Abdullah Topcu

Does vertebral augmentation cause adjacent fractures? This question has been debated since vertebroplasty and balloon kyphoplasty entered routine practice, and reported incidences range from 7% to 29% across heterogeneous cohorts. Two hypotheses dominate. The first attributes the risk to mechanical stiffening of the augmented vertebral body and draws on finite-element and cadaveric work. The second points to underlying osteoporotic disease, because candidates for augmentation already carry a high baseline risk. A 2024 network meta-analysis of 23 randomized trials found no statistically significant overall increase in adjacent-fracture risk compared with conservative management. We propose that these pooled estimates mask a temporal pattern, because most adjacent fractures cluster within the first three postoperative months, whereas later events resemble the natural history of untreated osteoporosis. On the basis of this observation, we propose a time-stratified framework. In the early window, procedure-related stress redistribution dominates, and modifiable technical factors are most important: cement volume, distribution symmetry, and intradiscal leakage. In the late window, the dominant driver is ongoing systemic bone fragility, which is addressed mainly through pharmacological therapy. After synthesizing biomechanical, observational, and randomized evidence in support of this dual-mechanism model, we outline a clinical decision framework organized around the temporal split. In most cases, adjacent fractures that occur beyond three months are better understood as a manifestation of ongoing and often inadequately treated osteoporosis than as a delayed complication of the procedure, although a mechanical contribution may persist in selected cases. Reducing the fracture burden in this population requires both technical optimization in the operating room and concurrent antiresorptive or anabolic treatment.

This qualitative inquiry presents the case study of five gifted eighth-grade students who engaged in an e-mentoring project in mathematics. The study reported in this article investigated the role of e-mentoring in gifted students’ academic life. Three themes predominated in the collected data were (a) motivation, (b) effective communication and supportive interaction, and (c) practicing as professionals. The findings indicated that the students engaged with e-mentoring had high motivation and desire and were able to maintain their perseverance to complete required individual and group tasks. The study revealed that the students formed an efficient and interactive group and worked collaboratively. They were able to find a way of working as a community. Furthermore, the findings showed that the treatment of students as practicing professionals encouraged them to think and work as real mathematicians.

Background: Hardware-related infection after deep brain stimulation (DBS) is one of the most serious complications and may need additional interventions. Objectives: To reuse the internal pulse generator (IPG) after DBS infection and to reduce the economic costs. Methods: A database of 102 patients who underwent DBS surgery was used in the study. The incidence, clinical characteristics and management of infections while reusing the IPG after DBS-related infection were analyzed and reported. Results: The overall infection rate was 5.9% (6 of 102 patients). Management consisted of total hardware removal followed by intravenous antibiotics. The IPG was at first kept in a solution, then rinsed with water and dried following sterilization with ethylene oxide gas at 38°C for 18 h. When the treatment of the infection was finished, we reused the IPG and reimplanted the DBS. No hardware-related infection or other complications were observed after reimplantation. Conclusions: Management of hardware-related infections can be challenging. The medical and economic costs associated with these infections are enormous. The IPG can often be saved in infected patients. Thus, a significant cost burden is eliminated. Properly executed, reuse of IPG should markedly reduce the costs of these devices.

Although research has shown that self-efficacy beliefs predict academic achievement across all academic subjects and levels, little is known about the effect of using spreadsheets on self-efficacy beliefs in mathematics. This study is an investigation of the effect of instruction that includes spreadsheet-based purposeful activities on secondary school students' self-efficacy beliefs for algebra. The context of the study is a 10th grade mathematics course in a public secondary school. Analysis of the data indicated that students who received spread-sheet-based instruction had significantly higher self-efficacy for algebra than those who received conventional instruction.