome Following Percutaneous Vertebroplasty. sscd 2017. [DOI: 10.5222/sscd.2015.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Yüksel MO, Gürbüz MS, Senol M, Karaarslan N. Spontaneous Subdural Haematoma Developing Secondary to Arachnoid Cyst Rupture. J Clin Diagn Res 2016; 10:PD05-PD06. [PMID: 27891397 DOI: 10.7860/jcdr/2016/21056.8708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
Arachnoid cysts are congenital, benign, non-neoplastic, extra-axial intra-arachnoidal lesions. Arachnoid cysts rarely become symptomatic, with bleeding. Intracranial haemorrhage as a complication of arachnoid cyst is a very rare condition. It is well-known that mid-cranial fossa cysts might cause intracerebral haemorrhage or subdural haematoma secondary to traumas. However, the occurrence of spontaneous subdural haematoma secondary to arachnoid cysts, developing without any trauma, is even rarer. A 17-year-old boy presenting with diplopia and headache, with no history of trauma, was diagnosed with left temporal lobe arachnoid cyst and left fronto-parietal subdural haematoma. He was operated on, solely for his haematoma, with no intervention performed for the arachnoid cyst. Authors suggest that it is sufficient to perform an operation for the haematoma only -without arachnoid cyst resection- if there is no clinical presentation specific to the arachnoid cyst itself.
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Affiliation(s)
- Mehmet Onur Yüksel
- Specialist Neurosurgeon, Department of Neurosurgery, Erzurum Bolge Training and Research Hospital , Erzurum, Turkey
| | - Mehmet Sabri Gürbüz
- Specialist Neurosurgeon, Department of Neurosurgery, Safa Hospital , Istanbul, Turkey
| | - Mehmet Senol
- Specialist Neurosurgeon, Department of Neurosurgery, Erzurum Bolge Training and Research Hospital , Erzurum, Turkey
| | - Numan Karaarslan
- Assistant Professor, Department of Neurosurgery, Namık Kemal University Faculty of Medicine , Tekirdag, Turkey
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Yüksel MO, Gürbüz MS, Karaarslan N, Caliskan T. Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: Case report. Surg Neurol Int 2016; 7:S872-S875. [PMID: 27999711 PMCID: PMC5154207 DOI: 10.4103/2152-7806.194495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/28/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Subdural empyema is a rare form of intracranial infection. It is described as accumulation of purulent infective material between the inner layer of dura mater and outer layer of arachnoid membrane. CASE DESCRIPTION A 17-year-old girl was admitted to the emergency department with acute left hemiplegia and was diagnosed with interhemispheric subdural empyema that showed a three-fold increase in size within 12 hours. Complete recovery was achieved with emergency surgical evacuation and additional 3 weeks of antibiotic treatment. CONCLUSION Subdural empyema should be diagnosed and managed early in time since it may progress very rapidly and can cause high morbidity and mortality. Complete recovery can be achieved if it is diagnosed early and treated in time.
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Affiliation(s)
- Mehmet O. Yüksel
- Department of Neurosurgery, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | | | - Numan Karaarslan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
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Gürbüz MS, Karaarslan N, Gök S, Soyalp C. Remote Cerebellar Haemorrhage after Burr Hole Drainage of Chronic Subdural Haematoma: A Case Report. J Clin Diagn Res 2016; 10:PD01-2. [PMID: 27437296 DOI: 10.7860/jcdr/2016/17218.7710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
Abstract
Remote cerebellar haemorrhage (RCH) is an unusual complication of supratentorial neurosurgical procedures. Even the rarer is cerebellar haemorrhage occurring after supratentorial burr hole drainage of Chronic Subdural Haematoma (CSDH). The exact mechanism is still unclear despite some possible causative factors such as rapid evacuation of haematoma and overdrainage of CSF (Cerebrospinal Fluid). We report a 80-year-old male patient who developed cerebellar haemorrhage after burr hole drainage of left frontoparietal chronic subdural haematoma and discuss the possible aetiological mechanisms through the review of the current literature.
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Affiliation(s)
| | - Numan Karaarslan
- Faculty, Department of Neurosurgery, Namık Kemal University Medical Faculty , Tekirdag, Turkey
| | - Sevki Gök
- Faculty, Department of Neurosurgery, Kars Public Hospital , Kars, Turkey
| | - Celaleddin Soyalp
- Faculty, Department of Anesthesiology, Agrı Public Hospital , Agrı, Turkey
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Ayan E, Tanriverdi HI, Caliskan T, Senel U, Karaarslan N. Intraabdominal Pseudocyst Developed after Ventriculoperitoneal Shunt: A Case Report. J Clin Diagn Res 2015; 9:PD05-6. [PMID: 26266167 DOI: 10.7860/jcdr/2015/14064.6114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/04/2015] [Indexed: 11/24/2022]
Abstract
Abdominal pseudocyst is a rare complication developing after ventriculoperitoneal shunt treatment. It is more commonly seen particularly in children. The underlying pathogenesis may be associated with repeat revisions or infections. Morphologically, it has no complete cyst wall, presenting only with a pseudocapsule among the intestinal loops, around the lower shunt tip. The principal problem appears to be the reduced peritoneal absorption capacity. The treatment is complicated and difficult. In this report, we present an 8-year-old abdominal pseudocyst case with a history of many shunt revisions.
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Affiliation(s)
- Erdogan Ayan
- Assistant Professor, Department of Neurosurgery, Namık Kemal Universtiy Medical School , Tekirdag-Turkey
| | - Halil Ibrahim Tanriverdi
- Assistant Professor, Department of Pediatric Surgery, Gaziosmanpasa University Medical School , Tokat-Turkey
| | - Tezcan Caliskan
- Assistant Professor, Department of Neurosurgery, Namık Kemal Universtiy Medical School , Tekirdag-Turkey
| | - Ufuk Senel
- Assistant Professor, Department of Pediatric Surgery, Gaziosmanpasa University Medical School , Tokat-Turkey
| | - Numan Karaarslan
- Assistant Professor, Department of Pediatric Surgery, Gaziosmanpasa University Medical School , Tokat-Turkey
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