bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermolecular Stereoselective Iridium-Catalyzed Allylic
Alkylation: An Evolutionary Account
Authors: Stoltz Brian , Shockley Samantha , Hethcox J. 
Published: August 2018

Our lab has long been interested in the development of methods for the creation of enantioenriched all-carbon quaternary stereocenters. Historically, our interest has centered on palladium-catalyzed allylic alkylation, though recent efforts have moved to include the study of iridium catalysts. Whereas palladium catalysts enable the preparation of isolated stereocenters, the use of iridium catalysts allows for the direct construction of vicinal stereocenters via an enantio-, diastereo-, and regioselective allylic alkylation. This Account details the evolution of our research program from inception, which focused on the first iridium-catalyzed allylic alkylation to prepare stereodyads containing a single quaternary stereocenter, to our most recent discovery that allows for the synthesis of vicinal quaternary centers.1	Introduction2	Synthesis of Vicinal Tertiary and All-Carbon Quaternary Stereocenters via Enantio- and Diastereoselective Iridium-Catalyzed Allylic Alkylation2.1	Cyclic Nucleophiles2.2	Acyclic Nucleophiles2.3	Alkyl-Substituted Electrophiles3	Umpoled Iridium-Catalyzed Allylic Alkylation Reactions3.1	Tertiary Allylic Stereocenters3.2	Quaternary Allylic Stereocenters4	Synthesis of Vicinal All-Carbon Quaternary Centers via Enantio­selective Iridium-Catalyzed Allylic Alkylation5	Summary and Future Outlook
Developmental Alterations of Cerebral Gray and White Matter in Children with Congenital Cyanotic Heart Disease
Authors: Leon-Wyss Juan , Rosario Cynthia , Toribio Janet , Speckter Herwin , Foerster Bernd , Oviedo Jairo , Huppertz Hans-Jürgen , Stoeter Peter 
Published: August 2018

AbstractThis article examines the relation between oxygen saturation and T2 star time in cyanotic congenital heart disease and its correlation to cerebral gray and white matter alterations. Magnetic resonance imaging was performed in 25 patients (mean age: 52.2 months) and 32 controls. Gray and white matter volumes, as well as fractional anisotropy and longitudinal diffusivity, were significantly reduced in patients. The reduction longitudinal diffusivity correlated to oxygen saturation and T2 star time of gray matter (p < 0.05). This diffusion tensor imaging (DTI) parameter was most affected in cyanotic congenital heart disease and because is the only parameter showing significant correlation to reduced oxygenation, it should be included more often in the follow-up of these patients over time.
Current Options for the Treatment of Pectus Carinatum: When to Brace and When to Operate?
Authors: Emil Sherif 
Published: August 2018

AbstractPectus carinatum has traditionally been described as a rare chest wall anomaly in comparison to pectus excavatum. However, recent data from chest wall anomaly clinics demonstrate that this deformity is probably much more frequent than once believed. In the past, invasive surgical correction by the Ravitch technique was essentially the only option for treatment of pectus carinatum. Major advances over the past two decades have provided additional options, including noninvasive chest wall bracing and minimally invasive surgical correction. This article will discuss current options for the treatment of pectus carinatum, and some of the factors that should be taken into account when choosing the options available. Diagnosis and treatment of the pectus arcuatum variant will also be described.
Patient Reported Outcomes Following Lower Extremity Soft Tissue Sarcoma Resection with Microsurgical Preservation of Ambulation
Authors: MacArthur Ian , McInnes Colin , Dalke Kim , Akra Mohamed , Banerji Shantanu , Buchel Edward , Hayakawa Thomas 
Published: August 2018

Background Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient-reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures.
Methods A retrospective review of all microsurgical reconstructions for limb salvage in lower extremity sarcoma patients was completed at our institution (2009–2013). Patients were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality of life survey.
Results Over a 5-year period, 23 patients (mean age: 53 years) underwent free flap reconstructions for 23 sarcomas (mean follow-up: 14 months). Seventy-eight percent of patients received neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles were resected on average. Perforator flaps were most frequently used (61%), and functional muscle transfers or immediate tendon transfers were used in four patients. There were no flap take-backs or failures, and 22 patients achieved independent ambulation. Three patients in the series died, two from metastatic disease found postoperatively and one from local recurrence. A 74% response rate was achieved for the TESS survey, with a mean score of 83.
Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enables preservation of independent ambulation. Restoration of function utilizing immediate functional microsurgical reconstructions and tendon transfers should be considered.
Deformities of the Thoracic Wall: Don't Forget the Plastic Surgeon
Authors: Schwabegger Anton 
Published: August 2018

AbstractSurgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair of pectus excavatum or similar interventions (modified open videoendoscopically assisted repair of pectus excavatum), for remodeling the anterior thoracic wall may finally not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric and polymorphic cases, remnant deformities may still be present after any sophisticated remodeling attempt. On the other hand, some cases despite optimal surgical management develop mild recurrences with partial concavity or rib cartilage distortion shortly after pectus-bar removal. Secondary treatment options then may include open access surgery, resection, or reshaping of deformed and prominent costal cartilage. Residual concave areas can be filled by autologous tissue, such as cartilage chips, liposhifting, or implantation of customized alloplastics. To provide the best options for a variety of primary or secondary postsurgical expressions of anterior wall deformities, any physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques or at least should have knowledge of such. However, among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. Careful selection of appropriate techniques, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be mandatory, based on the heterogeneity of symptoms, severity, expectations, and surgical and technical resources. A variety of such ancillary reconstructive procedures for PE repair are explained and illustrated herewith.
Is the Freedom SOLO Stentless Bioprosthesis a Useful Tool for Patients with Aortic Endocarditis and Aortic Annular Destruction?
Authors: Repossini Alberto , Bacco Lorenzo Di , Gazdag Laszlo , Grubitzsch Herko , Fischlein Theodor , Stara Alessandra , Muneretto Claudio , Santarpino Giuseppe 
Published: August 2018

Background The Freedom SOLO (FS) stentless bovine-pericardial prosthesis with a supra-annular implantation technique can be a viable option for patients with endocarditic annular destruction. We assessed early- and long-term outcomes following the use of this prosthesis in extensive aortic valve endocarditis.
Methods From 2006 to 2016, 59 patients with extensive aortic endocarditis underwent aortic valve replacement (AVR) with FS (cumulative follow-up 263 patients-years) in three European centers; all patients presented annular tissue infection, while 54.3% of patients had annular abscess.
Results Mean age was 66 ± 11 years and mean EuroSCORE I was 30.3% (standard deviation: 24.1%). In our series, 30.5% of patients had prosthetic valve endocarditis. Early mortality was 15.2% (nine patients). Estimated overall survival at 5 and 10 years was 68.9% (95% confidence interval [CI]: 62.8–75.0%) and 59.1% (95% CI: 66.8–81.2%), respectively. At 10-year survival, freedom from valve-related death was 83.7% (95% CI: 80.9–86.5%). No structural valve deterioration was reported in this series. Five patients (8.5%) had recurrent endocarditis during follow-up and two of them underwent reoperation. Survival freedom from reoperation and endocarditis at 10-year follow-up was 88.0% (CI: 80.4–95.6%) and 86.7% (CI: 80.5–92.9%), respectively.
Conclusion FS stentless bioprosthesis is a valuable and simple option to achieve AVR in patients with extensive aortic annulus endocarditis. Although in this group of complex patients, early mortality remains considerably high, late survival outcomes are comparable to the more technically demanding homografts and conventional stentless bioprostheses, with low rates of endocarditis recurrence.
Meta-analysis of Valve-in-Valve Transcatheter versus Redo Surgical Aortic Valve Replacement
Authors: Takagi Hisato , Mitta Shohei , Ando Tomo 
Published: August 2018

Objective The objective of this study was to determine whether valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) is associated with better survival than redo surgical aortic valve replacement (SAVR) in patients with degenerated aortic valve bioprostheses, and we performed a meta-analysis of comparative studies.
Methods To identify all comparative studies of VIV-TAVI versus redo SAVR; MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched through October 2017. For each study, data regarding all-cause mortality in both the VIV-TAVI and redo SAVR groups were used to generate odds ratios (ORs). To assess selection bias, we generated ORs and (standardized) mean differences (MDs) for baseline characteristics. Study-specific estimates were combined in the random-effects model.
Results Of 446 potentially relevant articles screened initially, 6 reports of retrospective comparative studies enrolling a total of 498 patients were identified. Pooled analyses of baseline characteristics demonstrated no statistically significant differences in the proportion of women, patients with diabetes mellitus, patients with coronary artery disease, and patients with baseline New York Heart Association functional class of ≥III; baseline ejection fraction; and predicted mortality between the VIV-TAVI and redo SAVR groups. Patients in the VIV-TAVI group, however, were significantly older (MD, 4.20 years) and had undergone prior coronary artery bypass grafting more frequently (OR, 2.19) than those in the redo SAVR group. Main pooled analyses demonstrated no statistically significant differences in early (30 days or in-hospital) (OR, 0.91; p = 0.83) and midterm (180 days–3 years) all-cause mortalities (OR, 1.42; p = 0.21) between the VIV-TAVI and redo SAVR groups.
Conclusion In patients with degenerated aortic valve bioprostheses, especially elderly or high-risk patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The lack of randomized data and differences in baseline characteristics in the present analysis emphasize the need for prospective randomized trials.
Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from Classical Necrotizing Enterocolitis
Authors: Siano Elisa , Lauriti Giuseppe , Ceccanti Silvia , Zani Augusto 
Published: August 2018

Aim The main purpose of this study was to investigate if necrotizing enterocolitis (NEC) has a different presentation and outcome in patients with congenital heart defect (CHD) (cardiogenic NEC) from those without (classical NEC).
Materials and Methods A systematic review of the literature on the characteristics of infants with NEC and CHD was performed by three independent investigators using a defined strategy (PubMed, Cochrane, Embase, and Web of Science). A meta-analysis was conducted on studies comparing NEC in infants with CHD and non-CHD infants using RevMan 5.3.
Results Systematic review: Of 7,291 abstracts screened, 126 full-text articles were analyzed and 51 studies were included. NEC had an incidence of 5.1% in CHD infants (7,728/151,046, range 0–24%) and 0.8% in non-CHD infants (26,430/3,256,891, range 0.1–8.9%; p < 0.0001). In very low birth weight infants, NEC occurred in 6.3% of CHD patients (6,361/100,454pts) and in 8.9% of non-CHD (23,201/257,794pts; p < 0.0001). In CHD cases, NEC occurred before cardiac surgery in 48% cases and surgery for NEC was required in 31% infants (2,037/6,683). Meta-analysis: In eight comparative studies, the incidence of NEC was higher in CHD infants (6%, 768/13,145) than in infants with no CHD (0.9%, 32,625/3,354,323pts; p < 0.00001, odds ratio [OR] 1.84, 95% confidence interval [CI] 1.7–1.9). The overall mortality was higher in infants with CHD and NEC (38%, 243/640) than in those without CHD (27%, 6651/24810; p < 0.00001, OR 3.4, 95% CI 2.8–4.1).
Conclusion This is the first evidence-based study showing that infants with cardiogenic NEC have different demographics and outcomes than those with classical NEC. The risk of developing NEC and the mortality rate are higher among infants with CHD than in those without. Conversely, the need for intestinal surgery is lower in babies with cardiogenic NEC than in those with classical NEC. Further studies are needed to establish preventative and management interventions that are specific to infants with or at risk of developing cardiogenic NEC.
Modern Neonatal Transport: Sound and Vibration Levels and Their Impact on Physiological Stability
Authors: Bailey Vickie , Cagle Kristi , Kurtz Deborah , Chaaban Hala , Wu Dee , Williams Patricia , Szyld Edgardo 
Published: August 2018

Objective To measure sound and vibration in rotary wing air transport (RWAT) and ground ambulance transport (GAT), comparing them to current recommendations, and correlating them with physiological stability measures in transported neonates.
Study Design This is a prospective cohort observational study including infants ≤ 7 days of age transported over an 8-month period. Infants with neurologic conditions were excluded. Sound and vibration was continuously measured during transport. Transport Risk Index of Physiologic Stability (TRIPS) scores were calculated from vital signs as a proxy for physiological stability.
Results In total, 118 newborns were enrolled, of whom 109 were analyzed: 67 in RWAT and 42 in GAT. Peak sound levels ranged from 80.4 to 86.4 dBA in RWAT and from 70.3 to 71.6 dBA in GAT. Whole-body vibration ranged from 1.68 to 5.09 m/s2 in RWAT and from 1.82 to 3.96 m/s2 in GAT. Interval TRIPS scores for each infant were not significantly different despite excessive sound and vibration.
Conclusion Noise levels during neonatal transport exceed published recommendations for both RWAT and GAT and are higher in RWAT. Transported infants are exposed to vibration levels exceeding acceptable adult standards. Despite excessive noise and vibration, levels of physiological stability remained stable after transport in both RWAT and GAT groups.
Muscular-stage Dissection during Far Lateral Approach and Its Transcondylar Extension
Authors: Hirai Sakyo , Obata Yoshiki , Maehara Taketoshi , Aoyagi Masaru , Sato Akihito 
Published: August 2018

Background The far lateral approach includes exposure of the C1 transverse process, vertebral artery, posterior arch of the atlas, and occipital condyle. We designed a method for systematic muscular-stage dissection and present our experience with this approach.
Operative Methods We used a horseshoe scalp flap that was reflected downward and medially. The lateral muscle layers were separated layer to layer to expose the suboccipital triangle. The medial muscle layers were separated in the midline and reflected in a single layer. At this stage, the midline of the C1 process and the foramen magnum were identified. The rectus capitis posterior major muscle was reflected to expose the posterior arch of the atlas. The C1 transverse process and vertebral artery were identified by reflection of the superior oblique muscle. The occipital condyle was separated accordingly.
Results We used this method of muscular dissection in 10 patients (foramen magnum meningioma, n = 5; hypoglossal schwannoma, n = 2; others, n = 3). Systematic muscular-stage dissection facilitates identification of the anatomical landmarks with no vertebral artery injury. Gross total removal was obtained in all 9 patients with complex tumors. The patient with vertebral artery dissection successfully underwent proximal clipping.
Conclusion Our muscular-stage dissection could contribute to safe and effective surgery for the far lateral approach.
Indications and Safety of the Zygomatic Osteotomy in Middle Cranial Fossa Surgery: A Retrospective Cohort Review
Authors: Neal Elliot , Pressman Elliot , Athienitis Alexia , Turner Adam , Ma Shunchang , Rao Gautam , Primiani Christopher , Agarwalla Pankaj , van Loveren Harry , Agazzi Siviero 
Published: August 2018

Background Zygomatic osteotomy, an adjunct to middle cranial fossa (MCF) surgical approaches, improves the superior-inferior angle of approach and minimizes temporal lobe retraction. However, a decision-making algorithm for selective use of the zygomatic osteotomy and the impact of the zygomatic osteotomy on surgical complications have not been well documented.
Objective We described an algorithm for deciding whether to use a zygomatic osteotomy in MCF surgery and evaluated complications associated with a zygomatic osteotomy.
Methods A retrospective review of MCF cases over 11 years at our academic tertiary referral center was conducted. Demographic variables, tumor characteristics, surgical details, and postoperative complications were extracted.
Results Of the 87 patients included, 15 (17%) received a zygomatic osteotomy. Surgical trajectory oriented from anterior to posterior (A-P) was significantly correlated with the use of the zygomatic osteotomy. Among the cases approached from A-P, we found (receiver-operating characteristic curve) that the cut-off tumor size that predicted a zygomatic osteotomy was 30 mm. Of the 87 cases included, 15 patients had a complication. The multivariate logistic regression model failed to reveal any significant correlation between complications and zygomatic osteotomies.
Conclusions We found that the most important factor determining the use of a zygomatic osteotomy was anticipated trajectory. A-P approaches were most highly correlated with zygomatic osteotomy. Within those cases, a lesion size cut-off of 30 mm was the secondary predicting factor of zygomatic osteotomy use. The odds of suffering a surgical complication were not significantly increased by use of zygomatic osteotomy.
Sinonasal Undifferentiated Carcinoma: A 15-Year Single Institution Experience
Authors: Workman Alan , Brody Robert , Kuan Edward , Baranov Esther , Brooks Steven , Alonso-Basanta Michelle , Newman Jason , Rassekh Christopher , Chalian Ara , Chiu Alexander , Weinstein Gregory , Feldman Michael , Adappa Nithin , O'Malley Bert , Palmer James 
Published: August 2018

Objective Sinonasal undifferentiated carcinoma (SNUC) is an aggressive neoplasm, with conflicting existing literature regarding prognosis and treatment due to the rarity of disease. Characterization of optimal SNUC management is necessary for improved outcomes.
Study Design Case series with planned data collection and analysis.
Setting Hospital of the University of Pennsylvania and Pennsylvania Hospital.
Participants Patients with pathologically confirmed SNUC treated within a 15-year period were identified, and records were obtained and evaluated for several demographic characteristics.
Main Outcomes Measures Disease-specific survival from diagnosis was the primary endpoint, while disease recurrence was a secondary endpoint of the study.
Results Twenty-seven patients with established SNUC were included in this cohort, with a median age of 55 years. Eighty-five percent of patients were surgically treated, and 85% of patients presented with stage IV disease. Two-year disease-specific survival was 66% and 5-year disease-specific survival was 46%. Ninety-six percent of patients received both chemotherapy and radiation as adjuvant treatment. Nodal disease at presentation and disease recurrence both significantly decreased patient survival (p < 0.05).
Conclusions The majority of patients at this institution presented with clinically advanced disease, and most were managed with a multimodal approach of surgical resection, chemotherapy, and radiation. Extent of disease at presentation and progression of disease following treatment are poor prognostic signs and may merit a more aggressive approach, while early detection and treatment may improve survival and decrease patient morbidity.
Surgical Intervention for Chronic Mesenteric Ischemia
Authors: Klein Andrea , Bennett Lisa , Ha Cindy , Kirkwood Melissa 
Published: August 2018

AbstractSymptomatic chronic mesenteric ischemia (CMI) is a relatively rare condition, yet there are significant clinical consequences for those affected by the disease. CMI not only reduces quality of life but also increases an individual's risk for life-threatening acute mesenteric ischemia. Surgery is the definitive treatment to reduce the risk for this potentially fatal outcome, and both endovascular and open surgical strategies are currently utilized. This review article discusses the approach to making a diagnosis of CMI, as well as the surgical techniques used to revascularize the mesenteric circulation.
Cervical Cerclage versus Vaginal Progesterone for Management of Short Cervix in Low-Risk Women
Authors: Dotters-Katz Sarah , Hughes Brenna , Wood Amber 
Published: August 2018

Objective To evaluate the risk of preterm birth in low-risk women with cervical length (CL) ≤25 mm on transvaginal ultrasound (TVUS) managed with vaginal progesterone (VagP) therapy versus cerclage.
Study Design This is a retrospective cohort of women with no prior history of preterm birth or cervical insufficiency and CL ≤ 25 mm on TVUS, managed with either VagP therapy alone or cerclage (with or without VagP). The primary outcome was rate of preterm delivery < 37 weeks gestational age (GA). Secondary outcomes included delivery at ≤ 32 or ≤ 28 weeks GA, premature preterm rupture of membranes, pregnancy latency, GA at delivery, and composite neonatal outcome.
Results Women undergoing cerclage placement (n = 31) were older and had an earlier GA at the time of diagnosis of short cervix compared with women receiving VagP (n = 62). Delivery at < 37 weeks occurred in 21/62 (33.9%) in the VagP group and 14/31 (45.2%) in the cerclage group (adjusted odds ratio: 1.72, 95% confidence interval: 0.52, 5.66). There were no differences in secondary outcomes.
Conclusion Cerclage compared with VagP therapy did not decrease risk of preterm birth in women with CL ≤ 25 mm. Further research is needed to determine optimal management in such women given a residual 40% risk of preterm birth despite optimal therapy.