Dual Plate Minifragment Fixation of Clavicle Fractures- Technique and Approach.

The treatment of midshaft clavicle fractures continues to evolve, with a variety of fixation techniques and constructs used. Symptomatic hardware is a common complication related to plate fixation of the clavicle, and often results in secondary surgery for implant removal. The minifragment dual plate fixation technique for clavicle fractures provides a construct that may result in fewer implant related complications with comparable fixation stability to precontoured locking plates.

Variation in practice for preoperative antibiotic prophylaxis: a survey from an academic tertiary referral center in the United States.

Background: Antibiotic surgical prophylaxis is a core strategy for prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. This study was designed to determine the individual perspectives of perioperative providers at an academic tertiary referral center regarding their knowledge of preoperative antibiotic choice, dosing, and timing.

Juvenile psammomatoid ossifying fibroma of the calcaneus.

Juvenile ossifying fibromas (JOFs) are a rare group of fibro-osseous lesions, typically of odontogenic origin. Juvenile psammomatoid ossifying fibroma (JPOF) is one variant, that is, histopathologically distinguished by spherical ossicles resembling psammoma bodies. JPOF tumours are most commonly found in craniofacial skeletal structures and can be locally aggressive.

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification.

The surgical excision of heterotopic ossification can provide improved function for patients; however, complications can include damage to nearby vessels and nerves, blood loss and recurrence. In the preoperative planning for excision, our case report describes the combination of CT angiography, preoperative embolisation of involved vascular structures and the use of intraoperative vascular surgery for dissection around key structures to aid in the reduction of morbidity in these patients.

Group B streptococcus septic arthritis of the hip following spontaneous abortion.

Group B streptococcus (GBS) infection of the hip in otherwise healthy adults is a rare entity that is previously only reported following peripartum gynaecological procedure and instrumentation. We report a case of infection of the hip with GBS following spontaneous abortion. Delay in identification of infection as the cause of pain ultimately leads to irreversible joint destruction.

Septic Arthritis of the Wrist: Incidence, Risk Factors, and Predictors of Infection.

Septic arthritis of the wrist can result in permanent damage to the joint, making timely diagnosis crucial to initiate empiric antibiotics and surgical intervention. Although septic arthritis is routinely included in the differential diagnosis of atraumatic wrist pain, the incidence is unknown. Unlike large joints, there is no consensus on cell count values considered pathognomonic for wrist septic arthritis.

Insulin Regulates Hepatic Triglyceride Secretion and Lipid Content via Signaling in the Brain.

Hepatic steatosis is common in obesity and insulin resistance and results from a net retention of lipids in the liver. A key mechanism to prevent steatosis is to increase secretion of triglycerides (TG) packaged as VLDLs. Insulin controls nutrient partitioning via signaling through its cognate receptor in peripheral target organs such as liver, muscle, and adipose tissue and via signaling in the central nervous system (CNS) to orchestrate organ cross talk.

Brain insulin lowers circulating BCAA levels by inducing hepatic BCAA catabolism.

Circulating branched-chain amino acid (BCAA) levels are elevated in obesity/diabetes and are a sensitive predictor for type 2 diabetes. Here we show in rats that insulin dose-dependently lowers plasma BCAA levels through induction of hepatic protein expression and activity of branched-chain α-keto acid dehydrogenase (BCKDH), the rate-limiting enzyme in the BCAA degradation pathway. Selective induction of hypothalamic insulin signaling in rats and genetic modulation of brain insulin receptors in mice demonstrate that brain insulin signaling is a major regulator of BCAA metabolism by inducing hepatic BCKDH.

Binge drinking induces whole-body insulin resistance by impairing hypothalamic insulin action.

Individuals with a history of binge drinking have an increased risk of developing the metabolic syndrome and type 2 diabetes. Whether binge drinking impairs glucose homeostasis and insulin action is unknown. To test this, we treated Sprague-Dawley rats daily with alcohol (3 g/kg) for three consecutive days to simulate human binge drinking and found that these rats developed and exhibited insulin resistance even after blood alcohol concentrations had become undetectable.

Short term voluntary overfeeding disrupts brain insulin control of adipose tissue lipolysis.

Insulin controls fatty acid (FA) release from white adipose tissue (WAT) through direct effects on adipocytes and indirectly through hypothalamic signaling by reducing sympathetic nervous system outflow to WAT. Uncontrolled FA release from WAT promotes lipotoxicity, which is characterized by inflammation and insulin resistance that leads to and worsens type 2 diabetes. Here we tested whether early diet-induced insulin resistance impairs the ability of hypothalamic insulin to regulate WAT lipolysis and thus contributes to adipose tissue dysfunction.

Central endocannabinoid signaling regulates hepatic glucose production and systemic lipolysis.

Objective: The endocannabinoid (EC) system has been implicated as an important regulator of energy homeostasis. In obesity and type 2 diabetes, EC tone is elevated in peripheral tissues including liver, muscle, fat, and also centrally, particularly in the hypothalamus. Cannabinoid receptor type 1 (CB₁) blockade with the centrally and peripherally acting rimonabant induces weight loss and improves glucose homeostasis while also causing psychiatric adverse effects.

Brain insulin controls adipose tissue lipolysis and lipogenesis.

White adipose tissue (WAT) dysfunction plays a key role in the pathogenesis of type 2 diabetes (DM2). Unrestrained WAT lipolysis results in increased fatty acid release, leading to insulin resistance and lipotoxicity, while impaired de novo lipogenesis in WAT decreases the synthesis of insulin-sensitizing fatty acid species like palmitoleate. Here, we show that insulin infused into the mediobasal hypothalamus (MBH) of Sprague-Dawley rats increases WAT lipogenic protein expression, inactivates hormone-sensitive lipase (Hsl), and suppresses lipolysis.