Is YouTube a Reliable and Quality Source on Unilateral Biportal Endoscopic Spine Surgery? A Cross-Sectional Study.

OBJECTIVE: This study aimed to evaluate the quality and reliability of YouTube videos focusing on unilateral biportal endoscopic spine surgery, a novel technique for spinal decompression in degenerative spinal disease. METHODS: This cross-sectional study, conducted in February 2023, involved an online search on YouTube using the term "unilateral biportal endoscopic spine surgery". Video popularity was assessed using the Video Power Index. Video reliability and quality were measured using the Global Quality Scale, the Journal of the American Medical Association benchmark criteria, and the modified DISCERN instrument. RESULTS: Ninety-three videos were included for evaluation. Uploader profiles were categorized by continent, with 61.3% from Asia, 35.5% from the United States, 2.2% from Africa, and 1.1% from Australia. When comparing 3 groups as South Korea, United States, and other countries, no significant differences were observed in the technical characteristics of the videos. However, the educational quality and reliability of the videos were higher in those uploaded from South Korea (P < 0.001).When the videos were divided into 2 groups according to their educational quality, significant difference were noted in video duration, loading time, video quality, and reliability (P < 0.001). CONCLUSIONS: The YouTube videos on unilateral biportal endoscopic spine surgery showed high quality and reliability. However, videos from South Korea were found to have higher educational quality and reliability, while other specifications were similar for all videos. Furthermore, it was determined that videos uploaded more recently and with longer duration were of higher quality.

Computational Mechanical Analysis of AO 44A1, 44B1, and 44C1 Fractures with Finite Element Modeling: Evaluation of Screw, Plate, and Kirschner Wire Fixation.

BACKGROUND: The aim of this study was to create AO 44A1, 44B1, and 44C1 fractures using finite element analysis to determine the stability of Kirschner wire, intramedullary screw, and plate-screw fixation methods in fracture. METHODS: Using finite element analysis, the postreduction behavior of AO 44A1, 44B1, and 44C1 fractures with Kirschner wire, intramedullary screw, and plate-screw fixation methods was analyzed and compared in terms of displacement and stress. RESULTS: The lowest amount of displacement was provided with the intramedullary screw method in AO 44A1 and 44B1 fractures and with the 4-mm Kirschner wire method in AO 44C1 fractures. The total displacement of the intramedullary screw system used for fixation in AO 44A1, 44B1, and 44C1 fractures was lower. CONCLUSIONS: According to finite element analysis results, the lowest amount of displacement was obtained with intramedullary screw fixation in AO 44A1 and 44B1 fractures, and 4-mm Kirschner wire fixation was achieved in AO 44C1 fractures.

Biomechanical effect of ankle ligament injury in AO 44B2.1 lateral malleolus fractures after lateral plate fixation: A finite element analysis.

BACKGROUND: Distal fibula fractures at the ankle level are common and are usually accompanied by ligament injuries. This study aims to evaluate the effects of ankle ligament ruptures on ankle joints, fracture instability, and plate stress after distal fibula fracture fixed with plate created by finite element analysis (FEA) modeling and loading applied to ligament rupture models that may accompany this fracture. METHODS: A finite element model consisting of 3-D (3D) fibula, tibia, foot bones, and ankle ligaments was designed to investigate the effects of ligament injuries accompanying plate-detected Arbeitsgemeinschaft für Osteosynthesefragen (AO 44B2.1)-type fractures on fracture detection, fixation material, and ankle joints. Then, the results were evaluated by modeling ligament rupture in 6 different ways. RESULTS: In the modeling where the deltoid and the talofibular ligament are broken together, instability is the highest in the ankle (2.31 mm) and fracture line (0.15 mm). In our study, the rupture of the tibiofibular anterior and posterior ligaments associated with syndesmosis caused less instability in the fracture and ankle than the single rupture models of both the deltoid and the talofibular ligament. CONCLUSIONS: In the finite element modeling of AO 44B2.1-type fractures detected with plate, the importance and potential effects of often overlooked ankle ligaments are pointed out shown. It is important to keep in mind that when treating ankle injuries, the ankle should be treated as a whole, with both bone and soft tissue. In some cases, the fracture may represent the visible tip of the iceberg.

Two-Point Discrimination in Feet with Ankle Sprains.

BACKGROUND: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains. METHODS: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in mm were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, as well as in right and left feet. RESULTS: The study determined that the two-point discrimination threshold values measured at the 1st toe tip, heel, 3rd plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems. CONCLUSIONS: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.

An overview of the orthopedic patient profile in the first five days following February 6th, 2023 Kahramanmaras earthquake: A single-center experience in the earthquake zone.

OBJECTIVES: This study aims to investigate the patient profile at a medium-volume hospital located in the earthquake zone among patients who received orthopedic treatment within the first five days after the natural disaster that was considered a major earthquake. PATIENTS AND METHODS: Between February 6th, 2023 and February 10th, 2023, a total of 338 patients (156 males, 182 females; mean age: 42.2±9.7 years; range, 0 to 87 years) who received orthopedic treatment in our center were retrospectively analyzed. The patients were divided into four groups according to age as follows: infants (younger than one year of age), children (one to 13 years), adults (14 to 59 years), and elderly (60 years or older). RESULTS: Considering the age distribution, 291 (86%) patients were young adults. A total of 173 orthopedic surgeries were performed, including internal fixation in 63 patients, external fixation in 11 patients, upper/lower extremity fasciotomy in 47 patients, amputation in 39 patients, and soft tissue debridement in 13 patients. CONCLUSION: It is of utmost importance to recognize the principles of emergency fracture fixation and fasciotomy to successfully perform orthopedic surgeries after a natural disaster such as a major earthquake, particularly when the number of earthquake victims is considerably high.

Contribution of Multilevel Transformainal Lumbar Interbody Fusion Surgery to Restoration of Lumbar Lordosis in Patients with Degenerative Spine: Comparison of Long and Short Level Fusion.

AIM: To investigate the effect of multilevel transforaminal lumbar interbody fusion (TLIF) procedures in lumbar degenerative spine conditions on the restoration of lumbar lordosis (LL) in patients with short- and long-level fusion, and to examine the associated radiological results. MATERIAL AND METHODS: This retrospective study reviewed patients with degenerative spinal diseases who underwent lumbar fusion using a multilevel TLIF procedure. Patients with three or fewer segments involved in fusion were assigned to the shortlevel fusion group and those with more than three segments involved in fusion were assigned to the long-level fusion group. The anteroposterior and lateral spine radiographs of the patients were used to measure LL, distal lumbar lordosis and radiological parameters. RESULTS: The study included 47 patients who met the inclusion criteria, with a mean age of 60.4 ± 12.2 years. The mean follow-up time of our patients was 18.3 ± 11 months. Thirty-five (74.5%) patients were women and 12 (25.5%) were men. Overall, 12 patients underwent 3-level and 35 patients underwent 2-level TLIF. Long-level fusion was performed in 24 patients and short-level fusion was performed in 23 patients. CONCLUSION: Multilevel TLIF can be used to correct spinopelvic alignment when applied with the appropriate indications and techniques in patients with degenerative spinal disorders. Multilevel TLIF is associated with substantial improvements in LL, distal lumbar lordosis, and SVA (sagittal vertical axis). It also helps to correct the correlation between PI and LL.

Okadaic Acid-Induced Alzheimer's in Rat Brain: Phytochemical Cucurbitacin E Contributes to Memory Gain by Reducing TAU Protein Accumulation.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory loss and cognitive decline, with hallmark pathologies related to amyloid beta (Aß) and TAU. Natural phytochemicals show promise for drug discovery to fill the current therapeutic innovation gap in AD. This study investigated the effect of cucurbitacin E (CuE), one of the bioactive components of Ecballium elaterium, on TAU fibril formation in okadaic acid-induced AD in rats. In a randomized design, we assigned 30 female Sprague Dawley rats to one of five experimental groups: (1) control, (2) stereotaxic surgery, (3) stereotaxic surgery + artificial cerebrospinal fluid, (4) stereotaxic surgery + okadaic acid (AD model), and (5) stereotaxic surgery + okadaic acid + CuE treatment. For experimental groups 4 and 5, rats were administered OKA-ICV (200 ng/kg) followed by CuE (4 mg/[kg·day], intraperitoneally) for 20 days. Expression of the MAPK1/3 and MAPK14 genes associated with TAU metabolism, hippocampal protein levels of these genes, cognitive functions of the rats, and histological accumulation of TAU in the brain were evaluated. Our findings in this preclinical model collectively suggest that phytochemical CuE contributes to memory gain by reducing TAU protein accumulation, which warrants further evaluation in future in vitro and in vivo studies.

Effects of antidiabetics and exercise therapy on suppressors of cytokine signaling-1, suppressors of cytokine signaling-3, and insulin receptor substrate-1 molecules in diabetes and obesity.

OBJECTIVE: Pathological destruction of insulin signaling molecules such as insulin receptor substrate, especially due to the increase in suppressors of cytokine signaling molecules, has been demonstrated in experimental diabetes. The contribution of suppressors of cytokine signaling proteins to the development of insulin resistance and the effects of antidiabetic drugs and exercise on suppressors of cytokine signaling proteins are not clearly known. METHODS: A total of 48 Wistar albino adult male rats were divided into six groups: control group, obese group with diabetes, obese diabetic rats treated with metformin, obese diabetic rats treated with pioglitazone, obese diabetic rats treated with exenatide, and obese diabetic rats with applied exercise program. Immunohistochemical staining was performed in both the liver and adipose tissue. RESULTS: There was a statistically significant decrease in suppressors of cytokine signaling-1, a decrease in suppressors of cytokine signaling-3, an increase in insulin receptor substrate-1, and a decrease in immunohistochemical staining in the obese group treated with metformin and exenatide compared to the obese group without treatment in the liver tissue (p<0.05). A statistically significant decrease in immunohistochemical staining of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 was found in the obese group receiving exercise therapy compared to the obese group without treatment in visceral adipose tissue (p<0.05). Likewise, no significant immunohistochemistry staining was seen in diabetic obese groups. CONCLUSION: Metformin or exenatide treatment could prevent the degradation of insulin receptor substrate-1 protein by reducing the effect of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins, especially in the liver tissue. In addition, exercise can play a role as a complementary therapy by reducing suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins in visceral adipose tissue.

Effects of antidiabetics and exercise therapy on suppressors of cytokine signaling-1, suppressors of cytokine signaling-3, and insulin receptor substrate-1 molecules in diabetes and obesity

SUMMARY OBJECTIVE: Pathological destruction of insulin signaling molecules such as insulin receptor substrate, especially due to the increase in suppressors of cytokine signaling molecules, has been demonstrated in experimental diabetes. The contribution of suppressors of cytokine signaling proteins to the development of insulin resistance and the effects of antidiabetic drugs and exercise on suppressors of cytokine signaling proteins are not clearly known. METHODS: A total of 48 Wistar albino adult male rats were divided into six groups: control group, obese group with diabetes, obese diabetic rats treated with metformin, obese diabetic rats treated with pioglitazone, obese diabetic rats treated with exenatide, and obese diabetic rats with applied exercise program. Immunohistochemical staining was performed in both the liver and adipose tissue. RESULTS: There was a statistically significant decrease in suppressors of cytokine signaling-1, a decrease in suppressors of cytokine signaling-3, an increase in insulin receptor substrate-1, and a decrease in immunohistochemical staining in the obese group treated with metformin and exenatide compared to the obese group without treatment in the liver tissue (p<0.05). A statistically significant decrease in immunohistochemical staining of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 was found in the obese group receiving exercise therapy compared to the obese group without treatment in visceral adipose tissue (p<0.05). Likewise, no significant immunohistochemistry staining was seen in diabetic obese groups. CONCLUSION: Metformin or exenatide treatment could prevent the degradation of insulin receptor substrate-1 protein by reducing the effect of suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins, especially in the liver tissue. In addition, exercise can play a role as a complementary therapy by reducing suppressors of cytokine signaling-1 and suppressors of cytokine signaling-3 proteins in visceral adipose tissue.

Investigation of Possible Reasons of Failed Treatment of Conservative Thoracolumbar Osteoporotic Vertebral Fractures.

AIM: To investigate the possible reasons of failed conservative treatment of osteoporotic thoracolumbar vertebral compression fractures (VCFs). Sagittal balance impairment may weaken union by increasing the load on the fracture line. Most osteoporotic vertebral fractures occur in the thoracolumbar and mid-thoracic regions. MATERIAL AND METHODS: We investigated the records of patients aged > 60 years who underwent treatment for osteoporotic thoracolumbar VCFs between 2012 and 2020. The patients were divided into two groups: those who required surgical treatment due to the failure of conservative treatment and those who were successfully treated with conservative treatment. All the patients underwent lateral radiography and computer tomography of the whole spine at their initial and final visit. The radiographic parameters of spine and presence of sarcopenia, age, and gender were compared between the groups. RESULTS: Of the study subjects, the mean age of 13 females and 7 males in whom conservative treatment was successful was 67.4 years and the mean follow-up period was 23.5 months, while in 18 females and 5 males who underwent surgical treatment due to the failure of conservative treatment, the mean age was 68.7 years and the mean follow-up period was 22.1 months. No significant differences between the groups regarding age and gender were observed. However, significant differences were observed between the groups regarding the presence of sarcopenia and thoracic kyphosis, thoracolumbar kyphosis and distance from the center of the fractured vertebra to the plumb line (DSVA). CONCLUSION: Sarcopenia and DSVA were significantly higher in the surgical treatment group. Receiver operating characteristic analysis demonstrated that the sensitivity and specificity of DSVA for identifying high-risk patients for failed conservative treatment of osteoporotic thoracolumbar VCFs were 100% and 95%, respectively, with an optimum diagnostic cutoff value of 6.5 mm.

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis. METHODS: This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6-15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer's migration index, and Sitting Assessment Scale were measured before and after treatments. RESULTS: A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer's migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups. CONCLUSION: The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy.

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial

SUMMARY OBJECTIVE: This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis. METHODS: This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6-15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer's migration index, and Sitting Assessment Scale were measured before and after treatments. RESULTS: A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer's migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups. CONCLUSION: The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy.

The effects of metformin, pioglitazone, exenatide and exercise on fatty liver in obese diabetic rats: the role of IRS-1 and SOCS-3 molecules.

BACKGROUND: Obesity-induced inflammation mechanism is seen as a mechanism that may be the cause of insulin resistance and non-alcoholic fatty liver disease (NAFLD). Pathological destruction of insulin signaling molecules such as insulin receptor substrate proteins (IRS), especially due to the increase of cytokine signal suppressors (SOCS), has been demonstrated in experimental diabetes. The aim of this study was to determine the effects of metformin, pioglitazone, exenatide and exercise treatments used in type 2 diabetes on fatty liver and the role of Irs-1 and Socs3 molecules in this process in obese diabetic rats. METHODS: The study was conducted on 48 Wistar albino adult male rats weighing 180-220 g and randomly divided into 6 groups. The obese rat model with fatty liver was formed with a 60% fat diet for 4 weeks. Afterwards, drug treatment with metformin (Ob + D + M), pioglitazone (Ob + D + P), exenatide (Ob + D + ExA)) or exercise (Ob + D + ExE) was applied for 4 weeks to these obese groups, in which diabetes was induced by streptozocin (STZ). At the end of the experimental protocol, liver tissue samples were taken from all rat groups and histopathological and genetic analyses were performed. RESULTS: The mean steatosis degrees of the Ob + D + ExA and Ob + D + ExE groups were statistically significantly decreased compared to the obese diabetic group (p < 0.001). The group with the lowest mean steatosis grade was the Ob + D + ExE. Decrease in SOCS-3 expression was significant in Ob + D + M and Ob + D + P groups than other groups (p < 0.05). Mean staining intensities of Ob + D + Ex group, Ob + D + ExE group and Ob + D + P group according to IRS-1 expression statistically significantly increased compared to obese diabetic group (p < 0.05). Average staining intensity of Ob + D + ExE group according to IRS-1 expression was significant than other groups. CONCLUSION: Exercise and exenatide treatments seemed to be the prominent treatment methods by showing a statistically significant effect in decreasing the degree of steatosis, decreasing the Socs3 expression level and increasing the Irs-1 expression level.

Surgical Approach Algorithm in the Treatment of Lumbar and Thoracolumbar Pyogenic Spondylodiscitis.

AIM: To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure. MATERIAL AND METHODS: Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of > 1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria. RESULTS: The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injury; 2 and 10 patients with stage 3 had grades D and E injuries, respectively; two patients with stage 4 had grade D injury and two had grade E injury at the last follow-up. Moreover, 100%, 84.6%, and 50% of the patients with stages 1 and 2, 3, and 4 spondylodiscitis achieved good or excellent results, respectively. CONCLUSION: The choice of the surgical technique depends on the destruction severity at the adjacent vertebral corpus. Surgical staging system for spondylodiscitis is useful and reliable in choosing appropriate surgical techniques.

Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients.

BACKGROUND: We aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. MATERIALS AND METHODS: This was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease. RESULTS: Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively. CONCLUSIONS: Under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.

The effect of medullary fill on varus collapse in AO 31A3 intertrochanteric (reverse obliquity) fracture treated with cephalomedullary nails.

OBJECTIVE: Cephalomedullary nails are tools commonly used for surgical fixation in proximal femoral fractures. The most common complications in their use are varus collapse and screw cutout of the femoral head. The objective of this study is to examine the effects of intramedullary nail movement on varus collapse and screw cutout. MATERIALS AND METHODS: The study was conducted on 70 composite femur models treated with PFNA. We divided the femurs into 4 groups based on the differences in nail diameter, fracture type and filling of the distal intramedullary area. All femurs were exposed to axial cyclic loading. Each femur was examined in terms of intramedullary nail movement and amount of erosions in femoral medulla [amount of erosion in femoral head (FT distance), amount of erosion in femoral neck (FB distance), amount of erosion in trochanteric major (TB distance) and expansion of trochanter tip (TT distance)]. RESULTS: We found that degree of nail movement in the intramedullary region was inversely correlated with nail diameter and directly correlated with instability of fracture. One of the parameters used to evaluate varus development, FB distance, was affected by the degree of intramedullary nail movement and fracture type. TB distance was affected by nail diameter. CONCLUSIONS: Nail diameter and fracture type are effective in intramedullary nail movement. Varus collapse progress is accelerated by the increase in nail movement in the intramedullary region. Thus, we conclude that it is important to strengthen diaphyseal adherence, which decreases intramedullary movement of the nail. LEVEL OF EVIDENCE: III; well-design case control study.

Prognostic factors, treatment methods and survival time in hepatocellular carcinoma: A decade of experience at a single center.

Background and Aim: The objective of this study was to investigate the etiology, prognostic factors, treatment methods, and effects of treatment on survival in cases of hepatocellular carcinoma (HCC). Materials and Methods: This was a retrospective study of 158 patients diagnosed with HCC at a single hospital between the years 2000 and 2010. Results: The etiological factor of HCC was the hepatitis B virus (HBV) in 53.2% of the cases, the hepatitis C virus (HCV) in 21.5%, alcohol use in 6.3%, HBV+alcohol in 5.7%, HCV+alcohol in 1.9%, HBV+HCV in 1.9%, and the cause was unknown in 9.5%. Of the 158 patients, 120 were treated at the study hospital, and complete follow-up data were available for 81. The mean length of follow-up was 17.9 months (range: 0.6-124 months). Multivariate analysis indicated that a lesion size >5 cm, Child-Pugh class C, a high creatinine level, and a distant metastasis were prognostic factors of reduced survival. Conclusion: HBV was the most frequent cause of HCC in this study group, followed by HCV. The most effective treatment methods for survival were liver transplantation and hepatic resection. A lesion size >5 cm, Child-Pugh class C, a high creatinine level, and distant metastasis were independent poor prognostic factors for survival.

Biomechanical Comparison of Pull-out Strength of Different Cementation and Pedicle Screw Placement Techniques in a Calf Spine Model.

BACKGROUND: We hypothesized that an entire pedicle screw tract cement augmentation has greater strength than traditional techniques. METHOD: Twenty-four fresh frozen calf lumbar spines were randomized into three study groups, each having eight vertebrae: (1) screw cemented after vertebroplasty; (2) fenestrated cemented screw; and (3) cementation of the entire pedicle screw tract. For the right side screws, two pedicle screws were inserted in each vertebra with the standard position in the sagittal plane, whereas the left side screws were placed at a 30° angle craniocaudal plane. From the recorded force-displacement curves, the maximum peak load (failure load) of each screw was determined. The mode of failure was screw stripping at all levels tested. RESULTS: The pull-out strength for standard screw replacement at the sagittal plane was 1843.3 N, 1707.45 N, and 5365.1 N consecutively. The failure load value in the standard position in the sagittal plane in the cementation of the entire pedicle screw tract group was significantly higher than that in the fenestrated cemented screw group and screw cemented after vertebroplasty (p < 0.001 and p < 0.001, respectively). The standard pedicle screw position in the sagittal plane showed a significant pull-out strength than the others (p < 0.001). CONCLUSION: The pull-out strength of the cementation of the entire pedicle screw tract was 2.5 times higher than the others. The pull-out strength of the pedicle screws in malposition obtained the same strength to the standard positions after the augmentation procedure in our study.

Automatic Segmentation of Meniscus in Multispectral MRI Using Regions with Convolutional Neural Network (R-CNN).

The meniscus has a significant function in human anatomy, and Magnetic Resonance Imaging (MRI) has an essential role in meniscus examination. Due to a variety of MRI data, it is excessively difficult to segment the meniscus with image processing methods. An MRI data sequence contains multiple images, and the region features we are looking for may vary from each image in the sequence. Therefore, feature extraction becomes more difficult, and hence, explicitly programming for segmentation becomes more difficult. Convolutional Neural Network (CNN) extracts features directly from images and thus eliminates the need for manual feature extraction. Regions with Convolutional Neural Network (R-CNN) allow us to use CNN features in object detection problems by combining CNN features with Region Proposals. In this study, we designed and trained an R-CNN for detecting meniscus region in MRI data sequence. We used transfer learning for training R-CNN with a small amount of meniscus data. After detection of the meniscus region by R-CNN, we segmented meniscus by morphological image analysis using two different MRI sequences. Automatic detection of the meniscus region with R-CNN made the meniscus segmentation process easier, and the use of different contrast features of two different image sequences allowed us to differentiate the meniscus from its surroundings.

Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years' Results of 21 Patients.

BACKGROUND: Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS. METHODS: Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%. RESULTS: Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired. CONCLUSIONS: Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications. LEVEL OF EVIDENCE: Level IV.