Clinical predictors of Alzheimer's disease-like brain atrophy in individuals with memory complaints.

OBJECTIVES: The definition and assessment methods for subjective cognitive decline (SCD) vary among studies. We aimed to investigate which features or assessment methods of SCD best predict Alzheimer's disease (AD)-related structural atrophy patterns. METHODS: We assessed 104 individuals aged 55+ with memory complaints but normal cognitive screening. Our research questions were as follows: To improve the prediction of AD related morphological changes, (1) Would the use of a standardized cognitive screening scale be beneficial? (2) Is conducting a thorough neuropsychological evaluation necessary instead of relying solely on cognitive screening tests? (3) Should we apply SCD-plus research criteria, and if so, which criterion would be the most effective? (4) Is it necessary to consider medical and psychiatric comorbidities, vitamin deficiencies, vascular burden on MRI, and family history? We utilized Freesurfer to analyze cortical thickness and regional brain volume meta-scores linked to AD or predicting its development. We employed multiple linear regression models for each variable, with morphology as the dependent variable. RESULTS: AD-like morphology was associated with subjective complaints in males, individuals with advanced age, and higher education. Later age of onset for complaints, complaints specifically related to memory, excessive deep white matter vascular lesions, and using medications that have negative implications for cognitive health (according to the Beers criteria) were predictive of AD-related morphology. The subjective cognitive memory questionnaire scores were found to be a better predictor of reduced volumes than a single-question assessment. It is important to note that not all SCD-plus criteria were evaluated in this study, particularly the APOE genotype, amyloid, and tau status, due to resource limitations. CONCLUSIONS: The detection of AD-related structural changes is impacted by demographics and assessment methods. Standardizing SCD assessment methods can enhance predictive accuracy.

The Impact of Complex Loadings on the Structure of the L2-L3 Intervertebral Disc in a Sheep Spine Cadaver Model: A Biomechanical and Histological Evaluation.

Background The human vertebral column generates movements under versatile, dynamic loads. Understanding how the spine reacts to these movements and loads is crucial for developing new spine implants and surgical treatments for intervertebral disc injuries. Mechanically uni-axial compression models have been extensively studied. However, the spine's daily loading is not limited to compression, so it is crucial to measure its behavior in all movements (flexion-extension, rotation, and axial compression). Methods This study utilized L1-L5 segments from 19 healthy adult sheep spines. The L2-L3 disc of the first spine underwent only histological evaluation without biomechanical testing to define basic histological parameters. The remaining 18 were divided into three groups of six and subjected to biomechanical tests. Different mechanisms for three groups of spinal segments were prepared, and tests were performed on Shimadzu AG-IS 10 KN (Universal Drawing Press, Kyoto, Japan). An axial load (800 N) was applied to the first group, an axial load with 15 degrees of flexion to the second group, and an axial load with 10 degrees of rotation plus 15 degrees of flexion to the third group. A biomechanical evaluation of the maximum elongation amounts (MEAs) was performed and compared between the groups. Then, the L2-L3 discs were removed from the sheep spines, and a histological examination of the discs was conducted using Hematoxylin-Eosin (HE), Alcian Blue (AB), and Masson's Trichrome (MT) staining. Results The mean MEA ± Standard Deviation (Range) was 1.39 ± 0.38 (0.91-1.94) for Group 1, 2.02 ± 0.75 (0.91-3.01) for Group 2, and 2.47 ± 1.09 (0.64-3.9) for Group 3. Biomechanically, although MEAs increased from Group 1 to Group 3 (meaning that the mean MEAs increased as the number of types of applied force increased), there was no statistically significant difference between the groups regarding the MEAs (P = 0.092). Histologically, no significant differences were observed between all groups after HE staining. In all groups, hypercellularity, edema in the connective tissue, separation between tissue layers, delamination, and signs of swelling and necrosis in the cells were observed similarly. For the AB staining, there was a decrease in the glycosaminoglycan (GAG) structure in the tissue samples compared to the control tissue, but no significant differences were observed between the groups. However, it was observed that the stratification in Group 3 was slightly more deteriorated than in the other groups. For the MT staining, collagen structure deterioration was observed in all groups. It was observed that the amount of collagen was significantly reduced compared to the control tissue. Conclusion As a result, when the axial load is applied biomechanically, there is more displacement of the vertebral discs in Group 3 with multidimensional movements. Furthermore, histological studies revealed deterioration between tissue layers when exposed to complex movements, and the degradation of stratification in group 3 compared to other loading combinations in groups 2 and 3 may indicate the role of complex loads in the formation of disc herniation.

Valproate, obesity and other causes of clozapine poor metabolism in the context of rapid titration may explain clozapine-induced myocarditis: A re-analysis of a Turkish case series.

INTRODUCTION: Clozapine-induced myocarditis or any clozapine-induced inflammation may be a hypersensitivity reaction due to titration that was too rapid for the patient's clozapine metabolism. Clozapine metabolism is influenced by ancestry, sex, smoking and the presence of confounders including obesity, infections, and inhibitors (e.g., valproate) causing the patient to behave as a clozapine poor metabolizer (PM). A published study in a Turkish hospital identified 1 case of clozapine-induced pancreatitis and hepatitis and 9 cases of clozapine-induced myocarditis. To explore the hypothesis that the 10 patients were clozapine PMs, their serum clozapine concentrations were investigated using concentration-to-dose (C/D) ratios and their titrations carefully reviewed. METHODS: Dividing the trough serum concentration by the dose produces the clozapine C/D ratio. The dose required to reach 350ng/ml was considered the minimum therapeutic dosage and was used to classify patients according to clozapine PM status. Titration speed was assessed. RESULTS: All 10 patients were possibly clozapine PMs (3 of them had as minimum therapeutic doses: 72, 82 or 83mg/day). Nine of the 10 patients may have behaved as clozapine PMs due to obesity and/or valproate co-prescription during titration. One also had an undiagnosed infection. Of the 10 patients, 9 had at least 1 of 3 factors: too-rapid titration in the first or second weeks, or a final dosage that was too high. CONCLUSIONS: Future studies using clozapine levels and considering the role of clozapine PM status should explore whether or not all cases of clozapine-induced inflammation could be explained by lack of individualized titration.

Reliability and Validity of the Snaith-Hamilton Pleasure Scale Clinician Administered Turkish Form. / Klinisyen Tarafindan Uygulanan Snaith-Hamilton Zevk Alma Ölçegi Türkçe Uyarlamasinin Geçerlik ve Güvenilirlik Çalismasi.

OBJECTIVE: Anhedonia, which is defined as diminished capacity of having pleasure, is a common symptom in many mental disorders. It has been aimed in this study to adapt to the Turkish language the Snaith- Hamilton Pleasure Scale Clinician Administered Form (SHAPS-C) and examining reliability and validity of Snaith-Hamilton Pleasure Scale Clinician Administered Turkish Form (SHAPS-C-TR) which measures anhedonia in clinical and healthy samples. METHOD: Two groups consisting of 63 participants consulting the psychiatry clinic and 67 non-clinical participants were included in the study. Data were collected with the Turkish version of the SHAPS-C (the SHAPS-C-TR), the Beck Depression Inventory (BDI), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Positive Negative Affect Scale (PANAS). RESULTS: The Kuder-Richardson internal consistency coefficient for the entire participants, the clinical and the non-clinical group were, 0.765, 0.813 and 0.657 respectively. The intra-class coefficient for test-retest reliability was 0.732. The total score on the SHAPS-C-TR significantly correlated with the scores on the anhedonia items of the BDI and the MADRS but not the scores on anxiety items. The PANAS positive symptoms scores were negatively correlated with the SHAPSC- TR total score. In the clinical group, the participants followed up with depression had significantly higher SHAPS-C-TR score than the rest of the participants. A similar difference was not demonstrated by the scores of the clinical group participants followed up with anxiety disorder. Scores on the SHAPS-C-TR did not vary with respect to the demographic characteristics of the participants. CONCLUSION: The SHAPS-C-TR is a valid and reliable measurement tool to assess anhedonia in both clinical and non-clinical individuals irrespective of differences in demographic features.

The evaluation of a de novo biplanar distal humerus plate: A biomechanical study.

OBJECTIVES: The aim of this study was to compare the stability of a novel biplanar distal humerus plate with the single- and double-columns J-plating techniques. MATERIALS AND METHODS: Eighteen sawbones humera were divided into three groups. In Groups 1, 2 and 3, biplanar plate, single lateral J-plate and double J-plate, were used, respectively. Transverse osteotomies at the upper portion of the olecranon fossa were made. Blocks of 10-mm was removed from each sample. Axial, torsional, and extensional stiffness of each group were measured. RESULTS: The mean axial stiffness values in Groups 1, 2, and 3 were 64.80±6.75, 33.70±5.71, and 171.48±9.53 N/mm, respectively. Group 1 demonstrated a statistically significant difference compared to Group 2 (p=0.032), whereas Group 3 showed a statistically significant difference compared to Groups 1 and 2 (p=0.025 and p=0.014, respectively). The mean torsional stiffness values of Groups 1, 2, and 3 were 0.23±0.01, 0.14±0.008, and 0.30±0.007 N/ degree, respectively. Groups 1 and 3 demonstrated a statistically significant difference compared to Group 2 (p=0.042 and p=0.028, respectively). No statistically significant difference was detected between Groups 1 and 3 (p=0.27). The mean extensional bending stiffness values of Groups 1, 2 and 3 were 2.64±0.31, 1.17±0.13, and 3.2±0.1 N/mm, respectively. Group 1 demonstrated a statistically significant difference compared to Group 2 (p=0.041). There was no statistically significant difference between Groups 1 and 3 (p=0.083). CONCLUSION: Biplanar plate allows applying enough numbers of long sagittal screws and offers more biomechanical stability than lateral column J-plate and in some aspects strong as dual J-plating in torsional and bending tests.

What is the Effect of Pedicle Screw Reinsertion Through the Same Trajectory on Pullout Strength?

AIM: To investigate the pullout strength of a pedicle screw reinserted through the same trajectory MATERIAL and METHODS: Fifty freshly frozen lamb L4 vertebrae were divided into the following five groups: Group 1, inserted with a 5-mm pedicle screw; Group 2, inserted with a 5-mm pedicle screw followed by the removal and reinsertion of the same screw after control; Group 3, inserted with a 5-mm pedicle screw followed by the removal and reinsertion of a 5.5-mm screw after control; Group 4, inserted with a 5.5-mm pedicle screw; and Group 5, inserted with a 5.5-mm pedicle screw followed by the removal and reinsertion of the same screw after control. Pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at 5 mm/min. All data were recorded. A load-displacement curve was used to obtain the peak value of the pullout strength for all specimens. RESULTS: The mean pullout strengths were 1086.22 N, 1043.32 N, 1039.18, 1199.10, and 1131.68 N for Groups 1?5, respectively. No significant difference was observed among all groups (p > 0.05). CONCLUSION: Perioperative reinsertion of the same screw or (0.5 mm) larger in diameter through the same trajectory after the control of the screw trajectory did not affect the pullout strength of the screw.

The Validity and Reliability of the Turkish Version of MacArthur Competence Assessment Tool for Treatment Decision: Correlates of Competence in Schizophrenia Patients.

INTRODUCTION: Informed consent is an indispensable condition of the clinical practice for the provision of health care. The main objective of this study is to translate the MacArthur competence assessment tool for treatment (MacCAT-T) into Turkish and evaluate the validity and reliability of the Turkish version in schizophrenia patients and healthy control subjects. METHODS: In this cross-sectional study, 30 hospitalized schizophrenia patients and 25 healthy subjects were assessed with MacCAT-T, Mental Competence Evaluation Form for Assessment of Competency (MCEF), Positive and Negative Syndrome Scale, Beck Depression Inventory, Mini Mental State Examination, Wechsler Adult Intelligence Scale (WAIS) - Similarities subtest and the Schedule for Assessing the Three Components of Insight. Psychometric properties of MacCAT-T were examined by intra-class correlation coefficients and Cronbach's alpha values. RESULTS: Intra-class correlations ranged between 0.83 and 0.99 for four subscales of the tool. Cronbach alpha value of MacCAT-T was found 0.89. Severity of psychopathology and indices of insight were found to be negatively correlated with the subscales of the tool. WAIS-Similarities subtest scores were found to be positively correlated with understanding and reasoning subscales of MacCAT-T. CONCLUSION: The Turkish version of MacCAT-T is a valid and reliable instrument for Turkish patients. The severity of psychopathology, insight and executive functions were shown to be significantly related to the decision making capacity in patients with schizophrenia.

Bioactive snail mucus-slime extract loaded chitosan scaffolds for hard tissue regeneration: the effect of mucoadhesive and antibacterial extracts on physical characteristics and bioactivity of chitosan matrix.

Biobased extracts comprise various bioactive components and they are widely used in tissue engineering applications to increase bioactivity as well as physical characteristics of biomaterials. Among animal sources, garden snailHelix aspersahas come into prominence with its antibacterial and regenerative extracts and show potential in tissue regeneration. Thus, in this study, bioactiveH. aspersaextracts (slime, mucus) were loaded in chitosan (CHI) matrix to fabricate porous scaffolds for hard tissue regeneration. Physical, chemical properties, antimicrobial activity was determined as well asin vitrobioactivity for bone and cartilage regeneration. Mucus and slime incorporation enhanced mechanical properties and biodegradation rate of CHI matrix. Scanning electron microscopy images showed that the average pore size of the scaffolds decreased with higher extract content. Mucus and slime extracts showed antimicrobial effect on two bacterial strains.In vitrocytotoxicity, osteogenic and chondrogenic activity of the scaffolds were evaluated with Saos-2 and SW1353 cell lines in terms of Alkaline phosphatase activity, biomineralization, GAG, COMP and hydroxyproline content. Cell viability results showed that extracts had a proliferative effect on Saos-2 and SW1353 cells when compared to the control group. Mucus and slime extract loading increased osteogenic and chondrogenic activity. Thus, the bioactive extract loaded CHI scaffolds showed potential for bone and cartilage regeneration with enhanced physical properties andin vitrobioactivity.

Biomechanical comparison of pullout strengths of six pedicle screws with different thread designs.

OBJECTIVES: This study aims to assess the pullout strength of six different pedicle screw thread patterns. MATERIALS AND METHODS: A total of 36 sheep spines were divided into six groups including six spines in each group: fully threaded cortical (Type A), fully threaded spongeous (Type B), fully cortical threads in the proximal half and fully spongeous threads in the distal half (Type C), fully spongeous threads in the proximal half and fully cortical threads in the distal half (Type D), unthreaded proximal half with fully spongeous threads in the distal half (Type E), and unthreaded proximal half with fully cortical threads in the distal half (Type F). The axial compression-traction machine was used for biomechanical testing at a pullout rate of 1 mm/min. RESULTS: The mean values of pullout strength of the groups A, B, C, D, E, and F were 1112±7.52 N, 986±8.34 N, 646±3.88 N, 676±7.16 N, 609±9.52 N, and 769±6.49 N, respectively. There was a statistically significant difference between the screw groups A and B, C, D, E and F (p=0.036, p=0.028, p=0.04, p=0.039, and p=0.046, respectively). A statistically significant difference was observed between the groups B versus C and E (p=0.037 and p=0.021, respectively). There was no statistically significant difference between the groups B versus D and F (p=0.35 and p=0.61, respectively). CONCLUSION: Fully threaded cortical pedicular screw design exhibited the strongest bone grasp compared to other thread designs. Further studies should be conducted in multidirectional force pattern on human spine to assess the six screw thread designs in a closer real-life setting simulation model.

A comparative study of detection of myocarditis induced by clozapine: With and without cardiac monitoring.

The aim of this study was to investigate and compare the incidence of suspected or definite cases of clozapine induced myocarditis (SDM) and clinical factors which could influence its onset in two different time periods, defined by pre- and post-cardiac monitoring at an inpatient setting, during the initiation phase of clozapine treatment. Hospital records of patients started on clozapine in the inpatient unit between 2011 and 2018 were investigated. Eight in 38 patients (11.3%) were classified as SDM after the initiation of the monitoring protocol, whereas only 1 in 33 patients (1.4%) was classified as SDM, before. Monitored and non-monitored patient groups were similar with regard to demographic and clinical variables. Diagnosis of schizoaffective disorder and use of concominant lithium, valproic acid and atypical antipsychotics were higher in patients with SDM, while clozapine dose titration was similar compared to the rest of the patients. Cardiac monitoring seems to be the main factor leading to the increase in the detection of clozapine induced myocarditis (CIM). If not monitored, the outcome of CIM can be fatal without any warning signs and symptoms. Concominant use of mood stabilizers including valproic acid and lithium, are important risk factors for the development of CIM.

Straight-Forward versus Bicortical Fixation Penetrating Endplate in Lumbosacral Fixation-A Biomechanical Study.

OBJECTIVE: Many lumbosacral fixation techniques have been described to offer a more screw-bone purchase. The forward anatomical fixation parallel to the endplate is still the most preferred method. Literature revealed little knowledge regarding the mechanical stability of lumbosacral trans-endplate fixation compared to the traditional trans-pedicular screw fixation method. The aim of this study is to assess the pull-out strength of lumbosacral screws penetrating the end plate and comparing it to the conventional trans-pedicular screw insertion method. METHODS: Eight lumbar and eight sacral vertebrae, with average age 69.4 years, Left pedicles of the 5th lumbar vertebrae were used for trans-endplate screw fixation, group 1A, right pedicles were used for anatomical trans-pedicular screw fixation, group 1B. In the sacral vertebrae, the right side S1 pedicles were used for trans-endplate fixation, group 2A, left side pedicles were used for anatomical trans-pedicular screw fixation, group 2B. The biomechanical tests were performed using the axial compression testing machine. All tests were applied using 2 mm/min traction speed. RESULTS: The average pull-out strength values of groups 1A and 1B were 403.78±11.71 N and 306.26±17.55 N, respectively. A statistical significance was detected with p=0.012. The average pull-out strength values of groups 2A and 2B were 388.73±17.03 N and 299.84±17.52 N, respectively. A statistical significance was detected with p=0.012. CONCLUSION: The trans-endplate lumbosacral fixation method is a trustable fixation method with a stronger screw-bone purchase and offer a good alternative for surgeons specially in patients with osteoporosis.

A novel anatomical patellar plate for transverse patellar fracture - A biomechanical in-vitro study.

OBJECTIVE: The aim of this study was to assess the safety and stability of our novel anatomical patella plate and to compare its stability with tension band-wire technique. METHODS: A total of 12 cadaveric preserved knees (six right and six left patellae) with close patellar size were chosen to form two groups of six samples. Each group received either plate or tension band-wiring fixation for an experimentally created patella fracture. Cyclic load of an average of 350 N was applied for all specimens and after accomplishing 50 cycles the displacements of all fracture edges were recorded. RESULTS: After completing 50 cycles in each group, the average fracture edges displacement measured in the plate group was 1.98 ± 0.299 mm, whereas the average fracture edges displacement measured in the tension band-wire group was 2.85 ± 0.768 mm (p = 0.016). CONCLUSION: In the operative treatment of displaced transverse patellar fractures, the strength of fixation obtained by titanium curved plates is highly stronger when compared to the fixation with a tension band-wire technique. Fixation with titanium curved plates provides satisfactory stability at the fracture site which allow withstanding the cyclic loads during the postoperative rehabilitation.

The effectiveness of extracorporeal shock wave therapy in snapping scapula.

BACKGROUND: Bursitis of the snapping scapula is commonly a misdiagnosed problem. Extracorporeal shockwave therapy (ESWT) has been used successfully in the treatment of many chronic inflammatory conditions. The aim of this study was to assess and compare the effectiveness of ESWT in the treatment of scapulothoracic bursitis with the outcome of corticosteroid injection. METHODS: Using the randomized controlled trials 43 patients with scapulothoracic bursitis were divided into two groups. Group 1 ( n = 22) received three sessions of ESWT. Group 2 ( n = 21) received a single local injection of 80 mg of methylprednisolone. Visual analogue scale (VAS) scores were recorded at each follow-up, whereas the level of satisfaction was evaluated using the Roles and Maudsley criteria. RESULTS: In group 1, the average VAS scores after 1, 2, 3, and 6 months were 39, 30, 27, and 16, respectively, whereas, in group 2, the average VAS scores were 46, 44, 35, and 36, respectively. There was no statistical significance between the two groups in the first and second months. However, after 3 and 6 months, group 1 revealed lower average VAS scores compared to that of the second group with p-values (0.012 and 0.001), respectively. Roles and Maudsley criteria showed that first group patients were 46% excellent, 36% good, 14% acceptable, and 4% had poor results. However, second group patients were 24% excellent, 33% good, 19% acceptable, and 24% had poor results. CONCLUSION: We believe that ESWT is a beneficial and trustable method of treatment and can be strongly recommended in painful cases of scapulothoracic bursitis.

The reliability of Cavalier's principle of stereological method in determining volumes of enchondromas using the computerized tomography tools.

INTRODUCTION: Volumetric measurements of benign tumors enable surgeons to trace volume changes during follow-up periods. For a volumetric measurement technique to be applicable, it should be easy, rapid, and inexpensive and should carry a high interobserver reliability. We aimed to assess the interobserver reliability of a volumetric measurement technique using the Cavalier's principle of stereological methods. MATERIALS AND METHODS: The computerized tomography (CT) of 15 patients with a histopathologically confirmed diagnosis of enchondroma with variant tumor sizes and localizations was retrospectively reviewed for interobserver reliability evaluation of the volumetric stereological measurement with the Cavalier's principle, V = t × [((SU) × d) /SL]2 × Σ P. RESULTS: The volumes of the 15 tumors collected by the observers are demonstrated in Table 1. There was no statistical significance between the first and second observers ( p = 0.000 and intraclass correlation coefficient = 0.970) and between the first and third observers ( p = 0.000 and intraclass correlation coefficient = 0.981). No statistical significance was detected between the second and third observers ( p = 0.000 and intraclass correlation coefficient = 0.976). CONCLUSION: The Cavalier's principle with the stereological technique using the CT scans is an easy, rapid, and inexpensive technique in volumetric evaluation of enchondromas with a trustable interobserver reliability.

Femur can be lengthened over nail, along its mechanical axis : a modified lengthening over nail technique.

The theoretical risk of medialisation of the knee joint and the lateral shift of the lower extremity mechanical axis, due to achievement of lengthening along the anatomical axis is present in the process of lengthening with elongation nails and the "lengthening over nail" technique. With this new technique described in this study we aimed to prove that lengthening over nail can be performed along the mechanical axis of the femur. Six lower-limb models were used to perform three different lengthening techniques. In group 1, lengthening was achieved along the anatomical axis with an external fixator. In group 2, the clamps of the external fixator were adjusted at 6° to achieve lengthening along the mechanical axis. In group 3, eight different sized nails were applied with an external fixator (angle adjustable clamps were at 6°) to achieve lengthening along the mechanical axis by LON technique. Photographs were taken after each cm of lengthening and the distance from the mechanical axis line were measured. The modified LON technique described in this study provided lengthening along the mechanical axis. One of the main advantages of the procedure described in our study is the chance for reconsideration and revision of unforeseen angulations and malalignments, via the help of the distal angular adjustable clamps; during the time of the surgery for external fixator removal before application of the poller screws.

Biomechanical comparison of pullout strengths of five cortical screw types: An innovative measurement method.

OBJECTIVES: This study aims to assess five different cortical screw types using artificial femurs, under equated testing conditions. MATERIALS AND METHODS: We investigated the maximum force needed to cause deformation at screw-bone interface using fourth generation composite femurs by conducting separate pullout tests for each screw type. We normalized obtained results with traditional methods and cross-comparison. To conduct pullout tests dependent on screw dimensions, we eliminated the effect of bicortical bone thickness by equalizing the conditions of screw insertion. RESULTS: Non-locking screws with larger diameter and pitch depth required larger pullout forces to be extracted, showing statistically superior performance compared to locking screws with smaller dimensions. However, the statistical differences between the absolute pullout forces decreased after the traditional normalization of the results. We proposed a new normalization method based on solid geometric reasoning. CONCLUSION: This novel approach showed that a screw type that appeared to show average performance, in fact, did not have statistically significantly different results than the top performers. Surgeons are not required to prefer larger dimension screws in small dimension host bones.

Emergency physicians performed Point-of-Care-Ultrasonography for detecting distal forearm fracture.

OBJECTIVES: Several studies focusing diagnosis of forearm fracture using Point-of-Care-Ultrasonography (POCUS) had been carried out in children. There is a lack of evidence for the utility of sonographic (US) examination for detecting of distal forearm fracture in adults. We aim to determine the diagnostic sensitivity and specificity of POCUS examination for the fracture of the distal radius and ulna in adult patients presenting with blunt forearm trauma. MATERIAL AND METHODS: Adult patients presenting with acute distal forearm trauma and suspicion of fracture were enrolled into study. POCUS had been performed by blinded emergency physicians, than anteroposterior and lateral x-rays was obtained. If inconsistency between x-rays and POCUS has been occurred, computed tomography were ordered. Assessment of orthopedic surgeon was accepted as a gold standard diagnosis. RESULTS: Ninety three POCUS were performed in 90 patients. Fifty nine radius and 19 ulna fracture had been diagnosed. POCUS detected all radius fracture, but missed 2 ulna fracture. There were 4 false positive results for both radius and ulna with POCUS. X-ray missed 4 radius, and 1 ulna fractures. Diagnostic sensitivity and specificity of POCUS for fracture of ulna were 89.5% (CI%95, 65.5-98.1) and 94.6 (CI%95, 86-98.2), for fracture of radius were 100% (CI%95, 92.4-100), and 88.2%. (CI%95, 71.6-96.1). CONCLUSION: Emergency physician performed POCUS examination is very sensitive and specific the diagnosis of distal forearm fracture. Diagnostic sensitivity of POCUS for radius fracture is higher than x-ray.

The Mechanical Effect of Rod Contouring on Rod-Screw System Strength in Spine Fixation.

OBJECTIVE: Rod-screw fixation systems are widely used for spinal instrumentation. Although many biomechanical studies on rod-screw systems have been carried out, but the effects of rod contouring on the construct strength is still not very well defined in the literature. This work examines the mechanical impact of straight, 20° kyphotic, and 20° lordotic rod contouring on rod-screw fixation systems, by forming a corpectomy model. METHODS: The corpectomy groups were prepared using ultra-high molecular weight polyethylene samples. Non-destructive loads were applied during flexion/extension and torsion testing. Spine-loading conditions were simulated by load subjections of 100 N with a velocity of 5 mm min(-1), to ensure 8.4-Nm moment. For torsional loading, the corpectomy models were subjected to rotational displacement of 0.5° s(-1) to an end point of 5.0°, in a torsion testing machine. RESULTS: Under both flexion and extension loading conditions the stiffness values for the lordotic rod-screw system were the highest. Under torsional loading conditions, the lordotic rod-screw system exhibited the highest torsional rigidity. CONCLUSION: We concluded that the lordotic rod-screw system was the most rigid among the systems tested and the risk of rod and screw failure is much higher in the kyphotic rod-screw systems. Further biomechanical studies should be attempted to compare between different rod kyphotic angles to minimize the kyphotic rod failure rate and to offer a more stable and rigid rod-screw construct models for surgical application in the kyphotic vertebrae.