RETRACTED ARTICLE: Outcomes of length-stable fixation of femoral neck fractures

Introduction  

The most common implants for treating unstable femoral neck fractures are sliding constructs, which allow postoperative collapse. Successful healing, typically, is a malunion with a shortened femoral neck. Functional sequelae resulting from altered femoral neck biomechanics have been increasingly reported. Re-operation rate due to nonunion, avascular necrosis, hardware cut-out and prominence is high with this treatment modality. We evaluated the outcomes of patients with femoral neck fractures treated with stable calcar pivot reduction, intraoperative compression across the fracture, and stabilization with length-stable implants.     

Über die Reaktionsweise von α-Aminoacetonitrilen mit metallischem Natrium in flüssigem Ammoniak. VIII. Mitt. über Umsetzungen von α-Aminonitrilen

Reactions with α-Aminonitriles. Part 8 α-Aminoacetonitriles react with metallic sodium in toluene producing dimer and hydrogen exchange products, whereas in liquid ammonia only hydrogen exchange products are obtained. The reasons for this difference in the course of reaction are presented.     

Dimerisierung von α-Piperidinoacetonitril durch t-Butylmagnesiumchlorid IV. Mitt. über Umsetzungen von α-Aminonitrilen

Dimerisation of α-Piperidinoacetonitrile with t-Butylmagnesium chloride Under the influence of t-butylmagnesium chloride α-piperidinoacetonitrile dimerises to 3-amino-2,4-dipiperidinocrotononitrile. The mechanism of the dimerisation has been established.     

Rat alpha-lactalbumin has a 17-residue-long COOH-terminal hydrophobic extension as judged by sequence analysis of the cDNA clones.

cDNA for rat alpha-lactalbumin has been cloned in bacterial plasmid, and its sequence has been analyzed. The DNA sequence analysis shows that rat alpha-lactalbumin has 17 extra residues beyond the COOH terminus of the alpha-lactalbumin isolated and sequenced to date from other species. The predicted COOH-terminal sequence is hydrophobic and proline rich and bears some resemblance to beta-casein sequences.     

Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). DESIGN: Retrospective interventional case series. METHODS: Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. RESULTS: Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). CONCLUSIONS: There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.     

The anterolateral approach to the proximal humerus for nonunions and delayed unions

Nonunions of proximal humerus fractures can be disabling as a result of pain, deformity and instability, and are often found in geriatric patients with poor bone quality. There are relatively few studies examining the treatment of nonunions of the proximal third of the humerus and the ideal treatment and surgical approach remains unclear. This case series reports the successful use of the anterolateral acromial approach for treatment of the symptomatic proximal third humerus nonunions in a geriatric group of patients with clear challenges as a result of patient comorbidities and bone quality.     

Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS) to Identify Patients With Sepsis Improve Mortality?

PurposeThe objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) and evidence of organ dysfunction identified through electronic alerts improves patient mortality.MethodsThis is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScience^TM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC) reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed.ResultsOf those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21) after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience^TM Predicted Mortality Risk Score. Female gender (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.63) and facility were also independently associated with mortality.ConclusionThe use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.     

COVID-19 highlights the policy barriers and complexities of postpartum sterilization

Multiple barriers exist to sterilization in the postpartum period. One such barrier, the Medicaid Title XIX sterilization policy, requires publicly insured patients to complete a sterilization consent form at least 30 days prior to their scheduled procedure. While this policy was set in place in the 1970s to address the practice of coerced sterilization among marginalized women, it has served as a significant barrier to obtaining the procedure in the contemporary period. The COVID-19 pandemic has highlighted specific complexities surrounding postpartum sterilization and created additional barriers for women desiring this contraceptive method. Despite the time constraints to perform postpartum sterilization, some hospital administrators, elective officials, and state Medicaid offices deemed sterilization as “elective.” Additionally, as the Center for Medicare and Medicaid Services (CMS) has revised telemedicine reimbursement and encouraged its increased use, it has provided no guidance for the sterilization consent form, use of oral consents, and change to the sterilization consent form expiration date. This leaves individual states to create policies and recommended procedures that may not be accepted or recognized by CMS. These barriers put significant strain on patients attempting to obtain postpartum sterilization, specifically for patients with lower incomes and women of color. CMS can support reproductive health for vulnerable populations by providing clear guidance to state Medicaid offices, extending the 180-day expiration of a sterilization consent form signed prior to the pandemic, and allowing for telemedicine oral consents with witnesses or electronic signatures.