Comparisons of Occupational Balance Within Informal Caregivers of Individuals With Schizophrenia.

The caregiving burden experienced by informal caregivers of individuals with schizophrenia (ICIWS) can affect their perceived occupational balance (OB). This study examines the differences in OB among ICIWS with different caregiving burden levels. This cross-sectional study was conducted with a sample of 149 ICIWS. The Occupational Balance Questionnaire 11-Turkish Version (OBQ11-T) was used to assess the participants' OB. The Zarit Caregiver Burden Scale was employed to evaluate caregiving burden levels. Statistically significant differences were found in the total score of OBQ11-T, Item 3 (time for doing things wanted), Item 5 (having sufficient time for doing obligatory occupations), and Item 9 (balance between obligatory/voluntary occupations) between the severe and little caregiving burden groups (p < .05). Caregiving for individuals with schizophrenia can lead to varying levels of caregiving burden, which negatively affects OB. Occupational therapists working with ICIWS should assess OB and address OB-related challenges to alleviate caregiver burden.

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration.

OBJECTIVES: This study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. PATIENTS AND METHODS: Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ≥30 min n=80) was examined. RESULTS: No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). CONCLUSION: Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively.

Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results.

Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth.

Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients.

BACKGROUND: : The purpose of this study is to investigate whether the etiological factors accepted as causes of idiopathic subscapularis tears are true or not when the comparison is made with the opposite side healthy shoulder of the patients who underwent arthroscopic repair for an isolated subscapularis tear. METHODS: Sixteen patients who underwent shoulder arthroscopy between February 2016 and January 2018 and were diagnosed with isolated subscapularis tear were evaluated. The coracohumeral distance (CHDax), coracoid overlap (CO), and tuberculum minus cysts (TMC) were evaluated on the axial images of the MRI studies while the acromiohumeral distance (AHDsag), CHDsag, and subscapularis tendon slip number (STSN) on the sagittal oblique images and the AHDcor and SLAP lesion on the coronal oblique images. Degeneration of the coracoacromial ligament was evaluated during arthroscopy. RESULTS: The mean CHDsag (11.26-10.08), CHDax (10.63-9.98), CO (14.2-15.43), AHDsag (8-7.66), and AHDcor (7.65-7.68) measurements (operated side-healthy side, respectively) were statistically similar (p > 0.05). No statistically significant difference was found between TMC and STSN in healthy and operated shoulders (p > 0.05). There was mild coracoacromial ligament fraying in 4 (25%) and obvious coracoacromial ligament fraying in 8 (50%) which indicated subacromial impingement in 75% of the patients. DISCUSSION: The parameters of the coracoid process did not reveal any significant difference between the operated (for an isolated subscapularis tear) and opposite-side healthy shoulders of the patients. However, coracoacromial ligament degeneration was present in 75% of the patients.

High-resolution dielectric anisotropy investigation of carbon nanotube-smectic-A liquid crystal dispersions: An upper limit of the latent heat and the pretransitional anomaly at the nematic-smectic-A transition.

Within the entire mesomorphic range, high-precision dielectric anisotropy data with the high-temperature resolution is presented for a highly polar smectic-A liquid crystal 8CB (octylcyanobiphenyl) as well as 8CB nanocomposites doped with both pristine multi-walled carbon nanotubes (p-MWCNTs) and carboxyl group (-COOH) functionalized MWCNTs (f-MWCNTs). The temperature variation of the nematic order parameter across both the nematic-isotropic (N-I) and the nematic-smectic-A (N-Sm-A) phase transitions of the neat 8CB and 8CB+MWCNT nanocomposites has then been derived from the dielectric anisotropy data within the framework of the Maier-Meier theory. With the inclusion of MWCNTs, both the N-I and the N-Sm-A transition temperatures have been noted to shift to lower temperatures as compared to the 8CB host. Also, for all 8CB+MWCNT nanocomposites, regardless of the surface functionalization, it has been well documented that the N-I transition is weakly first order, whereas the N-Sm-A transition remains continuous within the experimental resolution. For all investigated samples, the temperature dependence of the nematic order parameter has been shown to be quasitricritical, within the experimental resolution. From the attentive inspection of the dielectric anisotropy data in the vicinity of the N-Sm-A transition, the upper limits for a possible latent heat ΔH_{NA} for the 8CB host and all 8CB+MWCNT composites, for the first time, have been derived. The so-derived ΔH_{NA} values for all investigated samples have also been compared with those extracted from the optical birefringence data, and an excellent consistency has then been noted. The N-Sm-A pretransitional anomaly has been investigated and the effective specific heat capacity exponent α values have been yielded from the power-law analysis of our high-resolution Δɛ(T) data across the N-Sm-A transition for all investigated samples. It has been well documented that the incorporation of MWCNTs to the 8CB host leaves the N-Sm-A transition essentially bulklike. We discussed that, to some extent, the compliance of MWCNTs does not drive the N-Sm-A transition to 3D-XY-like behavior, that is the strength of de Gennes coupling will remain the same for all nanocomposites. This issue can be ascribed to the weaker nature of MWCNT disorder. In this work, for the first time, high-resolution Δɛ(T) data has been shown to be very adequate and offer an easy way to investigate the N-Sm-A transition as compared to calorimetric methods.

Postoperative Pulmonary Complications after Percutaneous Nephrolithotomy Under Spinal Anesthesia.

PURPOSE: To evaluate risk factors and outcomes of Pulmonary Complications (PCs) in Percutaneous Nephrolithotomy (PCNL) under Spinal anesthesia (SA). MATERIAL AND METHOD: 286 patients who underwent PCNL under SA between 2017 and 2021 were identified retrospectively and divided into group 1 (clinically significant PCs) and group 2 (no clinically significant PCs). Demographic, preoperative, and intraoperative variables and postoperative outcomes were compared between both groups. Independent risk factors for PCs were evaluated by univariable and multivariable logistic regression analyses. RESULTS: PCs were noted in 90 patients (31.5%). Advanced age (P = .011), high body mass index (BMI) (P < .001), and the presence of chronic obstructive pulmonary disease (COPD) (P < .001) were risk factors for PCs. CONCLUSION: SA is an effective method of anesthesia for all PCNL patients and carries a lower rate of PCNL-associated PCs. Risk factors for PCs after PCNL were advanced age, obesity, and preoperative COPD.

Analysis of the Vibration Characteristics of a Leaf Spring System Using Artificial Neural Networks.

The real-time vibrations occurring in a leaf spring system may cause undesirable effects, such as stresses, strains, deflections, and surface deformations over the system. In order to detect the most appropriate working conditions in which the leaf spring system will work more stably and also to design optimized leaf spring systems, these external effects have to be detected with high accuracy. In this work, artificial neural network-based estimators have been proposed to analyze the vibration effects on leaf spring systems. In the experimental studies carried out, the vibration effects of low, medium, and high-pressure values applied by a hydraulic piston on a steel leaf spring system have been analyzed by a 3-axial accelerometer. After the experimental studies, the Radial Basis Artificial Neural Network (RBANN) and Cascade-Forward Back-Propagation Artificial Neural Network (CFBANN) based nonlinear artificial neural network structures have been proposed to analyze the vibration data measured from the leaf spring system under relevant working conditions. The simulation results represent that the RBANN structure can estimate the real-time vibrations occurring on the leaf spring system with higher accuracy and reaches lower RMS error values when compared to the CFBANN structure. In general, it can be concluded that the RBANN and CFBANN network structures can successfully be used in the estimation of real-time vibration data.

Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear?

BACKGROUND: The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair. METHODS: Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated. RESULTS: While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2. CONCLUSION: Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Analysing the effect of robotic gait on lower extremity muscles and classification by using deep learning.

Robotic gait training helps the nervous system recover and strengthen weak muscle groups. Many studies in the literature show that applying robotic gait rehabilitation to patients with neurological disorders such as Multiple Sclerosis (MS), Stroke and Spinal Cord Injection (SCI) effectively restores gait ability. In contrast to the studies in the literature that included only healthy individuals, both the control and patient groups were formed and detailed analyses were carried out for both groups. In this study, EMG signals in GMA, GME, ILP, BF, VM, MG, TA muscles were recorded simultaneously with a different electrode placement during robotic gait for the first time in literature and then a location that prevents a phase shift was presented. The classification performance has also been increased by removing 26 different attribute parameters like time, frequency and statistics from the signals instead of gait studies with a maximum of 12-16 traits extraction. The extracted features were classified with the approaches Multilayer Perceptron Neural Networks (MLP), Support Vector Machines (SVM), K-Nearest Neighbourhood algorithm (KNN), Random Forest Classification Algorithm (RF) and Deep Learning and then a detailed performance comparison have been realized. Among the approaches compared the Stochastic Gradient Optimization Algorithm-based deep learning structure produced the best performance with 98.5714% accuracy. It was also seen that it is essential to plan the exoskeleton and the robotic gait pattern suitable for patients' disease state and muscle activation.

Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity.

Introduction: The effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research question: To determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methods: In this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results: 1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P â€‹< â€‹0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P â€‹= â€‹0.016) and 1.182 times (P â€‹= â€‹0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P â€‹= â€‹0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p â€‹= â€‹0.016). Discussion and conclusions: Preoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.

Boron Nano-hydroxyapatite Composite Increases the Bone Regeneration of Ovariectomized Rabbit Femurs.

Osteoporosis is a systemic metabolic disease defined by a decreased bone mineral density, microarchitectural deterioration, and an increased incidence of fragility fractures that may lead to morbidity and mortality. Boron may stimulate new bone formation and regeneration, when combined with nano-hydroxyapatite. We questioned whether injecting boron-containing nano-hydroxyapatite composites with hyaluronan increased the bone mineral density and new bone formation in osteoporotic rabbit femurs. The regenerative effects of injectable boron-containing nano-hydroxyapatite composites from 6 to 12 weeks, which may prevent osteoporotic femoral fractures, were assessed. Boron-containing (10 µg/ml) nano-hydroxyapatite composites were injected into the intramedullary femoral cavity with hyaluronan. These significantly increased the histomorphometric new bone surface to the total bone surface ratio at 6 and 9 weeks. The micro-tomographic bone volume to the total volume ratio and bone mineral density in osteoporotic rabbit femurs increased when compared to the hyaluronan (p = 0.004, p = 0.004, p = 0.004, p = 0.01, respectively) and the sham-control (p = 0.01, p = 0.004, p = 0.01, p = 0.037, respectively) groups. The boron-containing group had a higher bone mineralization and new bone formation compared to the nano-hydroxyapatite group, although the difference was not statistically significant. These findings reveal that intramedullary injection of boron-containing nano-hydroxyapatite with hyaluronan increases new bone formation and mineralization in ovariectomized rabbit femurs. Boron-containing nano-hydroxyapatite composites are promising tissue engineering biomaterials that may have regenerative potential in preventing primary and/or secondary femoral fractures in osteoporosis patients.

The role of endocannabinoid system and TRPV1 receptors in the antidepressant and anxiolytic effects of dipyrone in chronic unpredictable mild stress in mice.

Although dipyrone is a widely used analgesic and antipyretic, its mechanism of action is not fully clarified. Recent studies have drawn attention to its central effects and its relationship with the endocannabinoid system. The endocannabinoid system plays important roles in processes such as anxiety, depression, fear, and learning-memory. In this study, we aimed to investigate whether endocannabinoid levels change in the amygdala in chronic unpredictable mild stress model in mice and whether cannabinoid and TRPV1 receptors mediate antidepressant and anxiolytic effects of dipyrone. Mice were submitted to chronic unpredictable mild stress protocol of 6-weeks, then behavioral test were performed. In the first part of the study, dipyrone was injected at doses of 150, 300, and 600 mg/kg (i.p.) during behavioral tests. In the second part, the CB1 antagonist AM 251 (1 mg/kg, i.p.), the CB2 antagonist AM630 (1 mg/kg, i.p.), and the TRPV1 antagonist capsazepine (3 mg/kg, i.p.) were administered alone or in combination with 300 mg/kg dipyrone to observe if these receptors mediate dipyrone effects. Endocannabinoid and N-acylethanolamines levels were measured by LC-MS/MS in amygdala. Our results showed that there were no changes in AEA, 2-AG, PEA, OAE levels in the amygdala in mice exposed to chronic unpredictable mild stress model; dipyrone exerted antidepressant and anxiolytic effects at doses of 300 and 600 mg/kg; its anxiolytic effect appears to be mediated via CB1 receptors, whereas TRPV1 receptors seems to mediate its antidepressant action.

The validity and reliability study of the Turkish version of the spinal appearance questionnaire for congenital scoliosis patients over 10 years old.

PURPOSE: In this study, we aimed to evaluate the validity and the reliability of the Turkish version of the SAQ (Tr-SAQ) in congenital scoliosis patients. METHODS: Applied to 52 patients with congenital scoliosis (38 female), the Tr-SAQ was applied to the same patients for the second time with an average interval of 14.9 ± 0.9 days. Construct validity was evaluated using factor analysis. SRS-22 was used to test the convergent validity of Tr-SAQ. Internal consistency analysis and test-retest reliability were evaluated to show the reliability of Tr-SAQ. RESULTS: A two-factor structure with eigenvalues greater than one, namely "6.1" and "2.6" belonging to the Tr- SAQ, was obtained. The total variance of the factors is 62.1%. The factor load of each item in the first factor 'Appearance' domain varies between 0.7 and 0.8. The second factor 'Expectations' consists of four items. The factor load of each item varies between 0.7 and 0.8. A significant negative correlation was found between the Tr-SAQ appearance score and the self-image/appearance score of SRS-22 (r = - 0.5; p < 0.001). Cronbach alpha for Tr-SAQ was found to be 0.9. The intraclass correlation coefficient (ICC) calculated for test-retest reliability was 0.991 CONCLUSION: Previous validity and reliability studies of SAQ have been performed in idiopathic scoliosis patients. This is the first study containing patients diagnosed with congenital scoliosis. In this piece of work, the 2-factor structure of the Tr-SAQ consisting of 14 items was found to be valid and reliable in patients over 10 years of age with a diagnosis of congenital scoliosis. LEVEL OF EVIDENCE: Level I.

The Correlation of the SLAP II Lesion Findings Between Physical Examination, Magnetic Resonance Imaging, and Arthroscopic Surgery.

OBJECTIVES: The aim of this study is to demonstrate the importance of clinical diagnosis by comparing with preoperative physical examination and magnetic resonance imaging (MRI) images in patients who were arthroscopically diagnosed as having Superior Labrum Anterior-Posterior (SLAP) II lesions. MATERIALS AND METHODS: 134 patients, arthroscopically diagnosed as SLAP II, established the study group, and 200 patients who underwent shoulder arthroscopy for the other pathologies established the control group. Preoperative clinical examination of the patients, MRI findings, and the arthroscopic findings of the patients were recorded. RESULTS: Out of the patients diagnosed with a SLAP II lesion, 107 (79.9) of those had an MRI finding while only 60 (30%) of the control group had it. The O'Brien test results of the patients diagnosed with SLAP were positive in 111 (82.8%) while those diagnosed with intact superior labrum were positive in 132 (66%). Of the 134 patients with a SLAP II lesion, 89 (66.4%) had both O'Brien test positiveness and MRI finding, and 129 (96%) had at least one positive result of the O'Brien test or MRI examination. CONCLUSION: The O'Brien test and MRI examination are not capable enough to indicate a SLAP lesion one by one, because of the low sensitivity and specificity. But, combining the test with MRI findings provides more trustable information about the superior labrum.

A detailed and comparative work for retinal vessel segmentation based on the most effective heuristic approaches.

Computer based imaging and analysis techniques are frequently used for the diagnosis and treatment of retinal diseases. Although retinal images are of high resolution, the contrast of the retinal blood vessels is usually very close to the background of the retinal image. The detection of the retinal blood vessels with low contrast or with contrast close to the background of the retinal image is too difficult. Therefore, improving algorithms which can successfully distinguish retinal blood vessels from the retinal image has become an important area of research. In this work, clustering based heuristic artificial bee colony, particle swarm optimization, differential evolution, teaching learning based optimization, grey wolf optimization, firefly and harmony search algorithms were applied for accurate segmentation of retinal vessels and their performances were compared in terms of convergence speed, mean squared error, standard deviation, sensitivity, specificity. accuracy and precision. From the simulation results it is seen that the performance of the algorithms in terms of convergence speed and mean squared error is close to each other. It is observed from the statistical analyses that the algorithms show stable behavior and also the vessel and the background pixels of the retinal image can successfully be clustered by the heuristic algorithms.

The Buford complex: prevalence and relationship with labral pathologies.

BACKGROUND: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. METHODS: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. RESULTS: The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001). CONCLUSIONS: This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.

A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes.

OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

Partial and full-thickness rotator cuff tears in patients younger than 45 years.

OBJECTIVE: The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. METHODS: Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. RESULTS: At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). CONCLUSION: The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Personalized Three-Dimensional Printing Pedicle Screw Guide Innovation for the Surgical Management of Patients with Adolescent Idiopathic Scoliosis.

OBJECTIVE: To assess the safety and efficacy of patient-specific three-dimensional (3D) rapid-prototype printing technology for pedicle screw insertion in patients with adolescent idiopathic scoliosis (AIS). METHODS: The 3D pedicle screw guides were produced after selecting the fixation points for all individual levels to be used intraoperatively. Preoperative computed tomography images recreated 3D bone models of each vertebra specific to each patient. Safe pedicle trajectories were determined in all 3 planes on these models. 3D printed guides were modeled according to these trajectories and manufactured with a biocompatible material. Postoperatively, all screws were evaluated and scored with computed tomography as class 1 (accurate), class 2 (inaccurate), or class 3 (deviated). The mean angle between the inserted pedicle screw and the intended trajectory, and the mean distance between the central longitudinal axis of a screw and pedicle were also measured. RESULTS: A total of 134 screws were inserted. On the concave and convex sides, the mean medial malposition was 0.5 ± 0.8 and 0.4 ± 0.6 mm, the mean lateral malposition was 1.4 ± 2.3 and 0.8 ± 1.3 mm, angle between the inserted pedicle screw and the intended trajectory was 4.2 ± 4.6 and 4.3° ± 6.0°, and distance between the central longitudinal axis of a screw and pedicle was 1.5 ± 2.1 and 0.9 ± 1.2 mm, respectively. A total of 117 screws were regarded as class 1, 14 as class 2, and 3 as class 3. Of all screws inserted, 92.5% achieved positional accuracy. There were no screw-related complications. CONCLUSIONS: This is one of the initial reports to note the novel design and implementation of patient-specific 3D pedicle screw guides for adolescent idiopathic scoliosis surgery. Our pilot study shows that the use of these low-cost personalized 3D guides is completely safe and effective in both convex and concave sides of the curves.