Zobrazení zdroje stránky Fultonmarks3330

3% of energy) having a CHD HR of 0.39 (95% CI 0.22, 0.71), compared with 0.92 (95% CI 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group. Conclusions Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol https//www.whi.org/about/SitePages/Dietary%20Trial.aspx. Copyright © The Author(s) 2020.This review article examines updates to the literature during the past 5 years on numerous topics which were felt to have ongoing controversy. These topics include venous thromboprophylaxis, tranexamic acid usage, tourniquet usage, and wound closure techniques. Methods For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials. Results Tranexamic acid is a safe and effective treatment modality, and consideration should be given to use multiple doses and combine different modes of administration. Certain treatment modalities (skin sutures, limited or no tourniquet usage) can cause greater patient satisfaction at a cost of longer operating times. [https://www.selleckchem.com/products/fsen1.html selleck chemicals] Postoperative anticoagulation is still a very controversial topic. There is however some evidence suggesting prolonging anticoagulation to 35 days postoperative. Conclusions By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.Opioids are routinely prescribed to manage acute postoperative pain, but changes in postoperative opioid prescribing associated with the marketing of long-acting opioids such as OxyContin have not been described in the surgical cohort. Methods Using a large commercial claims data set, we studied postoperative opioid prescribing after selected common surgical procedures between 1994 and 2014. For each procedure and year, we calculated the mean postoperative morphine milligram equivalents (MME) filled on the index prescription and assessed the proportion of patients who filled a high-dose prescription (≥350 MME). We reported changes in postoperative opioid prescribing over time and identified predictors of filling a high-dose postoperative opioid prescription. Results We identified 1,321,264 adult patients undergoing selected common surgical procedures between 1994 and 2014, of whom 80.3% filled a postoperative opioid prescription. One in five surgery patients filled a high-dose postoperative opioid prescriptiogery patients. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.Giant cell tumor of bone (GCTB) is a locally aggressive benign neoplasm that is associated with a large biological spectrum ranging from latent benign to highly recurrent and occasionally metastatic tumor. In this article, we present a case of a 26-year-old woman who presented with swelling at the left lower ribs during pregnancy. Surgical excision was done, and histopathology showed tumor with features consistent with GCTB. MRI preformed after delivery revealed recurrence of the mass with extensive growth reaching 17 cm with two subcutaneous satellite nodules in the adjacent abdominal wall. positron emission tomography-computed tomography (PET-CT) scan revealed bilateral fluorodeoxyglucose (FDG)-avid lung nodules. Surgical resection was done, and histopathology showed no evidence of malignant transformation. Few months later, the tumor recurred again, with peritoneal deposits. The patient underwent wide massive resection of the recurrent mass and then started on denosumab therapy. Molecular analysis of the tumor detected H3F3A G34W mutation with no copy number alterations. We are presenting this case of GCTB with pulmonary distant metastasis and extrapulmonary seeding to upsurge awareness among clinicians about the possible extreme aggressive biological behavior of GCTB that can mimic the presentation of malignant bone tumor and also to discuss the possible predictive factors of such aggressive behavior. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.Limited data exist delineating the reasons women choose subspecialties within orthopaedics. Purpose (1) To perform a survey that determines subspecialties female orthopaedic surgeons select and (2) to analyze the motivations behind their choices. Methods A 10-question survey was distributed via e-mail to the Ruth Jackson Orthopaedic Society (RJOS), Texas Orthopaedic Association (TOA), and to a private internet page for women in Orthopaedics, which covered the area of subspecialty practice, motivations, and demographic data. Practicing female orthopaedic surgeons, fellows, or fellowship-matched residents were included. Respondents' ranked motivations when deciding for or against a subspecialty were analyzed and comparisons made. Results Of the 304 survey responses, 288 met inclusion criteria. The most common subspecialties were hand (24.0%), pediatrics (22.6%), and sports medicine (16.3%). A higher proportion of younger surgeons are electing to subspecialize in sports medicine, whereas a lower proportion of younger surgeons are pursuing general orthopaedics.