bluuebunny/crossref_metadata_2025_split huggingface dataset:
90/90 Bicortical, double-loop, interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures
Authors: Afifi Ahmed , Dobal M. Hussein , Mahmoud Mostafa , Moharram Ashraf N. 
Published: February 2019

Background:
The purpose of this study was to determine the effectiveness of 90/90 interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures on early motion.

Methods:
This prospective study was conducted at an academic Level 1 trauma Center from 2015 to 2017. The study included 20 patients (16 males and 4 females). The mean age was 27.3 yr (range, 12 to 44 yr). The dominant hand was affected in 10 patients, and the nondominant hand was affected in the other 10 patients. Regarding the fracture pattern, 17 were transverse and three were short oblique fractures. The mean follow-up period was 6 mo (range, 4 to 8 mo). Patients were assessed for union (clinically and radiographically), range of motion (total active motion [TAM] and total active flexion [TAF]), hand grip strength, and patient-reported outcome using the quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results:
All patients achieved union after a mean of 7 wk (range, 6 to 8 wk). The mean TAF was 246 degrees (range, 150̊ to 260 degrees). TAM was excellent in 13 digits and good in seven digits. The mean grip strength was 90.20% (range, 61.53% to 100%) of the unaffected side. The mean quick-DASH score was 2.72 (range, 0 to 20.45).

Conclusions:
The interosseous wiring technique is an effective method of fixation that can be used alone for transverse or short oblique fractures of the metacarpal and can permit early hand mobilization postoperatively without loss of reduction.
Preoperative assessment of pediatric supracondylar humeral fractures by orthopaedic residents and orthopaedic surgeons: is there a difference?
Authors: Haruno Lee S. , Hill Jaclyn F. , Sanderson Cody J. , Browne Theodora , Zhu Huirong , McKay Scott D. 
Published: February 2019

Background:
The urgency of pediatric supracondylar humeral (SCH) fracture treatment is influenced by preoperative evaluation and neurovascular integrity. This assessment often is completed by a resident. The purpose of this analysis was to determine differences in assessments made by orthopaedic residents and attending physicians in patients with supracondylar humeral fractures.

Methods:
Data were collected on 210 children with displaced supracondylar humeral fractures. A standardized 15-variable checklist was completed by an orthopaedic resident and attending physician. For each variable, Stuart-Maxwell and McNemar tests were used to determine significant differences (P<0.05) in marginal frequencies between the two cohorts. Cohen's kappa analysis (κ) quantified agreement between residents’ and attending physicians’ findings. Κ > 0.75 was considered excellent, 0.40-0.75 moderate, and < 0.40 marginal-poor.

Results:
The agreement between resident and attending physicians was 89%. Three variables had excellent agreement: hand temperature and color (κ~1), and Gartland fracture type (κ=0.81). Moderate agreement was observed for fracture direction (κ=0.68), pulse (κ=0.52), and radial nerve motor function (κ=0.49). The remaining variables: swelling, ecchymosis, motor function of the median, ulnar, anterior/posterior interosseous, and sensory function of the radial, median, and ulnar nerves had poor-marginal agreement (κ-range:−0.042-0.388). Only the attending physicians noted neurovascular abnormalities in 38/63 documented instances (60%). There was no significant association between agreement and evaluation time intervals or resident experience.

Conclusions:
Resident physicians and attending physicians agreed in 89% of the documentation; however, disparities were present in nearly 60% of patients with neurovascular abnormalities. Educational initiatives should target improvement of resident performance in upper extremity neurovascular examination in children. With accurate initial assessment, proper care can be provided according to published guidelines.
National access to pediatric care based on insurance type for children with buckle fractures
Authors: Marchenko Mikhail , Iobst Christopher A. 
Published: February 2019

Background:
Previous studies have shown that there is a disparity between access to medical care for U.S. patients with Medicaid and patients with private insurance. This difference has been determined in previous studies of pediatric access to orthopaedic care, and in this study the access to pediatric care was analyzed.

Methods:
Five randomly selected pediatric offices from each state were called with a fictitious scenario to schedule an appointment for a child with a simple bone fracture called a buckle fracture. Once, the office was called with the child having private insurance and the second time the same office was called with the child having Medicaid.

Results:
Of the 250 offices that were contacted, 221/250 (88.4%) of the offices accepted private insurance, and 113/250 (45.2%) of the offices accepted Medicaid. There was a statistically significant difference between the two groups (P<0.0001). The percentage of offices that scheduled an appointment within 7 days was 95.5% for privately insured patients, and 83.6% for patients with Medicaid. This difference was also statistically significant (P=0.0005).

Conclusions:
Although earlier studies have shown that Medicaid patients are less likely to be accepted by specialty care providers, this study determined that pediatric patients will also have more difficulty in scheduling appointments with pediatricians if they are covered by Medicaid.
A novel technique to prevent distal anterior femoral cortical perforation
Authors: El Beaino Marc , Chen Jie , Hagedorn John C. 
Published: February 2019

Background:
Anterograde femoral intramedullary nailing is a commonly used operative technique in orthopaedic surgery. Of its related complications, distal femoral anterior cortical breach is of special concern.

Methods:
We describe the steps of an anterograde femoral intramedullary nailing surgical technique performed on three patients to mitigate their risk of developing an anterior distal perforation of the femoral cortex.

Results:
All patients presented with a proximal intertrochanteric femoral fracture and underwent an intramedullary femoral nail placement. They all had an anatomic reduction radiographically. No complications intraoperatively or at last follow-up were recorded.

Conclusions:
By surgically redirecting the guidewire posteriorly before placing the nail in its desired position, our surgical technique prevents the anterior intramedullary nail abutment against the femoral cortex and the risk of anterior femoral cortical perforation.

Level of Evidence:
V.
Does orthopaedic resident efficiency improve with respect to decreased fluoroscopic times in tibial intramedullary nailing? A measure of an ACGME milestone
Authors: Bradburn Kayla , Patel Jay H. , Cannada Lisa K. 
Published: February 2019

Background:
Intramedullary nailing of tibial fractures is a surgical milestone from the Accreditation Council for Graduate Medical Education (ACGME). Our purpose was to evaluate if fluoroscopic time decreased with increasing resident experience and could be used as a measure of this milestone.

Methods:
Current Procedural Terminology (CPT) codes were used to identify patients who underwent intramedullary nailing of tibial shaft fractures under the direction of fellowship-trained trauma attending staff. The data collected included patient demographics, fracture classification, fluoroscopic imaging total time, and the post-graduate years (PGY) of orthopaedic residency of the operating resident. Exclusions of patients included concomitant fluoroscopic procedures, inadequate records, or surgeries involving primary assisting residents with less than PGY-2 experience. We compared overall groups between half years and looked at individual resident years for each of the continuous variables.

Results:
When residents were grouped as senior (PGY-4 and PGY-5) or junior (PGY-2 and PGY-3), seniors used significantly less fluoroscopy than juniors (207.39 sec vs. 258.30 sec, P=0.018). In the first half of the academic year, PGY-2 residents completed tibial nailing slowest in terms of fluoroscopic usage (P=0.003). PGY-4 residents completed tibial nailing faster in terms of fluoroscopic usage than other years (P=0.031). In the second half of the academic year, PGY-5 residents used significantly less fluoroscopy than PGY-2 residents (P=0.035).

Conclusions:
As the ACGME currently has no measurement for resident progress and efficiency regarding tibial shaft intramedullary nailing, our data indicate that fluoroscopic measurements may be useful in assessing resident proficiency.
Treatment of Atrophic Facial Acne Scars With Microneedling Followed by Polymethylmethacrylate-Collagen Gel Dermal Filler
Authors: Biesman Brian S. , Cohen Joel L. , DiBernardo Barry E. , Emer Jason J. , Geronemus Roy G. , Gold Michael H. , Lehman Alayne S. , Pilcher Brian K. , Monheit Gary D. , Schlesinger Todd E. , Teller Craig F. 
Published: February 2019

BACKGROUND
Microneedling and soft-tissue filler injections have been used independently to improve acne scarring. The effectiveness of a combined approach using microneedling followed by polymethylmethacrylate (PMMA)-collagen gel has not been carefully studied.

OBJECTIVE
The goal of this study was to assess the effectiveness and safety of microneedling alone versus microneedling followed by injection of PMMA-collagen gel filler for correction of atrophic facial acne scars.

METHODS
We conducted a multicenter, open-label, randomized, prospective study on subjects with distensible atrophic acne scars in the face to determine whether microneedling with PMMA-collagen gel is a superior acne scar treatment over microneedling alone. Forty-four subjects received 3 microneedling treatments over a 12-week period followed by randomization to treatments with PMMA-collagen gel (treatment group) or no further treatment (control group).

RESULTS
At 24 weeks, the treatment group achieved a statistically significant improvement in acne scores over microneedling alone. The improvement continued at 36 weeks. At 24 weeks, the treatment group showed a strong trend in improvement on the Physician Global Aesthetic Improvement Scale compared with microneedling alone.
Immunohistochemical Expression of Cyclooxygenases in Hypertrophic Scars and Keloids
Authors: Pavelecini Michel , Zettler Cláudio G. , Fernandes Marilda C. , Ely Pedro B. 
Published: February 2019

Background:
There are studies demonstrating an increased expression of cyclooxygenase (COX) in keloids and hypertrophic scars, suggesting that anti-inflammatory drugs could be used in their treatment. However, a precise relationship between COX and pathological scarring has not been established in the literature yet. This study aims to evaluate the immunohistochemical expression of COXs in these scars.

Methods:
Prospective study, including 54 patients (aged 18–60 years) undergoing scar excision: 18 normal scars (group 1), 18 hypertrophic scar (group 2), and 18 keloids (group 3). The group classification was performed by clinical criteria. Scars samples were collected and anatomopathological examination (through hematoxylin-eosin method) was performed to confirm the scar type. Immunohistochemistry was performed to assess the expression of COX1 and COX2 in epidermis and dermis. Results were compared among all groups and between group I versus II and III together (abnormal scars).

Results:
For COX1, in the epidermis, there was no significant difference in the immunohistochemical expression when comparing the 3 groups. In the dermis, groups 2 and 3 had greater expression than group 1, with a significant difference being found when comparing all groups (P = 0.014), and in the comparison between normal versus abnormal scars (P = 0.004). For COX2, there was no significant difference between the groups in both the epidermis and dermis.

Conclusions:
The immunohistochemical expression of COX1 was greater in the dermis of abnormal scars when compared with normal scars. Future studies can be performed involving COX blockade as a perspective of these scars treatment.
Infectious Mononucleosis Caused by Dual Infection With Cytomegalovirus and Epstein-Barr Viruses
Authors: Dylewski Joe , Drummond Kenneth John 
Published: February 2019

Abstract
Mononucleosis syndromes are most commonly caused by infection with either Epstein-Barr virus or cytomegalovirus. There are differences in their clinical presentation and means of acquisition. Both viruses establish lifelong latency. They are associated with inducing some degree of immunosuppression potentially resulting in reactivation of the second “infecting” virus. There are few reports of suspected dual infections, and it is serologically difficult to prove. We wish to describe 2 cases of mononucleosis for which the serologic evidence for dual infection is presented. We also wish to review the serologic tests that help establish an acute infection with each virus.
Performance on the Plastic Surgery In-Service Examination Can Predict Success on the American Board of Plastic Surgery Written Examination
Authors: Girotto John A. , Adams Nicholas S. , Janis Jeffrey E. , Brandt Keith E. , Slezak Sheri S. 
Published: February 2019

Background:
Originally developed for resident self-assessment, the Plastic Surgery In-Service Examination has been administered for over 45 years. The Accreditation Council for Graduate Medical Education requires that at least 70 percent of graduates pass the American Board of Plastic Surgery Written Examination on their first attempt. This study evaluates the role of In-Service Exam scores in predicting Written Exam success.

Methods:
In-Service Exam scores from 2009 to 2015 were collected from the National Board of Medical Examiners. Data included residency training track, training year, and examination year. Written Exam data were gathered from the American Board of Plastic Surgery. Multivariate analysis was performed and receiver operating characteristic curves were used to identify optimal In-Service Exam score cut-points for Written Exam success.

Results:
Data from 1364 residents were included. Residents who failed the Written Exam had significantly lower In-Service Exam scores than those who passed (p < 0.001). Independent residents were 7.0 times more likely to fail compared with integrated/combined residents (p < 0.001). Residents who scored above the optimal cut-points were significantly more likely to pass the Written Exam. The optimal cut-point score for independent residents was the thirty-sixth percentile and the twenty-second percentile for integrated/combined residents.

Conclusions:
Plastic Surgery In-Service Exam scores can predict success on the American Board of Plastic Surgery Written Exam. Residents who score below the cut-points are at an increased risk of failing. These data can help identify residents at risk for early intervention.
Facial Nerve Trauma: Clinical Evaluation and Management Strategies
Authors: Brown Stav , Isaacson Brandon , Kutz Walter , Barnett Samuel , Rozen Shai M. 
Published: February 2019

Summary:
The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.
Sparstolonin B: A Unique Anti-Inflammatory Agent
Authors: Yepuri Natesh , Dhawan Ravi , Cooney Mitchell , Pruekprasert Napat , Meng Qinghe , Cooney Robert N. 
Published: February 2019

ABSTRACT
Toll-like receptors are transmembrane proteins which sense and transmit infectious and inflammatory responses to the cells expressing them. Therapeutic strategies for the blockade of excessive Toll-like receptor signaling are being actively pursued for several diseases. Recently, Sparstolonin B, isolated from Chinese herb, which suppresses selectively Toll-like receptors has been studied in various inflammatory models. The objective of this review is to summarize the current literature regarding the use of Sparstolonin B in various in vitro and in vivo studies and to provide an overview regarding the potential use of this agent in different inflammatory diseases. Additionally, the current knowledge regarding the role of Toll-like receptors in inflammatory disease and the usage of various Toll-like receptor antagonists will be summarized. Based on our review, we believe Sparstolonin B could serve as a potential therapeutic agent for treatment of Toll-like receptor-mediated inflammatory disorders.
Association of Urinary Phytoestrogens With Pelvic Organ Prolapse and Fecal Incontinence Symptoms in Postmenopausal Women
Authors: Cardenas-Trowers Olivia , Meyer Isuzu , Richter Holly E. , Addis Ilana , Markland Alayne D. 
Published: February 2019

Objectives
The aim of this study was to investigate the association between urinary phytoestrogen levels with symptoms of pelvic organ prolapse (POP) and fecal incontinence (FI) in postmenopausal women.

Methods
This is a cross-sectional study using the National Health and Nutrition Examination Survey database from 2005 to 2010 including postmenopausal women 40 years or older who either had both ovaries removed and/or had no period in the past year due to hysterectomy and/or menopause. Urinary concentrations of 6 phytoestrogens were measured. Pelvic organ prolapse symptoms were defined as a positive response to the question, “Do you see or feel a bulge in the vaginal area?” Fecal incontinence was defined as leakage of mucus, liquid, or solid stool occurring at least monthly. Using appropriate sample weights, prevalence estimates and 95% confidence intervals were calculated. Logistic regression was performed assessing associations between pelvic floor symptoms and log-transformed phytoestrogen levels adjusting for appropriate covariates.

Results
Participants included 1341 postmenopausal women with phytoestrogen data; 1213 with or without POP symptoms and 1221 with or without FI symptoms. Multivariable analysis revealed no association of urinary phytoestrogen levels with POP symptoms. Higher urinary O-desmethylangolensin level was associated with decreased odds of FI symptoms in postmenopausal women (adjusted odds ratio, 0.92; 95% confidence interval, 0.86–0.99).

Conclusions
Increased urinary O-desmethylangolensin level was associated with lower odds of FI. Future research may be warranted to further investigate the potential of specific phytoestrogens as mediators of FI, as well as the role of phytoestrogens on POP symptoms.
The Effect of Lidocaine Gel on Pain Perception During Diagnostic Flexible Cystoscopy in Women: A Randomized Control Trial
Authors: Dougher Erin , Zoorob Dani , Thomas Diane , Hagan Joseph , Peacock Lisa 
Published: February 2019

Objective
The objective of this study was to determine if there is a clinically meaningful variation in pain perception when using lidocaine gel versus plain lubricant prior to office-based diagnostic flexible cystoscopy.

Methods
This was a randomized, controlled, double-blind trial comparing lidocaine gel and water-based lubricant for the performance of diagnostic flexible cystoscopy. Women undergoing cystoscopy were randomized to either transurethral 2% lidocaine (Uro-Jet) or water-based lubricant prior to cystoscopy. Participants and physicians were blinded, and pain was assessed using an 11-point numeric rating scale (NRS). A priori sample size calculation indicated the need for 40 patients per group to achieve 90% power. Descriptive statistics and Student t test were utilized.

Results
The study included 116 patients, 61 in the lidocaine group and 55 in the plain lubricant group. Numeric rating scale in the lidocaine group (2.43 [SD, 1.95]) was significantly lower than that in the plain lubricant group (3.58 [SD, 2.73]) (P = 0.01). After controlling for age and ethnicity, separately as well as together, the procedural NRS scores were 1.37 points (P = 0.002), 0.97 points (P = 0.04), and 1.22 points (P = 0.01) lower in those receiving lidocaine. After the procedure, fewer patients in the lidocaine group (2/61 = 3.3%) requested pain medicine when compared with the plain lubricant group (11/55 = 20%) (P = 0.01). Although anticipated pain scored similarly between groups, actual pain compared with anticipated pain was significantly lower in the lidocaine group (P = 0.02).

Conclusions
Pain perception during flexible cystoscopy decreased when using 2% transurethral lidocaine gel. The use of 2% lidocaine gel is suggested for the reduction of pain at the time of diagnostic flexible cystoscopy in women.
Gene Expression Modulation by the Linker of Nucleoskeleton and Cytoskeleton Complex Contributes to Proteostasis
Authors: Levine Amir , Grushko Danielle , Cohen Ehud 
Published: February 2019

SummaryCellular mechanisms that act in concert to maintain protein homeostasis (proteostasis) are vital for survival. Nevertheless, subsets of aggregation-prone proteins form toxic aggregates (proteotoxicity) that sometimes underlie the development of neurodegenerative diseases. Proteotoxic aggregates are often deposited in the vicinity of the nucleus, a process that is cytoskeleton-dependent. Accordingly, cytoskeletal dysfunction contributes to pathological hallmarks of various neurodegenerative diseases. Thus, we asked whether the Linker of Nucleoskeleton and Cytoskeleton (LINC) complex, which bridges these filaments across the nuclear envelope, is needed for the maintenance of proteostasis. Employing model nematodes, we discovered that knocking down LINC components impairs the ability of the worm to cope with proteotoxicity. Knocking down anc-1, which encodes a key component of the LINC complex, modulates the expression of transcription factors and E3 ubiquitin ligases, thereby changing the rates of protein ubiquitination and degradation. Our results establish a link between the LINC complex and aging-associated proteotoxicity.