Case Report A Surgical Opinion in a 36-Week Pregnant with Tibia Fracture: Intramedullary Nailing

The operative treatment of tibial fractures in late pregnancy is a controversial issue that is rarely discussed in the literature. Here we present a case of a tibial diaphyseal fracture in a woman that was 36 weeks pregnant, which was treated with intramedullary nails under noninvasive foetal monitoring with cardiotocography. The patient underwent a successful surgery, and no harm or adverse events to either the mother or the foetus were reported during or after the procedure. Following surgery, the mother had a comfortable pregnancy and a normal spontaneous vaginal delivery with a healthy newborn

Evaluation of oxidative stress in degenerative rotator cuff tears

Background: Oxidative stress occurs as a result of the disruption of the balance between the formations of reactive oxygen species and antioxidant defense mechanisms during the conversion of nutrients into energy. Increased body oxidative stress has been reported to be involved in the etiology of several degenerative and chronic diseases. We hypothesized that the body oxidative stress level is higher in patients with atraumatic degenerative rotator cuff tear than that in healthy individuals. Methods: The patients who underwent arthroscopic repair for atraumatic, degenerative rotator cuff tear were prospectively evaluated. A total of 30 patients (group 1, 19 females and 11 males; mean age: 57.33 ± 6.96 years; range: 50-77 years) and 30 healthy individuals (group 2, 18 females and 12 males; mean age: 56.77 ± 6 years; range: 51-72 years) were included in the study. The Constant and American Shoulder and Elbow Surgeons scoring systems were used to evaluate the clinical outcomes. Serum oxidative stress parameters of the patients and the control group were biochemically evaluated. Accordingly, thiol/disulfide (DS) balance (DS/native thiol [NT], DS/total thiol [TT]), Total Oxidant Status (TOS), oxidative stress index, and nuclear factor erythroid-2–associated factor-2 values were used as the biochemical parameters indicating an increase in the serum oxidative stress level. Total antioxidant status and NT/TT values served as the biochemical parameters indicating a decrease in the serum oxidative stress level. Results: The study follow-up duration was 12 months. A statistically significant increase was observed in American Shoulder and Elbow Surgeons and Constant scores of patients who underwent arthroscopic rotator cuff repair relative to that during the preoperative period (P = .01). The values of biochemical parameters (DS/NT, DS/TT, TOS, oxidative stress index, and nuclear factor erythroid-2–associated factor-2), which indicated an increase in the serum oxidative stress, were significantly higher in preoperative patients than those in postoperative patients, albeit the control group values were significantly lower than those of the postoperative patients. The biochemical parameters (NT/TT and total antioxidant status) indicating a decrease in the serum oxidative stress levels were significantly higher in the postoperative patients than those in the preoperative patients and significantly lower than those in the control group. Conclusion: High levels of markers indicating an increase in the serum oxidative stress in patients with degenerative rotator cuff rupture suggested that TOS may be involved in the etiopathogenesis of rotator cuff degeneration. Although the oxidative load decreases during the postoperative period, the fact that it is still higher than that in healthy individuals supports this claim. © 2022 Journal of Shoulder and Elbow Surgery Board of Trustee

Impact of an educational meeting on knowledge and awareness of general practitioners on upper respiratory tract infections

Objectives: This study aimed to evaluate knowledge ofprimary care physicians regarding the use of antibioticsfor the upper respiratory tract infections (URTIs) and thespecific outcomes of a health educational meeting in twocities using a self -administered questionnaire.Materials and methods: A standard questionnaire wasfilled by the participants before and after the meeting. Thequestionnaire had seven questions about definition, epidemiology,diagnosis and treatment of URTIs. The knowledgeand approaches of practitioners concern about diagnosisand antibiotic use in URTIs were evaluated. Theproportion of overall satisfied answers before and afterthe meeting was compared.Results: Totally 110 primary care physicians joined intothe study. Before the educational meeting, more than30% of participants stated that the at least 50% of thecausative agents of the URTIs are bacteria. Eighty-eightpercent declared that anaerobes or Neisseria are not theplausible causative agents in URTIs. Only 14% of them indicatedthat procaine penicillin is the primary agent for thetreatment of Streptococcus pyogenes. On the other hand,95% of survey participants considered that penicillin isthe first choice for URTI with Beta-hemolytic Streptococcus.After the educational meeting, most of participants’knowledge showed a significant improvement in knowledge.There were a significantly more correct answers toall questions after the educational meeting compared tobefore the meeting. (27.7% of doctors before vs.92.7%after, p<0.001).Conclusion: As a conclusion, attending the educationalmeetings helps primary care physicians’ to increase theirknowledge and it provides to gain a standard approach intheir professional life

Biomechanical Evaluation of a Novel Apatite-Wollastonite Ceramic Cage Design for Lumbar Interbody Fusion: A Finite Element Model Study

Objectives. Cage design and material properties play a crucial role in the long-term results, since interbody fusions using intervertebral cages have become one of the basic procedures in spinal surgery. Our aim is to design a novel Apatite-Wollastonite interbody fusion cage and evaluate its biomechanical behavior in silico in a segmental spinal model. Materials and Methods. Mechanical properties for the Apatite-Wollastonite bioceramic cages were obtained by fitting finite element results to the experimental compression behavior of a cage prototype. The prototype was made from hydroxyapatite, pseudowollastonite, and frit by sintering. The elastic modulus of the material was found to be 32 GPa. Three intact lumbar vertebral segments were modelled with the ANSYS 12.0.1 software and this model was modified to simulate a Posterior Lumbar Interbody Fusion. Four cage designs in different geometries were analyzed in silico under axial loading, flexion, extension, and lateral bending. Results. The K2 design had the best overall biomechanical performance for the loads considered. Maximum cage stress recorded was 36.7 MPa in compression after a flexion load, which was within the biomechanical limits of the cage. Conclusion. Biomechanical analyses suggest that K2 bioceramic cage is an optimal design and reveals essential material properties for a stable interbody fusion

LOMBER İNTERBODY FÜZYON İÇİN YENİ BİR KAFES TASARIMININ SONLU ELEMANLAR MODELİYLE BİYOMEKANİK OLARAK DEĞERLENDİRİLMESİ

Amaç Bu çalışmada dejeneratif omurga hastalıklarının lomber interbody füzyon ile tedavisinde kullanılmak üzere biyocam içerikli yeni bir interbody kafes tasarlanması ve tasarlanan kafesin gerçek ortam ve sonlu elemanlar modeli ile biyomekanik olarak değerlendirilmesi ve tasarımının optimalize edilmesi amaçlandı. Gereç ve Yöntem 15,5mm x 15,5mm x 10,2mm boyutlarında biyocam kafes prototipi üretildi. Üretilen prototip kafes gerçek ortamda İnstron test cihazıyla ve sanal ortamda SEM ile değerlendirildi. Sonrasında ise iki yöntem karşılaştırıldı. Ardından üç adet lomber vertebra (L3-L4-L5) SEM ile modellendi. Bu model ile intakt omurga modeli, ve prototip kafesin işlenmesiyle elde edilen farklı geometrilerdeki biyocam kafesler sanal olarak değerlendirildi. Bu sanal değerlendirme sonrasında elde edilen verilerle, en uygun geometriye sahip kafes belirlendi ve üretimi yapıldı. Ardından üretilen bu kafeslere Dartec test cihazında basma testleri uygulandı. Aynı düzenek SEM ile de modellendi ve sanal olarak testler tekrarlandı ve sonuçlar karşılaştırıldı. Bulgular Prototip (işlenmemiş) kafese instron test cihazında basma testi uygulandı. Elastik modülüs değeri 31,88 GPa ve maksimum kompresyon değeri 121,16 MPa olarak saptandı. Ardından SEM ile L3-L4-L5 omurga modeli geliştirildi. Bu model ile dört farklı kafes geometrisi 400 N aksiyel yüklenme ve 6 Nm moment uygulanarak fleksiyon, ekstansiyon, bending ve rotasyon hareketleri ile değerlendirildi ve en uygun kafes geometrisi saptandı. Ardından prototip kafes Challenger 2412 microcut tezgahında işlendi. Elde edilen üç adet kafese Dartec test cihazında basma testi uygulandı. Test sonucunda kafeslerin 4,3 kN, 3,9 kN ve 5,63 kN&#8217;luk yüklere dayanabildiği görüldü. Bu test SEM ile simüle edildi ve 5 kN&#8217;luk aksiyel yüklenme uygulandı. Gerçek test ve SEM testi sonuçlarının uyumlu olduğu görüldü. Sonuç Bu çalışmanın sonucunda tasarlanan biyocam kafesin yeterli biyomekanik güce sahip olduğu görüldü. Bu nedenle yeni geliştirilen biyocam kafesin, gelecekte interbody füzyon uygulamaları için ümit veren bir malzeme olduğu düşünülmektedir. Ancak, son ürünü elde edebilmek için, geliştirilen kafesin in vivo ortamdaki davranışının saptanabilmesi için değişik hayvan modellerinde denenmesine ihtiyaç vardır.Introduction The aim of this study is to design o novel lumbar interbody cage made of bioglass in the treatment of degenerative lumbar vertebrae disease and optimize the geometry of this novel cage biomechanically with finite element method (FEM) and real biomechanical tests. Materials and Methods A bioglass cage prototype made in dimensions 15,5mm x 15,5mm x 10,2mm. This cage was tested with the instron universal test machine and with FEM. Then the results are compared. After that L3-L4-L5 lumbar vertebrae are modelled by FEM. With this model intact vertebrae and the processed cages in different geometries are evaluated. By the FEM test data the appropriate cage design is determined and the cage is processed. Then these cages are tested with the Dartec test machine. The same tests are done with FEM and then the results are compared. Results Unprocessed cage is tested with the Instron testing machine. Elastic modulus value is 31,88 GPa and the maximum compression value is 121,16 MPa. Then L3- L4-L5 vertebraes are modeled with FEM. 400 N axial compression and 6 Nm moment force is applied. Under flexion, extension, bending and rotation movements the cages are evaluated and the appropriate geometry is determined. After that three unprocessed cage is processed with Challenger 2412 microcut machine. These cages are tested with Dartec testing machine. The cages are broken at 4,3 kN, 3,9 kN and 5,63 kN loadings. This test is simulated with FEM and 5 kN axial load is applied. The real and FEM test results are harmonious. Conclusions By the results of this study we have observed that the bioglass cage is found as a biomechanically compatible implant. Finally, we think that this novel cage is a promising material for the interbody fusion applications in the future. But in order to get the biocompatibility and in vivo behavior of the material, we need to test the novel cage in different animal models

A Surgical Opinion in a 36-Week Pregnant with Tibia Fracture: Intramedullary Nailing

The operative treatment of tibial fractures in late pregnancy is a controversial issue that is rarely discussed in the literature. Here we present a case of a tibial diaphyseal fracture in a woman that was 36 weeks pregnant, which was treated with intramedullary nails under noninvasive foetal monitoring with cardiotocography. The patient underwent a successful surgery, and no harm or adverse events to either the mother or the foetus were reported during or after the procedure. Following surgery, the mother had a comfortable pregnancy and a normal spontaneous vaginal delivery with a healthy newborn

Layer-parallel shortening and related structures in zones undergoing active regional horizontal extension

Folds and thrust faults formed by layer-parallel shortening coaxial with extensional structures such as normal dip-slip faults and ductile necking structures with orthorhombic fabric symmetry are usual, but little-recognised structures formed within normal dip-slip shear zones bounding rifts. They are generated because of the shear distribution in a zone of progressive deformation and may be later extended and disrupted depending on which part of the strain ellipsoid they may be located. We here describe folds and thrust faults from the southern margin of the AlaAYehir Rift in western Turkey as an opportunity to discuss the properties of pure extension-related structures formed by layer-parallel shortening. Such structures are more commonly generated during the early stages of rifting, when deformation rates are slow and the shear zones broader than those forming later in the life of a rift when strain rates are usually higher. Such structures have commonly been mistaken for witnesses documenting regional episodes of shortening rather than as integral parts of the extensional structures forming rifts. Not all layer-parallel shortening-related structures therefore indicate regional shortening. We plead that hasty statements concerning the meaning of geological structures at all scales be avoided before a thorough understanding of bulk strains that have affected a region are properly understood

Layer parallel shortening and related structures in zones undergoing active regional pure horizontal extension

Folds and thrust faults formed by layer-parallel shortening coaxial with extensional structures such as normal dip-slip faults and ductile necking structures with orthorhombic fabric symmetry are usual, but little-recognised structures formed within normal dip-slip shear zones bounding rifts. They are generated because of the shear distribution in a zone of progressive deformation and may be later extended and disrupted depending on which part of the strain ellipsoid they may be located. We here describe folds and thrust faults from the southern margin of the Alaşehir Rift in western Turkey as an opportunity to discuss the properties of pure extension–related structures formed by layer-parallel shortening. Such structures are more commonly generated during the early stages of rifting, when deformation rates are slow and the shear zones broader than those forming later in the life of a rift when strain rates are usually higher. Such structures have commonly been mistaken for witnesses documenting regional episodes of shortening rather than as integral parts of the extensional structures forming rifts. Not all layer-parallel shortening-related structures therefore indicate regional shortening. We plead that hasty statements concerning the meaning of geological structures at all scales be avoided before a thorough understanding of bulk strains that have affected a region are properly understood