bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sequential Lateral Lymphatic Metastasis Shows Similar Oncologic Outcomes to Upward Spread in Advanced Rectal Cancer After Preoperative Chemoradiotherapy
Authors: Kim Hye Jin , Choi Gyu-Seog , Cho Seung Hyun , Kang Min Kyu , Park Jun Seok , Park Soo Yeun , Kang Byung Woog , Kim Jong Gwang 
Published: November 2023

BACKGROUND:
Whether lateral pelvic node metastasis should be considered as a regional or systemic disease is a longstanding debate. While previous Japanese studies have considered it to be locoregional disease, Western countries consider it a systemic disease and do not perform lateral pelvic node dissection after preoperative chemoradiotherapy.

OBJECTIVES:
To evaluate whether lateral pelvic node metastasis is a systemic or regional disease that is amenable to curative resection.

DESIGN:
Retrospective analysis of a prospectively collected database.

SETTING:
This study was conducted at a tertiary cancer center.

PATIENTS:
There were 616 consecutive patients who underwent curative total mesorectal excision alone or with lateral pelvic node dissection after preoperative chemoradiotherapy for locally advanced rectal cancer between 2011 and 2019.

MAIN OUTCOME MEASURES:
Three-year disease-free and overall survival.

RESULTS:
A total of 360 patients underwent total mesorectal excision, and 160 patients underwent total mesorectal excision with lateral pelvic node dissection. There was no difference in the 3-year disease-free survival (p = 0.844) or overall survival rates (p = 0.921) between the groups. Patients with lateral pelvic node metastasis showed similar disease-free survival to those with perirectal lymph node metastasis in the total mesorectal excision group. In a subgroup analysis, patients with internal iliac pelvic node metastasis showed a comparable disease-free survival to those with perirectal node involvement, and patients with other lateral pelvic node metastasis showed a similar disease-free survival to those with intermediate node involvement. In the lateral pelvic node dissection group, the lateral pelvic node metastatic rate was 32.5%. On multivariate analysis, <8 of unilateral harvested lateral pelvic nodes and advanced ypT stage were significantly associated with poor disease-free survival.

LIMITATION:
The retrospective design.

CONCLUSIONS:
Lateral lymphatic metastasis showed similar oncologic outcomes to upward spread, especially perirectal lymph nodes metastasis. Large cohort studies with long-term follow-up are required to confirm these results.
Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology
Authors: Guzman Anthony K. , Schmults Chrysalyne D. , Ruiz Emily S. 
Published: November 2023

BACKGROUND
According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown.

OBJECTIVE
To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus.

METHODS
An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery.

RESULTS
Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training.

CONCLUSION
Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.
Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study
Authors: Lai Jonathan , Bao Aaron , McCaffrey Tara , Salman Rumsha , Gelderen Evelien V. , Rizk Emanuelle , Thompson Katherine G. , Epstein Jeremy A. , Bibee Kristin , Scott Jeffrey 
Published: November 2023

BACKGROUND
Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied.

OBJECTIVE
This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes.

METHODS
A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals.

RESULTS
Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383–14.304) or family history (aOR = 11.307, 95% CI 2.344–20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285–12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181–0.882).

LIMITATIONS
Single institution, retrospective study, limited surgical patients.

CONCLUSION
Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.
Alternating Treatment With Nonablative Fractional Laser and Radiofrequency Microneedling for the Treatment of Acne Scars: A Prospective, Randomized, Split-Face Study
Authors: Hartman Nina , Loyal Jameson , Borsack Summer , Goldman Mitchel 
Published: November 2023

BACKGROUND
Acne scarring is an unfortunate sequela affecting up to 95% of patients with acne and carries profound psychosocial impact. Both nonablative fractional lasers (NAFL) and microneedling with radiofrequency (MNRF) have demonstrated comparable efficacy in the treatment of atrophic acne scars.

OBJECTIVE
To determine whether alternating NAFL and MNRF is superior to NAFL alone in the treatment of atrophic acne scars.

METHODS AND MATERIALS
This was a prospective, single-center, double-blinded, split-face clinical trial. Twenty patients with atrophic acne scars who had their facial halves randomized to receive either NAFL alone or NAFL alternating with MNRF. Patients received 4 total treatments at 4-week intervals.

RESULTS
Ninety days after the final treatment, both facial halves demonstrated a significant improvement in the mean global échelle d'évaluation clinique des cicatrices d'acné (ECCA) score from baseline (p < .001 for both halves). The average percentage improvement at the final end point was 20% to 30% from baseline. No significant difference was noted between facial halves for mean global ECCA score or percentage improvement at any time point.

CONCLUSION
Although both NAFL and MNRF are safe and effective in the treatment of atrophic acne scars, alternating NAFL and MNRF does not seem to be superior to NAFL alone.
Performance of Staging Systems for Non–Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Guerra Ricardo , Shahwan Kathryn T. , Nikahd Melica , Hyer Madison , Carr David R. 
Published: November 2023

BACKGROUND
The performance of staging systems in non–head and neck cutaneous squamous cell carcinomas has not been well established.

OBJECTIVE
To evaluate the performance of the American Joint Committee on Cancer 8th Edition and Brigham and Women's Hospital staging systems in non–head and neck squamous cell carcinomas.

MATERIALS AND METHODS
Eligible tumors were identified and staged from an existing retrospective database. Cumulative incidence function curves of any poor outcome were generated. Distinctiveness, sensitivity, specificity, positive and negative predictive value, and concordance index were calculated.

RESULTS
1,042 primary tumors were included, with 38 resulting in any poor outcome and 16 in any major poor outcome. High-stage tumors represented 2.2% and 3.5% of tumors; these accounted for 10/38 of the poor outcomes (26.3%) and 8/16 of the major poor outcomes (50%). High-stage tumors predicted major poor outcomes with a sensitivity of 0.5 and specificity of 0.99 for the Brigham and Women's Hospital system, and a sensitivity of 0.5 and specificity of 0.97 for the American Joint Committee on Cancer 8th edition system. The concordance index for both was 0.74.

CONCLUSION
Current staging systems can be used to predict poor outcomes in cutaneous squamous cell carcinomas off the head and neck.
Racial–Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis
Authors: Tran Andrew X. , Barriera Paola , Xiong David , Knackstedt Thomas 
Published: November 2023

BACKGROUND
Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown.

OBJECTIVE
To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables.

MATERIALS AND METHODS
A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998–2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization.

RESULTS
A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998–2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64–0.80; p < .001), third (OR 0.74; 95% CI 0.63–0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35–0.55; p < .001) were less likely to undergo MMS for their MIS/LM.

CONCLUSION
Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
Clinical Characteristics of Marginally Recurrent Melanoma After Primary Excision: A Multisite Retrospective Analysis of 140 Cases Referred for Mohs Surgery
Authors: Soh Jonathan M. , Brodland David G. , Zitelli John A. 
Published: November 2023

BACKGROUND
Marginally recurrent melanoma (MRM) manifests immediately adjacent to or within a scar and arises from incomplete tumor clearance after primary treatment. Little is known about the progression and treatment of MRM after all forms of excision.

OBJECTIVE
To determine the invasive growth potential, tumor-stage progression, and outcomes of those with MRM.

METHODS
One hundred forty patients with MRM were collected from 5 practice databases. All patients were treated with Mohs micrographic surgery. They were evaluated for Breslow depth and tumor stage change from the time of primary treatment and recurrent treatment.

RESULTS
Of 101 cases initially treated as melanoma in situ, 13 (12.9%) marginally recurred with invasive disease at the time of Mohs micrographic surgery. The median thickness of these recurrent melanomas was 0.58 mm. Of 39 cases initially treated as invasive melanoma, 10 (25.6%) marginally recurred with a greater Breslow depth. The median increase in thickness from initial treatment to recurrence was 1.31 mm.

CONCLUSION
Marginally recurrent melanoma retains its invasive growth potential. This can lead to Breslow depth increase, tumor-stage progression, and a worse prognosis on recurrence. Obtaining tumor-free margins is critical in initial and recurrence treatments.
Fatigue among anaesthesiologists in Europe
Authors: Camilleri Podesta Anne Marie , Redfern Nancy , Abramovich Igor , Mellin-Olsen Jannicke , Oremuš Krešimir , Kouki Pinelopi , Guasch Emilia , Novak-Jankovic Vesna , Sabelnikovs Olegs , Bilotta Federico , Grigoras Ioana 
Published: November 2023

BACKGROUNDAnaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness.1OBJECTIVEThis study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists.DESIGNAn online survey of specialist anaesthesiologists.PARTICIPANTSThe survey was sent to anaesthesiologists in 42 European countries by electronic mail.MAIN OUTCOME MEASURESResponses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries.RESULTSWork-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being.CONCLUSIONWork-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.
High Incidence of Postoperative Nausea and Vomiting in Transgender Women Undergoing Facial Feminization Procedures
Authors: Mukerji Shivali , Uppalapati Akhil , Lee Rebekah , Price Ryan , Debryn Deen , Nozari Ala , Streed Carl , Kim Eugene 
Published: November 2023

Background:
Postoperative nausea and vomiting (PONV) is a significant concern due to its impact on patient comfort, recovery time, and extended hospital stay. Previous research links higher PONV rates in women during their periovulatory phase to estrogen. This study investigates the PONV risk in transgender women after facial feminization surgery.

Methods:
Retrospective chart reviews of transgender women aged older than 18 undergoing facial feminization from 2014 to 2020 were undertaken. Data included demographics, hormone use history, comorbidities, and PONV history. PONV was classified as any nausea/vomiting episode before discharge. Anesthesia records were examined, and PACU notes were analyzed for PONV indicators. A cis-gender male and female cohort undergoing rhinoplasty served as controls.

Results:
Of the 282 transgender women receiving facial feminization surgery, 104 experienced PONV, marking a 37% PONV rate. Compared with the 11% PONV rate among cis-gender rhinoplasty patients, this was notably higher. Hormone therapy discontinuation showed no influence on PONV incidence.

Conclusions:
Transgender women undergoing facial feminization surgery have a 38% PONV rate, surpassing the 11% rate in cis-gender rhinoplasty patients and the general 20%–30% rate for all procedures, including the 25% for oral and maxillofacial surgery. This suggests a heightened PONV risk for transgender women after facial feminization procedures.
Cataract surgery after corneal refractive surgery: preoperative considerations and management
Authors: Ting DSJ , Gatinel Damien , Ang Marcus 
Published: November 2023

Purpose of reviewCorneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE).Recent findingsChallenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS.SummaryOphthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future.
Impact of COVID-19 on HPV Vaccination Rates in New York City and Long Island
Authors: Bower Maria , Kothari Ulka , Akerman Meredith , Krilov Leonard R. , Fiorito Theresa M. 
Published: November 2023

Background:
In the United States, uptake of human papillomavirus (HPV) vaccination has been exceptionally low as compared with other vaccines. During the coronavirus disease (COVID-19) pandemic, routine vaccinations were deferred or delayed, further exacerbating HPV vaccine hesitancy. The specific effect of the pandemic on HPV vaccination rates in the United States has not been yet described.

Methods:
We aimed to determine the percentage of children achieving full HPV vaccination (2 doses) by age 15 years and to compare prepandemic to pandemic rates of HPV vaccination at pediatric practices across our institution. A retrospective chart review was performed to compare HPV vaccination rates in the “prepandemic” and “pandemic” periods for all children 9 through 14 years of age. Additionally, peaks in COVID-19 positivity were compared with HPV vaccination rates.

Results:
Of children 9–14 years old, 49.3% received at least 1 dose of HPV vaccine in the prepandemic period, compared with 33.5% during the pandemic (P < 0.0001). Only 33.5% of patients received the full 2-dose series of HPV prepandemic, compared with 19.0% of patients during the pandemic (P < 0.0001). When COVID-19 positivity rates peaked, HPV vaccination also declined.

Conclusions:
The issue of low HPV vaccination rates was amplified due to the COVID-19 pandemic, as illustrated by the correlation between peaks in COVID-19 positivity and low rates of HPV vaccination.
Evaluation of corneal power from an AS-OCT thick lens model and ray tracing: reliability of the keratometer index
Authors: Langenbucher Achim , Hoffmann Peter , Cayless Alan , Wendelstein Jascha , Szentmáry Nóra 
Published: November 2023

Purpose:
To investigate and compare different strategies of corneal power calculations using keratometry, paraxial thick lens calculations and ray tracing.

Setting:
Tertiary care center.

Design:
Retrospective single-center consecutive case series.

Methods:
Using a dataset with 9780 eyes of 9780 patients from a cataractous population the corneal front (Ra/Qa) and back (Rp/Qp) surface radius/asphericity, central corneal thickness (CCT), and entrance pupil size (PUP) were recorded using the Casia 2 tomographer. Beside keratometry with the Zeiss (PKZ) and Javal (PKJ) keratometer index, a thick lens paraxial formula (PG) and ray tracing (PR) was implemented to extract corneal power for pupil sizes from 2 mm to 5 mm in steps of 1 mm and PUP.

Results:
With PUP PKZ/PKJ overestimates the paraxial corneal power PG in around 97%/99% of cases and PR in around 80% to 85%/99%. PR is around 1/6 or 5/6 diopters (D) lower compared with PKZ or PKJ. For a 2 mm pupil PR is around 0.20/0.91 D lower compared with PKZ/PKJ and for a 5 mm pupil PR is comparable with PKZ (around 0.03 D lower) but around 0.70 to 0.75 D lower than PKJ.

Conclusions:
“True” values of corneal power are mostly required in lens power calculations before cataract surgery, and overestimation of corneal power could induce trend errors in refractive outcome with axial length and lens power if compensated with the effective lens position.
Medicare Data Linkages for Conducting Patient-Centered Outcomes Research on Economic Outcomes
Authors: Brown Derek S. , Srinivasan Mithuna , Zott Courtney , Wilson Kala , Dullabh Prashila , Smith Scott R. 
Published: November 2023

Background:
Medicare patients and other stakeholders often make health care decisions that have economic consequences. Research on economic variables that patients have identified as important is referred to as patient-centered outcomes research (PCOR) and can generate evidence that informs decision-making. Medicare fee-for-service (FFS) claims are widely used for research and are a potentially valuable resource for studying some economic variables, particularly when linked to other datasets.

Objective:
The aim of this study was to identify and assess the characteristics of federally funded administrative and survey data sources that can be linked to Medicare claims for conducting PCOR on some economic outcomes.

Research Design:
A targeted internet search was conducted to identify a list of relevant data sources. A technical panel and key informant interviews were used for guidance and feedback.

Results:
We identified 12 survey and 6 administrative sources of linked data for Medicare FFS beneficiaries. A majority provide longitudinal data and are updated annually. All linked sources provide some data on social determinants of health and health equity-related factors. Fifteen sources capture direct medical costs (beyond Medicare FFS payments); 5 capture indirect costs (eg, lost wages from absenteeism), and 7 capture direct nonmedical costs (eg, transportation).

Conclusions:
Linking Medicare FFS claims data to other federally funded data sources can facilitate research on some economic outcomes for PCOR. However, few sources capture direct nonmedical or indirect costs. Expanding linkages to include additional data sources, and reducing barriers to existing data sources, remain important objectives for increasing high-quality, patient-centered economic research.