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Augmentation of cerclage wire strength with a basic knot technique: A biomechanical study

Aim: Loosing of cerclage wire is a common problem in the fixation of fractures and alternative techniques are required to provide more strength cable systems. The aim of this study was to evaluate the benefit of an additional knot to the cable system to increase durability and strength of wire 

Material and Methods: Twelve artificial bone fragments were bisected thoroughly in the coronal plane. Two mm diameter CoCr Dall Miles were used in two groups; the first group was the sleeve group (n=6) and the second group was the sleeve + knot group (n=6). All cables were once looped around the saw bone with positioning the sleeve at the beaded end of the cable, and the tensioner knob was used to create tension to 90 lb/in2 (62,05 N/cm2). In the sleeve + knot group, one more simple knot was performed with conventional surgery skill, and the two ends of cerclage wire were put into the tensioner knob to create tension again. Mechanical tension testing was performed at a velocity of 20mm/min. Axial tension force was applied until failure. The maximum force and displacement values were recorded at the failure point.

Results: There was a significant difference in the mean rank of applied force between the sleeve and sleeve + knot groups (p=0,025). However, there was no statistical difference in the amount of displacement between the two groups (p=0,378). The ratio of force/displacement displayed a significant difference between the two groups, it was shown that the sleeve + knot group was more durable than the sleeve only group (p=0,01).

Discussion: Adding a knot to the cable system increases the durability and strength of the cable system by approximately %40. These findings showed that adding a knot to the cable-domino system had decreased the possibility of loosening and fixation failure.

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Renal leiomyosarcoma: A rare entity

Renal leiomyosarcoma is one of the rare tumors. It constitutes only 0.5% of all primary renal malignancies. It accounts for 50-60% of primary renal sarcomas. The majority of cases are adults, and their mean age is 58 years. Renal leiomyosarcomas originate from the renal capsule, pelvis renalis, calyces, and vascular smooth muscles. These tumors have a poor prognosis, and surgery is the main treatment modality. In this article, in the light of the literature, we aimed to present a case report of renal leiomyosarcoma 16x15x11cm in size in the right kidney of a 39-year-old female patient who presented with complaints of abdominal pain and hematuria. Although leiomyosarcomas are limited in the kidney, they are aggressive tumors with a poor prognosis.

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Prenatal distress level and its predictors according to the gestational age in pregnant women

Aim: The aim of the present study was to determine the level and predictors of prenatal distress in pregnant women according to gestational age. 

Material and Methods: This cross-sectional study was conducted in eight Family Health Centers (FHCs) in Kırklareli in Northwestern Turkey. The study included 179 pregnant women at ≥12th week of gestation, who presented to the FHCs. 

Results: The frequency of prenatal distress among the participants was 21.2% (between 12th-27th weeks: 16.5%, between 28th-41st weeks:  26.8%). It was found that level of education, age of the spouse, current pregnancy being unplanned, and social support levels were associated with the level of prenatal distress in  ≥12th week or between 12-27 weeks or between 28-41 weeks (p<0.05). In addition, perceived income level, abortion, and the number of pregnancies were associated with the level of prenatal distress in  ≥12 weeks; the age of women, perceived income levels, previous abortion experience, and the number of pregnancies were associated with the level of prenatal distress in between 12-27 weeks; the age of women, education level of a spouse, and previous delivery experience were associated with prenatal distress levels in between 28-41weeks (p<0.05).

Discussion: The level of prenatal distress according to the gestational age, the education level of the woman, the age of her spouse, unplanned pregnancies, and social support levels were predictors. In the 12-27 weeks and 28-41 weeks, the age of women was found to be a determining factor in prenatal stress levels in pregnant women. Pregnant women should be screened by healthcare professionals in terms of prenatal distress when they visit FHCs, and interventions to activate their social support mechanisms should be planned.

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