bluuebunny/crossref_metadata_2025_split huggingface dataset:
Five-Year Outcome Analysis of Intertrochanteric Femur Fractures: A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail
Authors: Berger-Groch Josephine , Rupprecht Martin , Schoepper Steffen , Schroeder Malte , Rueger Johannes Maria , Hoffmann Michael 
Published: April 2016

Objectives:
To compare the radiological and functional outcome after fixation of intertrochanteric fractures (IF) using either an integrated 2-screw cephalomedullary nail [InterTan (IT); Smith & Nephew] or a single-screw device [Gamma3 (G3); Stryker] with a 5-year follow-up.

Design:
Prospective, randomized.

Settings:
A single-center study.

Patients:
One hundred four patients with a mean age of 81.2 ± 9.2 years were included, 33 patients were available for the final 5-year follow-up, 63 patients died, and 8 patients were lost for follow-up.

Intervention:
Internal fixation of intertrochaneteric femur fractures using a cephalomedullary nail with either a single screw or an integrated 2-screw system.

Main Outcome Measurements:
Length of hospital stay, SF-36-questionnaire, Harris-Hip-Score, radiographs.

Results:
SF-36 index at 6 months indicated that 93% of the IT group returned to their prefracture status compared with only 80% in the G3 group. For the mental health SF-36 index, the IT patients showed a significant increased level 6 months after the index procedure (IT: P = 0.02; G3: P = 0.20). The length of hospital stay was significantly (P = 0.03) shorter in the IT group. After 5 years however, neither group had significant implant-related complications or differences in terms of functional outcome.

Conclusions:
Regarding functional outcome and hospital stay, the IT collective performed better in the 6-month follow-up. After 5 years, no significant differences were recorded.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Time-Dependent Effectiveness of Locally Applied Vancomycin Powder in a Contaminated Traumatic Orthopaedic Wound Model
Authors: Tennent David J. , Shiels Stefanie M. , Sanchez Carlos J. , Niece Krista L. , Akers Kevin S. , Stinner Daniel J. , Wenke Joseph C. 
Published: April 2016

Objectives:
To evaluate the effectiveness of locally applied vancomycin powder at different times postinfection in a contaminated traumatic animal model.

Methods:
This study used an established segmental defect rat femur model contaminated with Staphylococcus aureus UAMS-1 followed by treatment at 6 or 24 hours postinfection. Three treatments were evaluated: debridement and irrigation alone (control group) or in combination with either vancomycin powder or vancomycin-impregnated poly(methyl methacrylate) beads. Serum vancomycin levels were determined at scheduled time points over 14 days; bone, surrounding muscle, and implants were harvested for bacterial and inflammatory analyses.

Results:
Locally applied vancomycin powder and impregnated beads significantly reduced bacteria both within the bone and implant when treatment was performed at 6 hours. Delaying treatment to 24 hours significantly reduced the therapeutic efficacy of locally applied vancomycin of both groups. Serum vancomycin levels were detectable in all animals treated with vancomycin powder at 24 hours, but absorption was negligible from beads. At 14 days, vancomycin was detectable in the surrounding musculature of all animals and in serum of 20% of animals treated with vancomycin powder.

Conclusions:
This study suggests that vancomycin powder is a promising adjunctive therapy for preventing infection in traumatic wounds when treatment is performed early. This time-dependent effectiveness of vancomycin powder is similar to that observed with systemic and other local delivery adjuncts, which is likely attributable to biofilm formation after contamination, conferring intrinsic recalcitrance to antimicrobials.
Ketorolac Administered in the Recovery Room for Acute Pain Management Does Not Affect Healing Rates of Femoral and Tibial Fractures
Authors: Donohue David , Sanders Drew , Serrano-Riera Rafa , Jordan Charles , Gaskins Roger , Sanders Roy , Sagi H. Claude 
Published: April 2016

Objectives:
To determine whether ketorolac administered in the immediate perioperative period affects the rate of nonunion in femoral and tibial shaft fractures.

Design:
Retrospective comparative study.

Setting:
Single Institution, Academic Level 1 Trauma Center.

Patients:
Three hundred and thirteen skeletally mature patients with 137 femoral shaft (OTA 32) and 191 tibial shaft (OTA 42) fractures treated with intramedullary rod fixation.

Intervention:
Eighty patients with 33 femoral shaft and 52 tibial shaft fractures were administered ketorolac within the first 24 hours after surgery (group 1—study group). Two-hundred thirty-three patients with 104 femoral shaft and 139 tibial shaft fractures were not (group 2—control group).

Main Outcome Measurements:
Rate of reoperation for repair of a nonunion and time to union.

Results:
Average time to union of the femur was 147 days for group 1 and 159 days for group 2 (P = 0.57). Average time to union of the tibia was 175 days for group 1 and 175 days for group 2 (P = 0.57). There were 3 femoral nonunions (9%) in group 1 and eleven femoral nonunions (11.6%) in group 2 (P = 1.00). There were 3 tibial nonunions (5.8%) in group 1 and 17 tibial nonunions (12.2%) in group 2 (P = 0.29). The average dose of ketorolac for patients who healed their fracture was 85 mg, whereas it was 50 mg for those who did not (P = 0.27). All patients with a nonunion in the study group were current smokers.

Conclusions:
Ketorolac administered in the first 24 hours after fracture repair for acute pain management does not seem to have a negative impact on time to healing or incidence of nonunion for femoral or tibial shaft fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
STAT3 Suppression Is Involved in the Protective Effect of SIRT6 Against Cardiomyocyte Hypertrophy
Authors: Zhang Xiaoying , Li Wei , Shen Peiye , Feng Xiaojun , Yue Zhongbao , Lu Jing , You Jia , Li Jingyan , Gao Hui , Fang Shi , Li Zhuoming , Liu Peiqing 
Published: April 2016

Abstract:
The activation of signal transducer and activator of transcription 3 (STAT3) is critical for the development of cardiac hypertrophy and heart failure. Sirtuin 6 (SIRT6) protects cardiomyocytes from hypertrophy. This study focused on the association between SIRT6 and STAT3 in the regulation of cardiomyocyte hypertrophy. In the phenylephrine (PE)-induced hypertrophic cardiomyocyte model and in the hearts of isoprenaline-induced cardiac hypertrophic rat model, the mRNA and protein expressions of STAT3 and its phosphorylated level at tyrosine 705 (P-STAT3) were significantly increased. By contrast, the deacetylation activity of SIRT6 was weakened without altering its protein expression. In addition, the nuclear localization of STAT3 and P-STAT3 was enhanced by PE, suggesting that STAT3 was activated in cardiomyocyte hypertrophy. Adenovirus infection–induced SIRT6 overexpression repressed the activation of STAT3 by decreasing its mRNA and protein levels, by suppressing its transcriptional activity, and by hindering the expressions of its target genes. Moreover, the effect of SIRT6 overexpression on eliminating PE-induced expressions of hypertrophic biomarkers, such as atrial natriuretic factor and brain natriuretic peptide, was reversed by STAT3 overexpression. Likewise, SIRT6 knockdown–induced upregulation of atrial natriuretic factor and brain natriuretic peptide was reversed by STAT3 silencing. These observations suggest that the antihypertrophic effect of SIRT6 involves STAT3 suppression. In conclusion, SIRT6 prevents PE-induced activation of STAT3 in cardiomyocyte hypertrophy; the inhibitory effect of SIRT6 on STAT3 contributes to cardiac protection.
External Volume Expansion in Irradiated Tissue: Effects on the Recipient Site
Authors: Chin Michael S. , Lujan-Hernandez Jorge , Babchenko Oksana , Bannon Elizabeth , Perry Dylan J. , Chappell Ava G. , Lo Yuan-Chyuan , Fitzgerald Thomas J. , Lalikos Janice F. 
Published: April 2016

Background:
External volume expansion prepares recipient sites to improve outcomes of fat grafting. For patients receiving radiotherapy after mastectomy, results with external volume expansion vary, and the relationship between radiotherapy and expansion remains unexplored. Thus, the authors developed a new translational model to investigate the effects in chronic skin fibrosis after radiation exposure.

Methods:
Twenty-four SKH1-E mice received 50 Gy of β-radiation to each flank and were monitored until fibrosis developed (8 weeks). External volume expansion was then applied at −25 mmHg to one side for 6 hours for 5 days. The opposite side served as the control. Perfusion changes were assessed with hyperspectral imaging. Mice were euthanized at 5 (n = 12) and 15 days (n = 12) after the last expansion application. Tissue samples were analyzed with immunohistochemistry for CD31 and Ki67, Masson trichrome for skin thickness, and picrosirius red to analyze collagen composition.

Results:
All animals developed skin fibrosis 8 weeks after radiotherapy and became hypoperfused based on hyperspectral imaging. Expansion induced edema on treated sides after stimulation. Perfusion was decreased by 13 percent on the expansion side (p < 0.001) compared with the control side for 5 days after stimulation. Perfusion returned to control-side levels by day 15. Dermal vasculature increased 38 percent by day 15 (p < 0.01) in expansion versus control. No difference was found in collagen composition.

Conclusions:
External volume expansion temporarily reduces perfusion, likely because of transient ischemia or edema. Together with mechanotransduction, these effects encourage a proangiogenic and proliferative environment in fibrotic tissue after radiotherapy in the authors’ mouse model. Further studies are needed to assess these changes in fat graft retention.
Big Data and Machine Learning in Plastic Surgery: A New Frontier in Surgical Innovation
Authors: Kanevsky Jonathan , Corban Jason , Gaster Richard , Kanevsky Ari , Lin Samuel , Gilardino Mirko 
Published: April 2016

Summary:
Medical decision-making is increasingly based on quantifiable data. From the moment patients come into contact with the health care system, their entire medical history is recorded electronically. Whether a patient is in the operating room or on the hospital ward, technological advancement has facilitated the expedient and reliable measurement of clinically relevant health metrics, all in an effort to guide care and ensure the best possible clinical outcomes. However, as the volume and complexity of biomedical data grow, it becomes challenging to effectively process “big data” using conventional techniques. Physicians and scientists must be prepared to look beyond classic methods of data processing to extract clinically relevant information. The purpose of this article is to introduce the modern plastic surgeon to machine learning and computational interpretation of large data sets. What is machine learning? Machine learning, a subfield of artificial intelligence, can address clinically relevant problems in several domains of plastic surgery, including burn surgery; microsurgery; and craniofacial, peripheral nerve, and aesthetic surgery. This article provides a brief introduction to current research and suggests future projects that will allow plastic surgeons to explore this new frontier of surgical science.
Collagen and Fractionated Platelet-Rich Plasma Scaffold for Dermal Regeneration
Authors: Houdek Matthew T. , Wyles Cody C. , Stalboerger Paul G. , Terzic Andre , Behfar Atta , Moran Steven L. 
Published: April 2016

Background:Current options for in vivo regeneration of dermal tissue remain limited. The purpose of this study was to engineer a unique scaffold capable of recruiting dermal stem cells from adjacent tissue, thus circumventing the need to seed the scaffolds with stem cells before implantation, leading to skin regeneration.Methods:A hydrogel scaffold was created through combination of type I collagen along with fractionated platelet-rich plasma. This was compared to a control hydrogel consisting of type I collagen and fetal bovine serum. Hydrogels were cultured with fresh human skin tissue and incubated with supplemental media. Gels were digested weekly for cellular content as examined by flow cytometry at the 4- and 8-week time points. The fractionated platelet-rich plasma and collagen gels were then implanted onto full-thickness skin defects on the backs of rats and compared to wounds healing by secondary intention. Wound area was evaluated for epithelialization and neovascularization.Results:Platelet-rich plasma fractionation increased platelet-derived growth factors. In contrast to collagen scaffolds, fractionated platelet-rich plasma–supplemented scaffolds recruited more dermal-derived stem cells from fresh skin tissue compared with collagen hydrogels at the 4- and 8-week time points. Furthermore, fractionated platelet-rich plasma–supplemented hydrogels accelerated wound healing, angiogenesis, and hair and sweat gland formation, ultimately regenerating a dermis-like tissue.Conclusions:Generation of hydrogels with fractionated platelet-rich plasma was able to improve cellular recruitment and growth and differentiation of dermal-derived stem cells, leading to hair growth and sweat gland formation. This provides a novel approach to regenerate skin for treating large defects.
Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin Type A—Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations
Authors: Sundaram Hema , Liew Steven , Signorini Massimo , Vieira Braz André , Fagien Steven , Swift Arthur , De Boulle Koenraad L. , Raspaldo Hervé , Trindade de Almeida Ada R. , Monheit Gary 
Published: April 2016

Background:
Combination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades.

Methods:
A multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes.

Results:
Global Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders.

Conclusions:
The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Research Procurement: A Translational Simulation Model
Authors: Sosin Michael , Ceradini Daniel J. , Hazen Alexes , Sweeney Nicole G. , Brecht Lawrence E. , Levine Jamie P. , Staffenberg David A. , Saadeh Pierre B. , Bernstein G. Leslie , Rodriguez Eduardo D. 
Published: April 2016

Background:
Cadaveric face transplant models are routinely used for technical allograft design, perfusion assessment, and transplant simulation but are associated with substantial limitations. The purpose of this study was to describe the experience of implementing a translational donor research facial procurement and solid organ allograft recovery model.

Methods:
Institutional review board approval was obtained, and a 49-year-old, brain-dead donor was identified for facial vascularized composite allograft research procurement. The family generously consented to donation of solid organs and the total face, eyelids, ears, scalp, and skeletal subunit allograft.

Results:
The successful sequence of computed tomographic scanning, fabrication and postprocessing of patient-specific cutting guides, tracheostomy placement, preoperative fluorescent angiography, silicone mask facial impression, donor facial allograft recovery, postprocurement fluorescent angiography, and successful recovery of kidneys and liver occurred without any donor instability. Preservation of the bilateral external carotid arteries, facial arteries, occipital arteries, and bilateral thyrolinguofacial and internal jugular veins provided reliable and robust perfusion to the entirety of the allograft. Total time of facial procurement was 10 hours 57 minutes.

Conclusions:
Essential to clinical face transplant outcomes is the preparedness of the institution, multidisciplinary face transplant team, organ procurement organization, and solid organ transplant colleagues. A translational facial research procurement and solid organ recovery model serves as an educational experience to modify processes and address procedural, anatomical, and logistical concerns for institutions developing a clinical face transplantation program. This methodical approach best simulates the stressors and challenges that can be expected during clinical face transplantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Social Capital is Associated With Late HIV Diagnosis: An Ecological Analysis
Authors: Ransome Yusuf , Galea Sandro , Pabayo Roman , Kawachi Ichiro , Braunstein Sarah , Nash Denis 
Published: April 2016

Background:
Late HIV diagnosis is associated with higher medical costs, early mortality among individuals, and HIV transmission in the population. Even under optimal configurations of stable or declining HIV incidence and increase in HIV case findings, no change in proportion of late HIV diagnosis is projected after year 2019. We investigated the association among social capital, gender, and late HIV diagnosis.

Methods:
We conduct ecological analyses (ZIP code, N = 166) using negative binomial regression of gender-specific rates of late HIV diagnoses (an AIDS defining illness or a CD4 count ≤200 cell/μL within 12 months of a new HIV diagnosis) in 2005 and 2006 obtained from the New York City HIV Surveillance Registry, and social capital indicators (civic engagement, political participation, social cohesion, and informal social control) from the New York Social Indicators Survey, 2004.

Results:
Overall, low to high political participation and social cohesion corresponded with significant (P < 0.0001) decreasing trends in late HIV diagnosis rates. Among men [relative risk (RR) = 0.66, 95% CI: (0.47 to 0.98)] and women [RR = 0.43, 95% CI: (0.28 to 0.67)], highest political participation was associated with lower relative odds of late HIV diagnosis, independent of income inequality. Highest informal social control [RR = 0.67, 95% CI: (0.48 to 0.93)] among men only and moderate social cohesion [RR = 0.71, 95% CI: (0.55 to 0.92)] among women only were associated with the outcome adjusting for social fragmentation, income inequality, and racial composition.

Discussion:
The magnitude of association between social capital and late HIV diagnosis varies by gender and by social capital indicator.
Ultrabrief Electroconvulsive Therapy for Manic Episodes of Bipolar Disorder
Authors: Anand Sandip 
Published: April 2016

Abstract
Right unilateral ultrabrief-pulse electroconvulsive therapy (RUL-UB ECT) is gaining popularity and is being used for the treatment of severe major depression. Though brief pulse-width ECT has shown to have robust antimanic effects, the efficacy of UB ECT for mania has not been studied, and there are very few reports on its use in mania. A brief case series of 3 patients with manic episode of bipolar disorder who were treated with RUL-UB ECT is presented here. The successful treatment of 2 patients in this report suggests that some manic episodes can be rapidly and effectively treated with RUL-UB ECT.
Police integrity in South Africa: a tale of three police agency types
Authors: Ivković Sanja Kutnjak , Sauerman Adri 
Published: April 2016

Purpose– Following the theory of police integrity, the purpose of this paper is to explore empirically the contours of police integrity in South Africa using survey of the three South African police agency types.Design/methodology/approach– During the period from 2010 to 2012, a police integrity survey was used to measure the contours of police integrity among 871 police officers across South Africa, covering all three police agency types. The questionnaire contains descriptions of 11 scenarios, covering different forms of police misconduct, followed by seven questions measuring officer views of scenario seriousness, the appropriate and expected discipline, and willingness to report the misconduct.Findings– The results show that the respondents from the three police agency types were about equally likely to recognize behaviors as rule-violating and, in most scenarios, evaluated these scenarios to be of the same level of seriousness. The contours of the code of silence were very similar as well. The authors found the largest and most systematic differences in the respondents’ perceptions of disciplinary environment, with the traffic respondents expecting harsher disciplinary environments than either the South African Police Service or metro police respondents.Research limitations/implications– Similar sample group sizes would have been preferred, although the current sample group proportions are certainly representative of a collective, agency size comparison.Practical implications– Although the respondents from the three police agency types expressed similar views of misconduct seriousness and their willingness to report, and were as likely to recognize these behaviors as rule-violating, their views depicted markedly different disciplinary environments. These results clearly support the critical importance of consistent enforcement of official rules.Originality/value– Whereas several integrity studies have explored the country’s national police service, empirical studies on the integrity of the other South African police agency types are non-existent.