Long-term evaluation of combined prosthetic-surgical approach and soft tissue augmentation in the esthetic zone.

Background: There is no standard protocol for immediate implant placement and subsequent loading in the smile zone. We aimed to evaluate the long-term outcomes of simultaneous implant placement, soft tissue grafting, and immediate prosthetic loading in the esthetic zone.

Methods: Thirty-five implants were placed in the maxillary aesthetic zone.

The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction.

Background: A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprosthesis is relatively unclear.

Worse Outcomes Are Associated With Proximal Femoral Replacement Following Periprosthetic Joint Infection.

Background: Proximal femoral replacements (PFRs) are often used in the setting of severe bone loss. As osteolysis has become less common, PFR may be used to address other causes of bone loss such as infection or periprosthetic fracture. The aim of this study is to investigate the clinical outcomes of PFR for non-neoplastic conditions.

How to Organize Affordable Microsurgical Training Laboratory: Optimal Price-quality Solution.

Today, microsurgery is an integral part of plastic surgery, maxillofacial surgery, hand surgery, and neurosurgery. More and more surgical procedures are accompanied by microsurgical intervention. Long training is required to develop the necessary skills for fine work with microsurgical instruments and delicate tissues under magnification.

Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis.

Background: Distal femoral replacement (DFR) is commonly used to manage massive bone loss around the knee arising from aseptic loosening, periprosthetic joint infection (PJI), and distal femoral fractures. A number of studies report the outcome of DFR with considerable variation in long-term survivorship. This study investigated the outcome of DFR for patients with aseptic failures, fractures, and PJI.

Stroke Code From EMS to Thrombectomy: An Interdisciplinary In Situ Simulation for Prompt Management of Acute Ischemic Stroke.

Introduction: Treatment of acute ischemic stroke is challenging because it requires prompt management, interdisciplinary collaboration, and adherence to specific guidelines. This resource addresses these challenges by providing in situ simulated practice with stroke codes by practicing clinicians at unannounced times.

Methods: An emergency department team was presented with a 55-year-old simulated patient with speech difficulty and right-sided weakness.

3D-Volume Rendering of the Pelvis with Emphasis on Paraurethral Structures Based on MRI Scans and Comparisons between 3D Slicer and OsiriX®.

The feasibility of rendering three dimensional (3D) pelvic models of vaginal, urethral and paraurethral lesions from 2D MRI has been demonstrated previously. To quantitatively compare 3D models using two different image processing applications: 3D Slicer and OsiriX. Secondary analysis and processing of five MRI scan based image sets from female patients aged 29-43 years old with vaginal or paraurethral lesions.

Substantial Preoperative Work Is Unaccounted for in Total Hip and Knee Arthroplasty.

Background: The Centers for Medicare and Medicaid Services has recently designated the codes for total hip and knee arthroplasty as misvalued and has asked the Relative Value Scale Update Committee (RUC) to review the work required to perform these procedures. Although other studies have reported time spent on perioperative and postoperative care, time spent on coordinating and performing preoperative care is not included in current RUC methodology and has yet to be addressed in literature.

Methods: We prospectively tracked a consecutive series of 438 primary total hip arthroplasty and total knee arthroplasty patients by one of the 5 surgeons over a 3-month period.

Quantifying the Perioperative Work Associated With Total Hip and Knee Arthroplasty: The Burden Has Increased With Contemporary Care Pathways.

Background: Recently, the Centers for Medicare and Medicaid Services (CMS) has labeled the procedural codes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) as potentially misvalued and has asked the American Medical Association (AMA) and its Relative Value Scale Update Committee (RUC) to review this. To assess the validity of this claim, we aimed to catalog the specific service tasks and duration of time required for each task associated with the perioperative care of the patient who underwent primary THA and TKA.

Methods: We prospectively timed preservice and immediate postservice activities performed outside of the operating room (OR) by 7 arthroplasty surgeons over a four-week period.

Correction: Correction to 'Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department' [Annals of Emergency Medicine 66 (2015) 322-333.e31].

Due to a miscommunication during the process of transferring this manuscript from our editorial team to Production, the Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee) were not properly indexed in PubMed. This has now been corrected online. The publisher would like to apologize for any inconvenience caused.

Three-dimensional volume rendering of pelvic models and paraurethral masses based on MRI cross-sectional images.

Aims: Our aim was to assess the feasibility of rendering 3D pelvic models using magnetic resonance imaging (MRI) scans of patients with vaginal, urethral and paraurethral lesions and obtain additional information previously unavailable through 2D imaging modalities.

Methods: A purposive sample of five female patients 26-40 years old undergoing investigations for vaginal or paraurethral mass was obtained in a tertiary teaching hospital. 3D volume renderings of the bladder, urethra and paraurethral masses were constructed using 3D-Slicer v.

Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study.

Background: The Veterans Health Administration (VA) Women's Health Practice-Based Research Network (WH-PBRN) was created to foster innovations for the health care of women veterans. The inaugural study by the WH-PBRN was designed to identify women veterans' own priorities and preferences for mental health services and to inform refinements to WH-PBRN operational procedures. Addressing the latter, this article reports lessons learned from the inaugural study.

[Use of bone blocks by sinus floor lifting].

The paper presents clinical cases illustrating two sinus floor lifting technique performed for dental implant placement in areas with maxillary sinus floor atrophy: bone block fixation for vertical augmentation (used for immediate implant placement by sinus floor atrophy to 1 mm thickness) and perforation closure. Sinus floor perforations wider than 5 mm were repaired by mandible bone graft providing the possibility of immediate implantation. Bone block was fixed between cortical layers of the maxilla with no internal fixation.

Posttraumatic stress disorder, substance use disorders, and medical comorbidity among returning U.S. veterans.

Evidence suggests that posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with poorer physical health among U.S. veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).

[Reconstruction techniques preparing jaws for fixed dentures placement].

Dental implantation is a widespread method of dental arch reconstruction. Alveolar bone quantity in implantation area is crucial for proper implant placement. The paper presents author's experience in alveolar bone reconstruction with mandibular autografts, bone height reconstruction with parietal partial thickness grafts, as well as jaw defects reconstruction with microvascular flaps with subsequent implantation.

Management of a pelvic mass following a worn uncemented total hip arthroplasty.

Intrapelvic granulomatous masses from polyethylene wear debris can easily be misdiagnosed if orthopaedic etiology is not considered. This article presents the case of a 50 year old woman with history of hip joint trauma and total hip arthroplasty (THA) revisions who presented to her gynecologist with a large intrapelvic cyst. Prolonged use of an indwelling drain and failure to recognize the orthopaedic origin of the mass resulted in articular infection that required an antibiotic spacer and subsequent THA revision.

Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma.

This clinical policy from the American College of Emergency Physicians is an update of the 2004 clinical policy on the critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. A writing subcommittee reviewed the literature as part of the process to develop evidence-based recommendations to address 4 key critical questions: (1) In a hemodynamically unstable patient with blunt abdominal trauma, is ultrasound the diagnostic modality of choice? (2) Does oral contrast improve the diagnostic performance of computed tomography (CT) in blunt abdominal trauma? (3) In a clinically stable patient with isolated blunt abdominal trauma, is it safe to discharge the patient after a negative abdominal CT scan result? (4) In patients with isolated blunt abdominal trauma, are there clinical predictors that allow the clinician to identify patients at low risk for adverse events who do not need an abdominal CT? Evidence was graded and recommendations were based on the available data in the medical literature related to the specific clinical question.

Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization.

Forefoot pain is one of the most common presenting problems in a foot and ankle practice. One of the most common presenting problems, yet most commonly missed problems, is a plantar plate tear. Often the problem is considered to be potential neuroma, fat pad atrophy, or a generalized diagnosis of metatarsalgia or metatarsal head overload.

[Use of fissured mandible autotransplants for eye socket walls reconstruction].

Mandible cortical spongy autotransplants were used for a long period of time in dentoalveolar surgery for alveolar process reconstruction with the aim to prepare for implantation and prosthesis making. For the first time in our country mandible transplants were used by us for eye socket walls defects of traumatic and posttraumatic origin. In the article the results of the use of parietal and mandible spongy-cortical transplants with the aim to reconstruct eye socket in cases of isolated fractures.

The relationship between stressors and creativity: a meta-analysis examining competing theoretical models.

Competing theoretical models and equivocal evidence leave unanswered questions regarding stressors' effect on creativity. The present meta-analysis of 76 experimental studies (including 82 independent samples) aims to clarify this association and identify factors that may explain differences between studies. Our results suggest that the effect of stressors on creative performance depends on how stress-inducing the stressor is and what type of stress is induced.

Clinical policy: critical issues in the management of adult patients presenting to the emergency department with community-acquired pneumonia.

This clinical policy from the American College of Emergency Physicians focuses on critical issues concerning the management of adult patients presenting to the emergency department (ED)with community-acquired pneumonia. It is an update of the 2001 clinical policy for the management and risk stratification of adult patients presenting to the ED with community-acquired pneumonia. A subcommittee reviewed the current literature to derive evidence-based recommendations to help answer the following questions: (1) Are routine blood cultures indicated in patients admitted with community-acquired pneumonia? (2) In adult patients with community-acquired pneumonia without severe sepsis, is there a benefit in mortality or morbidity from the administration of antibiotics within aspecific time course? The evidence was graded and recommendations were given based on the strength of evidence.