Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Πέμπτη 25 Ιουλίου 2019

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical...
Morphology of the Middle Ear Ossicles in the Rodent Perimys (Neoepiblemidae) and a Comprehensive Anatomical and Morphometric Study of the Phylogenetic Transformations of these Structures in CaviomorphsAbstractThe extinct clade of caviomorph rodents Neoepiblemidae includes forms that lived in South America from the early Miocene to Pliocene. Among them is Perimys. The exceptional preservation of ear ossicles in this rodent is described and analyzed in a study of the phylogenetic transformations of...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:41
Dual PPARα/γ agonist aleglitazar confers stroke protection in a model of mild focal brain ischemia...
Dual PPARα/γ agonist aleglitazar confers stroke protection in a model of mild focal brain ischemia .....in miceAbstractPeroxisome proliferator-activated receptors (PPARs) control the expression of genes involved in glucose homeostasis, lipid metabolism, inflammation, and cell differentiation. Here, we analyzed the effects of aleglitazar, a dual PPARα and PPARγ agonist with balanced affinity for either subtype, on subacute stroke outcome. Healthy young adult mice were subjected to transient 30 min...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:38
Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in breast carcinoma Subbiah...
Thermo mammogram as a tool to assess response to neoadjuvant chemotherapy in breast carcinomaSubbiah Shanmugam, Gopu Govindasamy, Sujay Susikar, Muniasamy PalaniyandiIndian Journal of Medical and Paediatric Oncology 2019 40(5):25-32Introduction: Response to neoadjuvant chemotherapy (NACT) is predicted by clinical examination alone in locally advanced breast carcinoma. This study uses thermo mammogram (TMG) to assess the response. Aim and Objectives: The aim is to study TMG changes during NACT in...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:37
Head and neck squamous cell carcinoma in young adults: A hospital-based study Jagannath Dev Sharma,...
Head and neck squamous cell carcinoma in young adults: A hospital-based studyJagannath Dev Sharma, Nizara Baishya, Amal Chandra Kataki, Chandi Ram Kalita, Ashok Kumar Das, Tashnin RahmanIndian Journal of Medical and Paediatric Oncology 2019 40(5):18-22Background: Head and neck cancers (HNCs) account for 30% of all cancers in India. In north eastern India, tobacco-related cancers are very common because of the widespread use of tobacco. The paucity of any study from this region in young head and neck...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:36
Coalescence Models Reveal the Rise of the White-Bellied Rat ( Niviventer confucianus ) Following the...
Coalescence Models Reveal the Rise of the White-Bellied Rat ( Niviventer confucianus ) Following the Loss of Asian MegafaunaAbstractRodents are the major remaining mammals in many terrestrial ecosystems after the historical loss of megafauna and large-bodied taxa. Niviventer confucianus is a dominant habitat generalist in natural forests in most of China. It is also recorded as an important vector of diverse zoonotic diseases. Here, three mitochondrial and one nuclear DNA fragments were sequenced...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:36
Introduction to the multi-author review on methylation in cellular physiology Abstract Protein post-translational...
Introduction to the multi-author review on methylation in cellular physiologyAbstractProtein post-translational modifications (PTMs) have long been a topic of intensive investigation. Covalent additions to the 20 genetically encoded amino acids can alter protein interactions and can even change enzymatic function. In eukarya, PTMs can amplify both the complexity and functional paradigms of the cellular environment. Therefore, PTMs have been of substantial research interest, both for understanding...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:35
Avoiding Brooms, Forks, and Butterflies in the Linear Lattices Abstract Let n be a positive integer, q a...
Avoiding Brooms, Forks, and Butterflies in the Linear LatticesAbstractLet n be a positive integer, q a power of a prime, and \(\mathcal {L}_{n}({q})\) the poset of subspaces of an n-dimensional vector space over a field with q elements. This poset is a normalized matching poset and the set of subspaces of dimension ⌊n/2⌋ or those of dimension ⌈n/2⌉ are the only maximum-sized antichains in this poset. Strengthening this well-known and celebrated result, we show that, except in the case of \(\mathcal...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:35
Elevated expression of CST1 promotes breast cancer progression and predicts a poor prognosis In Figure...
Elevated expression of CST1 promotes breast cancer progression and predicts a poor prognosisIn Figure 7f the panel for c-myc of MDA-MB-468 was erroneously duplicated. The corrected version of the figure is shown in this paper. This correction does not influence the conclusion of the study and we sincerely apologize for this oversight.Correction to: STIM1 deficiency is linked to Alzheimer's disease and triggers cell death in SH-SY5Y cells by upregulation of L-type voltage-operated Ca 2+ entryThe original...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:32
Bone marrow infiltration by nonhematopoetic small round cell tumors: A clinicopathological study from...
Bone marrow infiltration by nonhematopoetic small round cell tumors: A clinicopathological study from a tertiary care centre in South IndiaTriveni Bhopal, Abid Hussain, Sai Mallikarjun, Sree Lakshmi, Sudha SinhaIndian Journal of Medical and Paediatric Oncology 2019 40(5):1-5Objectives: The objective of this study to comprehensively analyze bone marrow (BM) infiltration by nonhematological round cell tumors. Materials and Methods: A total of 206 diagnosed cases of small round blue cell tumors (excluding...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:31
Inferring the history of surname Ye based on Y chromosome high-resolution genotyping and sequencing...
Inferring the history of surname Ye based on Y chromosome high-resolution genotyping and sequencing dataZhen Zeng, Jiaoyang Tian, Chuangui Jiang, Weijian Ye, Kaijun Liu et al. Journal of Human Genetics 2019 64 :703 - 709; May 15, 2019; 10.1038/s10038-019-0616-2Abstract | Full TextClinical and genetic analysis of patients with primary ciliary dyskinesia caused by novel DNAAF3 mutationsZhuoyao Guo, Weicheng Chen, Jianfeng Huang, Libo Wang & Liling Qian Journal of Human Genetics 2019 64 :711 - 719;...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:29
National Cancer Institute theNCI25 JulRT @NCIDrDougLowy: At @theNCI we are training the next generation...
National Cancer Institute theNCI25 JulRT @NCIDrDougLowy: At @theNCI we are training the next generation of cancer researchers—both in our intramural program and by funding train…Details  |  RetweetNational Cancer Institute theNCI25 JulA program called #NCICONNECT from @NIHBrainTumor aims to study 12 rare brain and spine tumors to improve approaches… https://t.co/xQeSRnX6jTDetails  |  RetweetNational Cancer Institute theNCI24 JulNeuroblastoma is a cancer of immature nerve cells that most often occurs...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:27
First-in-human gene therapy launches for pediatric patient with rare neurogenerative disease  In May,...
First-in-human gene therapy launches for pediatric patient with rare neurogenerative disease In May, a ten-year-old girl named JoJo received gene therapy for an extremely rare neurogenerative disease called GM1 gangliosidosis. GM1 progressively destroys nerve cells (neurons) in the brain and spinal cord, leading to muscle and movement weakness, difficulty swallowing and a shortened life expectancy. 
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:16
Fermentative Escherichia coli makes a substantial contribution to H2 production in coculture with phototrophicRhodopseudomonas...
Fermentative Escherichia coli makes a substantial contribution to H2 production in coculture with phototrophicRhodopseudomonas palustris    Amee A Sangani; Alexandra L McCully; Breah LaSarre ; James B McKinlay
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:15
Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted...
Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted Regression Trees for imputation    Alpha Forna, MSc ; Pierre Nouvellet, PhD; Ilaria Dorigatti, PhD; Christl A Donnelly, ScD  Plazomicin: A New Aminoglycoside  Louis D Saravolatz, MD, MACP, FIDSA; Gary E Stein, PharmD
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:15
Notes on Church-State Affairs    David W Hendon; Scott Prather 
Notes on Church-State Affairs    David W Hendon; Scott Prather 
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:15
Space as Testimony: Collecting Oral Histories Among Nigerian Seamen    Lynn Schler
Space as Testimony: Collecting Oral Histories Among Nigerian Seamen    Lynn Schler
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:14
Unity and Plurality. Logic, Philosophy, and Linguistics    Riccardo Baratella  The Possibility of Unity  H...
Unity and Plurality. Logic, Philosophy, and Linguistics    Riccardo Baratella  The Possibility of Unity  H W Noonan  Manipulated Agents: A Window to Moral Responsibility  Taylor W Cyr  Working from Within: The Nature and Development of Quine's Naturalism  Ali Hossein Khani  Deflating Deflationary Truthmaking  Jamin Asay; Sam Baron  Determined by Reasons: A Competence Account of Acting for a Normative Reason  J J Cunningham
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:14
Fanconi anemia study using eltrombopag Volunteers at least 4 years of age with Fanconi anemia are...
Fanconi anemia study using eltrombopagVolunteers at least 4 years of age with Fanconi anemia are needed for a research study.Fanconi anemia is a rare genetic disorder that mostly affects children and often leads to bone marrow failure. Researchers at the National Institutes of Health (NIH) are investigating a new drug to improve blood counts in individuals diagnosed with Fanconi anemia. Eltrombopag is an oral drug that mimics a special protein that causes the body to make more platelets. Currently...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:13
  Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results...
 Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort The 2018 Lake Louise criteria provide a high diagnostic accuracy for the diagnosis of acute myocarditis and significantly increase the sensitivity compared with the original score.   Julian A. Luetkens, Anton Faron... Daniel Thomas
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:13
Realizing Shared Decision-making in Practice   Mary Catherine Beach, MD, MPH; Jeremy Sugarman, MD,...
Realizing Shared Decision-making in Practice  Mary Catherine Beach, MD, MPH; Jeremy Sugarman, MD, MPH, MAHarms From Uninformative Clinical TrialsDeborah A. Zarin, MD; Steven N. Goodman, MD, MHS, PhD; Jonathan Kimmelman, PhDShared Decision Making and the Importance of Time
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:12
JAMA Otolaryngology–Head & Neck Surgery
ORIGINAL INVESTIGATIONAssociation Between Annual Surgeon Total Thyroidectomy Volume and Transient and Permanent ComplicationsCharles Meltzer, MD; Michaela Hull, MS; Alvina Sundang, MBA; et alComparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear SurgeryLukas Anschuetz, MD; Laura Niederhauser, MSc; Wilhelm Wimmer, PhD; et alREVIEWAssociation of Preoperative, Subjective Pediatric Tonsil Size With Tonsillectomy Outcomes: A...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:11
Serious Bacterial Infections in Neonates Presenting Afebrile With History of Fever   Sriram Ramgopal,...
Serious Bacterial Infections in Neonates Presenting Afebrile With History of Fever  Sriram Ramgopal, Lorne W. Walker, Melissa M. Tavarez, Andrew J. Nowalk and Melissa A. VitaleMonthly FeatureThe Fight Over the Juvenile Giant: Contesting Growth in the 1930sSamuel V. SchotlandQuality ReportUsing Quality Improvement to Implement a Standardized Approach to Neonatal Herpes Simplex VirusLaura H. Brower, Paria M. Wilson, Eileen Murtagh Kurowski, David Haslam, Joshua Courter, Neera Goyal, Michelle Durling,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:09
Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions...
Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital AdmissionsIntroduction: Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:04
Negative priming is diminished under high blood pressure in healthy subjects Abstract The ability to...
Negative priming is diminished under high blood pressure in healthy subjectsAbstractThe ability to ignore distracting objects is a core mechanism in selective attention and has been analyzed particularly with respect to its clinical implications (e.g., depression, schizophrenia, or unhealthy life-style). Here, we investigated the correlation between an established experimental task to measure distractor-processing and participants' blood pressure. We used the negative priming (NP) task in which participants...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:03
Strategic cooperation for transnational adaptation: lessons from the economics of climate change mitigation...
Strategic cooperation for transnational adaptation: lessons from the economics of climate change mitigationAbstractThe literature on climate adaptation has so far conceptualized it as a domestic issue, to be governed somewhere between the local and the national scale. By contrast, scholars have shown little interest in exploring the case of cross-boundary adaptation spillovers, where adaptation by one country affects other countries. Two decades of the economic literature on climate mitigation may...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:03
Design of a synthetic miniR1 plasmid and its production by engineered Escherichia coli Abstract A synthetic...
Design of a synthetic miniR1 plasmid and its production by engineered Escherichia coliAbstractA synthetic plasmid consisting of the minimal elements for replication control of the R1 replicon and kanamycin resistance marker, which was named pminiR1, was developed. pminiR1 production was tested at 30 °C under aerobic and microaerobic conditions in Escherichia coli W3110 recA− (W1). The plasmid DNA yields from biomass (YpDNA/X) were only 0.06 ± 0.02 and 0.22 ± 0.11 mg/g under aerobic and microaerobic...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:02
White Matter Lesion Penumbra Shows Abnormalities on Structural and Physiologic MRIs in the Coronary...
White Matter Lesion Penumbra Shows Abnormalities on Structural and Physiologic MRIs in the Coronary Artery Risk Development in Young Adults CohortI.M. Nasrallah, M.-K. Hsieh, G. Erus, H. Battapady, S. Dolui, J.A. Detre, L.J. Launer, D.R. Jacobs, C. Davatzikos and R.N. BryanAJNR Am J Neuroradiol first published on 25 July 2019 doi:10.3174/ajnr.A6119 OPEN ACCESS ARTICLEhttp://www.ajnr.org/content/early/2019/07/25/ajnr.A6119.abstractSignal Hyperintensity on Unenhanced T1-Weighted Brain and Cervical...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:02
Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the World No abstract available...
Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the WorldNo abstract availableResearch HighlightsNo abstract availableB Cell Recruitment Follows Kidney Injury and Maladaptive RepairNo abstract availablePeople in TransplantationNo abstract availableVisual Abstracts (#VisualAbstract): A New Journal Initiative to Disseminate ResearchNo abstract availableOrgans From Executed People Are Not a Source of Scientific DiscoveryNo abstract availablePatient Selection and Ethical Considerations—Justifying...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:01
Does Women's Health Matter? No abstract available Restriction in Pelvis and Trunk Motion in Postpartum...
Does Women's Health Matter?No abstract availableRestriction in Pelvis and Trunk Motion in Postpartum Runners Compared With Pre-pregnancyBackground: Biomechanical changes in gait during pregnancy have been well studied in walking but not in running. Objective: To specifically examine adaptations in running biomechanics pre- to post-pregnancy, especially in the pelvis and trunk. Study Design: Pilot study. Methods: Five regular runners who were pregnant for the first time participated in this study....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
09:00
Vegetarian Diet Patterns and Chronic Disease Risk: What We Know and What We Don't Vegetarianism continues...
Vegetarian Diet Patterns and Chronic Disease Risk: What We Know and What We Don'tVegetarianism continues to increase globally due, in part, to perceived health benefits. Results from observational studies indicate that vegetarian dietary patterns are associated with favorable cardiometabolic risk factor profiles and lower risks of chronic diseases including obesity, diabetes mellitus type 2, cardiovascular disease, and cancer. Aside from avoidance of meat and the compensatory dietary alterations,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:59
Trauma
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled TrialObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention:...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:57
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum,...
Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled TrialObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention:...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:57
Toward Achieving Risk-Appropriate Maternity Care: Maternal Morbidity Prediction No abstract available...
Toward Achieving Risk-Appropriate Maternity Care: Maternal Morbidity PredictionNo abstract availablePredictive Model of Factors Associated With Maternal Intensive Care Unit AdmissionOBJECTIVE: Severe maternal morbidity has increased in the United States over the past two decades by approximately 200%, to 144 cases per 10,000 delivery hospitalizations. There are limited data available to assist in identifying at-risk women before parturition. We sought to evaluate risk factors associated with maternal...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:56
Breast Reconstruction
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and ImplicationsBackground: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:54
Plastic and Reconstructive Surgery
Pediatric/Craniofacial Article: Focus of Live Facebook #PRSJournalClub Q&ASurvival Following Self-inflicted Gunshots to the FaceSpecial Topic Article with an Expert DiscussionThe Use of Emotional Artificial Intelligence in Plastic SurgeryCosmetic Article Featured in the PressAppreciation of Postpartum Changes of the Rectus Muscles in Primary and Re-Do AbdominoplastyHead and Neck Article Featured in a Plastic Surgery Hot Topic VideoFacial Transplantation for an Irreparable Central and Lower Face...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:53
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications...
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and ImplicationsBackground: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:53
Prolyl Tripeptidylpeptidase   Yoshitaka Nakajima, ... Tadashi Yoshimoto, in Handbook of Proteolytic...
Prolyl Tripeptidylpeptidase  Yoshitaka Nakajima, ... Tadashi Yoshimoto, in Handbook of Proteolytic Enzymes (Third Edition), 2013Biological AspectsPorphyromonas gingivalis is a Gram-negative anaerobic bacteriumand is considered to be a major pathogen associated with periodontitis. Since this bacterium is known to be a very poor carbohydrate utilizer and cannot take up free amino acids, it only utilizes short oligopeptides as carbon and energy sources. P. gingivalis produces gingipains R and K, collagenase,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:50
Rheumatoid Arthritis and Infections    Hussein Mahajna, ... Howard Amital, in Infection and Autoimmunity...
Rheumatoid Arthritis and Infections   Hussein Mahajna, ... Howard Amital, in Infection and Autoimmunity (Second Edition), 2015Gingival infection caused by is another that is associated with RA. It is postulated that this microbe causes a citrullination process in human proteins that leads to a cascade causing autoimmunity.26Periodontitis, in which P. gingivalis is a major pathogenic bacterium, has been linked to RA in epidemiological studies, and they share similar genomic and environmental associations....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:49
Karilysin    Jan Potempa, ... Abdulkarim Y. Karim, in Handbook of Proteolytic Enzymes (Third Edition),...
Karilysin   Jan Potempa, ... Abdulkarim Y. Karim, in Handbook of Proteolytic Enzymes (Third Edition), 2013Name and HistoryTannerella forsythia (formerly Bacteroides forsythus), together withand Treponema denticola, are considered to be the major periodontal pathogens [1]. A common feature of these organisms is the production of high levels of proteolytic activity. This activity is considered an important virulence factor contributing to pathological chronic inflammation, which drives tissue damage...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:49

Metallocarboxypeptidase G (Porphyromonas gingivalis)   Yu-Yen Chen, ... Eric C. Reynolds, in Handbook...
Metallocarboxypeptidase G (Porphyromonas gingivalis)  Yu-Yen Chen, ... Eric C. Reynolds, in Handbook of Proteolytic Enzymes (Third Edition), 2013Name and HistoryThe first isolated carboxypeptidase from Porphyromonas gingivaliswas reported in 2002 by two independent research groups. Masuda et al. [1] reported the isolation of 'Arg carboxypeptidase' (RCP) from strain W381, which was resolved by SDS-PAGE into three major bands of 43, 33 and 32 kDa with identical N-terminal amino acid sequences (YEWNAYPTYEAYISMMEEFQTKYPSLXTXS)....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:49
Acute orofacial pain   Yair Sharav, Rafael Benoliel, in Orofacial Pain and Headache, 2008Pathophysiology...
Acute orofacial pain  Yair Sharav, Rafael Benoliel, in Orofacial Pain and Headache, 2008PathophysiologyHigh prevalences of putative periodontal pathogens including Fusobacterium nucleatum, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia and Bacteroides forsythus were found in periodontal abscesses (Herrera et al 2000a).Significant differences in the levels of prostaglandin E2 (PGE2) and LTB4 were found between patients with and without periodontitis. The PGE2 and LTB4 levels...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:48
Phage therapy against Enterococcus faecalis in dental root canals
J Oral Microbiol. 2016; 8: 10.3402/jom.v8.32157.Published online 2016 Sep 16. doi: 10.3402/jom.v8.32157PMCID: PMC5027333PMID: 27640530Leron Khalifa,1 Mor Shlezinger,2 Shaul Beyth,3 Yael Houri-Haddad,2 Shunit Coppenhagen-Glazer,1 Nurit Beyth,2,†and Ronen Hazan1,*†Author information Article notes Copyright and License information Disclaimer1Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel2Department of Prosthodontics, The Hebrew University Hadassah...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:47
Bilateral intermittent nasal obstruction in adolescent rats leads to the growth defects of mandibular...
Bilateral intermittent nasal obstruction in adolescent rats leads to the growth defects of mandibular condyle Publication date: October 2019Source: Archives of Oral Biology, Volume 106Author(s): Xiaoling Wang, Huijun Sun, Yanfei Zhu, Yanmei Tang, Xiaochen Xue, Ping Nie, Min Zhu, Bing WangAbstractObjectiveThis study aimed to evaluate the effects of nasal obstruction on mandibular growth, especially condyle, in adolescent rats and explore the possible mechanism with a focus on mesenchymal stem cells...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:45
Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line,  Kah Yan How,1,* Keang...
Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line, Kah Yan How,1,* Keang Peng Song,2 and Kok Gan Chan1Author information Article notes Copyright and License information Disclaimer1Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia2School of Science, Monash University Sunway Campus, Subang Jaya, MalaysiaEdited by: Laurel L. Lenz, University of Colorado School of Medicine,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:44
Porphyromonas gingivalis lipopolysaccharide promotes T- helper 17 cell differentiation from human CD4+ naïve...
Porphyromonas gingivalis lipopolysaccharide promotes T- helper 17 cell differentiation from human CD4+ naïve T cells via toll-like receptor-2 in vitroPublication date: November 2019Source: Archives of Oral Biology, Volume 107Author(s): Liping Zhang, Li Gao, Chenrong Xu, Xiting Li, Panpan Wang, Chi Zhang, Chuanjiang ZhaoAbstractObjectivesThe persistence of T-helper 17 (Th17) cells has been shown to support chronic inflammation and mediate tissue destruction in periodontitis. However, little is known...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:40
Carabid community stability is enhanced by carabid diversity but reduced by aridity in Chinese steppes...
Carabid community stability is enhanced by carabid diversity but reduced by aridity in Chinese steppesPublication date: August 2019Source: Acta Oecologica, Volume 99Author(s): Noelline Tsafack, Letizia Di Biase, Yingzhong Xie, Xinpu Wang, Simone FattoriniAbstractCarabids (Coleoptera, Carabidae) are an important arthropod component of grassland ecosystems, where they are involved in many important ecosystem services. Grasslands are the most widespread ecosystems in China, where they are under increasing...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:38
Brain tissue segmentation using improved kernelized rough-fuzzy C-means with spatio-contextual information...
Brain tissue segmentation using improved kernelized rough-fuzzy C-means with spatio-contextual information from MRIPublication date: October 2019Source: Magnetic Resonance Imaging, Volume 62Author(s): Anindya Halder, Nur Alom TalukdarAbstractSegmentation of brain tissues from MRI often becomes crucial to properly investigate any region of the brain in order to detect abnormalities. However, the accurate segmentation of the brain tissues is a challenging task as the different tissue regions are usually...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:38
Thoughts and Words
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:37
Health of asylum-seeking immigrants: Providing medical care from a volunteer's perspective No abstract...
Health of asylum-seeking immigrants: Providing medical care from a volunteer's perspectiveNo abstract availableUsing pharmacogenetics in primary carePharmacogenetics offers a way to personalize medication prescribing for patients. Through the use of genetic tests that identify variations in enzymes important to drug metabolism, PAs can have patients' genetic information before prescribing a medication. This may reduce the risks of adverse reactions and lost treatment time when patients are given...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
08:34
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
A comparison of the academic performance and intelligence scores of asthmatic and nonasthmatic primary...A comparison of the academic performance and intelligence scores of asthmatic and nonasthmatic primary school pupils in Enugu State, NigeriaObinna Chukwuebuka NduagubamNigerian Medical Journal 2019 60(1):1-8Background: Children with asthma (subjects), just as their non asthmatic colleagues, are expected to perform optimally academically and with a good intelligent score. A number of activities...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 12:51
Urogynecology
Commentary to: Prospective comparative study on the effects of lidocaine on urodynamic and sensory parameters in bladder-pain syndromeCommentary on: "Does spinal anesthesia lead to postoperative urinary retention in same day urogynecology surgery: a retrospective review"Treatment of subacute rectosigmoid obstruction secondary to uterosacral ligament suspensionThe transition from resident to consultantA live porcine model for robotic sacrocolpopexy trainingAbstractIntroduction and hypothesisRobotic...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 09:18
Clinical Oncology,Pediatric Hematology/Oncology
Maintenance Therapy in Metastatic Solid Tumors: Innovative Strategy or Simple Second-line Treatment?Managing metastatic diseases involves defining the best strategy that is supposed to take into account both efficacy and quality of life. To this end, clinicians use stop and go or maintenance strategies. As a matter of fact, 2 maintenance strategies can be distinguished: continuation maintenance using a drug already present in induction treatment and switch maintenance with a newly introduced drug....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 09:12
Clinical Rheumatology
Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic ReviewObjective To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential. Methods We performed a sensitive search strategy and searched systematically...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 09:04
Clinical Obstetrics and Gynecology
Contributors: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableForeword: Burnout and Resilience in Obstetrics and GynecologyNo abstract availableBurnout in Obstetricians and GynecologistsProfessional burnout threatens all high-functioning professionals and affects not only the individual, but, by extension, the patients they serve. The characteristics that make someone competitive for medical school, residency, or successful in academics or practice, make us particularly vulnerable...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 09:03
Implant Dentistry
Device Legislation...... Now Tread CautiouslyNo abstract availableThe Sinus Bone Graft— Third Edition 2019No abstract availableRidge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue RegenerationObjective: To compare hard-tissue healing after 3 exodontia approaches. Materials and Methods: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 09:00
Dermatologic Surgery
Use of Autologous, Noncultured Melanocyte–Keratinocyte Transplantation in Patients With Stable Genital LeucodermaNo abstract availableA Closure Option for Sinuous Hairline Preservation on the Upper ForeheadNo abstract availableSharp Debulking and Nonbeveled Layers in Mohs Micrographic Surgery, A Video Walkthrough: How We Do ItNo abstract availableVulvar Lichen Sclerosus: Consider Treatment With Heterologous Type I CollagenNo abstract availableEfficacy, Patient-Reported Outcomes, and Safety in Male...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,
Thu Jul 25, 2019 08:55

Trauma

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial
imageObjective: To assess the safety and efficacy of tranexamic acid (TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur. Design: Prospective, randomized controlled trial. Setting: Single Level 1 trauma center. Patients: Forty-seven patients were randomized to the study group, and 46 patients comprised the control group. Intervention: The study group received 15 mg/kg IV TXA before incision and a second identical dose 3 hours after the initial dose. Main Outcome Measurements: Transfusion rates and total blood loss (TBL) [via hemoglobin-dilution method and rates of venous thromboembolic events (VTEs)]. Results: TBL was significantly higher in the control group (TXA = 952 mL, no TXA = 1325 mL, P = 0.028). The total transfusion rates between the TXA and control groups were not significantly different (TXA 1.51, no TXA = 1.17, P = 0.41). There were no significant differences between the TXA and control groups in inpatient VTE events (P = 0.57). Conclusion: The use of TXA in high-energy fractures of the pelvis, acetabulum, and femur significantly decreased calculated TBL but did not decrease overall transfusion rates. TXA did not increase the rate of VTE. Further study is warranted before making broad recommendations for the use of TXA in these fractures. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity
imageObjectives: To evaluate the reliability, convergent validity, known-groups validity, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Computer Adaptive Test (CAT) and PROMIS Physical Function 8a Short Form. Design: Prospective cohort study. Setting: Two Level-I trauma centers. Patients: Eligible adults with an isolated lower extremity trauma injury receiving treatment were approached consecutively (n = 402 consented at time 1, median = 80 days after treatment). After 6 months, 122 (30.3%) completed another assessment. Intervention: Cross-sectional and longitudinal monitoring of patients. Main Outcome Measurements: Floor and ceiling effects, reliability (marginal reliability and Cronbach's alpha), convergent validity, known-groups discriminant validity (weight-bearing status and fracture severity), and responsiveness (Cohen's d effect size) were evaluated for the PROMIS Mobility CAT, PROMIS Physical Function 8a Short Form, and 5 other measures of physical function. Results: PROMIS PFSF8a and Foot and Ankle Ability Measure Activities of Daily Living Index had ceiling effects. Both PROMIS measures demonstrated excellent internal consistency reliability (mean marginal reliability 0.94 and 0.96; Cronbach's alpha = 0.96). Convergent validity was supported by high correlations with other measures of physical function (r = 0.70–0.87). Known-groups validity by weight-bearing status and fracture severity was supported as was responsiveness (Mobility CAT effect size = 0.81; Physical Function Short Form 8a = 0.88). Conclusions: The PROMIS Mobility CAT and Physical Function 8a Short Form demonstrated reliability, convergent and known-groups discriminant validity, and responsiveness in a sample of patients with a lower extremity orthopaedic trauma injury.

A Randomized Controlled Trial Comparing rhBMP-2/Absorbable Collagen Sponge Versus Autograft for the Treatment of Tibia Fractures With Critical Size Defects
imageObjectives: To compare radiographic union of tibia fractures with bone defects treated with recombinant bone morphogenetic protein‐2 (rhBMP‐2) with allograft to autogenous iliac crest bone graft (ICBG). Design: FDA-regulated multicenter randomized trial. Setting: Sixteen US trauma centers. Patients/Participants: Thirty patients (18–65 years of age) with Type II, IIIA, or IIIB open tibia fracture and bone defect treated with an intramedullary nail. Intervention: rhBMP-2 (n = 16) versus ICBG (n = 14). Main Outcome Measurements: Radiographic union within 52 weeks. Secondary outcomes included clinical healing, patient-reported function, major complications, and treatment cost. Equivalence was evaluated by testing whether a 90% two‐sided confidence interval for the difference in the probability of radiographic union between rhBMP‐2 or ICBG is contained with the interval [220% to +20%]. A post hoc Bayesian analysis, using data from a previous trial, was also conducted. Results: Twenty-three patients had union data at 52 weeks: 7/12 (58.3%) rhBMP-2 were radiographically united compared with 9/11 (81.8%) ICBG, resulting in a treatment difference of −0.23 (90% CI: −0.55 to 0.10). Patients treated with rhBMP-2 had lower rates of clinical healing at 52 weeks (27% vs. 54%), higher mean Short Musculoskeletal Function Assessment scores (dysfunction: 33.3 vs. 23.7; bother score: 32.8 vs. 21.4) and experienced more complications (5 vs. 3). Mean treatment cost for rhBMP-2 was estimated at $14,155 versus $9086 for ICBG. Conclusions: These data do not provide sufficient evidence to conclude that ICBG and rhBMP-2 are equivalent regarding radiographic union. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?
imageObjectives: To determine whether immediate weightbearing after intramedullary (IM) fixation of extra-articular distal tibial fractures (OTA/AO 43-A) results in a change in alignment before healing. Design: Retrospective review. Setting: Level 1 trauma center. Intervention: IM nailing of distal tibial fractures. Patients/Participants: Fifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 43-A1, 20 OTA/AO 43-A2, and 16 OTA/AO 43-A3; 20 fractures were open. Main Outcome Measurements: Change in fracture alignment or loss of position. Results: Average change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment; and 2 fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap coverage and 4 required staged grafting because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement without implant revision, and 2 for aseptic nonunion). No patient had revision for implant failure. Conclusions: Immediate weightbearing after IM fixation of extra-articular distal tibial fractures (OTA/AO 43-A) led to minimal change in alignment and seems to be safe for most patients. Complications were consistent with those reported in previous non-weightbearing cohorts. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries
imageObjectives: To evaluate the relationship between syndesmosis reduction and outcome. Design: Retrospective cohort study. Setting: One Level 1 and 1 Level 3 Trauma Center. Patients: Ninety-seven patients with syndesmosis injury. Intervention: Stabilization of syndesmosis injury. Open reduction and internal fixation of malleolar fracture, if present. Main Outcome Measurements: Anterior, central, and posterior measures of syndesmosis width on computed tomography scans, Olerud–Molander Ankle score, American Orthopaedic Foot and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, and range of motion measurements. Results: Eighty-seven patients completed 2 years of follow-up. The difference in anterior tibiofibular distance (aTFD) between the injured and noninjured ankle postoperatively had a significant effect on the Olerud-Molander Ankle score after 6 weeks [b = −2.6, 95% confidence interval (CI), −4.8 to −0.4; P = 0.02], 1 year (b = −2.7, 95% CI, −4.7 to −0.8; P < 0.001), and 2 years (b = −2.6, 95% CI, −4.6 to −0.6; P = 0.009) and on American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score after 6 weeks (b = −2.2, 95% CI, −3.7 to −0.7; P = 0.004), 1 year (b = −1.7, 95% CI, −3.0 to −0.4; P = 0.04), and 2 years (b = −1.9, 95% CI, −3.2 to −0.5; P = 0.006). The effect of computed tomography measurements on range of motion was inconsistent. Receiver operating characteristic (ROC) curves demonstrated that aTFD had adequate discriminatory performance (area under the ROC curve ≥ 0.7) 1 and 2 years after surgery and the central measurement at only 2 years after surgery. ROC analyses indicate a cutoff value for syndesmosis malreduction of 2 mm. The postoperative rate of malreduction was 32%. Conclusions: The aTFD correlated with clinical outcome. A 2-mm difference in aTFD seems to predict poorer clinical outcome. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Quantification of Postoperative Posterior Malleolar Fragment Reduction Using 3-Dimensional Computed Tomography (Q3DCT) Determines Outcome in a Prospective Pilot Study of Patients With Rotational Type Ankle Fractures
imageObjective: To correlate Q3DCT measurements of residual step-off, gap, and 3D multidirectional displacement of postoperative posterior malleolar fracture fragment reduction in patients with rotational type ankle fractures, with patients' clinical outcome using standardized patient- and physician-based outcome measures. Design: Prospective cohort study. Setting: Level-I Trauma Center. Patients: Thirty-one patients with ankle fractures including a posterior malleolar fracture (OTA/AO type 44) were included. Intervention: All patients underwent open reduction internal fixation of their ankle fracture, of which 18 patients (58%) had direct fixation of the posterior malleolar fragment. Decision of (direct) fixation of the posterior malleolar fragment was not standardized and guided by surgeons' preference. Main Outcome Measurements: Quality of postoperative reduction was quantified using Q3DCT: posterior fragment size (% of joint surface), residual step-off (mm), postoperative gaps (mm2), and overall multidirectional displacement were quantified. Foot and Ankle Outcome Score pain and symptoms subscales and quality of life (Short Form-36) at 1 year postoperatively were included as the main outcome measures. Results: Step-off (mean 0.6 mm, range 0.0–2.7, SD 0.8) showed a significant correlation with worse Foot and Ankle Outcome Score pain and symptoms subscales. Residual fracture gap (mean 12.6 mm2, range 0.0–68.8, SD 19.5) and 3D multidirectional displacement (mean 0.96 mm, range 0.0–2.8, SD 0.8) showed no correlation. Conclusions: In patients with rotational type ankle fractures involving a posterior malleolar fracture, contemporary Q3DCT measurements of posterior fragment size and residual intra-articular step-off—but not gap—show significant correlation with patient-reported pain and symptoms. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical Analysis of Instability in Rotational Distal Fibula Fractures (OTA/AO 44-B1) With an Intact Deltoid Ligament
imageObjectives: To biomechanically analyze instability in supination external rotation (SER) II/III patterns. Methods: Nineteen cadaver legs were tested in a mechanical jig. One, 2, 3, and 4 Nm of external rotation were applied to intact ankles, SER II injuries, and SER III injuries. The talar position relative to the tibia was recorded using 3D motion tracking. Change from the unloaded state in each condition and the torque level was calculated. Results were analyzed using analysis of variance with post hoc paired t tests. Results: SER II showed statistically significant differences from the intact state with coronal translation (2, 3, and 4 Nm), sagittal translation (1 and 2 Nm), axial rotation (1, 2, 3, and 4 Nm), and coronal rotation (3 and 4 Nm). SER III showed statistically significant differences from the intact state with coronal translation (2, 3, and 4 Nm), sagittal translation (1, 2, and 3 Nm), axial rotation (1, 2, 3, and 4 Nm), and coronal rotation (3 and 4 Nm). SER II and SER III differed significantly from each other with coronal translation (1, 2, and 3 Nm), axial rotation (2, 3, and 4 Nm), and coronal rotation (1, 3, and 4 Nm). Conclusion: Instability in SER injuries has only been described with coronal translation and suggests that deltoid rupture is necessary. Our data demonstrate instability in SER II/III in sagittal translation and axial rotation as well as subtle instability in coronal translation. The clinical impact is unclear, but better understanding of long-term sequelae of this instability is needed.

Hook Plate Fixation for Acute Unstable Distal Clavicle Fracture: A Systematic Review and Meta-analysis
imageObjectives: To compare the outcome of hook plate fixation with other techniques in surgical fixation of acute unstable distal clavicle fractures. Data Sources: In July 2018, a systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane databases for systematic reviews) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles were limited to English language. Study Selection: Studies were included if they compared the results of hook plate fixation of acute unstable distal clavicle fracture in adults with other surgical techniques. Data Extraction: Data on the study setting, functional outcome, union, and complication rates were extracted. A quality assessment was performed using the Newcastle–Ottawa Scale. Data Synthesis: Eleven studies were found that met the inclusion criteria. Six hundred thirty-four patients were pooled using a random effects model. There were 397 male and 237 female patients. Primary outcome measure was functional result, and the secondary outcome measures were union and complication rates. There was no significant difference between the functional outcome and union rate between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Hook plate fixation resulted in a higher Constant–Murley score compared with tension band wiring (TBW) [odds ratio (OR), 3.52; 95% confidence interval (CI), 0.79–6.26]. It was also associated with a higher complication rate compared with CC stabilization (OR, 3.68; 95% CI, 1.19–11.33) and the locking plate (OR, 5.19; 95% CI, 1.58–17.06). Compared with TBW, hook plate fixation was associated with a lower complication rate (OR, 0.28; 95% CI, 0.10–0.77). Conclusions: Hook plate fixation achieves a similar functional outcome and union rate compared with CC stabilization and locking plate fixation. However, it has a superior functional result compared with TBW. The complication rate is higher compared with CC stabilization and locking plate fixation and is lower compared with TBW. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons
imageObjectives: In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI. Methods: An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making. Results: Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient. Conclusions: There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes. Level of Evidence: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Delaying Surgery in Type III Supracondylar Humerus Fractures Does Not Lead to Longer Surgical Times or More Difficult Reduction
imageObjective: To determine if delay in surgical treatment of type III supracondylar humerus fracture would affect the length of operative time. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients/Participants: This is a series of 309 modified Gartland type III supracondylar fractures treated operatively from 2011 to 2013. Intervention: Fifteen hours was defined as the cutoff between early and delayed treatment. A total of 53.7% (166/309) fractures were treated early, and 46.4% (143/309) were delayed. Main Outcome Measurements: Surgical time was defined as "incision start" to "incision close." Fluoroscopy time was used as a surrogate for difficulty of reduction. Results: Time from injury to operating room was shorter for high-energy fractures (fractures with soft-tissue or neurovascular injury) versus low-energy fractures (12.9 vs. 15.3 hours, P < 0.0001); however, surgical time (37.3 vs. 31.8 minutes, P = 0.004) and fluoroscopy time (54.6 vs. 48.6 seconds, P = 0.027) were longer in high-energy fractures versus low-energy fractures. Among low-energy fractures, no significant difference was detected in the surgical time between the early and delayed treatment groups or in the fluoroscopy time. In addition, there was no statistically significant difference found in the surgical or fluoroscopy time with the presence of a surgical assistant. Conclusions: Delay in surgery did not result in a longer surgical time or more difficult reduction for type III supracondylar humerus fracture. Patients with low-energy fractures still underwent a shorter operative time even with delay from injury to surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial
Clay A. Spitler, Elliot R. Row, Warren E. Gardner, II, Rachel E. Swafford, Michael J. Hankins, Peter J. Nowotarski, Dirk W. Kiner

Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity
Nan E. Rothrock, Aaron J. Kaat, Mark S. Vrahas, Robert V. O'Toole, Sarah K. Buono, Suzanne Morrison, Richard C. Gershon

Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?
Michael J. Beebe, Michael Morwood, Rafael Serrano, Jonathan H. Quade, Darryl A. Auston, David T. Watson, Roy W. Sanders, Hassan R. Mir

Importance of Syndesmotic Reduction on Clinical Outcome After Syndesmosis Injuries
Mette R. Andersen, Lien M. Diep, Frede Frihagen, Johan Castberg Hellund, Jan E. Madsen, Wender Figved

Quantification of Postoperative Posterior Malleolar Fragment Reduction Using 3-Dimensional Computed Tomography (Q3DCT) Determines Outcome in a Prospective Pilot Study of Patients With Rotational Type Ankle Fractures
Diederik T. Meijer, Robert-Jan O. de Muinck Keizer, Sjoerd A. S. Stufkens, Tim Schepers, Inger N. Sierevelt, Gino M. M. J. Kerkhoffs, J. Carel Goslings, Job N. Doornberg

Biomechanical Analysis of Instability in Rotational Distal Fibula Fractures (OTA/AO 44-B1) With an Intact Deltoid Ligament
Eric Hempen, Bennet Butler, Mauricio Barbosa, Muturi Muriuki, Robert Havey, Anish Kadakia

Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment
Amy K. Fenoglio, Andrew R. Stephens, Chong Zhang, Angela P. Presson, Andrew R. Tyser, Nikolas H. Kazmers

Radiographic Evaluation of Bone Remodeling Around Osseointegration Implants Among Transfemoral Amputees
Seamus Thomson, Alasdair Thomson, Kevin Tetsworth, William Lu, Hala Zreiqat, Munjed Al Muderis



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Plastic and Reconstructive Surgery

Pediatric/Craniofacial Article: Focus of Live Facebook #PRSJournalClub Q&A

Special Topic Article with an Expert Discussion

Cosmetic Article Featured in the Press

Head and Neck Article Featured in a Plastic Surgery Hot Topic Video

Hand/Peripheral Nerve Article

Breast Patient Safety Article
Survival and Disease Recurrence Rates Among Breast Cancer Patients Following Mastectomy with or without Breast Reconstruction

Monthly CME Article


Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications
imageBackground: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process. Methods: A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting. Results: From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years. Conclusions: Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement
imageBackground: The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction offers expedited tissue expansion without affecting complication rates. Methods: Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05. Results: In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393). Conclusion: This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Discussion: Reducing Expansion Visits in Immediate Implant-Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement
No abstract available

Increases in Postmastectomy Reconstruction in New York State Are Not Related to Changes in State Law
imageBackground: Postmastectomy reconstruction remains underused. In 2011, new legislation in New York State mandated discussion of reconstructive options before mastectomy. This study assesses the impact of this policy on immediate breast reconstruction rates. Methods: The Statewide Planning and Research Cooperative System database was queried to identify women undergoing mastectomy from January of 2005 to October of 2015 and follow them for at least 1 year postoperatively to determine the incidence and timing of reconstruction. Demographic and socioeconomic characteristics were collected. Chi-square test and multivariable logistic regression were used to compare periods before (2005 to 2010) and after (2011 to 2015) the legislative change. Results: Of 52,837 records, there were 24,340 patients (46 percent) who underwent immediate breast reconstruction. The incidence of immediate breast reconstruction increased over the study period, most significantly in 2008 to 2009. Rates of immediate breast reconstruction continued to increase, although at a slower rate, after 2011 compared with before 2011 across all subgroups. Both implant and autologous reconstructive techniques increased over time. Implant-based reconstruction increased steadily, whereas autologous reconstruction increased most significantly between 2008 and 2009. Conclusions: Despite an overall increase in immediate breast reconstruction, there was an overall lack of effect on post-2011 reconstructive rates attributable to the legislative changes. Reconstructive rates have increased significantly in New York State over the past decade, and these changes appear to be largely independent of the 2011 New York State Breast Reconstruction Act. There are likely nonlegislative drivers of breast reconstruction use.

Discussion: Increases in Postmastectomy Reconstruction in New York State Are Not Related to Changes in State Law
No abstract available

Survival and Disease Recurrence Rates among Breast Cancer Patients following Mastectomy with or without Breast Reconstruction
imageBackground: Concerns have been expressed about the oncologic safety of breast reconstruction following mastectomy for breast cancer. This study aimed to evaluate the association of breast reconstruction with breast cancer recurrence, and 5-year survival among breast cancer patients. Methods: The authors analyzed data from The Johns Hopkins Hospital comprehensive cancer registry, comparing mastectomy-only to postmastectomy breast reconstruction in breast cancer patients to evaluate differences in breast cancer recurrence and 5-year survival. Kaplan-Meier curves were used to compare unadjusted estimates of survival or disease recurrence. Data were modeled through Cox proportional hazards regression, using as outcomes time to death from any cause or time to cancer recurrence. Results: The authors analyzed data on 1517 women who underwent mastectomy for breast cancer at The Johns Hopkins hospital between 2003 and 2015. Of these, 504 (33.2 percent) underwent mastectomy only and 1013 (66.8 percent) underwent mastectomy plus immediate breast reconstruction. Women were followed up for a median of 5.1 years after diagnosis. There were 132 deaths and 100 breast cancer recurrences. A comparison of Kaplan-Meier survival estimates demonstrated a survival benefit among patients undergoing mastectomy plus reconstruction. After adjusting for various clinical and socioeconomic variables, there was still an overall survival benefit associated with breast reconstruction which, however, was not statistically significant (hazard ratio, 0.78; 95 percent CI, 0.53 to 1.13). Patients who underwent reconstruction had a similar rate of recurrence compared to mastectomy-only patients (hazard ratio, 1.08; 95 percent CI, 0.69 to 1.69). Conclusion: This study suggests that breast reconstruction does not have a negative impact on either overall survival or breast cancer recurrence rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A Quantitative Analysis of Animation Deformity in Prosthetic Breast Reconstruction
imageBackground: Animation deformity is characterized by implant deformity with pectoralis contraction after subpectoral implant-based breast reconstruction. Extant methods to measure and analyze animation deformity are hampered by the paucity of objective, quantitative data. The authors endeavored to supplement subjective measures with an in-depth quantitative analysis. Methods: Patients undergoing subpectoral implant-based breast reconstruction were followed prospectively with video analysis of animation deformity. Nipple displacement and surface area of contour deformity in resting and contracted states were quantified using imaging software. Degree of animation was compared to breast size, body mass index, division of pectoralis muscle, complications, and radiation therapy. Results: One hundred forty-five reconstructed breasts (88 patients) were analyzed. Mean nipple displacement was 2.12 ± 1.04 cm, mean vector of nipple displacement was 62.5 ± 20.6 degrees, and mean area of skin contour irregularity was 16.4 ± 15.41 percent. Intraoperative pectoralis division, smooth/round implants, and bilateral reconstructions were associated with greater deformity. A three-tiered grading system based on thresholds of 2-cm net nipple displacement and 25 percent skin contour irregularity placed 41.4 percent of breasts in grade 1, 35.9 percent in grade 2, and 22.8 percent in grade 3. Interrater variability testing demonstrated 89.5 percent overall agreement (kappa = 0.84). Conclusions: This study presents the first quantitative analysis of animation deformity in prosthetic breast reconstruction. Geometric analysis of nipple displacement vector and increasing animation with pectoralis division both implicate the inferior pectoralis myotome as a primary driver of animation deformity. A concomitant grading schema was developed to provide a standardized framework for discussing animation from patient to patient and from study to study.

Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction
imageBackground: The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction. Methods: A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin. Results: A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, −1.2; p < 0.001), which indicated that sensory recovery of the breast was significantly better in innervated compared with noninnervated DIEP flaps. For every month of follow-up, the mean monofilament value decreased by 0.083 in innervated flaps (p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve coaptation significantly improved sensation in both immediate and delayed reconstructions. Conclusions: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.

Patterns and Correlates of Knowledge, Communication, and Receipt of Breast Reconstruction in a Modern Population-Based Cohort of Patients with Breast Cancer
imageBackground: Disparities persist in the receipt of breast reconstruction after mastectomy, and little is known about the nature of communication received by patients and potential variations that may exist. Methods: Women with early-stage breast cancer (stages 0 to II) diagnosed between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries and surveyed to collect additional data on demographics, treatment, and decision-making experiences. Treating general/oncologic surgeons were also surveyed. Primary outcomes measures included self-reported communication-related measures on receipt of information on breast reconstruction and on the receipt of breast reconstruction. Results: The authors analyzed 936 women who underwent mastectomy for unilateral breast cancer. Four hundred eighty-four (51.7 percent) underwent mastectomy with reconstruction. Women who were older and for whom English was not their primary spoken language had lower odds of being informed by a doctor about breast reconstruction. Ultimately, women who were older, were Asian, had invasive disease, had bronchitis/emphysema, and had lower income were less likely to undergo breast reconstruction. Breast reconstruction was performed more often in patients undergoing bilateral mastectomies (OR, 3.27; 95 percent CI, 2.26 to 4.75). Women cared for by surgeons with higher volumes of breast cancer patients (≥51 patients per year) were more likely to undergo breast reconstruction (OR, 2.43; 95 percent CI, 1.40 to 4.20). Conclusion: To eliminate existing disparities, increased efforts should be made in consultations for surgical management of breast cancer to provide information to all patients regarding the option of breast reconstruction, the possibility of immediate reconstruction, and insurance coverage of all stages of reconstruction.

Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model
imageBackground: Retrobulbar injection of hyaluronidase is a proposed but unproven treatment for blindness induced by hyaluronic acid gel fillers. This study examines the viability of this treatment by determining whether hyaluronidase can diffuse through the dural sheath of the optic nerve to clear a filler-mediated occlusion of the central retinal artery. Methods: Six human cadaveric optic nerves were studied in vitro. One optic nerve was selected as a control and maintained at physiologic temperature, without any exposure to hyaluronic acid gel or hyaluronidase. Another optic nerve was randomly selected to simulate the filler-induced central retinal artery occlusion with subsequent retrobulbar hyaluronidase injection. To simulate a central retinal artery occlusion, this experimental nerve and additional controls were injected with hyaluronic acid gel. These hyaluronic acid gel–injected nerves were then either injected directly with hyaluronidase to establish a control for intraneural hyaluronidase exposure, or immersed in undiluted hyaluronidase to simulate retrobulbar hyaluronidase injection. To control for passive diffusion of hyaluronic acid gel from neural parenchyma, one nerve was immersed in saline. Following fixation, the nerves were grossly and microscopically assessed for the quantity and distribution of hyaluronic acid. Results: Intact hyaluronic acid gel was observed grossly and microscopically in the control optic nerves injected directly with filler and not with hyaluronidase. The control optic nerve injected with intraneural hyaluronidase exhibited partial digestion of the filler. Immersion in undiluted hyaluronidase led to no apparent gross or microscopic digestion of injected intraneural hyaluronic acid gel. Conclusion: Hyaluronidase does not demonstrate the ability to cross the dural sheath of the optic nerve, suggesting that retrobulbar hyaluronidase injection is unlikely to alleviate hyaluronic acid gel–mediated central retinal artery occlusion and blindness.


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480