Nature relatedness, flow experience, and environmental behaviors in nature-based leisure activities.

Introduction: Through nature-based leisure activities, spending time in nature offers opportunities to reduce stress, relax the mind, and enhance feelings of well-being. Being aware of the benefits provided by these activities increases the nature relatedness, and during the time spent in nature, it enables experiencing positive and satisfying moments by entering into a state of flow. The concepts of nature-relatedness and flow experience represent psychological experiences and characteristics that play an important role in enhancing psychological well-being and life quality. Methods: Based on structural equation models, the relationships among nature-relatedness, flow experience, and environmental behaviors were investigated. Data were collected from 379 individuals (212 male, 167 female) who regularly engage in nature-based leisure activities such as cycling, hiking, and fishing. The participants were predominantly male (55.9%) and aged 45 years and over (53.3%). Results: The nature-relatedness significantly influences flow experience (R 2 = 0.505, p < 0.01), environmental behavior (R 2 = 0.108, p < 0.01), environmental sensitivity (R 2 = 0.137, p < 0.01), and communication with nature (R 2 = 0.200, p < 0.01). Specifically, nature-relatedness directly enhanced environmental sensitivity (0.494 total effect), environmental behavior (0.604 total effect), and communication with nature (0.599 total effect) and did so both directly and indirectly through the mediation of flow experience. Discussion: A higher level of nature-relatedness can lead to a stronger flow experience, which in turn can increase positive. environmental behavior, environmental sensitivity, and communication with nature.

The work-life balance: understanding the role of leisure involvement on workaholism from a gender perspective.

BACKGROUND: Work-life balance is an increasingly important issue in modern work environments, referring to a healthy harmony between work and personal life. Leisure is a crucial element supporting this balance, yet negative tendencies such as workaholism can challenge it. Over time, this can diminish work performance and lead to health problems. OBJECTIVE: This study aims to understand the role of leisure involvement in workaholism and evaluate this relationship with consideration for gender differences. METHOD: The data of the research were obtained through survey. The survey collected from individuals working in shopping centres in Konya province of Türkiye by using simple random sampling method. A total of 389 individuals (185 female and 204 male) working in shopping centers participated in the study. RESULTS: The findings indicate significant differences in leisure involvement and workaholism concerning gender. Additionally, a relationship between leisure involvement and workaholism was identified, with gender having a moderating effect on this relationship. CONCLUSION: Consequently, it was determined that women exhibit higher levels of leisure involvement and workaholism tendencies compared to men, highlighting the crucial role of the relationship between leisure involvement and workaholism in ensuring work-life balance. The results of the research are discussed in the relevant section. Based on the findings, theoretical and managerial implications are developed.

Anterior tibial artery pseudoaneurysm secondary to articulating spacer use for infected knee arthroplasty: A case report.

INTRODUCTION: Neurovascular compromise following primary or revision total knee arthroplasty is a rare but severe complication. To the best of our knowledge, there have been reports of pseudoaneurysm of the popliteal artery following primary and revision; however, an anterior tibial artery pseudoaneurysm with articulating spacer has not been described yet. CASE PRESENTATION: We introduce a rare case of anterior tibial artery pseudoaneurysm and concomitant foot drop caused by an articulating spacer in a two-stage revision for infected knee replacement. Displacement of the articular spacer was observed on knee x-rays. Hematoma and pseudoaneurysm were detected. The patient was operated on urgently, and a pseudoaneurysm originating from the anterior tibial artery was intraoperatively observed. DISCUSSION: Vascular complications following TKA are rare but could be limb-threatening and even life-threatening. If postoperative displacement of the articulating spacer is observed with neurovascular symptoms, orthopedic surgeons should be alerted to the possibility of a pseudoaneurysm. CONCLUSION: Although rare, anterior tibial artery pseudoaneurysm should be considered among vascular injuries in revision knee arthroplasty cases.

A new configuration of lateral-pin fixation for pediatric supracondylar humeral fracture: A biomechanical analysis.

OBJECTIVE: The aim of this study was to biomechanically compare a new lateral-pinning technique, in which pins engage the medial and lateral columns of the distal humerus in a divergent configuration in both the axial and sagittal planes instead of the coronal plane, with the cross-pin, and with 2 and 3 coronally divergent lateral-pin techniques in a synthetic humerus model of supracondylar humerus fractures. METHODS: Thirty-six identical synthetic models of the humerus simulating a standardized supracondylar humerus fracture were included in this study. They were divided into 4 groups based on the pin configuration of fixation: the new 3-lateral pin-fixation technique (group A), 2 crossed pins (group B), 3 divergent lateral pins (group C), and 2 divergent lateral pins (group D). Each model was subjected to combined axial and torsional loading, and then torsional stability and torsional stiffness (Nmm/°) were recorded. RESULTS: Group A had greater rotational stability than groups C and D but had no statistically significant additional rotational stability compared with group B (P=.042, P=.008, P=.648, respectively), whereas group B had greater rotational stability than only group D (P=.020). Furthermore, group A demonstrated higher internal rotational stiffness compared with groups C and D (P=.038, P=.006, respectively). Group B had better internal rotational stiffness than group D (P=.015). There was no significant difference in internal rotational stiffness between groups A and B (P=. 542), groups B and C (P=.804), and groups D and C (P=.352). Although no statistically significant differences existed between groups A and B, the modified pin configuration exhibited the highest torsional stability and stiffness. Group D showed the lowest values in all biomechanical properties. CONCLUSION: This study has shown us that this new lateral-pinning technique may provide torsional resistance to internal rotational displacement as strong as the standard technique of crossed-pin configuration of fixation. Furthermore, with this new pin configuration, greater torsional resistance can be obtained than with either the standard 2- or the standard 3-lateral divergent pin configuration. Cite this article as: Bilgili F, Demirel M, Birisik F, Balci HI, Sunbuloglu E, Bozdag E. A new configuration of lateral-pin fixation for pediatric supracondylar humeral fracture: A biomechanical analysis. Acta Orthop Traumatol Turc., 2023 10.5152/j.aott.2024.21091 [Epub Ahead of Print].

The Effect of Supplementary Staple Fixation on Biomechanical Properties of Soft Tissue Graft Tibial Fixation in Anterior Cruciate Ligament Reconstruction.

This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple). Each graft fixation was exposed to cyclic loading conditions. Significant differences were determined in failure load among the three groups (p = 0.008). The mean failure load was significantly higher in group B (717.04 ± 218.51 N) than in group A (308.03 ± 17.22 N) (p = 0.006). No significant differences were observed among the groups regarding axial stiffness (p = 0.442). Cyclic displacement differed significantly among the three groups (p = 0.005). In pairwise comparisons, the mean cyclic displacement was significantly higher in group A (8.22 ± 3.24 mm) compared with group C (1.49 ± 0.41 mm) (p = 0.005). Failure displacement varied considerably among the groups (p = 0.037). Although group B (15.53 ± 6.43 mm) exhibited a greater mean failure displacement than both group A (4.9 ± 0.75 mm) and group C (8.84 ± 4.65 mm), these differences did not reach statistical significance (p = 0.602 and p = 0.329, respectively). Interference screw fixation alone and supplementary staple fixation have biomechanically similar characteristics in terms of initial strength and stiffness of tibial ACL soft tissue graft fixation. Regardless of staple use, an interference screw with the same diameter as the tibial tunnel can ensure sufficient tensile strength in tibial ACL graft fixation.

Preliminary Results of Calcaneal Lengthening Osteotomy Combined With Extra-articular Subtalar Arthrodesis for Severe Pes Planovalgus Deformity in Children With Cerebral Palsy: A New Surgical Technique.

OBJECTIVE: Pes planovalgus is the most common foot deformity seen in patients with cerebral palsy (CP). There are several different treatment modalities to treat this condition. Single or double calcaneal osteotomies, extra-articular arthrodesis, calcaneo-cuboido-cuneiform osteotomy, intraarticular arthrodesis, and arthroereisis are some of these modalities. Currently, there is insufficient information to determine the most effective treatment approach for pes planovalgus in children with CP. The aim of this study is to show the short to mid-term results of the new technique which combines calcaneus lengthening osteotomy, extra-articular subtalar arthrodesis, and soft tissue reconstruction that aims to decrease recurrence and complication rates of pes planovalgus surgery for patients with ambulatory CP. METHODS: Patients with CP who were treated with calcaneal lengthening surgery and extra-articular subtalar arthrodesis between 2018 and 2021 were investigated retrospectively. All patients were ambulatory and Gross Motor Function Classification System I-II-III. Functional levels of the patients were assessed with the American Orthopaedic Foot and Ankle Society, Ankle-Hindfoot Score, and the Foot and Ankle Ability Score (Foot and Ankle Ability Measure) in preoperative and postoperative periods. On anteroposterior x-rays, talus-first metatarsal, talocalcaneal, talonavicular coverage angle and on lateral x-rays talus-first metatarsal, talocalcaneal, calcaneal inclination angle and talar tilt angle were evaluated. RESULTS: The mean follow-up was 46 (range: 36 to 60) months. The mean American Orthopaedic Foot and Ankle Society increased from 41 (20 to 79) to 74 (38 to 93; P < 0.001). The mean Foot and Ankle Ability Measure increased significantly from 35 (7 to 73) to 54 (29 to 96; P <0.001). Clinical results were "satisfactory" for 32 feet, while they were "unsatisfactory" for 2 feet. Significant deformity correction was observed in all radiologic parameters. CONCLUSION: Our technique is found to be efficient for patients with Gross Motor Function Classification System I-II-III CP with pes planovalgus deformity. In short to mid-term follow-up, the technique achieved successful clinical and radiologic results with low complication rates. Superiority of this technique compared with the traditional ones can only be shown with randomized prospective studies. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Background Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21-36% of all ankle fractures. Although mechanism of injury is similar to non-dislocated ankle fractures, fracture-dislocations cause more extensive bone and soft tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain and most importantly, posttraumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes. Methods 27 patients (17 female, 10 male) were included in the study. Records and data were retrospectively analyzed. Clinical status at the final follow-up was evaluated by a single orthopedic surgeon. Range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) were the clinical parameters that were assessed. Radiological assessment was made by standard anteroposterior [AP], lateral, and mortise views. Pre-operative osseo-ligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury and post-operative ankle osteoarthritis were investigated. Results For 27 patients that were evaluated, at the final follow-up, mean AOFAS was 85 ± 8.12, and mean VAS during daily activities was 1.52 ± 0.70. Mean ankle dorsiflexion and plantar flexion were significantly lower on the affected sides (14.07 ± 7.97° and 36.30 ± 6.59°) than on the unaffected sides (28.15 ± 2.82° and 46.30 ± 2.97°), respectively (p < 0.001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis, and three remained without evidence of osteoarthritis. No significant difference was found among Takakura's stages in any of the variables. Conclusion The results illustrated that although post-traumatic osteoarthritis rate was high for ankle fracture-dislocation patients, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura's classification developed, patients had satisfactory clinical and functional results.

Bayesian Statistical Analysis for Bacterial Detection in Pulmonary Endomicroscopic Fluorescence Lifetime Imaging.

Pneumonia, a respiratory disease often caused by bacterial infection in the distal lung, requires rapid and accurate identification, especially in settings such as critical care. Initiating or de-escalating antimicrobials should ideally be guided by the quantification of pathogenic bacteria for effective treatment. Optical endomicroscopy is an emerging technology with the potential to expedite bacterial detection in the distal lung by enabling in vivo and in situ optical tissue characterisation. With advancements in detector technology, optical endomicroscopy can utilize fluorescence lifetime imaging (FLIM) to help detect events that were previously challenging or impossible to identify using fluorescence intensity imaging. In this paper, we propose an iterative Bayesian approach for bacterial detection in FLIM. We model the FLIM image as a linear combination of background intensity, Gaussian noise, and additive outliers (labelled bacteria). While previous bacteria detection methods model anomalous pixels as bacteria, here the FLIM outliers are modelled as circularly symmetric Gaussian-shaped objects, based on their discrete shape observed through visual analysis and the physical nature of the imaging modality. A Hierarchical Bayesian model is used to solve the bacterial detection problem where prior distributions are assigned to unknown parameters. A Metropolis-Hastings within Gibbs sampler draws samples from the posterior distribution. The proposed method's detection performance is initially measured using synthetic images, and shows significant improvement over existing approaches. Further analysis is conducted on real optical endomicroscopy FLIM images annotated by trained personnel. The experiments show the proposed approach outperforms existing methods by a margin of +16.85% ( F1 ) for detection accuracy.

Augmentation with a non-vascularized autologous fibular graft for the management of Cierny-Mader type IV chronic femoral osteomyelitis: a salvage procedure.

PURPOSE: The study aimed to evaluate preliminary clinical and radiographic results of patients with Cierny-Mader type IV chronic femoral osteomyelitis and augmented with a non-vascularized fibular autograft as a salvage procedure because of the poorly regenerated new bone after bone transport over an intramedullary nail (BTON). METHODS: Patients diagnosed with CM type IV chronic femoral bone infection and treated with BTON procedure between 2003 and 2020 were retrospectively reviewed. Seven patients were included in the study whose distraction gap was poorly regenerated and then augmented with a non-vascularized fibular autograft. A three-stage treatment was administered. First, the infection was eradicated. Second, BTON was performed. Third, the poorly regenerated distraction gap was augmented with a fibular autograft before removing the external fixator (EF). Clinical and radiological results were evaluated based on the criteria described by Paley-Maar and Li classification. RESULTS: The mean patient age was 52 years. The mean treatment time was 24.8 months, with a mean femoral lengthening of 12.6 cm. The mean EF and bone healing indexes were 0.57 months/cm and 0.8 months/cm, respectively. The mean length of the fibular graft was 13 cm. The bone healing of new bones was achieved in all patients with good quality after grafting. Functional scores were excellent in four patients. No patients experienced any sequelae. CONCLUSIONS: Non-vascularized fibular autograft augmentation may be an effective salvage procedure for poorly regenerated new bone after BTON to manage chronic femoral bone infection.

Effect of strategies to increase progesterone levels on fertility of bovine embryo transfer recipients - A meta-analysis.

The pregnancy rate following embryo transfer (ET) is a very important factor in the success of embryo production programs. Different strategies were therefore developed to increase pregnancy rates. The aim of this meta-analysis was to investigate the effects of hormone treatments used to increase the success of embryo transfer programs on pregnancy rates. A meta-analysis was performed of 46 trials from 39 publications involving treated (n = 7856) and control (n = 6663) cattle. The meta-analysis explained the effect size with its 95 % confidence interval (CI) for pregnancy per embryo transfer (P/ET) after hormonal treatment under different moderators. Hormonal support was found to increase P/ET compared to the control group (P < 0.05). However, GnRH treatment was found to increase P/ET by approximately 4.3 % and hCG treatment by 8.0 %. Progesterone supplementation was not found to have a statistically significant effect on P/ET. In addition, GnRH treatment significantly increased P/ET when used to transfer in vitro or frozen-thawed embryos or in studies using cows as recipients. It was observed that hCG treatment had a positive effect on P/ET according to all moderators. Progesterone supplementation significantly increased P/ET when frozen embryos were transferred and reduced P/ET, especially in publications where fresh or in vitro produced embryos were transferred or cows were used as recipients. The results of this meta-analysis showed that the use of GnRH, and hCG, in bovine embryo transfer programs increased P/ET, whereas the use of progesterone had no effect on P/ET. However, it was found that P/ET could increase/decrease depending on the moderator.

Biomechanical Comparison of Uniplanar versus Biplanar Lateral Opening-wedge Distal Femoral Osteotomy Techniques in Terms of Risk for Medial Hinge Fracture.

The effect of osteotomy type on the initial stiffness of the bone-implant construct in lateral opening-wedge distal femoral osteotomy (LOWDFO) using a uniplanar compared with a biplanar technique has been investigated. However, no study has explored the biomechanical risk factors for medial hinge fracture. This study aimed to compare the biomechanical strength of uniplanar versus biplanar LOWDFO regarding the risk for medial hinge fracture during gap opening. Twelve composite femora were divided into two groups (six in each group) based on the distal femoral osteotomy technique: uniplanar versus biplanar LOWDFO. All LOWDFO models were subjected to incremental static loading. The gap distance was expanded by 1 mm, and displacement values were recorded as anterior and posterior gap distances (mm). The average force values of all samples at certain gap distances were recorded, and the head distance was measured. The uniplanar group had higher load values than the biplanar group at all anterior gap distances. These differences were only significant at 2- and 3-mm gap distances (p = 0.025 and 0.037). At all posterior gap distances, the uniplanar group had higher load values than the biplanar group, but these differences only reached statistical significance at 2 mm (p = 0.037). Both groups had similar anterior, posterior, and average gap distances (p = 0.75, 0.522, 0.873). The uniplanar group had a higher head insertion distance (15.3 ± 5.7) than the biplanar group (14.7 ± 2.9), but it was not significant (p = 0.87). The uniplanar group had a lower average load before medial hinge fracture (46.41 ± 13.91 N) than the biplanar group (54.92 ± 31.94, p = 0.81). The biplanar group had an average maximum load value of 64.18 ± 25.6 N, while the uniplanar group had 57.90 ± 12.21 N (p = 0.81). This study revealed that the biplanar osteotomy technique allows a wider opening wedge gap with less risk of a medial hinge fracture than uniplanar LOWDFO.Level of evidence was level 3, case-control series.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Occult Dorsal Wrist Ganglion Cysts Associated with Scapholunate Instability: Surgical Technique and Preliminary Clinical Results.

Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19-48) and the mean follow-up was 34 months (range: 24-48). The mean preoperative extension deficit decreased from 5.5° (range: 0°-20°) to 2.7° (range: 0°-15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°-15°) to 2.2° (range: 0°-10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7 kg (range: 22-36) to 38.3 kg (range: 31-46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25-65) pre-operatively to 91 (range: 70-100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic).

Comparison of sinus tarsi approach versus extensile lateral approach in the management of displaced intra-articular calcaneal fractures: A single-center study.

BACKGROUND: Controversy still exists for optimal treatment for displaced intra-articular calcaneal fractures (DIACFs). Conven-tionally, the extensile lateral approach (ELA) has been the most preferred approach. Although ELA provides excellent fracture access and direct evaluation of the depressed posterior facet, this approach has a high rate of serious complications, such as hematoma, superficial/deep infection, and wound healing issues. To overcome such complications, more minimally invasive techniques including external fixation, percutaneous fixation, arthroscopic assisted fixation, and sinus tarsi approach (STA) have been recently described. The primary aim of this study was to compare STA and LEA in the treatment of DIACFs. METHODS: Patients who were operated for DIACFs in our clinic were included in the study. Patients with closed DIACFs of Sanders Type II, III, IV, and over 18 years of age were identified. Physical examinations and radiological evaluations of the patients were per-formed, and clinical scores were filled. Patients were divided into subgroups according to the Sander's classification and comparisons were made again according to these subgroups. RESULTS: There were 37 patients (four female and 33 male) in STA group and 44 patients in LEA group (six female and 38 male). The mean age was 44.42±13.57 years (range, 18-61) for STA group and 37.32±11.09 years (range, 18-56) for the LEA group. In clinical outcomes, except for short-form survey (SF-12)/MCS-12 (Mental Score) and visual analog scale score, all the parameters were signifi-cantly better in STA group compared to LEA group. No significant difference was observed between the two groups in radiographic results, except for the Böhler angle. Significantly less infection occurred in the STA group compared to LEA group (P=0.021). According to Sander's classification, American Orthopedic Foot and Ankle Society, foot and ankle disability index, and SF-12/PCS-12 and foot function index scores, no significant differences were determined between STA and LEA groups for Sanders Type 2, whereas the values were considerably higher in STA group than in LEA group for Sanders Type 3 and 4. CONCLUSION: In DIACFs, STA is considered a safe and effective method for restoring the width, height, and length of the calca-neus and reconstruction of joint alignment and has now become our standard technique for all calcaneal fractures requiring operative treatment.

Crack Propagation and Fatigue Performance of Partial Posterior Indirect Restorations: An Extended Finite Element Method Study.

Dental ceramics are susceptible to slow, progressive crack growth after cyclic loading. The purpose of this study was to investigate the progressive patterns of cracks in two different types of CAD/CAM ceramic materials used with three different partial posterior indirect restoration (PPIR) designs and to determine the materials' failure risk using a fatigue test. Standard initial cracks were formed in Standard Tessellation Language (STL) files prepared for three different PPIRs. The materials chosen were monolithic lithium disilicate (LS) and polymer-infiltrated ceramic networks (PICNs). The extended finite element method (XFEM) was applied, and the fatigue performance was examined by applying a 600 N axial load. The cracks propagated the most in onlay restorations, where the highest displacement was observed. In contrast, the most successful results were observed in overlay restorations. Overlay restorations also showed better fatigue performance. LS materials exhibited more successful results than PICN materials. LS materials, which can be used in PPIRs, yield better results compared to PICN materials. While inlay restorations demonstrated relatively successful results, overlay and onlay restorations can be specified as the most and the least successful PPIR types, respectively.

Effect of putrescine supplementation to in vitro maturation medium on embryo development and quality in cattle.

This study aimed to investigate the effect of putrescine supplementation to maturation medium during in vitro embryo production in cattle on maturation and embryo development/quality. Oocytes obtained from the ovaries of Holstein cattle were used in the study. Obtained cumulus-oocyte complexes were evaluated according to morphological structure, cytoplasmic features, and cumulus cell number, and only Category-I ones were used in the study. Before the in vitro maturation step, oocytes were randomly divided into two groups. In the first group (Putrescine group, n = 159), 0.5 mM putrescine was added to the maturation medium before in vitro maturation. No addition was applied to the maturation medium of the second group (Control group, n = 149). Cumulus expansion degrees of oocytes following maturation (Grade I: poor, Grade II: partial, and Grade III: complete) were determined. In addition, the meiosis of oocytes after maturation was evaluated by differential staining. Then the oocytes were left for fertilization with sperm and finally, possible zygotes were transferred to the culture medium. After determining the developmental stages and quality of the embryos after in vitro culture, only the embryos at the blastocyst stage were stained with the differential staining method to determine the cell numbers. When the cumulus expansion degrees of the groups were evaluated, the Grade III cumulus expansion rate in the putrescine group was higher than the control group (74.21% and 60.4%; respectively) and the Grade I expansion rate (11.95% and 26.17%; respectively) was found lower (p < .05). When the resumption of meiosis was evaluated according to the cumulus expansion degrees, it was determined that the rate of resumption of meiosis increased as the cumulus expansion increased. In addition, the cleavage rates of oocytes and reaching the blastocyst in the putrescine group were found to be higher than in the control group (p < .05). Moreover, inner cell mass, trophectoderm cells, and total cell counts were found to be higher in blastocysts obtained after the putrescine supplementation to the maturation medium compared to the control group (p < .05). As a result, it was determined that the putrescine supplementation to the maturation medium during in vitro embryo production in cattle increased the degree of cumulus expansion and the rate of resumption of meiosis. In addition, putrescine supplementation was thought to increase the rate of reaching the blastocyst of oocytes due to better cell development in embryos.

Intra- and inter-observer reliability of Dias-Tachdjian classification in pediatric ankle fractures: do clinical experience and expertise matter?

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician's experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician's experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77-0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86-0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71-0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53-0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47-0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37-0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

The effect of posterior tibial slope on anteroposterior stability in posterior cruciate retaining total knee arthroplasty.

BACKGROUND: It has been suggested that the posterior tibial slope (PTS) plays an important role in increasing the anteroposterior stability following total knee arthroplasty. Although the relationship between the PTS and the flexion range has been investigated many times, studies on the relationship between PTS and anterior-posterior stability are limited. The primary aim of this study was to investigate the relationship and effects of PTS on anteroposterior stability in posterior cruciate retainer total knee arthroplasty. METHODS: 154 primary TKAs were identified retrospectively to analyze the any association between PTS and anteroposterior laxity following posterior cruciate-retaining total knee arthroplasty in the overall study populations. Anteroposterior displacement was measured at the final follow-up based on the following two procedures: KT-1000 arthrometer and sagittal drawer radiographic images. In addition, the relationship between PTS and functional scores-ROM was examined. RESULTS: There was no correlation between patients' posterior tibial slope and postoperative VAS (r: -0.060, p:0.544), WOMAC (r:0.037, p:0.709), KSS (r: -0.073, p:0.455). In addition, there was no significant correlation between postoperative knee ROM and postoperative PTS (r:0.159, p:0.106). Moreover, no correlation was found between KT-1000 arthrometer and 20 degrees AP translation with PTS. There was a negative correlation between PTS and 70 degrees AP translation (r: -0.281, p:0.008). CONCLUSIONS: This study aimed to clarify the association between instability and AP laxity in flexion of implanted knees, and to determine what degree of AP laxity results of instability. A fundamental finding of this study was that; the optimum TS angle to increase anterior-posterior stability after total knee arthroplasty is between ≥ 4 to < 6 degrees, we also proved that there is no relationship between stability and patient satisfaction.

Does using microfluidic sperm sorting chips in bovine IVEP affect blastocyst development?

This study aimed to determine the effect of microfluidic sperm sorting chip on embryo development and quality in the sperm treatment step in in vitro embryo production in cattle. Only A-quality oocytes obtained from the ovaries of Holstein cattle were included in the study. These oocytes were first placed in in vitro maturation medium, and matured oocytes were randomly divided into two groups at the 24th hour of maturation. Oocytes in the first group with the Microfluidic Sperm Sorting Chip (MFSC, n = 154) were put into a fertilization medium with spermatozoa prepared with microfluidic sperm sorting device. Oocytes in the second group (Con, n = 169) were fertilized with spermatozoa prepared by the routine sperm treatment step of the commercial company. The rate of cleavage (85.71% vs. 76.33%, respectively) and of reaching the blastocyst (44.15% vs. 32.54%, respectively) in the MFSC group were higher than the control group. In addition, it was determined that the numbers of ICM (45.8 ± 2.04 vs. 39.2 ± 1.85, respectively), TE (122.13 ± 2.19 vs. 115.0 ± 2.61, respectively), TC (167.93 ± 2.89 vs. 154.2 ± 2.62, respectively) increased in the MFSC group compared to the control group. A statistically significant difference was found in the number of cells with apoptosis per embryo (5.14 ± 0.77 vs. 11.91 ± 0.79) and apoptotic index rates (3.06 ± 0.47 vs. 7.72 ± 0.55%) of the MFSC and Con groups. As a result, we concluded that using microfluidic sperm sorting chips during sperm treatment in bovine IVEP increases the rate of reaching the blastocyst, embryo development, and quality and reduces the possibility of apoptosis in developing blastocysts. For this reason, it is also thought that the use of microfluidic sperm sorting devices during sperm treatment in bovine IVEP may be a new alternative in this field.

Orthopedic Management of Radial Tunnel Syndrome: A Diagnostic and Treatment Dilemma.

OBJECTIVE: The first-line treatment for radial tunnel syndrome is conservative despite limited evidence concerning its efficiency. Surgical release is indicated if nonsurgical measures fail. Radial tunnel syndrome cases may be misdiagnosed as the more common lateral epicondylitis, and misdiagnosing radial tunnel syndrome causes wrong treatment and, thus, the perpetuation or increase of the pain. Although radial tunnel syndrome is a rare disorder, such cases can be encountered in tertiary hand surgery centers. This study aimed to present our experience in diagnosing and managing patients with radial tunnel syndrome. MATERIAL AND METHODS: Eighteen patients (7 male, 11 female; mean age=41.5 years, age range=22-61) in whom radial tunnel syndrome was diagnosed and treated at a single tertiary care center were retrospectively reviewed and included. Previous diagnoses (wrong diagnosis, delayed diagnosis, missed diagnosis, and other), previous treatments for such diagnoses, and their results before presenting to our institution were recorded. The shortened disabilities of the arm, shoulder, and hand questionnaire score and visual analog scale score were recorded before the surgery and at the final follow-up appointment. RESULTS: All the patients included in the study underwent steroid injections. Eleven patients (11/18, 61%) benefited from steroid injection and conservative treatment. The remaining 7 patients refractory to conservative treatment were offered surgical treatment. Of these, 6 patients accepted surgery while 1 did not accept it. In all patients, the mean visual analog scale score significantly improved from 6.38 (range: 5-8) to 2.1 (range: 0-7) (P < .001). The mean quick-disabilities of the arm, shoulder, and hand questionnaire scores were significantly improved from 43.4 (range: 31.8-52.5) preoperatively to 8.7 (range: 0-45.5) at the final follow-up (P < .001). In the surgical treatment group, the mean visual analog scale score significantly improved from 6.1 (range: 5-7) to 1.2 (range: 0-4) (P < .001). The mean quick-disabilities of the arm, shoulder, and hand questionnaire scores were significantly improved from 37.4 (range: 31.2-45.5) preoperatively to 4.7 (range: 0-13.6) at the final follow-up (P < .001). CONCLUSION: Our experience has shown that satisfactory results can be obtained by surgical treatment for patients with radial tunnel syndrome refractory to nonsurgical treatment whose diagnosis is confirmed by a thorough physical examination.

Surgical Management and Outcomes of Patients with Idiopathic Peroneal Spastic Flatfoot: A Retrospective Case Series.

BACKGROUND: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF. METHODS: Seven patients with IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known causes, such as tarsal coalition or other causes (eg, traumatic) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in five patients and subtalar arthrodesis in two patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores and Foot and Ankle Disability Index scores were obtained preoperatively and postoperatively from all patients. RESULTS: On physical examination, all feet manifested rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores significantly increased from 42 (range, 20-76) and 45 (range, 19-68) preoperatively (P = .018) to 85 (range, 67-97) and 84 (range, 67-99) (P = .043) at the final follow-up, respectively. No major intraoperative or postoperative complications were observed in any of the patients. All computed tomographic and magnetic resonance imaging scans revealed no evidence of tarsal coalitions in any of the feet. All radiologic workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions. CONCLUSIONS: Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.