bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ein fallbasiertes Unterrichtskonzept mit praktischen Übungen im Fach Hygiene und Mikrobiologie: ein nachhaltiges Unterrichtskonzept zur Umsetzung der neuen Approbationsordnung in klinisch-theoretischen Fächern
Authors: Himmels Jan P.W. , Sterz Jasmina , Rüsseler Miriam , Kempf Volkhard A.J. , Brandt Claudia 
Published: December 2022

Zusammenfassung
Hintergrund Im Rahmen eines Lehrverbesserungsprojekts an der Goethe-Universität, Frankfurt am Main wurde das Praktikum Hygiene und Mikrobiologie für Studierende der Humanmedizin von einem Organsystem-bezogenen auf ein fallbasiertes Unterrichtsmodell umgestellt. Begleitend wurde diese Umstellung im Hinblick auf eine Verbesserung der Lernwahrnehmung und des Lernerfolgs untersucht.
Methoden An dem Projekt nahmen 54 Personen teil. In homogenen Fokusgruppen wurden 45 Studierende mit bis zu fünf Personen interviewt. Neun der Teilnehmenden waren Ärztinnen oder Ärzte, die in Einzelinterviews befragt wurden. Die Interviews wurden anhand eines Leitfadens offen durchgeführt, anschließend anonym transkribiert und einer strukturierten qualitativen Inhaltsanalyse unterzogen.
Ergebnis Die Ergebnisse belegen, dass sowohl Studierende als auch Ärztinnen und Ärzte im Praktikum Hygiene und Mikrobiologie eine fallbasierte Unterrichtsführung in Kombination mit dem Erwerb praktischer Kompetenzen präferieren. Studierende, die fallorientiert unterrichtet wurden, waren zufriedener und beklagten einen geringeren nachfolgenden Verlust des erworbenen theoretischen Fachwissens. Praktische Übungen im Fach Hygiene und Mikrobiologie waren allen Teilnehmenden auch noch nach langer Zeit gut erinnerlich. Unabhängig vom Unterrichtskonzept wurden die Dozenten als motivierende Schlüsselfigur identifiziert.
Schlussfolgerung Die Umstellung von einem Organsystem-bezogenen auf ein fallbasiertes Unterrichtskonzept mit praktischen Übungen führt im Fach Hygiene und Mikrobiologie zu einem besseren Verständnis für die Relevanz der Lerninhalte und zu einer subjektiven Steigerung des Lernerfolgs. Aufgrund der klinisch-theoretischen Verknüpfungen stellt das Unterrichtsmodell im Praktikum Hygiene und Mikrobiologie entsprechend den Vorgaben der neuen Approbationsordnung eine nachhaltige Unterrichtsalternative für klinisch-theoretische Fächer dar.
Evaluation des Prototyps eines neuen intraoperativen Aberrometers für die Vorhersage der postoperativen Zielrefraktion
Authors: Tandogan Tamer , Khoramnia Ramin , Choi Chul Young , Auffarth Gerd U. 
Published: December 2022

ZusammenfassungBei allen Fortschritten der präoperativen Biometrie in der Kataraktchirurgie und der refraktiven Linsenchirurgie sowie den verschiedenen heute gebräuchlichen Kalkulationsformeln gehören
„refraktive Überraschungen“ nach wie vor zum klinischen Alltag. Besonders nachteilig und enttäuschend ist ein Abweichen von der Zielrefraktion für Patienten, die sich für eine spezielle
Linse wie eine Multifokal- oder EDOF-IOL entschieden haben sowie vor allem für Patienten, die eine torische IOL implantiert bekommen, bei der schon leichte Abweichungen von der Zielachse die
Sehschärfe nachteilig beeinflussen können. Die intraoperative Aberrometrie ist eine Methode, die es dem Chirurgen ohne zusätzlichen größeren Aufwand erlaubt, die Refraktion des aphaken Auges
(nach Entfernung der natürlichen Linse) und kurz darauf des nunmehr pseudophaken Auges zu überprüfen. Die Methode, für die es zurzeit 3 unterschiedliche Geräte gibt, zeigt in den meisten
Evaluationen eine deutlich geringere Abweichung von der Zielrefraktion als die präoperative Biometrie. Neben einer Evaluation des Prototyps des I-O-W-A-Systems zur Ausmessung des Auges
während der Operation werden eigene Ergebnisse über den Einfluss des Anästhesieverfahrens und des IOL-Typs vorgestellt.
Evaluation of a Microsurgery Training Curriculum
Authors: Cuteanu Anita , Hellich Agathe , Cardinal Alba Le , Thomas Maeve , Valchanova Anna , Vara Sital , Horbury Gwynn , Boal Matt , Ghamrawi Walaa , Slim Naim , Francis Nader ,   On behalf of the Microsurgery Training Group at The Griffin Institute
Published: December 2022

Abstract
Background Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model.
Methods A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact.
Results In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for “good.” All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (chi square = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring 11 attempts on average to reach proficiency. In total, 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation, and actions to address them were implemented in the following programs.
Conclusion Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.
Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps
Authors: Chen Jonlin , Varagur Kaamya , Xun Helen , Wallam Sara , Karius Alexander , Ospino Rafael , Ji Jenny , Sanka Sai Anusha , Daines John , Skladman Rachel , Aliu Oluseyi , Sacks Justin M. 
Published: December 2022

AbstractBackground Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on postoperative patient outcomes and surgical costs.Methods A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020. Patient demographics, intraoperative management, anastomotic technique, and postoperative outcomes were collected. Data were analyzed using Student's t-tests, Chi-square analysis, and multivariate logistic regression.Results Of the 270 patients included in our study (mean age 52, majority Caucasian [74.5%]), intraoperative anastomotic failure occurred in 26 (9.6%) patients. Increased number of circulating nurses increased risk of anastomotic failure (odds ratio [OR] 1.02, 95% confidence Interval [CI] 1.00–1.03, p <0.05). Presence of a junior resident also increased risk of anastomotic failure (OR 2.42, 95% CI 1.01–6.34, p <0.05). Increased surgeon years in practice was associated with decreased failures (OR 0.12, CI 0.02–0.60, p <0.05). Intraoperative anastomotic failure increased the odds of postoperative hematoma (OR 8.85, CI 1.35–59.1, p <0.05) and was associated with longer operating room times (bilateral DIEP: 2.25 hours longer, p <0.05), longer hospital stays (2.2 days longer, p <0.05), and higher total operating room cost ($28,529.50 vs. $37,272.80, p <0.05).Conclusion Intraoperative anastomotic failures during DIEP flap reconstruction are associated with longer, more expensive cases and increased rates of postoperative complications. Presence of increased numbers of circulators and junior residents was associated with increased risk of anastomotic failure. Future research is necessary to develop practice guidelines for optimizing patient and surgical factors for intraoperative anastomotic success.
Outcomes of Palliative Colonic Stent Placement in Malignant Colonic Obstruction: Experience from a Tertiary Care Oncology Center in India
Authors: Sundaram Sridhar , Rathod Raosaheb , Patil Prachi , Mane Kiran , Seth Vishal , Saklani Avanish , Desouza Ashwin , Mehta Shaesta 
Published: December 2022

Abstract
Introduction Colonic self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analyzed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology center in Western India.
Methods Retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 and September 2021. Demographic details, intent of stent placement, site of obstruction, length of stricture, technical success of stenting, clinical success, and complications (both immediate and long term) were noted.
Results Sixty-one patients underwent colonic SEMS placement during the study period (mean age 53.6 years, 50.7% men). Obstruction was due to primary colonic malignancy in 43 (70.5%) patients and extracolonic malignancies in 18 (29.5%) patients. Most common extracolonic malignancy was gallbladder cancer in 8 (44.4%) patients. Most common site of obstruction was sigmoid colon in 18 (29.5%) patients. Proximal colonic obstruction was seen in 17 (27.9%) patients. Peritoneal metastases were seen in 26 (42.6%) patients. Colonoscopy revealed an impassable stenosis in 58 (95.1%) patients. Median length of stricture was 5 cm (range 2–9 cm). Technical success was achieved in 98.3% (60/61). Clinical success was achieved in 51 (86.4%) patients. Perforation during colonic SEMS placement was seen in 2 (3.4%) patients. Stent migration was seen in 3 (5.9%) patients, needing surgery for retrieval in all 3 patients. Over a median follow-up of 9 months (0–21 months), stent block was seen in 7 (13.7%) patients. Stent block developed after a median period of 6 months. Of these patients, three patients underwent SEMS placement within the SEMS and the other four patients underwent surgery.
Conclusion Colonic SEMS placement achieves good palliation of malignant colonic obstruction in approximately 87% patients. Long-term complications like obstruction occur in a few patients after a median duration of 6 months.
Reductive Umpolung and Defunctionalization Reactions through Higher-Order Titanium(III) Catalysis
Authors: Streuff Jan 
Published: December 2022

AbstractThe single-electron transfer from an in situ formed titanium(III) catalyst to ketones, imines, nitriles, Michael acceptors, and many other functions has enabled a large number of intra- and intermolecular reductive umpolung reactions. Likewise, it allows the homolytic cleavage of functional groups for selective defunctionalizations. These reactions often take place with the participation of two titanium(III) species, avoiding free-radical pathways and enabling high catalyst control of the reaction selectivity. This account discusses the development of the individual reactions together with the fundamental mechanistic discoveries that led to a better understanding of such titanium(III)-catalyzed processes in general.1	Introduction2	Active Titanium(III) Species and Additives3	Ketone-Nitrile Couplings4	Further Reductive Umpolung Reactions5	Catalytic Homolytic C–CN and C–SO2R Cleavage6	Conclusion
Endobiliary and Pancreatic Radiofrequency Ablations
Authors: Lavekar Anurag , Mukewar Saurabh 
Published: December 2022

AbstractRadio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs.
Addition of Tibial Tubercle Osteotomy to Combined MPFL Reconstruction and Lateral Retinacular Release not Recommended for Recurrent Patellar Dislocation in Patients with 15 to 20 mm TT-TG
Authors: Zhang Yuankai , Nan Kai , Zhao Yan , Zhang Xin , Song Qichun , Fan Lihong , Shi Zhibin , Dang Xiaoqian 
Published: December 2022

AbstractSurgery is the primary treatment for recurrent patellar dislocation. However, there is still a lack of consensus regarding the choice of combined surgical methods due to the complexity of the anatomical factors. This study aimed to investigate the efficacy and radiological changes in medial patellofemoral ligament reconstruction (MPFLR) and lateral retinacular release (LRR) with and without tibial tubercle osteotomy (TTO) for recurrent patellar dislocation in patients with a tibial tubercle-trochlear groove (TT-TG) distance of 15 to 20 mm. Fifty-four patients were enrolled in this retrospective study between 2010 and 2014. The average patient age was 21.6 ± 5.0 years. All patients underwent MPFLR and LRR, and in 18 patients, these procedures were combined with TTO. Patients were evaluated preoperatively and postoperatively for patellar lateral shift, patellar tilt angle, TT-TG distance, Q-angle, Caton–Deschamps index (CDI), Kujala, and Lysholm scores. The minimally clinical important difference was used to compare clinical outcomes between two groups. In the mean follow-up of 82.6 ± 15.9 months, functional scores improved significantly in both groups (p < 0.01). There were no significant differences in postoperative function scores between the two groups (Kujala, p = 0.25, mean difference = 1.5, 95% confidence interval [CI]: –1.4–4.4; Lysholm, p = 0.76, mean difference = –0.6, 95% CI: –5.9–4.7). Additionally, TTO significantly decreased Q-angle (23.6 ± 2.4 vs. 17.4 ± 2.9, p < 0.01), TT-TG (17.1 ± 1.5 vs. 10.4 ± 1.8, p < 0.01), and CDI (1.18 ± 0.12 vs. 1.08 ± 0.07, p < 0.01). Combined MPFLR and LRR with and without TTO are both effective techniques for recurrent patellar dislocation. Additional osteotomy can correct patellar alta and tibial tubercle lateralization. However, given that there were no significant differences in postoperative functional scores or recurrence rate between groups, we may not recommend TTO in addition to MPFLR and LRR in patients with TT-TG of 15 to 20 mm. Long-term and prospective cohort studies are required to assess further outcomes.
Concomitant Lateral Meniscus Tear is Associated with Residual Rotatory Knee Instability 1 Year after Anterior Cruciate Ligament Reconstruction: Case-cohort Study
Authors: Chiba Daisuke , Yamamoto Yuji , Kimura Yuka , Sasaki Shizuka , Sasaki Eiji , Yamauchi Shohei , Tsuda Eiichi , Ishibashi Yasuyuki 
Published: December 2022

AbstractLateral meniscus tear (LMT) accompanied by anterior cruciate ligament (ACL) injuries has been reported to provoke rotatory instability of the affected knee joint. Unfortunately, these previous papers did not determine whether LMT-derived rotatory knee instability is residual because only preoperative or time zero data exists. This study aimed to longitudinally investigate how the prevalence of comorbid LMT is associated with residual rotatory knee instability (RKI) 1 year after ACL reconstruction (ACLR). A total of 327 patients who underwent double-bundle ACLR (average age: 23.4 years, body mass index: 23.5 kg/m2, 215 females). The patients were divided into three groups based on arthroscopy: 1) intact lateral meniscus (LM); 2) unrepaired LMT; 3) repaired LMT. At the 1-year follow-up, the pivot-shift test was performed. The prevalence of RKI, determined according to IKDC grades (grade ≥1 denoted RKI), was compared with chi-square or Fisher's exact tests. Thirty-eight patients (11.6%) had RKI; 203 subjects (62.1%) showed LMT, and 124 patients were diagnosed with an intact LM. Out of the 203 patients, 79 (38.9%) underwent LM repair. RKI was more prevalent in the LMT group than in the intact group (13.8% versus 8.1%, p = 0.117; Odds ratio: 1.499 [95%CI: 0.864 - 2.600]). In addition, the prevalence of RKI was significantly higher in the LM-repair group than in the intact-LM group (17.7% versus 8.1%, p = 0.038; Odds Ratio: 2.455 [95%CI: 1.032 - 5.842]). Medial meniscus tear (MMT) was detected in 113 patients (34.6%); RKI prevalence was not statistically different between the intact-MM group and the MMT group (12.2% versus 10.6%, p = 0.681). The current cohort study clarified that LMT comorbid with ACL injury was longitudinally associated with increased RKI prevalence 1 year after ACLR. Therefore, patients who underwent both ACLR and LM repair demonstrated a significantly higher prevalence of residual RKI.
Clinical and Electrophysiological Features Predicting Response to Antiseizure Medications in Juvenile Absence Epilepsy
Authors: Karaoğlu Pakize , Tekin Hande Gazeteci 
Published: December 2022

Abstract
Background We aimed to evaluate the clinical findings and electroencephalographic (EEG) characteristics of patients with juvenile absence epilepsy (JAE) and to determine the factors that predict response to antiseizure medications (ASMs) in JAE.
Methods We reviewed the medical records of 29 patients with JAE. The patients who were seizure-free during the last 12 months of their follow-up and who did not have generalized spike waves on their last EEG were considered as the treatment-responsive group, and the patients whose clinical seizures persisted during the last 12 months of their follow-up or who had generalized spike waves on their follow-up EEGs were considered as patients who did not respond to ASMs.
Results There were 29 patients, 20 girls and nine boys, with a mean age of 13.34 ± 2.17 years and a follow-up time of 32.1 ± 11.9 months. Twenty-two cases (75.8%) were evaluated as responsive to treatment. Generalized tonic–clonic seizures (GTCS) were statistically more common in patients who did not respond to ASM. Epileptic seizures began at a younger age in the group that responded to medication. Occipital intermittent rhythmic delta activity (OIRDA) in EEG was significantly higher in the group that responded to the medication.
Conclusion Our study shows that concomitant GTCS may predict poorer response to ASMs in JAE. Younger age at diagnosis and OIRDA on EEG may be associated with better response to treatment. Our findings need to be confirmed by further prospective and long-term studies.
Supratentorial Demyelinating Lesions Following Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Pediatric Case Report
Authors: Boeri Silvia , Martinez Popple Marina , Giacomini Thea , Bellini Tommaso , Severino Mariasavina , Rossi Andrea , Debbia Carla , Ancona Silvana , Aldera Elena , Nobili Lino , Siri Laura 
Published: December 2022

Abstract
Introduction Most coronavirus disease 2019 (COVID-19) pediatric patients are asymptomatic; however, several neurological manifestations associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been reported. Demyelinating events such as acute disseminated encephalomyelitis have been recently included among potential complications of COVID-19.
Case Report We describe the case of a 12-year-old boy who developed central nervous system demyelinating lesions following SARS-CoV-2 infection. Two months prior he had been diagnosed with panuveitis but was otherwise healthy. Three weeks after testing positive for SARS-CoV-2, he started to complain of right temporal headache associated with right orbital pain without vision impairment. Brain magnetic resonance imaging showed large leukodystrophy-like demyelinating lesions. Standard electroencephalogram revealed a slow activity on the right hemisphere. His clinical and electroencephalographic course was favorable, with a good response to corticosteroid therapy and infusions of intravenous immunoglobulins. Delayed but complete resolution of brain lesions was noted on imaging.
Conclusion Our case contributes to broaden the knowledge regarding the spectrum of possible complications of SARS-CoV-2 infection. The relative lack of clinical manifestations in our patient can be seen as a warning not to underestimate even mild neurological symptoms correlated with COVID-19.
Is Preoperative Facial Palsy a Deterrent to Facial Nerve Preservation after Gross-Total Removal of Giant Vestibular Schwannomas?
Authors: Sahana Debabrata , Kumar Sanjeev , Rathore Lavlesh , Mittal Jatinder , Sahu Rajiv K. , Jain Amit K. , Tawari Manish 
Published: December 2022

AbstractBackground Although rare in small vestibular schwannomas, preoperative facial nerve paresis is often present in giant schwannomas. Preserving facial nerve function in these cases remains a herculean task. This study evaluates the facial functions after complete tumor removal and whether preoperative facial nerve involvement affects postoperative functional status.Methods This retrospective study from January 2014 to August 2021 excluded nongiant tumors (< 4 cm), neurofibromatosis type 2 cases, incomplete removals, redo surgeries, deaths, and cases done without nerve monitoring. These were grouped into preoperative facial palsy present (PFP) and no preoperative facial palsy (NFP). Facial nerve functions were assessed on first postoperative day, at the time of discharge, and at last follow-up and dichotomized into two groups: nondisfiguring (House–Brackmann [HB] grades I–III) and disfiguring (HB grades IV–VI). The cohort outcomes of patients with nondisfiguring PFP (HB grades I–III) were also analyzed.Results There were 88 cases (PFP, n = 57; NFP, n = 31). Facial nerve was preserved anatomically in 62 (70.45%) patients (PFP, n = 38; NFP, n = 24) without any statistical difference (p = 0.29). Statistically significant disfiguring facial outcomes (HB IV, V, VI) were seen in patients with preoperative facial palsy (p = 0.01); however, a comparison of facial functions in patients with only nondisfiguring PFP with those in NFP group did not show the statistical difference (p = 0.12).Conclusion Facial nerve palsy present before surgery does not seem to be a deterrent to intraoperative preservation of facial nerve during complete removal of giant vestibular schwannomas. Patients with nondisfiguring facial palsies have postoperative facial functions comparable to those without facial palsy.