bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgeon Factors Rather Than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients With Multiligament Knee Injury
Authors: Brinkman Niels , Nunziato Carl , Laverty David , Ring David , Hill Austin , Crijns Tom J. 
Published: July 2024

OBJECTIVES:
To seek the factors associated with timing, staging, and type of surgery in the management of multiligament knee injuries.

METHODS:

Design:
Cross-sectional scenario-based experiment.

Setting:
Fifteen fictional patient scenarios with randomized elements.

Participants:
Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons who studies variation in care, were invited to participate. Surgeons with limited experience treating multiligament knee injuries were asked to self-exclude.

Outcome Measures and Comparisons:
Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, and preexisting osteoarthritis) and surgeon factors (gender, practice location, years of experience, and supervision of trainees) associated with surgeon recommendations were assessed.

RESULTS:
Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (odds ratio [OR] = 0.051) and preexisting osteoarthritis (OR = 0.32) and more likely in knee dislocation (OR = 1.9) and disruption of anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament with or without medial collateral ligament (MCL; OR = 5.1 and OR = 3.1, respectively). Disruption of anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament was associated with shorter time to surgery (β = −11). Longer time to surgery was associated with contralateral fracture (β = 9.2) and surgeons supervising trainees (β = 23) and practicing in Europe (β = 13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs. 1.4%, respectively). Open surgery was more likely in patients with lateral collateral ligament injury (OR = 2.9 to 3.3).

CONCLUSIONS:
The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence.

LEVEL OF EVIDENCE:
Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Recovery of Comfort and Capability After Upper Extremity Fracture Is Predominantly Associated With Mindset: A Longitudinal Cohort From the United Kingdom
Authors: Brinkman Niels , Thomas Jacob E. , Teunis Teun , Ring David , Gwilym Stephen , Jayakumar Prakash 
Published: July 2024

OBJECTIVES:
To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures.

METHODS:

Design:
Secondary use of longitudinal data.

Setting:
Single Level-1 trauma center in Oxford, United Kingdom.

Patient selection:
English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded.

Outcome measures and comparisons:
Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2–4 weeks, and 6–9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects.

RESULTS:
Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P < 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P < 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P < 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P < 0.02).

CONCLUSIONS:
Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury.

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Bicortical Compression and Construct Stability With Variable Pitch Locking Screws in Cadaveric Specimens
Authors: Koroneos Zachary A. , Alwine Shelby , Tortora Peter , Pitcher Michaela , Benedict Christian , Wee Hwabok , Kunselman Allen , Aynardi Michael , Lewis Gregory S. 
Published: July 2024

OBJECTIVES:
A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws (3.5-mm KreuLock Ti locking compression screws, Arthrex Inc., Naples, FL) with standard locking screws (from the same manufacturer) in bicortical fixation scenarios in cadaver bone by assessing (1) interfragmentary compression and plate-bone compression and (2) construct biomechanical stability.

METHODS:
Nine matched pairs of fresh-frozen cadaveric specimens with an average age of 67.2 years (range, 37–83) were used. Interfragmentary compression and plate-bone compression associated with insertion of single bicortical screws were compared between the variable pitch and standard locking screws at increasing levels of torque. The specimens tested were distal tibiae having a simulated longitudinal fracture. Additionally, fibulae were osteotomized to create a stable longitudinal fracture pattern and were fixed with a 5-screw plate construct with either all variable pitch or all standard locking screws. One of the 5 screws was placed across the osteotomy without lagging. Fibulae were tested cyclically with axial with torsional loading to compare displacements, rotation, and loads at failure or tested in 4-point bending to compare construct stiffness and maximum force to failure.

RESULTS:
Interfragmentary and plate-bone compression forces in the distal tibia model varied across specimens but were significantly higher with variable pitch locking screws compared with standard locking screws [512 N (SD = 324 N) vs. 79 N (SD = 64 N), P = 0.002, and 242 N (SD = 119 N) vs. 104 N (SD = 123 N), P = 0.028, respectively]. In cyclic loading of fibula constructs, no significant differences were detected in construct axial displacement or angular displacement (P > 0.05). In 4-point bending, no differences were detected in maximum force or bending stiffness (P > 0.05).

CONCLUSIONS:
Variable pitch locking screws produced interfragmentary compression between cortices and plate-bone compression that was greater than that produced by standard locking screws. In a stable bicortical fibula fixation scenario under external loading, the stability of variable pitch locking screw constructs was similar to constructs with standard locking screws.
Multimodal Deep Learning-based Radiomics Approach for Predicting Surgical Outcomes in Patients with Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Maki Satoshi , Furuya Takeo , Katsumi Keiichi , Nakajima Hideaki , Honjoh Kazuya , Watanabe Shuji , Kaito Takashi , Takenaka Shota , Kanie Yuya , Iwasaki Motoki , Furuya Masayuki , Inoue Gen , Miyagi Masayuki , Ikeda Shinsuke , Imagama Shiro , Nakashima Hiroaki , Ito Sadayuki , Takahashi Hiroshi , Kawaguchi Yoshiharu , Futakawa Hayato , Murata Kazuma , Yoshii Toshitaka , Hirai Takashi , Koda Masao , Ohtori Seiji , Yamazaki Masashi 
Published: July 2024

Study Design.
A retrospective analysis.

Objective.
This research sought to develop a predictive model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using deep learning and machine learning (ML) techniques.

Summary of Background Data.
Determining surgical outcomes assists surgeons in communicating prognosis to patients and setting their expectations. Deep learning and ML are computational models that identify patterns from large data sets and make predictions.

Methods.
Of the 482 patients, 288 patients were included in the analysis. A minimal clinically important difference (MCID) was defined as gain in Japanese Orthopaedic Association (JOA) score of 2.5 points or more. The predictive model for MCID achievement at 1 year postsurgery was constructed using patient background, clinical symptoms, and preoperative imaging features (x-ray, CT, MRI) analyzed through LightGBM and deep learning with RadImagenet.

Results.
The median preoperative JOA score was 11.0 (IQR: 9.0-12.0), which significantly improved to 14.0 (IQR: 12.0-15.0) at 1 year after surgery (P < 0.001, Wilcoxon signed-rank test). The average improvement rate of the JOA score was 44.7%, and 60.1% of patients achieved the MCID. Our model exhibited an area under the receiver operating characteristic curve of 0.81 and the accuracy of 71.9% in predicting MCID at 1 year. Preoperative JOA score and certain preoperative imaging features were identified as the most significant factors in the predictive models.

Conclusion.
A predictive ML and deep learning model for surgical outcomes in OPLL patients is feasible, suggesting promising applications in spinal surgery.

Level of evidence.
4
Assessment of Pelvic Tilt in Anteroposterior Radiographs by Area Ratio Based on Deep Learning
Authors: Xian Jianming , Sun Jingwei , Xie Ruimou , Yang Fei , Huang Jiaqi , Yuan Kehong , Pan Yu , Luo Zhendong 
Published: July 2024

Study Design.
Diagnostics.

Objectives.
Based on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs.

Background.
Pelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement.

Methods.
PT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases.

Results.
We observed no disparity between men and women in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD ±4.71°), with a correlation coefficient between them reaching 0.96. In addition, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is −0.58° (SD ±5.97°).

Conclusions.
We found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.
Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma
Authors: Ertel Michelle , Vargo John A. , Weimer Anna , Richman Adam , Beriwal Sushil , Mohammed Mohammed , Lesnock Jaime 
Published: July 2024

Objective:
We aim to explore whether the surgical tumor free margin is important for overall survival (OS) and local control in patients who undergo neoadjuvant radiation (RT) for vulvar cancer.

Methods:
A retrospective review from 2004 to 2021 of patients who underwent RT followed by surgical resection was performed. Patients were categorized into groups based on margin status (no residual disease, >8 mm, close margins defined as 1 to 7 mm, or positive). Local control and OS were analyzed using the Kaplan-Meier with log rank test. Multivariate analysis was performed with cox hazards model.

Results:
Eighty-three patients were included. A complete pathologic response (pCR) was found in 56% (n=46) of patients. The median follow-up time was 35 months (range: 4 to 216). The median OS for the entire cohort was 46 months (95% CI: 32.3-59.7). Having a pCR improved both OS and disease-free survival (DFS) compared with residual disease by 81 and 91 months, respectively (P<0.001). In the 2 patients with a margin >8 mm, there was no statistical difference in survival between those with close margins (46 vs. 25 mo, P=0.485). Factors that significantly impacted both OS and DFS were depth of invasion (DOI) and LVSI. On multivariate analysis of those with residual disease, there was no difference in OS or DFS by margin status but having a DOI >9 mm showed decreased OS (HR: 3.654; 95% CI: 1.317-10.135).

Conclusions:
In this cohort, response to RT, not margin status drives survival and recurrence. Given residual disease, the optimal margin is not clear, as there were only 2 patients with >8 mm margins. A close or positive margin had no impact on OS or local recurrence. A DOI >9 mm significantly impacts both OS and local recurrence even when accounting for other factors.
CD73 Is an Immunometabolic Biomarker of Poor Prognosis in Patients With Primary Cutaneous Squamous Cell Carcinoma and Hematologic Malignancy
Authors: Saeidi Vahide , Jackson Cullison Stephanie R. , Doudican Nicole A. , Carucci John A. , Stevenson Mary L. 
Published: July 2024

BACKGROUND
Impaired immunity may drive the increased incidence and aggression of cutaneous squamous cell carcinoma (cSCC) in patients with hematologic malignancy; however, precise mechanisms and prognostic biomarkers remain undefined. CD73 maintains elevated immunosuppressive adenosine levels and is associated with poor prognosis in several tumor microenvironments.

OBJECTIVE
Identify poor outcome biomarkers in patients with cSCC and hematologic malignancy.

MATERIALS AND METHODS
Differentially expressed genes in tumors from patients with hematologic malignancy experiencing good (n = 8) versus poor (n = 7) outcomes were identified by NanoString analysis. Results were validated at the protein level using CD73 immunohistochemistry in cSCC patients with (n = 38) and without (n = 29) hematologic malignancy.

RESULTS
Forty-eight genes were differentially expressed in tumors from patients with hematologic malignancy experiencing good versus poor outcomes. CD73 gene expression was >2-fold higher in patients with poor versus good outcomes or normal skin. Significantly increased CD73 protein levels were observed in cSCC tumors with poor versus good outcomes from patients with hematologic malignancies (p < .01), whereas no differences were noted in tumors with poor versus good outcomes from patients without hematologic malignancies (p = .49).

CONCLUSION
CD73 is highly expressed in poor prognosis cSCC from patients with hematologic malignancy and may represent a useful biomarker and potential therapeutic target.
Mohs for Melanoma: A Review of MART-1 Frozen Section Interpretation
Authors: Contestable James J. , Lim Geoffrey F. S. , Willenbrink Tyler , Zitelli John A. , Brodland David G. 
Published: July 2024

BACKGROUND
Mohs surgery for melanoma has been performed for many decades, but advances in the use of immunohistochemistry with frozen sections during Mohs surgery have allowed for more accurate, reliable, and efficient margin assessment with improved local control of the disease.

OBJECTIVE
To describe the use of MART-1 in treating melanoma with Mohs surgery and serve as a primer for the Mohs surgeon adding melanoma cases to their repertoire.

MATERIALS AND METHODS
Review of the literature and discussion of experience with Mohs for melanoma.

RESULTS
Practical approach and pitfalls when assessing margins using MART-1 immunohistochemistry during Mohs surgery for the treatment of melanoma.

CONCLUSION
Mohs for melanoma is an expanding field—education of Mohs surgeons and increasing the practice of this technique has the potential to improve patient outcomes.
Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults
Authors: Olotu Cynthia , Lebherz Lisa , Mende Anna , Hempel Cordelia , Philipp Rebecca , Schroeter Jennifer , Plümer Lili , Koch Birgit , Härter Martin , Zöllner Christian , Kriston Levente , Kiefmann Rainer 
Published: July 2024

BACKGROUND
Maintaining functional status is an essential therapeutic goal in peri-operative care of older adults. Although several recommendations concerning peri-operative management are available, pragmatic approaches to their sustainable implementation are lacking.

OBJECTIVE
Multiple evidence-based recommendations for peri-operative care of older adults were bundled into a multicomponent intervention and assessed for feasibility and effectiveness.

DESIGN
A quality improvement study with before–after comparison using a hybrid implementation-effectiveness approach.

SETTING
University Medical Centre. The trial was conducted from 2017 to 2020, follow-up was 1 week, 1 month and 6 months after surgery.

PATIENTS
Patients at least 65 years old were scheduled for surgery; excluded: intercranial, ophthalmological, and emergency surgery; planned postoperative stay in the intensive care unit. A total of 720 patients were eligible; 278 patients were recruited, 95 (34) of whom were female.

INTERVENTIONS
The intervention consisted of a set of recommended measures for peri-operative management of older patients, including pre-operative assessment and measures to manage frailty, malnutrition, polypharmacy, cognitive impairment and delirium. Patients were sequentially assigned to three groups: control (no change from usual care), transition (to implementation of the intervention) and intervention (fully implemented).

MAIN OUTCOME MEASURES
Feasibility was assessed by determining the level of implementation, and barriers were identified by conducting qualitative interviews with the medical staff. Intervention effectiveness was estimated by Instrumental Activities of Daily Living (IADL; Lawton and Brody, primary clinical outcome) 1 and six months postoperatively. The secondary outcomes included postoperative complications, cognitive performance, quality of life and length of hospital stay.

RESULTS
The implementation rate was 77%. Pre-operative IADL was 9.9/10 (range 8 to 10; SD 0.4) and 9.7/10 (6 to 10, 0.8) for the control and intervention groups, respectively. There was no statistically significant difference between the groups in IADL (0.07, 95% CI −0.23 to 0.36, P = 0.66) and 6 months after surgery (0.01, 95% CI −0.29 to 0.31, P = 0.95).

CONCLUSION
The implementation of evidence-based interventions to improve peri-operative care of older patients showed good feasibility in clinical routine but did not improve patients’ functional status, which was already at a high level pre-operatively.

TRIAL REGISTRATION
ClinicalTrials.gov, Identifier: NCT03325413
Ivabradine Approved and Other Uses in Clinical Practice: A Systematic Review
Authors: Hajiqasemi Mohsen , Ebrahimzade Mandana , Ghelichkhan Zahra A. , Huang Xena , Morkos Demyana , Jennings Douglas , Talasaz Azita H. 
Published: July 2024

Abstract:
Heart rate (HR) stands as a prognostic indicator of cardiovascular disease and a modifiable risk factor in heart failure (HF). Medication intolerance can curtail the application of conventional HR-lowering β-blockers to the optimum target dose. Ivabradine (IVA), a specific negative-chronotropic agent, selectively inhibits If current in pacemaker cells of the sinoatrial node without depressing myocardial contractility or comprising hemodynamics. This review summarized ivabradine's clinical labeled and off-label uses and mechanism of action focusing on the clinical outcomes. PubMed was searched up to January 2024 using the main keywords of IVA, coronary artery disease (CAD), HF, postural tachycardia syndrome (POTS), and tachyarrhythmia. To comprehensively review IVA's clinical indications, mechanisms, and therapeutic effects, all studies investigating treatment with IVA in humans were included, comprising different types of studies such as randomized controlled trials and longitudinal prospective observational studies. After screening, 141 studies were included in our review. A large number of reviewed articles were allocated to heart failure with reduced ejection fraction and CAD, suggesting IVA as an alternative to β-blockers in case of contraindications or intolerance. The beneficial effects of IVA as premedication for coronary computed tomography angiography, HR lowering in POTS, and inappropriate sinus tachycardia constituted most studies among off-label uses. The promising results have been reported on the efficacy of IVA in controlling HR, especially in patients with inappropriate sinus tachycardia or POTS. Owing to the unique mechanism of action, IVA has the potential to be used more frequently in future clinical practice.