Application of ECC as a Repair/Retrofit and Pavement/Bridge Deck Material for Sustainable Structures: A Review

Concrete structures cannot efficiently perform their functions over time due to chemical and physical external effects. Thus, enhancing the relationship between repair and aged structures, and also improving the durability properties of concrete is crucial in terms of sustainability. However, high costs, negative environmental effects, and incompatibility problems occur in repair/retrofit applications. Furthermore, three-quarters of the failures in the repaired/retrofitted structures are caused by a lack of repair durability. The need for repair in pavement/bridge decks is also frequently encountered, and early-age performance problems with repair materials cause pavement/bridge decks to be unavailable for certain periods of time. Engineered Cementitious Composite (ECC) can be effectively used as repair/retrofit and pavement/bridge deck material. It also has a minimal need for repair/retrofit thanks to its high durability properties. This article presents state-of-the-art research regarding the application of ECC as a repair/retrofit and pavement/bridge deck material. Studies in the literature show that the repair/retrofit properties of ECC outperform conventional concrete and steel fiber-reinforced concrete. ECC can be a solution to high early strength and drying shrinkage problems frequently encountered in the use of repair materials. It could also be used for different repair applications such as cast, sprayed, and trenchless rehabilitation. Moreover, ECC might fulfill specific requirements for pavement, pavement overlay, tunnel pavement, airfield pavement, and bridge deck. These superior performances are attributed to ECC’s kink-crack trapping mechanism, uniquely large inelastic strain capacity, strain hardening, high tensile strain capacity, and multiple microcracking and ductile behaviors, especially bonding behavior and self-healing.     

Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates?

PURPOSEThis study evaluated single-center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy, and retreatment rates.METHODSA retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome, and complications were recorded. Patients were divided into 2 groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the 2 groups in terms of tumor size reduction, retreatment, and complication rates. RESULTSIn this study, 42 patients (37 (88.1%) females and 5 (11.9%) males) harboring 48 AMLs were included. The mean age was 43.46 (range, 20-78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94 ± 1 cm (P  < .001) after treatments; however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (P  = .21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48 ± 25.71 (range, 2-102) months.CONCLUSIONIn this study, no clear supplementary benefit was observed in terms of safety and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

Main points

• Transarterial embolization is safe and effective in reducing lesion size and bleeding rates in the management of angiomyolipomas.
• Lesion size reduction can be achieved with both techniques; solely microparticle embolization or distal microparticle embolization plus proximal coil embolization.
• Proximal coil embolization does not provide an additional benefit with lesions having intratumoral microaneurysms ≥5 mm as the study showed no difference in complication and bleeding rates.

Renal angiomyolipoma (AML) is one of the most common benign tumors of the kidney, with an incidence of 0.4% in the general population.^1,2 AMLs are seen in 2 forms; sporadic and tuberosclerosis (TSC) related. Sporadic form accounts for 80% of the AML cases. TSC-related AMLs tend to be bilateral, multifocal, larger with a faster growth rate and are more symptomatic than the sporadic type.³ AMLs have slow growth rates and rarely necessitate invasive treatment at all times.⁴ Historical data suggest that AMLs equal to or larger than 4 cm and those that have 5 mm or larger microaneurysms tend to be more symptomatic and prone to hemorrhage.^5,6 Although a treatment indication based on tumor size larger than 4 cm is subject to dispute,⁷ treatment decisions are often made using these cut-off values in the literature. Treatment options consist of medical treatment, surgery, transarterial embolization (TAE), and thermal ablation with no definitive recommendation on the first-line treatment choice.^8,9 However, because of its less-invasive nature, TAE is a favored choice in the management of AMLs over surgery. So far, various embolic agents (ethanol, microparticles, coils, gel foam, etc.) have been used in the management of patients with AML.¹⁰ Concerning the embolic materials, Patatas et al.¹¹ compared solely coil embolization with solely microparticle embolization in transarterial embolization of AMLs. They found similar reduction rates on computed tomography (CT) follow-up between the 2 groups. Ewalt et al.¹² showed that microparticle plus coil embolization is effective in terms of size reduction in large (>4 cm) and symptomatic and TSC-related AMLs. Although based on the literature, coils, microparticles, and microparticle + coil embolization are all safe and efficient, there are no clear data on the additional benefit of adding coil embolization to microparticle embolization in terms of treatment efficacy. Therefore, this study aimed to evaluate within single-center results whether there is clinical relevance of adding proximal coil embolization to distal microparticle embolization in terms of safety, efficacy, and retreatment rates.     

A comparison of double single suture-button fixation,suture-button fixation,and screw fixation for ankle syndesmosis injury: A retrospective cohort study

Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.     

Thrombin activatable fibrinolysis inhibitor and thrombin-antithrombin-III-complex levels in patients with gastric cancer

The relation between cancer and coagulation is the subject of investigation since a relation between tumor and thrombosis has been determined. Antithrombin III is an important thrombin inhibitor, and increased thrombin?Cantithrombin (TAT) complex levels activate coagulation. Activated thrombin activatable fibrinolysis inhibitor (TAFI) inhibits the conversion of plasminogen to plasmin. In addition, it directly inactivates plasmin. Defective fibrinolysis increases the risk of thrombosis. In this study, we evaluated homeostatic parameters, TAFI, and TAT levels in patients with gastric cancer applying to the medical oncology outpatient clinic. Fifty-two patients and 35 healthy controls were included. ELISA was used to measure TAFI and TAT complex levels. These were statistically higher in the patient group (p?<?0.05 and p?=?0.001, respectively). D-dimer levels were higher in stage IV (p?=?0.05). Correlations between lymph nodes and TAFI and TAT levels were examined. Weak but positive correlation between lymph nodes and TAFI was detected (R?=?0.452, p?=?0.027). TAFI and TAT levels were evaluated using relative operating characteristic analysis to differentiate the disease. TAT was more specific than TAFI according to this analysis (TAFI area under curve (AUC), 0.676; TAT AUC, 0.874). Thrombotic events and bleeding disorders need to be borne in mind in gastric cancer. This situation is due to the impairment of the balance between coagulation and fibrinolysis. Further studies are now needed to evaluate the effects of TAFI and TAT on survey and prognosis as well as the potential of these parameters as tumor markers for gastric cancer.     

The effect of a grief support program on Turkish parents whose babies have died

The purpose of this study was to determine the effect of the Grief Support Program on the bereavement of parents whose babies had died. The sample consisted of 77 couples. The data was collected by the Texas Revised Inventory of Grief and the Coping Strategies Inventory. The intervention group was offered before, immediately after, and a month after death of their baby in accordance with the Grief Support Program guideline. The Grief Support Program did not affect grief intensity in the short term but had a positive effect 1 year later.