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BACKGROUND Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spreader flaps. Vorinostat manufacturer We sought to clarify from highly experienced rhinoplasty surgeons their decision-making rationale for midvault reconstruction, distilling down the group consensus into algorithmic guidelines. METHODS A panel of internationally recognized rhinoplasty surgeons participated in a two-part organized communication method. An introductory summit consisted of open discussions on various topics in midvault reconstruction. The summit transcription was analyzed by thematic content analysis to develop a survey encompassing clinical scenarios for primary rhinoplasty, which was then individually administered to each panelist. Data gathered from both parts were used to generate technical guidelines and decision-making algorithm. RESULTS The panelist identified the following anatomic features as pertinent to their selection of midvault reconstruction method size of the dorsal hump reduction, width of the midvault relative to the upper vault, the presence of dorsal angulation, and the presence of nasal obstructive symptoms. Individual panelist preference was gathered from the 24-scenario survey divided into either cosmetic or functional rhinoplasty cases. CONCLUSIONS Management of the midvault after dorsal hump reduction is important in order to establish proper aesthetic relationships and to provide functional integrity of the internal valve. Our authors present an algorithmic approach to decision-making based on the systematic analysis practiced by senior rhinoplasty surgeons.BACKGROUND High-intensity focused ultrasound (HIFU) lipolysis still lacks treatment efficacy. We hypothesized that electrical stimulation (ES) of muscular groups can enhance the metabolism of free lipids released from HIFU-ablated adipocytes. METHODS Five-month-old, male Landrace swine, 95 kg average initial weight, were randomly divided into sham, HIFU-only, HIFU+ES I and HIFU+ES II groups. Subcutaneous adipose tissue of the porcine abdomen was treated once by HIFU on the 1 day of the 1, 3 and 5 weeks, and electrical stimulation of the quadriceps was performed once on the 1 day of the 1 to 6 weeks. The numbers of ultrasonic sonications were 70 per treatment for the HIFU-only and HIFU+ES I groups and 400 for the HIFU+ES II group. The measured data are expressed as medians (ranges). RESULTS The body weights of all pigs increased gradually with time. The waist circumferences below the sheath decreased from 97.7(6.0) cm in the 1 week, 97.9(5.3) cm in the 3 week to 96.4(10.0) cm in the 6 week and from 105.3(5.1) cm, 101.2(7.4) cm to 100.5(6.1) cm for the HIFU+ES I and HIFU+ES II groups, respectively, whereas they increased for the sham and HIFU-only groups. The reductions in the adipose tissue thickness were 0.59, 1.46 and 2.18 mm for the HIFU-only, HIFU+ES I and HIFU+ES II groups, respectively, when the sham group increased by 1.42 mm. Follow-up blood analyses demonstrated no significant changes in lipid panel parameters from baseline values. CONCLUSIONS HIFU-electrical therapy can induce a substantial reduction in the waist circumference of pigs.BACKGROUND Surgical videos are increasingly common although their role in residency curricula remains unclear. The aim of this study was to evaluate the impact of an educational surgical video on resident performance of an open carpal tunnel release through an Objective Structured Assessment of Technical Skills (OSATS) and serial questionnaires. METHODS Twenty-two residents representing six postgraduate years were randomized to receive text-based materials with or without a surgical video before performing a carpal tunnel release on human cadavers. Procedures were video recorded, anonymized, and independently evaluated by three hand surgeons using the OSATS global rating scale, a procedure-specific technical rating scale, a record of operative errors, and pass/fail designation. Residents completed questionnaires before and after the procedure to track confidence in their technical skills. RESULTS Residents in their first and second postgraduate years (n=10) who watched the surgical video committed fewer operative errors (median 4 vs 1.3, p = 0.043) and were more confident in their abilities following the procedure (median 75 vs 32, p = 0.043) than those receiving text resources alone. There were no significant differences in OSATS performance or questionnaire responses among more senior residents (n=12). The technical rating scale was internally consistent (Cronbach α 0.95, 95% CI 0.91 to 0.98), reliable (ICC 0.73, 95% CI 0.40 to 0.88), and correlated with surgical experience (Spearman ρ 0.57, p = 0.006). CONCLUSIONS Watching an educational surgical video to prepare for a cadaveric procedure significantly reduced operative errors and improved confidence among junior trainees performing a carpal tunnel release.BACKGROUND Optimal treatment for distal radius fractures (DRFs) in older adults remains uncertain. No randomized trials comparing the most frequently used treatments in this population have been conducted. Surgical treatment rates vary widely, though the sustained benefits of surgery are uncertain. METHODS The Wrist and Radius Injury Surgical Trial (WRIST), randomized, multicenter trial, enrolled 304 adults age 60 years and older with isolated, unstable DRFs at 24 institutions. Patients who wanted surgery (n=187) were randomized to internal fixation with volar plate (VLPS), external fixation (EFP), or percutaneous pinning; patients who preferred conservative management (n=117) received casting. The primary outcome was the 12-month Michigan Hand Outcomes Questionnaire (MHQ) Summary score. Secondary outcomes included MHQ domain scores and radiographic parameters. RESULTS At 12 months, there were no differences by treatment in primary or the majority of secondary outcomes. Twelve-month MHQ Summary scores differed between VLPS and EFP by 3 points (97.