bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes
Authors: Ahmadi Iraj , Herle Pradyumna , Hunter-Smith David , Leong James , Rozen Warren , Miller George 
Published: March 2017

Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes.
Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure.
Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53–3.21) and 1.50 (95% CI: 0.85–2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32–3.35) and 1.04 (95% CI: 0.72–1.48), respectively.
Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.
Evidence-based Surgery of Aortic Regurgitation: Results of a Questionnaire in German-speaking Countries
Authors: Steindl Johannes , Hitzl Wolfgang , Kiesslich Tobias , Seitelberger Rainald , Dinges Christian 
Published: March 2017

Background evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication.
Methods A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected.
Results Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons (n = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients.
Conclusion Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.
Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches
Authors: Wan Eric , Goldstein Andrew , Tolson Hillary , Dellon A. 
Published: March 2017

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN).
Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS).
Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms.
Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.
Surgeon-Based 3D Printing for Microvascular Bone Flaps
Authors: Taylor Erin , Iorio Matthew 
Published: March 2017

Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer.
Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models.
Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle.
Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer.
Level of Evidence Level IV.
Recombination reactions as a possible mechanism of mass-independent fractionation of sulfur isotopes in the Archean atmosphere of Earth
Authors: Babikov Dmitri 
Published: March 2017

Significance
Mass-independent fractionation of sulfur isotopes found in the Archean surface deposits (more than 2.3 billion y old) represents a “smoking gun” of anoxic atmosphere and gives a key element for determining the time of the great oxygenation event. Finding the molecular-level mechanism of these isotope enrichments is essential for understanding the environment on Earth just before, at the time of appearance, and during the evolution of early life. The theory of sulfur recombination processes proposed in this paper offers one possible explanation for the mass-independent fractionation effect, giving geochemists a useful tool for studying the atmospheric chemistry of Archean Earth, based on the rock record available to them today.
Recent progress in organocatalytic asymmetric total syntheses of complex indole alkaloids
Authors: Song Jin , Chen Dian-Feng , Gong Liu-Zhu 
Published: March 2017

Abstract
Indole and its structural analogues have been frequently found in numerous alkaloids, pharmaceutical products and related materials. The enantioselective construction of these structures allows efficient total synthesis of optically pure indole alkaloids, and hence has received worldwide interest. In the past decade, asymmetric organocatalysis has been recognized as one of the most powerful strategies to create chiral molecules with high levels of stereoselectivity. In particular, organocatalytic asymmetric cascade reactions often occur with multiple bond-breaking and forming events simultaneously or sequentially, leading to the appearance of various straightforward approaches to access core structures for asymmetric total synthesis. This review will summarize recent applications of asymmetric organocatalysis in the enantioselective synthesis of indole alkaloids.
Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease
Authors: Teatero Sarah , Coleman Brenda L. , Beres Stephen B. , Olsen Randall J. , Kandel Christopher , Reynolds Olivia , Athey Taryn B. T. , Musser James M. , McGeer Allison , Fittipaldi Nahuel 
Published: March 2017

Abstract

Background
Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described.

Methods
We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario.

Results
Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals.

Conclusions
The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.
Central Nervous System Infection Diagnosis by Next-Generation Sequencing: A Glimpse Into the Future?
Authors: Mai Nguyen Thi Hoang , Phu Nguyen Hoan , Nhu Le Nguyen Truc , Hong Nguyen Thi Thu , Hanh Nguyen Ho Hong , Nguyet Lam Anh , Phuong Tran My , McBride Angela , Ha Do Quang , Nghia Ho Dang Trung , Chau Nguyen Van Vinh , Thwaites Guy , Tan Le Van 
Published: March 2017

Abstract
Japanese encephalitis virus was detected by deep sequencing for the first time in urine of a 16-year-old boy with encephalitis. Seroconversion and polymerase chain reaction analysis confirmed the metagenomics finding. Urine is useful for diagnosis of flaviviral encephalitis, whereas deep sequencing can be a panpathogen assay for the diagnosis of life-threatening infectious diseases.
Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery
Authors: Connolly Joseph , Javed Zulqarnain , Raji Mukaila A. , Chan Winston , Kuo Yong-Fang , Baillargeon Jacques 
Published: March 2017

Study Design.A population-based retrospective cohort study.Objective.The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults.Summary of Background Data.Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention.Methods.Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study of 8377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long-term opioid use following lumbar fusion.Results.After adjusting for covariates, the following factors were associated with an increased risk of long-term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR = 2.27, 95% CI = 1.48–3.49; Quartile 2 (23–72 days): OR = 5.94, 95% CI = 4.00–8.83; Quartile 3: (73–250 days) OR = 25.31, 95% CI = 17.26–37.10; Quartile 4 (≥250 days) OR = 219.95, 95% CI = 148.53–325.71)], refusion surgery (OR = 1.32, 95% CI = 1.02–1.72), and diagnosis of depression (OR = 1.43, 95% CI = 1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR = 0.79, 95% CI = 0.63–0.99).Conclusion.These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.Level of Evidence:3
Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial
Authors: Hahne Andrew J. , Ford Jon J. , Richards Matthew C. , Surkitt Luke D. , Chan Alexander Y.P. , Slater Sarah L. , Taylor Nicholas F. 
Published: March 2017

Study Design.
A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial.

Objective.
To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice.

Summary of Background Data.
Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders.

Methods.
The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0–10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up.

Results.
Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis.

Conclusion.
These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores.

Level of Evidence: 2
The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU
Authors: Khan Babar A. , Perkins Anthony J. , Gao Sujuan , Hui Siu L. , Campbell Noll L. , Farber Mark O. , Chlan Linda L. , Boustani Malaz A. 
Published: March 2017

Objectives:
Delirium severity is independently associated with longer hospital stays, nursing home placement, and death in patients outside the ICU. Delirium severity in the ICU is not routinely measured because the available instruments are difficult to complete in critically ill patients. We designed our study to assess the reliability and validity of a new ICU delirium severity tool, the Confusion Assessment Method for the ICU-7 delirium severity scale.

Design:
Observational cohort study.

Setting:
Medical, surgical, and progressive ICUs of three academic hospitals.

Patients:
Five hundred eighteen adult (≥ 18 yr) patients.

Interventions:
None.

Measurements and Main Results:
Patients received the Confusion Assessment Method for the ICU, Richmond Agitation-Sedation Scale, and Delirium Rating Scale-Revised-98 assessments. A 7-point scale (0–7) was derived from responses to the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale items. Confusion Assessment Method for the ICU-7 showed high internal consistency (Cronbach’s α = 0.85) and good correlation with Delirium Rating Scale-Revised-98 scores (correlation coefficient = 0.64). Known-groups validity was supported by the separation of mechanically ventilated and nonventilated assessments. Median Confusion Assessment Method for the ICU-7 scores demonstrated good predictive validity with higher odds (odds ratio = 1.47; 95% CI = 1.30–1.66) of in-hospital mortality and lower odds (odds ratio = 0.8; 95% CI = 0.72–0.9) of being discharged home after adjusting for age, race, gender, severity of illness, and chronic comorbidities. Higher Confusion Assessment Method for the ICU-7 scores were also associated with increased length of ICU stay (p = 0.001).

Conclusions:
Our results suggest that Confusion Assessment Method for the ICU-7 is a valid and reliable delirium severity measure among ICU patients. Further research comparing it to other delirium severity measures, its use in delirium efficacy trials, and real-life implementation is needed to determine its role in research and clinical practice.
Common predictors of nurse-reported quality of care and patient safety
Authors: Stimpfel Amy Witkoski , Djukic Maja , Brewer Carol S. , Kovner Christine T. 
Published: March 2017

Background:
In the era of the Patient Protection and Affordable Care Act, quality of care and patient safety in health care have never been more visible to patients or providers. Registered nurses (nurses) are key players not only in providing direct patient care but also in evaluating the quality and safety of care provided to patients and families.

Purpose:
We had the opportunity to study a unique cohort of nurses to understand more about the common predictors of nurse-reported quality of care and patient safety across acute care settings.

Approach:
We analyzed cross-sectional survey data that were collected in 2015 from 731 nurses, as part of a national 10-year panel study of nurses. Variables selected for inclusion in regression analyses were chosen based on the Systems Engineering Initiative for Patient Safety model, which is composed of work system or structure, process, and outcomes.

Results:
Our findings indicate that factors from three components of the Systems Engineering Initiative for Patient Safety model–Work System (person, environment, and organization) are predictive of quality of care and patient safety as reported by nurses. The main results from our multiple linear and logistic regression models suggest that significant predictors common to both quality and safety were job satisfaction and organizational constraints. In addition, unit type and procedural justice were associated with patient safety, whereas better nurse-physician relations were associated with quality of care.

Conclusion:
Increasing nurses’ job satisfaction and reducing organizational constraints may be areas to focus on to improve quality of care and patient safety.

Practical Implications:
Our results provide direction for hospitals and nurse managers as to how to allocate finite resources to achieve improvements in quality of care and patient safety alike.
Job demands, job resources, and behavior in times of sickness: An analysis across German nursing homes
Authors: Schneider Daniel , Winter Vera , Schreyögg Jonas 
Published: March 2017

Background:The concept of presenteeism, that is, employees coming to work despite being sick, has recently received more attention in the literature. Presenteeism not only threatens employees' health but also substantially drains productivity and drives considerable costs. When they are sick, employees have the choice of whether to go to work or to stay at home. Therefore, determinants of (sickness) absenteeism and presenteeism should be examined simultaneously. Nursing homes are faced with a particularly high prevalence of both absenteeism and presenteeism and are therefore a relevant object of investigation.Purpose:The aim of our study is to analyze the effect of job demands and job resources on absenteeism, presenteeism, and the tendency to choose one behavior (being absent or being present in times of sickness) rather than the other over the last 12 months. To do so, we identify the determinants of absenteeism and/or presenteeism behavior based on theory and existing research about absenteeism, presenteeism, and job demands and job resources. After our empirical analysis, we provide explanations for our findings and offer practical suggestions for how to decrease the frequencies of absenteeism and presenteeism.Methodology:In this study, a sample of 212 nurses from German nursing homes was used for an ordinal logistic regression analysis.Results:Our results show that role overload significantly increases the frequencies of both absenteeism and presenteeism. A good team climate decreases absenteeism and increases the tendency to choose presenteeism rather than absenteeism, whereas strategic training and development opportunities decrease presenteeism and increase the tendency to choose absenteeism rather than presenteeism.