bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Modified Anterior Approach to L 1 Vertebra: An Early Clinical Experience
Authors: Kumar Vishal , Dhatt Sarvdeep S. , John Rakesh 
Published: November 2017

Purpose:
To study the results of a new surgical approach to the L1 vertebra which is a modified anterior approach and is extrapleural and retroperitoneal in nature.

Materials and Methods:
Five patients with fracture L1 vertebra underwent surgical decompression and stabilization via this modified anterior approach. In this approach, the L1 vertebra is approached anteriorly without invading the pleural cavity or the peritoneal cavity by gentle, blunt dissection (extrapleural and retroperitoneal approach)

Results:
No significant complications, especially pulmonary complications, were noted in any of the 5 cases.

Conclusions:
This modified anterior approach to L1 vertebra allows effective, circumferential decompression of the thoracolumbar spinal canal without the associated morbidity of the traditional anterior approach. However, comparative studies between the 2 approaches will be needed in the future to more accurately ascertain benefits of this approach.
Intraoperative Techniques for the Plastic Surgeon to Improve Pain Control in Breast Surgery
Authors: Farias-Eisner Gina , Kao Kenneth , Pan Judy , Festekjian Jaco , Gassman Andrew 
Published: November 2017

Summary:
In recent years, there has been a growing emphasis placed on reducing length of hospital stay and health costs associated with breast surgery. Adequate pain control is an essential component of enhanced recovery after surgery. Postoperative pain management strategies include use of narcotic analgesia, non-narcotic analgesia, and local anesthetics. However, these forms of pain control have relatively brief durations of action and multiple-associated side effects. Intraoperative regional blocks have been effectively utilized in other areas of surgery but have been understudied in breast surgery. The aim of this article was to review various intraoperative techniques for regional anesthesia and local pain control in breast surgery and to highlight areas of future technique development.
Prevalence of Spondylolysis in Symptomatic Adolescent Athletes: An Assessment of Sport Risk in Nonelite Athletes
Authors: Selhorst Mitchell , Fischer Anastasia , MacDonald James 
Published: November 2017

Objective:
To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP).

Design:
Retrospective case series.

Setting:
Hospital-based sports medicine clinic.

Patients:
The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis.

Assessment of Risk:
Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females.

Main Outcome Measure:
Relative risk of diagnosis of spondylolysis injury.

Results:
The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis.

Conclusions:
The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.
Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension
Authors: Schuman Theodore A. , Senior Brent A. 
Published: November 2017

Purpose of review
To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH).

Recent findings
Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP.

Summary
Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities.
An Academic-Practice Partnership Model to Grow and Sustain Advanced Practice Nursing
Authors: Williams Tracy E. , Howard Patricia B. 
Published: November 2017

OBJECTIVE
The aims of this article were to describe the implementation of an academic-practice partnership for healthcare system workforce development and provide preliminary outcomes of the associated pilot study.

BACKGROUND
The demand for cross-continuum healthcare delivery models necessitates creation of workforce development structures for advanced practice nursing.

METHODS
An academic-practice partnership specified enrollment of 5 cohorts of BSN staff nurses in a 3-year DNP program. Qualitative methods were used to explore pilot data at midpoint of cohort 1 student progression to determine learning outcomes and DNP projects with potential for impact on organization goals.

RESULTS
Partnership implementation experiences indicate that contractual agreements and an established evaluation plan are keys to academic-practice partnership success. Pilot study findings suggest that curriculum core courses provide a foundation for designing DNP projects congruent with acute and primary care health system goals. Implementing an academic-practice partnership is a strategy for workforce development to increase retention of advanced practice nurses.

CONCLUSION
Academic-practice partnerships can serve as a catalyst for a paradigm shift for changing models of care, thus enhancing workforce development succession planning for sustainable growth in healthcare systems.
Factors Associated With the Implementation of a Nurse Staffing Directive
Authors: Annis Ann M. , Robinson Claire H. , Yankey Nicholas , Krein Sarah L. , Duffy Sonia A. , Taylor Beth , Sales Anne 
Published: November 2017

BACKGROUND
In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing.

OBJECTIVE
We aimed to describe experiences and factors related to SM implementation.

METHODS
We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified.

RESULTS
Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers.

DISCUSSION
Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.
The Power and Pitfalls of Big Data Research in Obstetrics and Gynecology: A Consumer's Guide
Authors: Goodin Amie , Delcher Chris , Valenzuela Chelsea , Wang Xi , Zhu Yanmin , Roussos-Ross Dikea , Brown Joshua D. 
Published: November 2017

ImportanceResearch in obstetrics and gynecology (OB/GYN) increasingly relies on “big data” and observational study designs. There is a gap in practitioner-relevant guides to interpret and critique such research.ObjectiveThis guide is an introduction to interpreting research using observational data and provides explanations and context for related terminology. In addition, it serves as a guide for critiquing OB/GYN studies that use observational data by outlining how to assess common pitfalls of experimental and observational study designs. Lastly, the piece provides a compendium of observational data resources commonly used within OB/GYN research.Evidence AcquisitionReview of literature was conducted for the collection of definitions and examples of terminology related to observational data research. Data resources were collected via Web search and researcher recommendations. Next, each data resource was reviewed and analyzed for content and accessibility. Contents of data resources were organized into summary tables and matched to relevant literature examples.ResultsWe identified 26 observational data resources frequently used in secondary analysis for OB/GYN research. Cost, accessibility considerations for software/hardware capabilities, and contents of each data resource varied substantially.Conclusions and RelevanceObservational data sources can provide researchers with a variety of options in tackling their research questions related to OB/GYN practice, patient health outcomes, trends in utilization of medications/procedures, or prevalence estimates of disease states. Insurance claims data resources are useful for population-level prevalence estimates and utilization trends, whereas electronic health record–derived data and patient survey data may be more useful for exploring patient behaviors and trends in practice.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to identify and define terminology used in observational data research; compare the features, strengths, and limitations of observational study designs and randomized controlled trials; distinguish between types of observational data (eg, insurance administrative claims, discharges, electronic health record databases, surveys, surveillance data) and weigh the strengths and limitations of research that uses each data type; interpret and critique OB/GYN research that uses observational data and secondary data analysis; and gain exposure and familiarity with a selection of observational data sets used to study topics relevant to obstetrical and gynecological practice and/or health outcomes.
Use of Postmortem Computed Tomography to Detect Bowel Obstruction and its Relationship to the Cause of Death
Authors: Gascho Dominic , Schaerli Sarah , Tuchtan-Torrents Lucile , Thali Michael J. , Gorincour Guillaume 
Published: November 2017

Abstract
Bowel distension frequently indicates bowel obstruction, which is a common diagnosis in clinical radiology. Typically, symptoms and complaints lead to radiological examinations and the detection of the etiology. Untreated intestinal obstructions can lead to a fatal outcome through cardiac failure due to septic shock. Certain of these cases undergo medicolegal investigations depending on the case history, the condition of the decedent, the location of the finding, or recent visits to medical professionals. Computed tomography (CT) is a recommended method in clinical radiology for the detection of bowel obstruction, which is indicated by bowel distension and further radiological signs (eg, the whirl sign, which indicates a volvulus). Postmortem CT (PMCT) has increased worldwide, but PMCT differs from clinical CT; thus, the question of whether PMCT is also reliable for the detection of bowel obstruction in decedents or is negatively affected by postmortem modifications should be discussed. This study consists of 10 cases displaying radiological signs of bowel obstruction. Apart from bowel distension, the most common radiological signs (whirl sign, coffee bean sign, bird beak sign, and u-shape sign) are described and depicted. All decedents underwent autopsy and had a postmortem interval of less than 72 hours. Based on these cases, we assess the reliability of PMCT for detecting bowel obstruction and determining its relationship to the cause of death.
Evaluation of Preoperative and Postoperative Patient Satisfaction and Quality of Life in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-Analysis
Authors: Yang Fang , Liu Yin , Xiao Hong , Li Yuan , Cun Huanying , Zhao Yanan 
Published: November 2017

Background:
Improvement of nasal aesthetics by means of rhinoplasty is a highly sought-after procedure and leads to increased patient confidence. The aim of the study was to provide a quantitative synthesis of existing data regarding the ability of cosmetofunctional rhinoplasty to improve patient satisfaction and quality of life measured by the Rhinoplasty Outcomes Evaluation scale.

Methods:
Electronic databases were searched for studies evaluating quality of life following aesthetic rhinoplasty. Study results were pooled and analyzed using a random effects model. Effect size was estimated using standardized mean difference at a 95 percent confidence interval. Heterogeneity and benefit were assessed and reported using the I
2 and standard mean difference. Subgroup analyses were performed based on follow-up period and age group segregation.

Results:
A total of 377 articles were retrieved, of which eight studies were included in the final analysis. Overall, patient satisfaction analyzed by pooling eight observational studies improved following cosmetofunctional rhinoplasty (standard mean difference, 5.87; 95 percent CI, 3.55 to 8.19; I
2 = 100 percent). In addition, further subgroup analyses revealed that maximum benefit was derived by younger patients (standard mean difference, 6.69; 95 percent CI, 3.65 to 9.74; I
2 = 99 percent) compared with older patients (standard mean difference, 3.48; 95 percent CI, 3.01 to 3.96; I
2 = 0 percent). Postoperative patient satisfaction levels showed maximum improvement during a follow-up period of 6 to 12 months (standard mean difference, 11.07; 95 percent CI, −8.79 to 32.12; I
2 = 100 percent).

Conclusion:
Cosmetofunctional rhinoplasty improves patients’ quality of life as evidenced by an improvement in Rhinoplasty Outcomes Evaluation scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Nose and Lip Graft Variants: A Subunit Anatomical Study
Authors: Duisit Jérôme , Maistriaux Louis , Gerdom Alexander , Vergauwen Martial , Gianello Pierre , Behets Catherine , Lengelé Benoît 
Published: November 2017

Background:
In the field of vascularized composite tissue allotransplantation, the surgical design of facial subunit grafts is an evolving concept. The purpose of the present article is to study the possibility of dividing the historical nose and lip face transplant into several morphologic and functional subunit grafts, depending on their respective supply.

Methods:
This study was conducted in 20 adult cadavers. The facial artery and its branches were dissected bilaterally in 16 fresh and four embalmed heads. Nasolabial perfusion was assessed by selective injection of methylene blue and eosin (n = 2) or India ink (n = 2) in the superior labial and distal facial arteries. Dynamic perfusion through the distal facial artery was illustrated by fluoroscopy (n = 3). Three nose–upper lip grafts were harvested and injected with barium sulfate for microangiography computed tomographic analysis. Finally, three isolated nasal and bilabial grafts were procured and their vascular patency assessed by fluoroscopy.

Results:
The distal facial artery can perfuse the entire nose, septum, and upper lip, without any contribution of the superior labial artery. A dense anastomotic network indeed exists between the respective distal rami of both vessels. Furthermore, the exclusion of the superior labial artery from the harvested nasal subunit allowed safe bilabial subunit procurement, from the same specimen.

Conclusions:
The authors’ results demonstrate the feasibility of harvesting nasal and labial subunits, in an isolated or a combined manner. These results can find applications in subunit autologous replantation, allotransplantation, allogenic face partial retransplantation, and the emerging field of vascularized composite tissue engineering.
Gender-Confirmation Surgery Using the Pedicle Transverse Colon Flap for Vaginal Reconstruction: A Clinical Outcome and Sexual Function Evaluation Study
Authors: Manrique Oscar J. , Sabbagh M. Diya , Ciudad Pedro , Martinez-Jorge Jorys , Kiranantawat Kidakorn , Sitpahul Ngamcherd , Nippoldt Todd B. , Charafeddine Ali , Chen Hung-Chi 
Published: November 2017

Summary:
Vaginal reconstruction and vaginoplasty are indicated in vaginal agenesis, following pelvic tumor resection, trauma, and for gender-confirmation surgery. In this article, the authors present the clinical outcomes and sexual function evaluation when using the pedicle transverse colon flap for gender-confirmation surgery in transgender women. This is a retrospective chart review of all transgender women who underwent gender-confirmation surgery using the pedicle transverse colon flap. Demographics, procedure specifics, and surgical outcomes were recorded and analyzed. Sexual function was measured using the Female Sexual Function Index and the Female Genital Self-Image Scale 1 year after surgery. Fifteen patients underwent gender-confirmation surgery using the aforementioned technique. The average age of the patients was 20 years (range, 18 to 32 years), and the average operating room time was 10.1 hours (range, 8 to 12.5 hours). The average length and width of the flaps were 15 and 2.8 cm, respectively. During a 12-year follow-up, two complications were reported: one patient had pain caused by narrowing at the introitus, which required intervention, and one patient had an excessive amount of secretions in the first month, which subsided 3 months after surgery. The mean Female Sexual Function Index score was 28.6 (range, 24 to 31). All patients achieved normal sexual function as indicated by a Female Sexual Function Index score of 25 or more. For the Female Genital Self-Image Scale, the mean total score was 20.0 ± 4.5 (range, 7 to 28). The pedicle transverse colon flap is another valuable alternative method for vaginoplasty with promising results and minor complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Cleft-Related Orthognathic Surgery Based on Maxillary Vertical Lengthening of the Anterior Facial Height
Authors: Jeong Woo Shik , Jeong Hyung Hwa , Kwon Soon Man , Koh Kyung S. , Choi Jong Woo 
Published: November 2017

Background:
The conventional approach during orthognathic surgery for cleft-related deformities has focused largely on restoration of maxilla retrusion, using the maxillary advancement as a standard treatment objective. However, the authors thought that maxillary vertical shortening and deficient incisor show could be additional key elements of cleft-related deformities. Although slight vertical lengthening can be obtained with only maxillary advancement, it would not be enough to obtain satisfactory aesthetic results in terms of the anterior facial height. The authors hypothesized that vertical deficiency and anteroposterior maxillary retrusion exists in cleft-related deformities. Therefore, orthognathic surgery including intentional vertical lengthening and advancement would be better than the conventional simple advancement.

Methods:
A new approach was used to treat consecutive patients with dentofacial deformities between December of 2007 and December of 2016. Patients with cleft-related dentofacial deformities were included in the study.

Results:
Forty-one patients with cleft-related dentofacial deformities were included. The distance from the nasion to the incisor tip was 76.70 mm; the angle of the lines connecting the sella, nasion, and point A was 74.03 degrees; and the incisor show was 1.02 mm. Corresponding measurements in 40 patients without clefts were 81.57 mm, 80.08 degrees, and 3.38 mm, respectively. Postoperatively, the average vertical lengthening achieved was 0.88 mm in the simple maxillary advancement group and 7.65 mm in the intentional vertical lengthening accompanied by maxillary advancement group.

Conclusion:
The authors’ results suggest that simultaneous maxillary vertical lengthening with horizontal advancement is a viable approach to orthognathic surgery for cleft-related deformities, given the long-term stability of outcomes demonstrated in this study.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Lipopeptide PAM3CYS4 Synergizes N-Formyl-Met-Leu-Phe (fMLP)-Induced Calcium Transients in Mouse Neutrophils
Authors: Ding Renyu , Xu Ganqiong , Feng Yan , Zou Lin , Chao Wei 
Published: November 2017

ABSTRACT
N-Formyl-Met-Leu-Phe (fMLP), a mimic of N-formyl oligopeptides that are released from bacteria, is a potent leukocyte chemotactic factor. It induces intracellular calcium ([Ca2+]i) transient that is important for various neutrophil biological functions, e.g., adhesion, ROS, and cytokine productions. Toll-like receptors (TLRs), an essential part of host innate immunity, regulate neutrophil activities, but their role in [Ca2+]i signaling is less clear. In the present study, we examined the effect of several TLR ligands, including Pam3Cys4 (TLR1/2), lipopolysaccharide (LPS, TLR4), and lipoteichoic acid (LTA, TLR2/6), on calcium signaling and on the fMLP-induced [Ca2+]i transients in mouse neutrophils loaded with Fura-2/AM. We found that unlike fMLP, the three TLR ligands tested did not elicit any detectable Ca2+ flux. However, Pam3Cys4, but not LPS or LTA, markedly synergized the fMLP-induced [Ca2+]i transients, and had no effect on the host component keratinocyte-derived cytokine (KC)- or C5a-induced calcium flux. The effect of Pam3Cys4 on the fMLP-induced [Ca2+]i transients is by enhancing extracellular Ca2+ influx, not intracellular Ca2+ release. Surprisingly, deletion of TLR2 or MyD88 in neutrophils had no impact on the Pam3Cys4's effect, suggesting a TLR2-MyD88-independent mechanism. Finally, using the pan PKC activator and inhibitor, we demonstrated that PKC negatively regulated fMLP-induced [Ca2+]i transients and that inhibition of PKC did not prohibit Pam3Cys4's synergistic effect on the fMLP-induced calcium influx. In conclusion, the present study identified a novel synergistic effect of Pam3Cys4 on fMLP-induced [Ca2+]i transients, a process important for many neutrophil biological functions.