bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures
Authors: Busch Michael T. , Perkins Crystal A. , Nickel Brian T. , Blizzard Daniel J. , Willimon Samuel Clifton 
Published: October 2018

Introduction:
The insertion of 2 elastic stable intramedullary nails (ESINs) is a common treatment for pediatric femur fractures. However, the use of this technique in length-unstable or metadiaphyseal fractures has historically been associated with higher complication rates. To improve stability, the addition of a third ESIN has been assessed biomechanically and clinically, but the addition of a fourth nail has only been evaluated biomechanically. The purpose of this study is to report our surgical technique and radiographic outcomes using a quartet of ESINs in pediatric femur fractures.

Methods:
A retrospective review was performed of pediatric patients with length-unstable or metadiaphyseal femur fractures who were treated with 4 ESINs by a single surgeon from 2008 to 2013. Nails were inserted in a retrograde manner, 2 each from medial and lateral starting points. Patients were followed clinically and radiographically until the union and routine removal of hardware. Primary outcomes included fracture union, sagittal, and coronal plane alignment, and complications.

Results:
Fourteen patients underwent quartet ESIN placement. Two patients were excluded: one for early loss to follow-up and another with a diagnosis of osteogenesis imperfecta. The average patient age was 9.3 years (range, 4 to 14 y) and weight was 47 kg (range, 21 to 95 kg). All fractures achieved radiographic union at mean 5.5 months (range, 2 to 9 mo). Hardware was removed at a mean of 9.4 months (range, 2 to 22 mo) following implantation. At final mean follow-up of 18 months, patients and families reported no functional limitations. There were no hardware failures or revision surgeries. There were no limb length discrepancies or malalignment at the time of final radiographic follow-up. There were 2 minor complications—1 patient with pain secondary to nail migration resulting in prominence at the knee and another with refracture following a fall. The stable refracture occurred before complete fracture union and hardware removal and went on to the union without the need for any additional treatment.

Conclusions:
Treatment with a quartet of ESINs should be considered for skeletally immature children with length-unstable or metadiaphyseal femur fractures. In this series, all fractures achieved union without major complications or hardware failure. This modification to traditional elastic nailing techniques is an option for the surgeon to consider as an alternative to rigid intramedullary nailing, submuscular plating, or external fixation.

Level of Evidence:
Level IV.
Treatment of Acute Seymour Fractures
Authors: Lin James S. , Popp James E. , Balch Samora Julie 
Published: October 2018

Background:
Seymour fractures are distal phalanx fractures in children with a juxta-epiphyseal pattern. The purpose of our study was to investigate the treatments, outcomes, operative ;indications, and antibiotic choice for acute Seymour fractures (presenting within 24 h of injury), to better define optimal management. We hypothesized that: (1) cephalexin provides adequate antibiotic coverage for acute Seymour fractures; (2) most injuries will achieve good outcomes with management in the emergency department (ED) alone; and (3) indication for operative intervention is unsuccessful or unstable reduction in the ED.

Methods:
We performed a retrospective study of patients under 18 years old treated at a large pediatric hospital from 2009 to 2017 for an acute Seymour fracture. Study outcomes included management and antibiotic type, infection, fracture healing, malunion, physeal disturbance, nail dystrophy, antibiotic failure, and need for unplanned operative intervention.

Results:
Mean age of patients was 10 years, with 43 males and 22 females sustaining 65 Seymour fractures. Fifty-eight cases (89%) were initially managed in the emergency department. Seven cases were initially managed with an operative intervention that included I&D, open reduction, and K-wire fixation. The most commonly cited surgical indication was unsuccessful closed reduction. Four patients initially managed in the ED required an unplanned operation, usually because of fracture redisplacement. Complications were rare, with superficial infections being most common.

Conclusions:
Most acute Seymour fractures can be successfully managed in the emergency department if stable reduction is achieved.

Level of Evidence:
Level IV, therapeutic.
Pediatric Sports Medicine, A New Subspeciality in Orthopedics: An Analysis of the Surgical Volume of Candidates for the American Board of Orthopaedic Surgery Part II Certification Exam Over the Past Decade
Authors: Obey Mitchel R. , Lamplot Joseph , Nielsen Ena D. , Andras Lindsay M. , Mignemi Megan , Sawyer Jeffrey , Flynn John M. , Albanese Stephen A. , Hosseinzadeh Pooya 
Published: October 2018

Background:
Pediatric orthopaedic surgery has become increasingly subspecialized over the past decade. The purpose of this study was to analyze the volume of pediatric sports medicine cases performed by surgeons applying for the American Board of Orthopaedic Surgeons (ABOS) Part II certification exam over the past decade, comparing caseloads according to the type(s) of fellowship completed.

Methods:
The ABOS database was reviewed for all surgeons applying for the ABOS Part II certification exam from 2004 to 2014. Fellowship training of the candidates was recorded as Pediatrics, Sports, and Dual-Fellowship (fellowship in both Pediatrics and Sports). All other candidates were categorized as “Other”. A total of 102,424 pediatric cases (patients below 18 years) were reviewed to identify sports medicine cases performed by CPT code. Multiple linear regression and Mann-Whitney U tests were used to determine trends in case volume overall and according to fellowship training for all patients, patients ≥13 and patients <13. One-way ANOVA testing was used to compare multiple means followed by multiple post hoc comparisons using a Tukey all pairwise approach using SPSS.

Results:
A total of 14,636 pediatric sports medicine cases were performed. There was an increase in the number of sports medicine cases performed in patients <13 (117.5±31.8 from 2004-2009 to 212.4±70.1 from 2010-2014, P=0.035; r
2=0.743, P=0.0007). The number of Pediatrics (r
2=0.601, P=0.005), Sports (r
2=0.741, P=0.0007) and Dual-Fellowship candidates increased (r
2=0.600, P=0.005) from 2004-2014. Dual-Fellowship surgeons performed 21.4% of pediatric sports medicine cases in 2014 when compared to 2.1% in 2004 (919% increase). As a group, the number of pediatric sports cases performed by Dual-Fellowship (r
2=0.630, P=0.004) and Sports (r
2=0.567, P=0.007) candidates has increased, while the number performed by “Other” candidates has decreased (r
2=0.758, P=0.0005). Per surgeon, Dual-Fellowship candidates performed a greater number of pediatric sports cases per collection period (36.5±9.18) than Pediatrics (6.71±0.94), Sports (5.99±0.46), and “Other” (1.21±0.15, P<0.0001 for each) candidates from 2004 to 2014.

Conclusions:
Over the past decade operative sports injuries have increased in children with a similar increase in the number of orthopedic surgeons specializing in pediatric sports medicine. On a per surgeon basis, these dual fellowship-trained candidates have performed on average five times the number of pediatric sports medicine cases compared to all other ABOS Part II candidates. These trends may point towards the development of a new subspecialty of pediatric sports medicine among orthopedic surgeons.

Level of Evidence:
Level IV—Retrospective Database Review.
Serial CAD/CAM Bracing: An Alternative to Serial Casting for Early Onset Scoliosis
Authors: Thometz John , Liu Xue-Cheng 
Published: October 2018

Background:
Years of casting for infantile scoliosis can lead to significantly detrimental quality of life for both the child and parents. Concerns have been raised about the long-term negative neurodevelopmental effects of repeated anesthesia on young children. We developed an elongation bending derotation brace (EBDB) that uses primarily a bending derotation force applied to the curve to achieve the same goals as the cast. The goal of the study is to describe the preliminary results of a technique for creation of EBDB for infantile idiopathic scoliosis using computer-aided design/computer-aided milling (CAD/CAM) technology with at least 24 months follow-up.

Methods:
Nine patients with infantile idiopathic scoliosis had minimum 2-year follow-up (mean, 3.4 y; range, 2 to 6 y). Mean age at the treatment was 11 months (4 to 24 mo). There were 2 right thoracic, 7 left thoracic curves. CAD/CAM technology was used to create the EBDB after the child was placed in traction and a derotation strap applied. The same rotational forces that are used in the creation of the Mehta-type cast can also be utilized in creating the brace. A laser scanner was used to obtain the spinal geometry. Compliance can be monitored with a heat sensor.

Results:
Four patients were full corrected with serial bracing alone (curve ≤10 degrees). Five patients with more rigid curves showed improvement from mean 57 degrees (48 to 62 degrees) to mean 21 degrees (10 to 44 degrees).

Conclusions:
This paper describes the preliminary results of a new methodology for creating a patient-specific brace for infantile scoliosis using CAD/CAM technology. This methods shows promising potential to treat the infantile curve without the drawbacks of casting.

Level of Evidence:
Level IV.
In Vitro Analysis of the Degradation of Calcium Hydroxylapatite Dermal Filler: A Proof-of-Concept Study
Authors: Robinson Deanne M. 
Published: October 2018

BACKGROUND
A dissolving agent for calcium hydroxylapatite (CaHA, Radiesse) soft-tissue filler would be of value should inadvertent intravascular injection, vascular compromise, nodule formation, or overcorrection occur.

METHODS
In a prospective, single-center, proof-of-concept study, 12 cadaveric porcine skin samples were injected with CaHA (0.4–0.8 mL). Samples were then randomized to intralesional injection of 0.2-mL sodium thiosulfate (STS, 12.5 g/50 mL); 1 to 2 g of topical sodium metabisulfite (SMB, 25% SMB in 120-mL gel) applied with occlusion, or both intralesional STS and topical SMB. Control samples were not treated after CaHA injection. A 4-mm punch biopsy was obtained 24 hours after treatment, and tissue sections were stained with hematoxylin and eosin and prepared for light microscopy. A board-certified dermatopathologist estimated the amount of CaHA present in each sample.

RESULTS
Intralesional STS alone or combined with topical SMB completely dissolved CaHA in the porcine skin samples. Topical SMB treatment reduced, but did not entirely clear CaHA from the tissue samples. The control samples contained easily identifiable CaHA microspheres.

CONCLUSION
This proof-of-concept study illustrates the potential reversibility of CaHA filler with intralesional STS, topical SMB, and the combination of both agents. Larger, in vivo, studies are now warranted to provide further insight.
Appreciation of the Vascular Anatomy of Aesthetic Forehead Reflation
Authors: Carruthers Jean D.A. , Carruthers J. Alastair 
Published: October 2018

BACKGROUND
Worldwide, the brow is the most common facial site to receive aesthetic treatment. However, the forehead above the brows has been comparatively less well studied with respect to both neuromodulators and fillers. Age-related remodeling of the forehead with loss of facial bone has been demonstrated on detailed radiographic studies. Concurrent loss of facial fat deposits also adds to the volume depletion. The resulting shallow scalloped depressions in the central 2/3 of the forehead give a tired and aged appearance as do the deep etched horizontal forehead lines which are often associated. Temporal hollowing may be an important associated feature.

METHODS
Combination treatment of the upper face with neuromodulators to elevate the brows and diluted hyaluronic acid (HA) fillers to smooth the medial glabellar complex and reflate the forehead and temple has recently become a desired and popular treatment. Several techniques have been described in the literature. All these techniques are designed to allow forehead reflation with reduction of the possibility of vascular compromise.

CONCLUSION
Avoidance of the supratrochlear and supraorbital vasculature with cosmetic filler injections is possible by insertion of needle or cannula into the subgaleal space above their transition from preperiosteal to subcutaneous level. Using this technique we have so far not seen any vascular compromise and we present this technique in the interest of patient safety.
Effectiveness and Safety of Acne Scar Treatment With Nonanimal Stabilized Hyaluronic Acid Gel
Authors: Dierickx Christine , Larsson Markus K. , Blomster Stina 
Published: October 2018

BACKGROUND
Acne scarring affects most patients with acne and have a negative impact on quality of life. New effective treatment options offering minimal downtime are therefore needed.

OBJECTIVE
To evaluate improvement in overall facial appearance after hyaluronic acid (HA) treatment of atrophic acne scars.

METHODS
Twelve subjects with moderate-to-severe acne scars were treated at 3 sessions 4 weeks apart. At each session, up to 2-mL HA gel was injected into each side of the face. Acne scar severity, global facial aesthetic improvement, and subject satisfaction were assessed up to 36 weeks after treatment. Safety assessments included subject diaries and adverse events.

RESULTS
The overall facial appearance and the appearance of atrophic acne scars improved after treatment. Scar severity and subject satisfaction with the overall facial appearance and with the sensation and perception of the skin improved in most subjects. Subjects' self-esteem and self-confidence also improved. Adverse events were typically mild to moderate, expected, and procedure-related.

CONCLUSION
Hyaluronic acid gel injections were effective and safe for treatment of moderate-to-severe atrophic acne scars. The treatment effect developed gradually over time with the highest improvement observed at the end of the study.
Aromatase and estrogen receptor immunoreactivity in the coronary arteries of monkeys and human subjects
Authors: Diano Sabrina , Horvath Tamas L. , Mor Gil , Register Thomas , Adams Michael , Harada Nobuhiro , Naftolin Frederick 
Published: October 2018

Abstract

Objective:
The objective of this study was to determine whether estrogen could be formed locally in the coronary arteries.

Design:
Coronary arteries were examined from monkeys (Macaca fascicularis, one male and one female) and human subjects (one premenopausal woman, one postmenopausal woman, and one man) by immunocytochemistry, using purified antisera against human placental estrogen synthetase (aromatase) and ER α. The arteries were graded for the amount of atherosclerosis.

Results:
There was clear immunopositivity for both aromatase and estrogen receptors in all arteries studied. Although all endothelial cells (CD31 positive) stained for both antigens, the staining in macrophages, fibroblasts, and smooth muscle cells was irregular.

Conclusion:
The present results provide the first evidence for the local formation of estrogen in the coronary arteries. In addition to complementing the evidence of a cardioprotective effect of estrogen on the coronary circulation, our results highlight the potential importance of local regulation of estrogen formation and the role of available precursor androgens in maintaining the cardiovascular system.
Comparison of the antioxidant effects of equine estrogens, red wine components, vitamin E, and probucol on low-density lipoprotein oxidation in postmenopausal women
Authors: Bhavnani Bhagu R. , Cecutti Anthony , Gerulath Alan , Woolever Allan C. , Berco Mauricio 
Published: October 2018

Abstract

Objective:
Oxidized low-density lipoprotein (LDL) seems to play an important role in the etiology of atherosclerosis. To further study this, we performed two studies: (1) we determined the ability of 10 estrogen components of the drug, conjugated equine estrogen (CEE), trans-resveratrol (t-resveratrol) and quercetin (red wine components), trolox (vitamin E analog), and probucol (a serum cholesterol-lowering drug) to delay or prevent the oxidation of plasma LDL isolated from untreated postmenopausal women, and (2) we assessed the effect of long-term (>1 year) estrogen replacement therapy and hormone replacement therapy on LDL oxidation by ex vivo methods.

Design:
For the in vivo study, three groups of postmenopausal women were selected based on whether they were on long-term CEE therapy (group A: 0.625 mg CEE; n = 21), on combination CEE plus progestogen therapy (group B: 0.625 mg CEE + 5.0 mg medroxyprogesterone acetate, 10 days; n = 20), or not on any hormone therapy (group C; n = 37). For the in vitro study, only LDL samples obtained from group C were used. The kinetics of LDL oxidation were measured by continuously monitoring the formation of conjugated dienes followed by determination of the lag time.

Results:
All compounds tested protected the LDL from oxidative damage. The relative antioxidant potency of estrogen components was generally greater than that of the other compounds. The minimum dose (nmoles) required to double the lag time from the control lag time of 57 ± 2 min was 0.47 for 17β-dihydroequilenin, 17α-dihydroequilenin, Δ8-estrone; 0.6 to 0.7 for Δ8-17β-estradiol, equilenin, and quercetin; 0.9 for 17β-dihydroequilin and 17α-dihydroequilin; 1.3 for equilin, estrone, 17β-estradiol, 17α-estradiol; 1.4 for trolox; 1.9 for probucol; and 3.0 for t-resveratrol. The data from the in vivo study indicate that after long-term estrogen replacement therapy (group A) and hormone replacement therapy (group B), the LDL was significantly (p < 0.01) protected (higher lag time) against oxidation compared with the control (group C). There was no difference between groups A and B.

Conclusions:
The oxidation of LDL isolated from postmenopausal women is inhibited differentially by various estrogens and other antioxidants. The unique ring B unsaturated estrogen components of CEE were the most potent, and t-resveratrol, the red wine component, was the least potent. Long-term CEE or CEE + medroxyprogesterone acetate administration to postmenopausal women protects the LDL against oxidation to the same extent. These combined data support the hypothesis that some of the cardioprotective benefits associated with CEE therapy and perhaps red wine consumption may be due to the ability of their components to protect LDL against oxidative modifications.
Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy
Authors: Brotman Rebecca M. , Shardell Michelle D. , Gajer Pawel , Fadrosh Doug , Chang Kathryn , Silver Michelle I. , Viscidi Raphael P. , Burke Anne E. , Ravel Jacques , Gravitt Patti E. 
Published: October 2018

Abstract

Objective:
The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA).

Methods:
Eighty-seven women (aged 35-60 y) were classified as premenopausal (n = 30), perimenopausal (n = 29), or postmenopausal (n = 28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis.

Results:
Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P = 0.004) and between VVA and CST (P = 0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79).

Conclusions:
A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
Physiologically assessed hot flashes and endothelial function among midlife women
Authors: Thurston Rebecca C. , Chang Yuefang , Barinas-Mitchell Emma , Jennings J. Richard , von Känel Roland , Landsittel Doug P. , Matthews Karen A. 
Published: October 2018

Abstract

Objective:
Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations.

Methods:
Two hundred seventy-two nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40 to 60 years, and free of clinical cardiovascular disease, underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow-mediated dilation to assess endothelial function. Associations between hot flashes and flow-mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol.

Results:
In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (P < 0.05) indicated that among the younger tertile of women in the sample (age 40-53 years), the presence of hot flashes (beta [standard error] = −2.07 [0.79], P = 0.01), and more frequent physiologic hot flashes (for each hot flash: beta [standard error] = −0.10 [0.05], P = 0.03, multivariable) were associated with lower flow-mediated dilation. Associations were not accounted for by estradiol. Associations were not observed among the older women (age 54-60 years) or for self-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow-mediated dilation than standard cardiovascular disease risk factors or estradiol.

Conclusions:
Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.