Highlights of the Study • Existing literature does not explain the mechanism of extracorporeal shock wave therapy (ESWT) in reducing coccydynia. • This study shows that ESWT is a convenient, cost-effective method with low complication rates. • ESWT provides effective pain control for chronic coccydynia.

Departmental sources Background: Osteoarthritis secondary to developmental dysplasia of the hip (DDH) is one of the major causes of hip pain and disability. The aim of the study was to compare the effectiveness of prolotherapy (PrT) injections versus exercise protocol for the treatment of DDH. Material/Methods: There were 46 hips of 41 patients who had osteoarthritis secondary to DDH included in this study. Patients were divided into 2 groups: treated with PrT (PrT group; n=20) and exercise (control group; n=21). Clinical outcomes were evaluated with visual analog scale for pain (VAS) and Harris hip score (HHS) at baseline, 3 weeks, 3 months, 6 months, and a minimum of 1-year follow-up. In PrT group clinical results were also compared in Crowe type I-IV hips. Results: Between group analysis revealed no significant between group differences at baseline. Dextrose injection recipients out performed exercise controls for VAS pain change score at 6 months (-4.6±2.6 versus-2.8±2.5; P=0.016), and 12 months (-4.5±2.4 versus-2.9±2.5; P=0.017) and for HHS at 6 months (24.2±14.0 versus 14.8±12.4; P=0.007) and 12 months (24.3±13.4 versus 16.5±11.3; P=0.018). Conclusions: To our best knowledge, this study is the first regarding the effects of an injection method in the treatment of osteoarthritis secondary to DDH. According to our study, PrT is superior to exercises. PrT could provide significant improvement for clinical outcomes in DDH and might delay surgery.

Purpose Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS. Methods It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre-and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting. Results There was statistically significant difference between repeated VAS and ODI measurements. Conclusions These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery.

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Dextrose solutions (in 1%, 5%, 10%, 15%, 20% and 25% concentrations) were applied on adult human fibroblasts in vitro culture condition. Cell proliferation assay was used for finding the cell deaths in cell culture. Up to 80% fibroblast cells died in high dextrose concentrations (15%, 20% and 25%). The deaths of cells were visualized on inverted microscope. In low dextrose concentrations (1%, 5% and 10%), viable cell ratio was above 80%. The gene expression analysis were performed on selected genes which have roles on angiogenesis and apopitosis [VEGFA (Vascular Endothelial Growth Factor A-OMIM ABSTRACTObjectives: Hypertonic dextrose injection in prolotherapy is an injection-based treatment used in chronic musculoskeletal conditions. Dextrose prolotherapy raises growth factor levels and enhances tissue repair, reduces musculoskeletal pain. Despite of uses for many years, the effect of dextrose solution on cellular and molecular base is not fully clear. Here, the roles of dextrose solutions was tried to find out in different concentrations on human fibroblasts in vitro. Gene expression alterations were analyzed in uses of dextrose solutions on growth and apoptotic factors. Methods:The effects of dextrose solution (1%, 5%, 10%-low doses, 15%, 20% and 25%-high doses) were evaluated in vitro by using human fibroblast culture. In each condition total RNA extraction and cDNA synthesis were performed. The gene expression levels of angiogenic and apoptotic factors were analyzed by using real-time polymerase chain reaction. The gene expression results of growth and apoptotic factors were correlated with control results. Results:Results;Dextrose solutions were affected the viability of fibroblast cells in culture flask in high concentrations. In high doses dextrose concentrations, up to 80% of fibroblasts were died because of toxic conditions. Viable fibroblast cell ratios were decreased proportionally due to the dextrose concentration. Low dextrose concentrations increased gene expressions in angiogenic (VEGFA, PDGFA, PDGFB, IGF1) and in apopitotic factors (CASP3 and CASP8) in fibroblasts. Conclusions: Conclusion; Dextrose solution in high concentrations, decreases viable cell ratios on adult fibroblast cell line. Dextrose solutions in proper concentrations increase the gene expressions of angiagenic and apopitotic factors on viable cells in adult fibroblast cell culture.