Digital Commons Network^™

Investigation Of The Relationship Between Triglyceride Glucose Index And Metabolic And Hematological Parameters In Obese Individuals, Özge Baş Aksu, Feri̇de Özkara, Rifat Emral, Volkan Genç, Demet Çorapçioğlu, Mustafa Şahi̇n

Turkish Journal of Medical Sciences

Background/aim: This research examined the association between the triglyceride-glucose (TyG) index and metabolic, hepatic, and hematologic variables in a population of severely obese subjects, with a focus on the assessment of glycemic control.

Materials and methods: This retrospective study included 315 adult patients with a body mass index (BMI) ≥ 35 kg/m² who were evaluated for bariatric surgery. Participants were grouped according to HbA1c levels: those with HbA1c ≥ 6.5% and those with HbA1c < 6.5%. TyG, atherogenic index of plasma (AIP), fibrosis-4 (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and hematological inflammation markers were assessed and compared between groups. To investigate associations, correlation and regression analyses were conducted.

Results: Individuals with HbA1c ≥ 6.5% had significantly higher TyG, AIP, APRI, and FIB-4 values than those with lower HbA1c. The TyG index showed a strong …

Thermal Compensation Algorithm In Manoscan™ High-Resolution Esophageal Manometry: Does It Really Affect Manometry Metrics And Final Diagnosis?, Ekrem Aslan, Erdem Akbal

Turkish Journal of Medical Sciences

Background/aim: The accuracy of pressure measurements with ManoScan™ high-resolution manometry (HRM) catheters decreases due to the development of pressure drift (PD) resulting from variations between room and body temperature. The corrective algorithm called thermal compensation (TC), added to the manometry software program by the manufacturer is used to prevent the development of PD. To date, no studies have demonstrated that PD leads to changes in manometry metrics and/or clinical diagnosis. The present study aims to demonstrate the impact of the TC algorithm on HRM metrics and final diagnosis.

Materials and methods: Records of 124 consecutive esophageal HRM studies with ManoScan™ …

Health Impacts And Medical Assistance After Libyan Flood Disaster: Emergency Medical Teams’ Responses, Hakan Güner, Okan Maden, Muhammed Saltuk Deni̇z, Kerem Dost Bi̇lmez, Şükrü Yorulmaz, Mehmet Enes Gökler

Turkish Journal of Medical Sciences

Background/aim: Floods are the most frequent natural disasters and pose direct and indirect health risks, some well-documented and others poorly understood. Epidemiological studies help bridge these gaps and guide effective public health responses.In September 2023, Storm Daniel caused severe flooding in Libya, damaging infrastructure, including healthcare facilities. The disaster affected 250,000 people, displaced 48,000, and claimed 15,000 lives, making it the second deadliest natural disaster of the year. This study aims to assess the characteristics of flood-affected patients to improve disaster preparedness.

Materials and methods: This descriptive study examined disaster victims who visited three clinics established as part of an …

Development Study Of Scientific Competence And Activity Scale In Medical Faculty Research Assistants, Cemal Koçak, Hande Güverci̇n, Ecem Esen, Meltem Çöl

Turkish Journal of Medical Sciences

Background/aim: One mission of medical faculties is training scientists equipped with the necessary knowledge, skills, attitudes, who can evaluate the scientific research. The aim was to develop a scale for evaluating the level of scientific competence and activity in research assistants.

Materials and methods: The study is a methodological study, conducted in October 2023-May 2024 with 299 research assistants working at X University Faculty of Medicine. The reliability was assessed by item-total correlation and Cronbach-alpha coefficient; construct validity was assessed by EFA. In EFA, principal component analysis, Varimax rotation were used. KMO and Barttlet test p value were calculated. Groups …

Administration Of Adipose Tissue-Derived Mesenchymal Stem Cells And Bone Marrow-Derived Mesenchymal Stem Cells In Anosmic Mice, Burak Hazir, Alper Ceylan, Emi̇n Ümi̇t Bağriaçik, Duygu Dayanir, Betül Öğüt, Ni̇han Örüklü, Mücahi̇t Yalçin, Berkay Şi̇mşek, Muammer Meli̇h Şahi̇n

Turkish Journal of Medical Sciences

Background/aim: Anosmia, a serious condition that affects the sense of smell, has no universally agreed-upon treatment. Adult stem cells are considered a potential option for treating anosmia. This study aims to evaluate the efficacy of mesenchymal stem cells derived from different tissues in an anosmic mouse model induced by 3-methylindole (3-MI).

Materials and methods: In our study, 36 mice with 3-MI-induced anosmia were divided into subgroups. Anosmia was confirmed by performing a food-finding test (FFT) in each group. Intranasal phosphate-buffered saline was administered to the first group, adipose tissue-derived mesenchymal stem cells (ADSCs) to the second group, and bone marrow-derived …

Forensic Identification Using Airdna: A Preliminary Study On The Collection, Isolation, Amplification And Sequencing Of Human Dna From Air Samples, Sitki Tiplamaz, Zehra Ömeroğlu Ulu, Bestami̇ Çolak, Hizir Asliyüksek, Fi̇kretti̇n Şahi̇n

Turkish Journal of Medical Sciences

Background/aim: Humans continually release skin cells and DNA fragments into the air. This DNA can either remain airborne or drop onto surfaces as indoor dust. This study investigates the collection, isolation, amplification, and sequencing of human DNA from air samples, focusing on both nuclear DNA and mitochondrial DNA.

Materials and methods: This study was conducted in a 15 m3 room and a meeting room, where air samples were systematically collected and filtered using a vacuum device equipped with various sterile filters. The rigorous protocols were implemented to prevent contamination throughout the process. Thirteen air samples were processed in this research, …

Erratum To " Evaluation Of Clinical Features And Treatment Modality Of Pediatric Patients With Steven Johnson Syndrome/Toxic Epidermal Necrolysis: A Single-Center Experience " [ Turkish Journal Of Medical Sciences 55 2 461 469], Funda Ayteki̇n Güveni̇r

Turkish Journal of Medical Sciences

In the original article, the ORCID of one of the co-authors, Hatice Irmak ÇELİK, was incorrectly reported by the corresponding author. At the request of the authors, the ORCID has been corrected to reflect the accurate information. This correction does not affect the content or conclusions of the article. The authors apologize for this oversight.

Link to the original article: https://doi.org/10.55730/1300-0144.5990

Unraveling The Relationship Between Sexual Shame And Father-Child Sex Communication, Hannah Mireya Brundage

Theses and Dissertations

This study sought to understand the relationship between father’s sexual shame and children’s sexual shame. Parents play a role in shaping their children’s behaviors and perceptions in regard to sexuality. Most of this research analyzed data from the viewpoint of the mother, missing the potentially unique perspective and influence of fathers. Using longitudinal survey data from 361 fathers-adolescent dyads, I proposed to study the relations between father sexual shame and child sexual shame, and the possible mediating role of father-child sex communication. I predicted that quality of sex communication, including controlling and open communication, would mediate father sexual shame and …

A Study On Covid-19 Outbreak In Cook County Of Illinois, Suraj Powar

Research Papers

This study presents a mathematical model developed to better understand the transmission dynamics of COVID-19 and evaluate the effectiveness of different public health strategies. The model, called SEQIRD, includes of the disease such as exposure, quarantine, infection, recovery, and death. Using real case and death data from Cook County, Illinois, the model closely fits observed trends and captures both pre and post-lockdown dynamics with high accuracy.

Our results show that early intervention significantly reduces total infections, with lockdown imposed even a few days earlier preventing thousands of cases. Through sensitivity analysis, we also identify that parameters such as transmission rate, …

Emt Vision, Logan Calder, Grant Johnson, John Alvarado, Jack Landers

Computer Science and Engineering Senior Theses

Augmented Reality (AR) has demonstrated considerable promise for future mobile technologies, offering the ability to overlay crucial information within a user’s vision while they can still maintain awareness of the surrounding environment. Similarly, Artificial Intelligence (AI) is an increasingly influential technology with significant potential to revolutionize the medical field. Its ability to rapidly learn and adapt to specific tasks makes it particularly promising for supporting paramedics during emergency calls. AI can efficiently analyze real-time data and present it in a concise, actionable format, enhancing decision making in critical situations.

Given the potential of these technologies, we have developed a smart …

The Effects Of Sleep Restriction And Time Of Day On Food-Specific Impulsivity, Approach-Avoidance Bias And Delay Discounting, Naomi Kakoschke, David L. Dickinson, Sean P. A. Drummond

ESI Publications

Background:

Insufficient sleep and circadian timing are both linked with obesity, primarily via unhealthy food choice, yet the cognitive mechanisms underpinning such relationships remain unclear.

Methods:

Across two studies, we implemented an ecologically valid within-subjects at-home protocol. Study 1 (n = 118) involved a within-subjects examination of how sleep restriction (SR) versus well-rested (WR) sleep levels affect choices in a food-based approach-avoidance task (AAT) and go–no/go (GNG) task, a food liking task, a food-choice task, a psychomotor vigilance task (PVT), and a monetary choice task. Study 2 (n = 119) involved examining choices in the same set of …

Jeffrey Cuttler V. Allegheny County

2025 Decisions

USDC for the Western District of Pennsylvania

Expert Opinion On Clinical Presentation, Diagnosis And Treatment Of Infantile Onset Pompe Disease: A Delphi Study In Türkiye, Eki̇n Özsaydi Aktaşoğlu, Asli İnci̇, Ridvan Murat Öktem, Gürsel Bi̇beroğlu, İlyas Okur, Fati̇h Süheyl Ezgü, Fi̇li̇z Başak Cengi̇z Ergi̇n, Abdurrahman Akgün, Nur Arslan, Hali̇l İbrahi̇m Aydin, Ayşe Ergül Bozaci, Mahmut Çoker, Fatma Tuba Emi̇noğlu, Meli̇ke Ersoy, Emi̇ne Göksoy, Banu Kadioğlu Yilmaz, Mehtap Kağnici, Mustafa Kiliç, Nesli̇han Önenli̇ Mungan, Burcu Öztürk Hişmi̇, Pembe Soylu Üstkoyuncu, Ayşegül Tokatli, Ayşe Çi̇ğdem Aktuğlu Zeybek, Berrak Bi̇lgi̇ner Gürbüz, Sevi̇l Dorum, Di̇lek Güneş, Çi̇ğdem Seher Kasapkara, Sebi̇le Kilavuz, Erdoğan Soyuçen, Peli̇n Teke Kisa, Özlem Ünal Uzun, Fatma Derya Bulut, Songül Gökay, Selen Has Özhan, Deni̇z Kor, Aynur Küçükcongar Yavaş, Fi̇gen Özçay, Yilmaz Yildiz, Harun Yildiz, Leyla Tümer

Turkish Journal of Medical Sciences

Background/aim: Pompe disease (acid maltase deficiency, glycogen storage disease type II, OMIM #606800) is an autosomal recessive disorder characterized by lysosomal acid-α-glucosidase deficiency. The infantile-onset type of the disease is mainly characterized by cardiomegaly, hypotonia, and a high mortality rate. This study aimed to create a national consensus about infantile-onset Pompe disease (IOPD) to raise awareness among clinicians and standardize diagnosis and treatment approaches in Türkiye.

Materials and methods: The Gazi University Division of Metabolic Diseases and Nutrition developed this expert opinion consensus and expanded it to include metabolism specialists across Türkiye. A systematic literature review was performed, and the …

The Long-Term Efficacy Of Nusinersen On Respiratory Functions In Children With Symptomatic Spinal Muscular Atrophy Type 1, Mehmet Aki̇f Kiliç, Fulya Kürekçi̇, Osman Ki̇poğlu, Orhan Coşkun, Burçi̇n Nazli Karacebey, Selahatti̇n Katar, Ridvan Avci, Hülya Maraş Genç, Erkan Çakir, Edi̇be Pembegül Yildiz

Turkish Journal of Medical Sciences

Background/aim: Available data regarding the effects of nusinersen on respiratory function in the real-world setting are uncertain. We aim to evaluate the impact of nusinersen on respiratory outcomes with a follow-up period of up to 72 months in patients with symptomatic spinal muscular atrophy type 1 (SMA type1).

Materials and methods: Respiratory status is defined similarly to previous studies: spontaneous breathing, non-invasive ventilatory support for ≤16 hours per day, and permanent assisted ventilation. The planned evaluation time was day 180 (after the fourth dose), day 300 (after the fifth dose), and after the last injection for patients who received nusinersen …

Hmga2 Associated Cerna-Hotair Pathway In Breast Cancer Patients From Clinicopathological Perspective, Peli̇n Ercoşkun, Deni̇z Ağirbaşli, Mehmet Veli̇dedeoğlu, Mehmet Seven, Aysel Kalayci

Turkish Journal of Medical Sciences

Background/aim: Several epigenetic alterations are involved in the development of breast cancer. The long noncoding RNA HOTAIR and related RNAs play a role in initiation of breast cancer and are promising targets for diagnostic biomarker and therapeutic studies. In this study, we aimed to investigate HMGA2 associated ceRNA HOTAIR pathway in breast cancer patients.

Materials and methods: Forty breast cancer patients and ten healthy controls were included in this study, and then patients were divided into clinicopathologic groups. After total cell-free RNA isolation, expression levels of target RNAs were analysed by Real-Time PCR. The amount of gene expression was determined …

A Comprehensive Systematic Review Of Machine Learning Applications In Assessing Land Use/Cover Dynamics And Their Impact On Land Surface Temperatures, Rasool Vahid, Mohamed Aly

Environmental Dynamics Faculty Publications and Presentations

In a world experiencing rapid urbanization, the phenomenon of land surface temperature (LST) variation has invited substantial attention due to its profound impact on the environment and human well-being. Changes in land use and land cover (LULC) within urban areas significantly influence the dynamics of LST and are a major driver of urban eco-environmental change. The complex connections between LULC dynamics, LST, and climate change are investigated in this systematic review, with a focus on the combined effects of these variables and the use of Machine Learning (ML) techniques. The data in this study, based on peer-reviewed publications from the …

Ex Vivo And Simulation Comparison Of Leakage In End-To-End Versus End-To-Side Anastomosed Porcine Large Intestine, Youssef Fahmy, Mohamed Trabia, Brian Ward, Lucas Gallup, Whitney Elks

Mechanical Engineering Faculty Research

Anastomotic leaks after colorectal resection are serious surgical complications. We have compared the integrity of two common colorectal anastomosis techniques, end-to-side (ES) and end-to-end (EE), to control specimens using a novel experimental setup that mimics anastomotic air leak tests, which are typically performed during surgeries. Freshly harvested porcine colonic sections from 23 F1 cross-species pigs were used. Pressure measurements and video imaging were used to monitor the ex vivo experiments on EE, ES, and Control specimens. Using EE (n = 16), ES (n = 12), and Control (n = 22) specimens, leak pressure was 282.6 ± 3.0 mm Hg for …

Evaluating Behavioral Skills Training To Teach Salsa Dancing Skills To Adults With Autism Spectrum Disorder And/Or Intellectual Disabilities, Joshua I. Nieves

USF Tampa Graduate Theses and Dissertations

Research has demonstrated behavioral skills training (BST) to be an effective teaching procedure for acquisition of a variety of skills among both neurotypical and neurodiverse individuals across different ages. Moreover, recent studies have demonstrated the effectiveness of BST for enhancing sports performance when training neurotypical children and adults. However, there is limited research on the effectiveness of BST for enhancing sports performance, and specifically dance performance, among individuals with autism spectrum disorder (ASD) and/or intellectual disabilities (ID). Dance is a recreational activity that can serve as a form of physical activity for children and adults. Salsa is a Latin style …

Monoclonal Antibodies Targeting The Fimh Adhesin Protect Against Uropathogenic E. Coli Uti, Edward D B Lopatto, Jesús M Santiago-Borges, Denise A Sanick, Sameer Kumar Malladi, Philippe N Azimzadeh, Morgan W Timm, Isabella F Fox, Aaron J Schmitz, Jackson S Turner, Shaza M Sayed Ahmed, Lillian Ortinau, Nathaniel C Gualberto, Jerome S Pinkner, Karen W Dodson, Ali H Ellebedy, Andrew L Kau, Scott J Hultgren

2020-Current year OA Pubs

As antimicrobial resistance increases, urinary tract infections (UTIs) are expected to pose an increased burden in morbidity and expense on the health care system, increasing the need for alternative antibiotic-sparing treatments. Most UTIs are caused by uropathogenic

Elucidating Brain Transport Pathways And Cell Type-Dependent Gene Silencing Of A Durable Lipid-Sirna Conjugate Administered Into Cerebrospinal Fluid, Alexander G Sorets, Kathleen M Schoch, Timothy M Miller, Et Al.

2020-Current year OA Pubs

The clinical neurosciences are in the midst of a renaissance spurred by the development of new therapeutic modalities. Short interfering RNAs (siRNAs), in particular, are gaining interest for treating neurological diseases owing to their capacity to sustain inhibition of nearly any gene target. However, to be effective, siRNA therapies must achieve delivery and on-target gene silencing activity in specific sites and cells in the brain. To this end, we developed a lipid-siRNA conjugate (L2-siRNA) that transports effectively throughout the brain when injected into cerebrospinal fluid (CSF). We provide a detailed examination of regional bulk tissue gene silencing in mice, highlighting …

Um Hires Air Force Veteran To Oversee Veteran And Military Services, Clara Turnage

University of Mississippi News

OXFORD, Miss. – The University of Mississippi has hired U.S. Air Force veteran Jeremee Alexander as the new director of its Office of Veteran and Military Services.

Topical Lifitegrast Therapy For Dry Eye Disease, Lama Assi, Salim C. Lutfallah, Tsz Wing Yim, Su Hsun Liu, Sharon J. Duffy, Jayne Weiss

School of Medicine Faculty Publications

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effectiveness and safety of topical lifitegrast therapy alone or in combination with artificial tears, compared with a placebo, artificial tears alone, or no treatment for dry eye disease.

Bibliometric Analysis Of Colchicine In Cardiovascular Health: Trends, Key Contributors, And Global Collaborations, Meltem Sertbaş, Özlem Özaydin, Habi̇p Yilmaz, Abdullah Emre Güner, Özden Güdük, Nalan Okuroğlu, Ali̇ Özdemir, Yaşar Sertbaş

Turkish Journal of Medical Sciences

Background/aim: The study aims to systematically analyze the body of literature concerning the effects of colchicine on the cardiovascular system, providing a comprehensive evaluation of the current knowledge and highlighting the clinical and scientific relevance of colchicine in this field.

Materials and methods: Data were obtained from the Web of Science Core Collection database on November 17, 2024. The search terms included “Colchicine” AND "Cardiovascular effects" OR "Cardiovascular diseases" OR "Heart diseases" OR "Coronary artery disease" OR "Myocarditis" OR "Pericarditis" OR "Atherosclerosis" OR "Heart failure" OR "Myocardial infarction." No restrictions were applied regarding publication date or language, ensuring the comprehensive …

The Role Of The Hemoglobin-Albumin-Lymphocyte-Platelet (Halp) Score In Deep Neck Infections And Its Relationship With Clinical Parameters, Ayşe Seçi̇l Kayali Di̇nç, Nagi̇han Gülhan Yaşar, Agah Yeni̇çeri̇, Çeti̇n Şahutoğlu, İbrahi̇m Sevi̇m, Meli̇h Çayönü

Turkish Journal of Medical Sciences

Background/aim: Deep neck infections (DNI) are suppurative infections of the cervical spaces, which may lead to life-threatening complications. The HALP score is a laboratory parameter reflecting a patient’s nutritional and inflammatory status. The aim of this study was to compare the HALP scores of patients with DNI with those of a control group. A secondary objective was to investigate the potential relationship between the HALP score and clinical parameters, and to assess its role in determining disease severity.

Materials and methods: The study retrospectively included patients who were hospitalized and treated for DNI. Data were extracted from the hospital’s electronic …

2025-06-20 Agenda Book, Morehead State University. Board Of Regents.

Morehead State Board of Regents Agenda Books and Meeting Minutes

Agenda booklet for the Board of Regents meeting of June 20, 2025, which includes the minutes of the meeting held on March 28, 2025.

Psychology 32: Human Growth And Development Syllabus, Joanna M. Agnello

Open Educational Resources

This Open Educational Resources (OER) syllabus for an introductory Developmental Psychology course offers a no-cost, adaptable framework for exploring human development across the lifespan. The course is structured chronologically, from prenatal development through late adulthood, integrating cognitive, emotional, and sociocultural perspectives. This OER syllabus aims to foster student-centered learning, critical thinking, community building and real-world applications of developmental concepts. All content is openly licensed.

Ud In The News June 14-20, University Of Dayton

News Releases

The Conversation, GovTech, Spectrum News 1 Ohio, Fast Company, Catholic World Report; and radio stations in Alabama, Chicago and Cincinnati featured faculty expertise. Dayton Business Journal wrote about Fr. Jim Fitz's transition to semi-retirement.

Comparative Efficacy Of Adjuvant Folfox Vs. Flot Following Neoadjuvant Flot In Patients With Locally Advanced Gastric Cancer, Furkan Ceylan, Di̇dem Şener Dede, Safa Can Efi̇l, Ateş Kutay Tenekeci̇, Eren Göktuğ Ceylan, Serhat Sekmek, Mehmet Çakmak, Burak Bi̇lgi̇n, Şebnem Yücel, Hayri̇ye Tatli Doğan, Mehmet Ali̇ Nahi̇t Şendur, Muhammed Bülent Akinci, Doğan Uncu, Bülent Yalçin

Turkish Journal of Medical Sciences

Background/aim: Perioperative FLOT is considered the gold standard treatment for locally advanced gastric cancer. However, in the adjuvant setting, chemotherapy intolerance has brought de-escalation strategies to the forefront as an important area of research. This study aimed to compare the efficacy of adjuvant FLOT and FOLFOX regimens in enhancing survival outcomes in patients with locally advanced gastric cancer who underwent surgical resection following neoadjuvant FLOT treatment.

Materials and methods: Patients with locally advanced gastric cancer (cT2-4, N0-3) who received four cycles of neoadjuvant FLOT and subsequently underwent surgery at Ankara Bilkent City Hospital between January 2018 and September 2024 were …

Long-Term Results Of Branch Retinal Vein Occlusion: 5-Year Follow-Up, Ilkay Kilic Muftuoglu, Natasha Mayer, Katherina Du, Catalina Feistritzer, Elise Barberis, Sashwanti Mohan, Jay Chhablani

Turkish Journal of Medical Sciences

Background/aim: This study aimed to report the 5-year outcomes of patients with newly diagnosed branch retinal vein occlusion (BRVO).

Materials and methods: A retrospective review of patient charts was conducted. Data on central macular thickness (CMT), best-corrected visual acuity (BCVA), photoreceptor integrity, number of intravitreal (IV) antivascular endothelial growth factor (anti- VEGF) injections administered, and treatment regimen were assessed.

Results: Ninety-seven eyes from individual patients with a mean age of 70.90 ± 11.49 (38–92) were included. The mean BCVA improved, and the mean CMT decreased at all follow-up visits following treatment (p < 0.05). Thirty-two eyes (33%) gained 3 lines of BCVA at the five-year follow-up. The mean number of total IV anti-VEGF injections administered was 19 ± 13.35 (1–49) during the five-year period, and 27.83% of patients received rescue laser treatment. Fifty-four percent of eyes received three consecutive monthly loading doses of IV anti-VEGF injections. The mean change in BCVA in the loading dose (+) group was significantly greater than in the loading dose (–) group at 1-year and subsequent visits. The loading dose (+) group showed a significantly greater reduction in CMT compared to the loading dose (–) group. The mean estimated time for BCVA to decline by ≥3 lines was 117 ± 8.74 months (95% CI = 100.21–134.51)

Conclusion: Anti-VEGF treatment was effective in improving anatomical …

Diagnosis Of Knee Joint Invasion In Patients With Osteosarcoma: The Value Of Direct And Indirect Mri Findings, İpek Tamsel, Hüseyi̇n Kaya, Orkhan Aghamirzayev, Oğuz Di̇mdork, Başak Doğanavşargi̇l, Mehmet Argin, Dündar Sabah

Turkish Journal of Medical Sciences

Background/aim: Osteosarcoma is the most common primary malignant bone tumor in adolescents, and the evaluation of joint invasion with MRI is important for treatment planning. This study aimed to investigate the diagnostic value of MRI findings (direct and indirect) for joint invasion in patients diagnosed with osteosarcoma of the knee region.

Materials and methods: The MRI evaluations of 50 knee osteosarcoma patients who underwent surgical resection between 2006 and 2018 were reviewed retrospectively by two radiologists and an orthopedic oncologist. The presence of intrasynovial tumor tissue, intra-articular destruction of cartilage or bone, and invasion of the capsular and cruciate ligament …