bluuebunny/crossref_metadata_2025 huggingface dataset:
5. Accelerated Fracture Healing Targeting Periosteal Cells: Possibility of Combined Therapy of Low-Intensity Pulsed Ultrasound (LIPUS), Bone Graft, and Growth Factor (bFGF)
Authors: Uchida Kentaro , Urabe Ken , Naruse Koji , Mikuni-Takagaki Yuko , Inoue Gen , Takaso Masashi
Published: July 2016

We have studied the mechanism of fracture healing, and the effect of LIPUS, bone graft and growth factor on accelerating fracture healing. We present here the results of our research. To examine callus formation cells in fracture healing, we made marrow GFP chimera mice and a fracture model of marrow mesenchymal stem cell GFP chimera mice. It was demonstrated that periosteal cells were essential for callus formation. We focused on periosteal cells and examined the effect of LIPUS. In an in vitro experiment using a cultured part of the femur, LIPUS promoted ossification of the periosteal tissue. Further, LIPUS accelerated VEGF expression in the experiment using the femoral fracture model of mice. From these results, it was suggested that activation of periosteal cells might play a role in the fracture healing mechanism of LIPUS. Next, we discussed the possibility of combined therapy of LIPUS, bone graft and growth factor. Therapy involving the topical administration of bFGF using a controlled release system and bone graft could promote callus formation. In addition, LIPUS was able to promote membranaceous ossification after the bone graft. It was suggested that combined therapy of LIPUS, bone graft and bFGF could be a new option for treating fractures.
1. Morphological Implication on Cellular Response to Mechanical Stress in Bone
Authors: Amizuka Norio
Published: July 2016

In bone, there are 3 distinct cell types: an osteoblast, a bone forming cell; an osteocyte embedded in bone matrix as a consequence of being differentiated from an osteoblast; and an osteoclast, a multinucleated giant cell responsible for bone resorption. Bone is always remodeled by replacing old bone with new bone (bone remodeling), by which bone can maintain its stiffness and flexibility. However, in an osteoporotic state, the disrupted balance between bone resorption and formation results in not only markedly reduced bone mass, but also in disorganized geometry of trabecules, which can often give rise to a bone fracture. Osteocytes located in their lacunae insert their fine cytoplasmic processes into narrow passageways referred to as osteocytic canaliculi. Neighboring osteocytes connect to each other by means of a gap junction in their cytoplasmic processes. Therefore, osteocytes and their lacunae/canaliculi appear to form functional syncytium called osteocytic lacunar canalicular system (OLCS). The geometrical distribution of OLCS is poorly arranged in immature bone, while it appears well-arranged distribution in mature bone (cortical bone), in which molecular transports and sensing mechanical stress seems to be efficient, and therefore, may be able to respond to mechanical stress. In this seminar, I will introduce our recent findings on the morphology and function of OLCS which may respond to mechanical stress.
Component-resolved diagnostics in vernal conjunctivitis
Authors: Armentia Alicia , Sanchís Eugenia , Montero Javier A.
Published: July 2016

Purpose of review

Conventional diagnostic tests in allergy are insufficient to clarify the cause of vernal conjunctivitis. Component-resolved diagnostic (CRD) by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process.

Recent findings

In a recent trial in patients suffered from eosinophilic esophagitis, after 2 years of the CRD-guided exclusion diet and specific immunotherapy, significant clinical improvement was observed, and 68% of patients were discharged (cure based on negative biopsy, no symptoms, and no medication intake). Our new objective was to evaluate IgE-mediated hypersensitivity by CRD in tears and serum from patients with vernal conjunctivitis and treat patients with identified triggering allergens by specific immunotherapy. Twenty-five patients with vernal conjunctivitis were evaluated. The identified triggering allergens were n Lol p 1 (11 cases), n Cyn d 1 (eight cases), group 4 and 6 grasses (six cases) and group 5 of grasses (five cases). Prick test and pollen IgE were positive in one case. Clinical improvement was observed in 13/25 vernal conjunctivitis patients after 1-year specific immunotherapy.

CRD seems to be a more sensitive diagnostic tool compared with prick test and IgE detection. Specific CRD-led immunotherapy may achieve clinical improvements in vernal conjunctivitis patients.
Dental hygiene in maintaining a healthy joint replacement: a survey of Canadian total joint replacement patients
Authors: Wood Thomas J. , Petruccelli Danielle , Piccirillo Liz , Staibano Phillip , Winemaker Mitch , de Beer Justin
Published: July 2016

Background:

Dental procedures and their role in prosthetic joint infections remain controversial. Recent literature shows that total joint replacement in patients with good oral hygiene are less like to develop an prosthetic joint infection. The purpose of this study was to assess dental hygiene practices and knowledge of its importance in maintaining joint health among patients who have had a total joint replacement, and to understand, based on patient report, the extent to which current clinical practice guidelines have been adopted into everyday practice.

Methods:

A cross-sectional survey study of dental hygiene practices was conducted on patients who have had total joint replacement presenting for their 6 wk postoperative follow-up. We hypothesized that patients would have good dental hygiene habits, but limited knowledge of oral hygiene and prosthetic joint infection risk. Responses were analyzed using descriptive statistics and benchmarked against population data from the Oral Health Module of the Canadian Health Measures Survey (CHMS).

Results:

The study cohort included 453 patients (mean age 65.9±9.9 yr) with total joint replacements. Our findings demonstrated that although 86% had a cleaning within 12 mo, 5% did not visit a dentist. While 95% brush and 46% floss daily, 4% did not brush and 21% did not floss which is comparable to CHMS population data. Only 49% had been informed of dental hygiene in reducing prosthetic joint infection risk.

Conclusions:

Patients who have had total joint replacement practice good dental hygiene overall; however, communication regarding its importance in preventing prosthetic joint infection remains inconsistent. Healthcare practitioners must uniformly educate patients who have total joint replacement on the importance of good dental hygiene in maintaining joint health.
Retrospective comparative study of conventional arthrodesis versus clavicula pro humero for shoulder reconstruction after wide resection of malignant bone tumor of the proximal humerus
Authors: Rahman Mohamed Abdel , Mashhour Mohamed Ahmed , El Masry Ayman Mohammad , Azmy Sherif Ishak
Published: July 2016

Background:

The proximal humerus represents one of the most common sites for primary malignant bone tumors. Limb salvage procedures have become the standard modality in treatment of these tumors. Several techniques can be used in shoulder reconstruction after wide resection of malignant bone tumors. The purpose of this study was to compare the functional outcome and complications for two important methods of shoulder joint reconstruction: conventional arthrodesis using fibular autogenous graft and clavicula pro humero.

Methods:

We retrospectively studied 30 patients with malignant tumors of the proximal humerus treated with limb salvage procedures with mean follow-up period of 67.16 mo. In 13 we used the clavicula pro humerus technique for reconstruction, and in 17 we performed conventional shoulder arthrodesis using nonvascularized fibular graft.

Results:

The mean Musculoskeletal Tumor Score (MSTS) for the conventional shoulder arthrodesis group was 69.6%. For the clavicula-pro-humero group the score was 67.5%. The Oxford Shoulder Score (OSS) for the conventional shoulder arthrodesis group was 34.6, while for the clavicula-pro-humero group it was 36.8. The median time to union was 8 wk for both groups.

Conclusions:

Both techniques represent reliable methods of shoulder reconstruction after wide resection of malignant tumors with comparable functional outcome and complications rates.
Current and future designs for total ankle replacement
Authors: Roukis Thomas S.
Published: July 2016

Total ankle replacement (TAR) longevity continues to be questioned and poorly understood, especially the effect, if any, specific design characteristics have on prosthesis survival. The commonly held belief that first generation TAR prostheses were far inferior to the second generation prostheses and that these are in turn inferior to available third and fourth generation TAR systems is not universally supported. What is clear is that as the frequency of primary TAR continues to build, revision will become more commonplace. Unfortunately, a large percentage of published literature regarding primary TAR is riddled with bias because of industry sponsorship and inventor-paid consultant involvement. Evaluation of National Joint Registry (NJR) data may provide a better understanding of reasonable outcome expectations for foot and ankle surgeons. When analyzing the data available within NJR specific to primary TAR, four usage trends exist: abandonment, minimal use, initial embracement with diminished use, and initial embracement with sustained growth. Despite 10 fixed-bearing systems and one mobile-bearing TAR system available in the United States, few have any dedicated revision components. This is a problem because currently there are no “standard principles” for revision TAR and the approaches are technically complex, fraught with complications, and no one approach represents the only answer. There is a real need for a NJR that reports on primary TAR in the United States and tracks long-term survivorship after revision TAR. Future efforts should be directed in these areas.
Multiple Procedures in the Initial Surgical Setting: When Do the Benefits Outweigh the Risks in Patients With Multiple System Trauma?
Authors: Childs Benjamin R. , Nahm Nickolas J. , Moore Timothy A. , Vallier Heather A.
Published: July 2016

Objectives:

To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures.

Design:

Prospective, cohort.

Setting:

Level 1 trauma center.

Patients/Participants:

A total of 370 patients with high-energy fractures were treated after a standard protocol for resuscitation to lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥−5.5 mmol/L. Fractures included femur (n = 167), pelvis (n = 74), acetabulum (n = 54), and spine (n = 107).

Main Outcome Measurements:

Complications, including pneumonia, acute respiratory distress syndrome, infections, deep venous thrombosis, pulmonary embolism, sepsis, multiple organ failure, and death, and length of stay.

Results:

Definitive fixation was performed concurrently with another procedure in 147 patients. They had greater ISS (29.4 vs. 24.6, P < 0.01), more transfusions (8.9 U vs. 3.6 U, P < 0.01), and longer surgery (4:22 vs. 2:41, P < 0.01) than patients with fracture fixation only, but no differences in complications. When patients who had definitive fixation in the same setting as another procedure were compared only with other patients who required more than 1 procedure performed in a staged manner on different days (n = 71), complications were fewer (33% vs. 54%, P = 0.004), and ventilation time (4.00 vs. 6.83 days), intensive care unit (ICU) stay (6.38 vs. 10.6 days), and length of stay (12.4 vs. 16.0 days) were shorter (all P ≤ 0.03) for the nonstaged patients.

Conclusions:

In resuscitated patients, definitive fixation in the same setting as another procedure did not increase the frequency of complications despite greater ISS, transfusions, and surgical duration in the multiple procedure group. Multiple procedures in the same setting may reduce complications and hospital stay versus additional surgeries on other days.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Biomechanics of Fractures
Authors: Frankel Victor H. , Kaplan Daniel J. , Egol Kenneth A.
Published: July 2016

Background:

This video presents the digitized, original, reel-to-reel footage of Victor Frankel's groundbreaking 1960s experiments demonstrating the viscoelastic properties and fracture mechanics of loaded bone. As can be seen, novel instrumentation was used that resulted in an easily reproducible method of controlling bone loading rates. The innovation, and associated experiments, radically advanced our understanding of the mechanisms of acute fractures and bone's response to energy.

Methods:

Using the “Standard Torsion Testing Machine” that he helped design, the author explains how the mechanical and functional properties of bone are affected by various defects. Examples used include an intact dog femur, a femur with a hole in the cortex, and a femur with an open section defect. Slow motion depiction allows the viewer to appreciate the potential soft tissue damage associated with bone fragmentation and how this varies with energy input. The video concludes with a demonstration of the effect of torsional motion on the vasculature.

Results:

Graphs produced by the torsion tester display torque versus angular deformation plots for each experiment. These illustrate the relationship between bone structure, fracture, and energy. The x-ray contrast segment provides an example of associated arterial damage secondary to a fracture.

Conclusion:

This previously unreleased piece of orthopaedic history provides viewers with perspective on the early days of biomechanical study and an easy-to-understand tutorial on acute fracture mechanics and the role of energy in injury.
Operative Fixation of Chronic Acromioclavicular Joint Dislocation With Hook Plate and Modified Ligament Transfer
Authors: McKee Michael D.
Published: July 2016

Purpose:

The optimal treatment for acute dislocation of the acromioclavicular (AC) joint remains unclear, and prior randomized trials did not reveal any significant improvements in the operative groups. However, it is clear that some patients treated nonoperatively are dissatisfied with their outcome and request surgical correction. This video demonstrates one method of repair of a chronic dislocation of the AC joint in a patient with significant symptomatology following nonoperative treatment of a high-grade AC dislocation.

Methods:

This video demonstrates the open reduction of a chronically dislocated AC joint. After mobilization of the distal clavicle and debridement of the joint, a step cut is made in the anterior surface of the distal clavicle. The coracoacromial (CA) ligament is then identified and mobilized, taking care to preserve its acromial origin. An anterior acromioplasty is then performed with a microsaggital saw. The AC joint is reduced, and the acromial fragment is sculpted to fit the step cut in the distal clavicle, where it is then fixed with a small-fragment cancellous screw in lag fashion. The blade of the hook plate is then contoured to fit under the acromion (posteriorly) to hold the joint in a reduced position. The deltoid is repaired with number 1 absorbable sutures, followed by a standard closure.

Results:

Results are improved and complications minimized when care is taken to not avoid overreduction of the clavicle: an intraoperative radiograph, and/or comparison to the opposite side, may be useful. We do not shorten or resect the entire distal clavicle: this has been shown to lead to worse outcomes. We have found that CA transfer with a fragment of attached acromial bone results in more reliable healing than a CA transfer alone (the Weaver–Dunn transfer).

Discussion:

In the setting of a chronic AC dislocation, hook plate fixation provides excellent reduction of the joint and a stable mechanical environment: this allows for the optimal healing of the ligament transfer. Typically, 6–12 months postoperatively, the hook plate can be removed to improve motion and reduce local irritation because joint stability is then provided by the transfer with bone-to-bone healing.
The Anterior Subcutaneous Pelvic Fixator (INFIX) in an Anterior Posterior Compression Type 3 Pelvic Fracture
Authors: Vaidya Rahul , Tonnos Fred , Nasr Kerellos , Kanneganti Praveen , Curtis Gannon
Published: July 2016

Objectives:

The purpose of this video is to describe the equipment, anatomy, and surgical technique of anterior subcutaneous pelvic fixation (INFIX) using pedicle screws and a rod in an Anterior Posterior Compression 3 pelvic fracture, as well as how to distract in lateral compression fractures.

Methods:

The equipment required includes standard spine pedicle screw sets with long screws, 70–110 mm in length, and 7 or 8 mm in diameter. The approach is a mini open and one needs to be familiar with the iliac oblique, obturator outlet, and obturator inlet views. The length of the screw is measured from the sciatic notch to the skin, and they are placed so that the head sits just below the skin. The rod is passed just under the skin along the bikini line and the construct compressed or distracted against a c-clamp while monitored with fluoroscopy. In Orthopaedic Trauma Association C type injuries, we leave c-clamps on the outside the screws to reinforce them or use monoaxial screws. The implants are removed at 3–6 months postop.

Results:

The patients tolerate the implants and are able to sit and stand with out difficulty. Complications include lateral femoral cutaneous nerve irritation, heterotopic bone, loss of fixation if the implants are applied incorrectly.

Conclusions:

The INFIX procedure for anterior pelvic fixation is based on standard techniques that are familiar to the Orthopaedic Pelvic Surgeon including supraacetabular screws. Rod bending, rod passing, determining the ideal height of the screws, and distraction/compression maneuvers are demonstrated in this video.
Open Reduction, Internal Fixation Distal Intraarticular Distal Humerus Fracture
Authors: Fuller David A.
Published: July 2016

Purpose:

The purpose of this video is to demonstrate the surgical repair of an intraarticular distal humerus fracture.

Methods:

A polytrauma patient with an intraarticular distal humerus fracture is shown. The patient is positioned laterally, with a posterior skin incision and olecranon osteotomy for exposure. An anatomic reduction is achieved, and internal fixation with perpendicular plating of the distal humerus is performed.

Results:

The video is 18 minutes, 34 seconds duration in time and 2,048,752,000 bytes in size.

Conclusions:

Open reduction with internal fixation of a distal humerus fracture is demonstrated in this video.
Knee Extensor Mechanism Repairs: Standard Suture Repair and Novel Augmentation Technique
Authors: Meyer Zachary , Ricci William M.
Published: July 2016

Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges.
Percutaneous Sacroiliac Screw Technique
Authors: Tidwell John , Cho Rosa , Reid J. Spence , Boateng Henry , Copeland Carol , Sirlin Edward
Published: July 2016

Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case. A cannulated pig sticker (drill guide) used with long drill tip guide wires provide improved manual control to both finding a good start site and directing the trajectory. For patient safety, sacral anatomy and safe zones are discussed as well. Using these technical points will help make this a successful procedure.
Surgical Dislocation of the Hip in the Treatment of Complex Osteochondral Injury to the Femoral Head
Authors: Probe Robert
Published: July 2016

Purpose:

The optimal treatment for osteochondral fracture of the femoral head associated with posterior dislocation remains unclear. A case can be made to treat small fragments and those that concentrically reduce nonoperatively. On the other end of the spectrum are those where significant size and residual displacement warrant consideration of operative fixation. This video demonstrates the treatment of a large complex multifragmentary osteochondral femoral head fracture with surgical dislocation.

Methods:

With the patient in lateral decubitus position, the trochanter is approached through lateral incision. The trochanter is cut and capsulotomy performed taking care to preserve the critical medial femoral circumflex artery. Fixation with headless screws is performed from the small comminuted fragments into the dominant section of intact femoral head.

Results:

Experience suggests that anatomic fixation through surgical dislocation can be carried out with low incidence of subsequent avascular necrosis and degenerative articular change. Given the degree of local osseous and muscular trauma, consideration should be given to prophylaxis of heterotopic bone.

Discussion:

Although small osteochondral fragments restricted to the acetabular fossa can be treated nonoperatively, the size and displacement of the presented fragment mandated operative reduction. Given the predicted complexity of repair, the surgical dislocation approach was chosen to provide maximum exposure optimizing the chances for successful fixation.
Anterolateral Approach to the Pilon
Authors: Hickerson Lindsay E. , Verbeek Diederik O. , Klinger Craig E. , Helfet David L.
Published: July 2016

This video reviews the indications, surgical approach, and case examples of the anterolateral approach to a distal tibial plafond fracture. If this approach is used in a staged fashion, when the soft envelope is ready, it affords excellent visualization for fracture fixation through thick skin flaps. An associated article reviews a cohort of 44 mainly type C3 pilon injuries treated by 2 orthopaedic traumatologist using the anterolateral approach after staged external fixation. An anatomic or good fracture reduction was obtained in 41 fractures with 13.6% of patients undergoing a secondary surgical procedure for infection or nonunion.
Treatment Options for Distal Femur Fractures
Authors: von Keudell Arvind , Shoji Kristin , Nasr Michael , Lucas Robert , Dolan Robert , Weaver Michael J.
Published: July 2016

Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement.
Preliminary Evaluation of the Pathomechanisms of Dysphagia After Occipitospinal Fusion
Authors: Kaneyama Shuichi , Sumi Masatoshi , Takabatake Masato , Kasahara Koichi , Kanemura Aritetsu , Koh Akihiro , Hirata Hiroaki
Published: July 2016

Study Design.

Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS).

Objectives.

The aims of this study were to analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF.

Summary of Background Data.

Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches.

Methods.

Each four patients with or without postoperative dysphagia (group D and N, respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-mL diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution was analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment.

Results.

O-C2A in group D was −7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P = 0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical ocurvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing.

Conclusion.

This study presented that postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space towing to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as craniocervical junction during OSF.

Level of Evidence: 4
Novel Screw Head Design of Pedicle Screw for Reducing the Correction Loss in the Patients With Thoracolumbar Vertebral Fractures
Authors: Ye Bin , Yan Ming , Zhu Huiyang , Duan Wei , Hu Xueyu , Ye Zhengxu , Luo Zhuojing
Published: July 2016

Study Design.

A biomechanical study.

Objective.

To study the different biomechanical property among fixed-axis, monoplanar and polyaxial screws in the static and dynamic tests.

Summary of Background Data.

Correction loss is a common phenomenon in the patients with thoracolumbar vertebral fractures who underwent the posterior pedicle screw fixation. The incidence varies with the kinds of fixation instrumentation used. There is higher incidence in polyaxial pedicle screws group than in fixed-axis pedicle screws. Monoplanar pedicle screws, which are mobile in the axial plane but fixed in the sagittal plane, can be a better fixation instrumentation for thoracolumbar vertebral fractures in theory.

Methods.

A total of 30 porcine spinal units (L2–L4) were used for the static and dynamic tests, which were randomized into six groups (A1, A2, A3, B1, B2, and B3). Static test was performed in A1, A2, and A3. In this test, fixed-axis, monoplanar, and polyaxial screws were performed in A1, A2, and A3, respectively. The ultimate load was noted after tested. In addition, dynamic test was performed in B1, B2, and B3, used fixed-axis, monoplanar, and polyaxial screws, respectively. Correction loss (head-shank angle shift and anterior vertebral body height shift) was obtained and analyzed in each mode.

Results.

In static test, fixed-axis and monoplanar screws had significantly higher ultimate load than polyaxial screws (P < 0.05) and fixed-axis screws had a little higher ultimate load than monoplanar screws (P < 0.05). In dynamic test, correction loss was minimal in fixed-axis screws, medium in monoplanar screws, and maximal in polyaxial screws. However, the differences were statistically significant in all comparisons but not in the comparison of fixed-axis and monoplanar screws (P > 0.05).

Conclusion.

The findings from the current study suggest that monoplanar screws can significantly increase the stiffness in axial direction compared with polyaxial screws, and reduce the risks of correction loss. For thoracolumbar vertebral fractures, monoplanar screw is a better optional instrumentation for minimally invasive surgery.

Level of Evidence: N/A
Galectin-9 modulates immunity by promoting Th2/M2 differentiation and impacts survival in patients with metastatic melanoma
Authors: Enninga Elizabeth Ann L. , Nevala Wendy K. , Holtan Shernan G. , Leontovich Alexey A. , Markovic Svetomir N.
Published: July 2016

Galectin-9, a β-galactoside-binding protein, is defined as a negative regulator of T helper 1 (Th1) immune responses, favoring Th2 bias. Systemic immunity in patients with metastatic melanoma is predominantly Th2 biased. We hypothesized that galectin-9 can modulate systemic immunity toward Th2 polarization in patients with advanced melanoma. The presence or concentration of galectin-9 was assessed in tumors and plasma, in patients with metastatic melanoma. The immunomodulatory function of galectin-9 was determined by exposing human peripheral blood mononuclear cells to galectin-9 in vitro. Galectin-9 was expressed in 57% of tumors and was significantly (3.6-fold) increased in the plasma of patients with advanced melanoma compared with healthy controls (P<0.001). High plasma galectin-9 concentration was associated with systemic Th2 polarization and reduced 2-year survival compared with low/no galectin-9 expression. In-vitro, galectin-9 reduced proliferation of healthy peripheral blood mononuclear cells, and promoted Th1 cell apoptosis, Th2-biased cell phenotypes, and cytokine secretion. Galectin-9 also stimulated monocyte differentiation toward an M2 macrophage phenotype, as assessed by chemokine/cytokine secretion and CD206 expression, observed both in vitro as well as in patients with metastatic melanoma. Elevated galectin-9 in patient plasma correlated with Th2 systemic bias and less favorable clinical outcomes for patients with metastatic melanoma. This Th2 bias appears to be not only a feature of the known mechanisms of Th1 apoptosis by T-cell immunoglobulin and mucin-domain containing-3 binding, but also mediated by myeloid cell differentiation toward an M2 phenotype, that favors tumor progression. These data support galectin-9 as a novel therapeutic target for patients with metastatic melanoma.
Aseptic versus Sterile Acellular Dermal Matrices in Breast Reconstruction: An Updated Review
Authors: Lyons Daniel A. , Mendenhall Shaun D. , Neumeister Michael W. , Cederna Paul S. , Momoh Adeyiza O.
Published: July 2016

Background:

As the use of acellular dermal matrices in breast reconstruction has become more commonplace and efforts are made to improve on postoperative outcomes, the method of acellular dermal matrix (ADM) processing (aseptic versus sterile) has become a subject of interest. This article provides an updated overview of the critical aspects of ADM processing in addition to application of ADMs in single- and two-stage breast reconstruction, a review of the morbidity associated with ADM use, and alternatives.

Methods:

A literature review was performed in PubMed identifying recent systematic reviews, meta-analyses, and head-to-head comparisons on aseptically processed ADM and sterile-processed ADM in implant-based breast reconstruction.

Results:

Recent meta-analyses have shown a 2- to 3-fold increase in infections and tissue expander/implant explantation rates and a 3- to 4-fold increase in seroma formation compared with non-ADM reconstruction techniques. Comparisons of aseptic and sterile ADMs in multiple studies have shown no significant difference in infection rates and equivocal findings for other specific complications such as seroma formation.

Conclusions:

Current evidence on the impact of processing techniques that improve ADM sterility on postoperative morbidity in implant breast reconstruction is unclear. Deficiencies of the available data highlight the need for well-designed, multicenter, randomized controlled studies that will aid in optimizing outcomes in implant-based breast reconstruction.
A Bibliometric Analysis of the 100 Most-cited Articles in Rhinoplasty
Authors: Sinha Yashashwi , Iqbal Fahad M. , Spence John N. , Richard Bruce
Published: July 2016

Introduction:

Citation analysis aims to quantify the importance and influence of a published article within its field. We performed a bibliometric analysis to determine the most highly cited articles within rhinoplasty and their impact on current practice.

Methods:

The 100 most-cited articles relating to rhinoplasty, between and inclusive of January 1864 to September 2015, were extracted from Web of Science in October 2015. Title, source journal, publication year, total citations, average citations/year, type of article, level of evidence, country of origin, main focus, use of outcome measures, incorporation into “Selected Readings in Plastic Surgery,” and funding status were recorded.

Results:

The total number of citations per article ranged from 61 to 276 (1.5–12.1 average citations per year). Surgical technique was the focus of 53% of articles, particularly those for reconstruction (75%). The United States produced 72% of articles compared with 8% from the United Kingdom. The top 100 articles were published within 20 journals; “Plastic and Reconstructive Surgeons” contributed the most articles (n = 57). None of the articles achieved level 1 or 2 of evidence (Oxford Centre for Evidence-Based Medicine levels of evidence, 2011), with most achieving level 4 evidence (n = 64). Case-series were the most popular methodology (n = 37). Few articles used validated outcome measures (n = 21). Twenty-nine percent were referenced in “selected readings.” Eighty-nine percent were unfunded studies.

Conclusions:

These top 100 articles are used in current teaching material and underpin surgical decision making. Developing and using validated objective assessment tools will benefit surgeons, patients, and the greater scientific community in objectively evaluating techniques with the most favorable results.
An Alternative Technique for Immediate Direct-to-Implant Breast Reconstruction—A Case Series
Authors: Downs Ronald K. , Hedges Kellee
Published: July 2016

Background:

The practice of breast reconstruction continues to evolve with the introduction of new technologies. The authors describe a unique approach allowing immediate direct-to-implant reconstruction that can be performed on an outpatient basis.

Methods:

After a nipple-sparing mastectomy, acellular dermal matrix (ADM)-covered implants are placed in a prepectoral position in an immediate reconstruction. Assessment of results was performed via a retrospective review of demographic and procedural data.

Results:

Forty-five patients (79 breasts), mean age 46.8 years, were treated with direct-to-implant reconstruction using ADM-wrapped implants placed above the muscle with mean follow-up of 23.1 months (median 22 mo). Mean body mass index was 24.3, and 15 patients (33.3%) were current or former smokers. Twenty-seven patients (60%) had prior breast surgery with 22 (49%) exposed to chemotherapy and 34 (76%) radiation. Procedure time averaged 155 minutes and hospital length of stay averaged 0.6 days. Complications included flap necrosis in 22 cases (28%), seroma in 12 (15%), infection in 8 (10%), rippling in 28 (35%), and contracture in 8 (10%). In 14 breasts (18%), postoperative wound complications (flap necrosis or infection) led to implant loss.

Conclusions:

The availability of ADM and cohesive gel implants has allowed us to perform above-the-muscle implant breast reconstruction in reduced time and often on an outpatient basis. Complication rates were comparable to expected results of standard expander-to-implant, staged breast reconstruction. This technique is a viable option delivering clinically and aesthetically acceptable results in select patients.
Perinatal and Neonatal Health Information Technology
Authors: McCartney Patricia Robin , Drake Emily Eiwen
Published: July 2016

The 3 decades of The Journal of Perinatal & Neonatal Nursing history share the same 3 decades as the birth of the information age and health information technology (HIT). This article summarizes the history of HIT and the corresponding publication history of The Journal of Perinatal & Neonatal Nursing. Health information technology content has evolved from being the “how-to operate” topic of a publication to being integrated within a nursing practice publication. The article concludes with current HIT challenges and implications for the future.
Adverse Outcomes in Neonates and Children with Pulmonary Artery Hypertension Supported with ECMO
Authors: Nasr Viviane G. , Faraoni David , DiNardo James A. , Thiagarajan Ravi R.
Published: July 2016

Extracorporeal membrane oxygenation (ECMO) has been increasingly used to rescue neonates and children with cardiac or respiratory failure, and critical illnesses including pulmonary artery hypertension (PAH) unresponsive to conventional therapies. This study assesses mortality and outcomes in neonates and children with PAH supported with ECMO. Neonates and children from the 2012 Health Care Cost and Use Project Kids’ Database were identified using ICD-9 codes. Children with congenital heart disease were excluded. Univariate logistic regression was applied to assess the relationship between ECMO and outcomes using matched cohorts for age, elective admission, and Elixhauser comorbidity score. We identified 9,355 neonates and children with PAH (0.15%). The incidence of ECMO was 1.4% (132/9,355). After propensity-matched analysis, 130 neonates and children were included in each group. The incidence of mortality was 39% in the group supported with ECMO and 8% in the control group (odds ratio [OR]: 6.98, 95% confidence interval [CI]: 3.43–14.21, p < 0.001). Neonates and children on ECMO had higher odds for acute kidney injury (OR: 2.41, 95% CI: 1.30–4.47, p = 0.005), neurologic complications (OR: 7.11, 95% CI: 1.57–32.18, p = 0.011), sepsis (OR: 2.69, 95% CI: 1.46–4.96, p = 0.002), and thrombotic complications (OR: 2.90, 95% CI: 1.10–7.67, p = 0.032). Neonates and children with PAH supported with ECMO have higher mortality rate and complications compared with matched controls with PAH.
The impact of bariatric surgery on inflammation: quenching the fire of obesity?
Authors: Hafida Samar , Mirshahi Tooraj , Nikolajczyk Barbara S.
Published: July 2016

Purpose of review

Numerous lines of evidence support the likelihood that inflammation drives the transition from obese/metabolically healthy to obese/type 2 diabetes (T2D). Given the temporal flexibility of inflammation in obesity-associated T2D, investigators have hypothesized that a precipitous drop in diabetogenic cytokines is critical for rapid ‘T2D remission’ following surgery but prior to significant weight loss. We review the evidence that changes in diabetogenic cytokines play a role in outcomes of bariatric surgery, including improved glycemic control.

Recent findings

A 2016 indication for bariatric surgery to treat T2D integrates the large body of data showing rapid metabolic improvement. Parameters that account for improved glycemic control prior to significant weight loss, T2D recidivism over the long term, or failure of surgery to remit T2D in some patients are incompletely understood.

We review the evidence that changes in diabetogenic cytokines play a role in outcomes of bariatric surgery, including improved glycemic control. We brainstorm future research directions that may improve surgical results.
Re-evaluation of cholesteryl ester transfer protein function in atherosclerosis based upon genetics and pharmacological manipulation
Authors: Yamashita Shizuya , Matsuzawa Yuji
Published: July 2016

Purpose of review

To re-evaluate the functions of plasma cholesteryl ester transfer protein (CETP) in atherosclerosis based upon recent findings from human genetics and pharmacological CETP manipulation.

Recent findings

CETP is involved in the transfer of cholesteryl ester from HDL to apolipoprotein B-containing lipoproteins, a key step of reverse cholesterol transport (RCT). CETP inhibitors have been developed to raise serum HDL-cholesterol (HDL-C) levels and reduce cardiovascular events. However, outcome studies of three CETP inhibitors (torcetrapib, dalcetrapib and evacetrapib) were prematurely terminated because of increased mortality or futility despite marked increases in HDL-cholesterol and decreases in LDL-cholesterol except for dalcetrapib. Patients with CETP deficiency show remarkable changes in HDL and LDL and are sometimes accompanied by atherosclerotic cardiovascular diseases. Recent prospective epidemiological studies demonstrated atheroprotective roles of CETP. CETP inhibition induces formation of small dense LDL and possibly dysfunctional HDL and downregulates hepatic scavenger receptor class B type I (SR-BI). Therefore, CETP inhibitors may interrupt LDL receptor and SR-BI-mediated cholesterol delivery back to the liver.

For future drug development, the opposite strategy, namely enhancers of RCT via CETP and SR-BI activation as well as the inducers of apolipoprotein A-I or HDL production might be a better approach rather than delaying HDL metabolism by inhibiting a main stream of RCT in vivo.
Notch, lipids, and endothelial cells
Authors: Briot Anaïs , Bouloumié Anne , Iruela-Arispe M. Luisa
Published: July 2016

Purpose of review

Notch signaling is an evolutionary conserved pathway critical for cardiovascular development and angiogenesis. More recently, the contribution of Notch signaling to the homeostasis of the adult vasculature has emerged as an important novel paradigm, but much remains to be understood.

Recent findings

Recent findings shed light on the impact of Notch in vascular and immune responses to microenvironmental signals as well as on the onset of atherosclerosis. In the past year, studies in human and mice explored the role of Notch in the maintenance of a nonactivated endothelium. Novel pieces of evidence suggest that this pathway is sensitive to environmental factors, including inflammatory mediators and diet-derived by-products.

An emerging theme is the ability of Notch to respond to changes in the microenvironment, including glucose and lipid metabolites. In turn, alterations in Notch enable an important link between metabolism and transcriptional changes, thus this receptor appears to function as a metabolic sensor with direct implications to gene expression.
Principles of endoscopic ear surgery
Authors: Tarabichi Muaaz , Kapadia Mustafa
Published: July 2016

Purpose of review

The aim of this review is to study the rationale, limitations, techniques, and long-term outcomes of endoscopic ear surgery.

Recent findings

The article discusses the advantages of endoscopic ear surgery in treating cholesteatoma and how the hidden sites like facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope.

Transcanal endoscopic approach allows minimally invasive removal of cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.
Nursing Process Health Care Indicators
Authors: Xiao Sarah , Widger Kimberley , Tourangeau Ann , Berta Whitney
Published: July 2016

Identifying how nursing care directly affects patients is essential to improving care quality, reducing costs, and determining nursing's contribution to overall organizational performance. This scoping review examined methods used for developing nursing process health care indicators. Key concepts and sources of evidence were identified to lay a foundation for future development and identification of valid and reliable nursing process health care indicators.
Virtually Nursing
Authors: Foronda Cynthia L. , Alfes Celeste M. , Dev Parvati , Kleinheksel A.J. , Nelson Douglas A. , O'Donnell John M. , Samosky Joseph T.
Published: July 2016

Augmented reality and virtual simulation technologies in nursing education are burgeoning. Preliminary evidence suggests that these innovative pedagogical approaches are effective. The aim of this article is to present 6 newly emerged products and systems that may improve nursing education. Technologies may present opportunities to improve teaching efforts, better engage students, and transform nursing education.
Nurse Faculty Knowledge of and Confidence in Teaching Genetics/Genomics
Authors: Donnelly Mary Katherine , Nersesian Paula V. , Foronda Cynthia , Jones Emily L. , Belcher Anne E.
Published: July 2016

The aims of this project were to (1) assess nurse faculty members' knowledge of and confidence in teaching genetics/genomics to nursing students and (2) identify the needs of faculty members to inform a faculty development initiative. Significant knowledge gaps were noted, and more than 50% of respondents indicated that they lacked confidence in teaching genetics/genomics. Strategies to address this problem included identifying champions of genetics/genomics education, use of an educational template, and threading genetics/genomics throughout the curriculum.
Barriers to Civil Academic Work Environments
Authors: Peters Anya Bostian , King Lynne
Published: July 2016

Faculty-to-faculty incivility negatively affects not only the victim of the uncivil behavior but also the nursing program as a whole. This phenomenological study explored the experiences of academic nurse administrators who have dealt with incivility among and between faculty members. An interpretative approach was used to uncover themes, and suggestions are made for managing faculty-to-faculty incivility.