bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing the Satisfactory Patient Symptom State Thresholds for Patient Reported Outcomes After Operatively Treated Tibial Plateau Fractures
Authors: Sato Eleanor H. , Treu Emily A. , Froerer Devin L. , Zhang Chong , O’Neill Dillon C. , Cizik Amy M. , Haller Justin M. 
Published: December 2023

OBJECTIVES:
Define patient acceptable symptom state (PASS) thresholds and factors impacting PASS thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) following operatively treated tibial plateau fractures.

METHODS:

Design:
Retrospective cohort.

Setting:
Single Level I academic trauma center.

Patient Selection Criteria:
All patients (n=159) who underwent fixation of a tibial plateau fracture from 2016-2021 and completed patient reported outcome measurements (PROMs) at minimum one-year follow-up.

Outcome Measures and Comparisons:
PASS thresholds for global outcome (PASS-Global), pain (PASS-Pain), and function (PASS-Function) were determined using anchor-based questions such as “How satisfied are you today with your injured lower extremity?” with answer choices of very satisfied, satisfied, neutral, unsatisfied, and very unsatisfied. PASS thresholds for each PROM were calculated using three methods: 1) 80% specificity, 2) 75th percentile, and 3) Youden Index.

RESULTS:
60% of patients were satisfied with their global outcome and 53% with function. Using 80% specificity, 75th percentile, and Youden Index, PASS-Global thresholds were 48.5, 44.5, and 47.9 for PROMIS-PF and 56.3, 56.2, and 56.3 for KOOS-QOL, respectively. PASS-Pain threshold for KOOS-Pain was 84.4, 80.6, and 80.6. PASS-Function thresholds were 48.9, 46.8, and 48 for PROMIS-PF and 94.1, 90.2, and 86.8 for KOOS-ADL, respectively. Younger patients, those with bicondylar fractures and infections were associated with significantly lower PASS-Pain thresholds. Schatzker II fractures, lateral column involvement, or isolated lateral approach resulted in significantly higher PASS-global and -function thresholds.

CONCLUSIONS:
This study defines global, functional, and pain PASS thresholds for tibial plateau fractures. Patients with bicondylar fractures, infections, and medial column involvement were more often unsatisfied. These thresholds are valuable references to identify patients who have attained satisfactory outcomes and to counsel patients with risk factors for unsatisfactory outcomes following tibial plateau fractures.
Arthroscopic-assisted Tibiotalocalcaneal Arthrodesis Using a Hindfoot Nail for Treatment of Ankle Fractures in Medically Complex Patients: A Technique Guide and Retrospective Case Series
Authors: Washburn Frederic , Ahankoob Niaz , Bonavida Victor , Fang William , Pyle Casey 
Published: December 2023

Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients.

Level of Evidence:
Level IV, retrospective case series.
Wellness and burnout in cardiac surgery: not black and white
Authors: Izumi Aliya , Nwakoby Akachukwu , Verma Raj , Yanagawa Bobby 
Published: December 2023

Purpose of review
Despite a growing emphasis on burnout in medicine, there remains a paucity of data in cardiac surgery. Herein, we summarize recent data on cardiac surgeon well being and identify factors for consideration in future burnout inquiries and management.

Recent findings
Overall, 70–90% of cardiothoracic surgeons report job satisfaction in the United States. However, 35–60% still endorse burnout symptoms, and the specialty reports some of the highest rates of depression (35–40%) and suicidal ideation (7%). Such negative experiences are greater among early-stage and female surgeons and may be addressed through targeted, program-specific wellness policies. Canada's single-payer healthcare system might exacerbate surgeon burnout due to lower financial compensation and job autonomy.

Summary
Cardiothoracic surgeons appear simultaneously burnt out and professionally fulfilled. They report a high incidence of depression and clock in the most hours, yet the majority would choose this specialty again. These findings reveal a more nuanced state of well being than previously appreciated and speak to ambiguities in how burnout is conceived and measured. A broader examination across surgical and social contexts highlights the hierarchical nature of burnout factors and potential ways forward. Collectively, these insights can inform assessments of burnout in Canadian cardiac surgery that remain absent to date.
Seladelpar treatment reduces IL-31 and pruritus in patients with primary biliary cholangitis
Authors: Kremer Andreas E. , Mayo Marlyn J. , Hirschfield Gideon M. , Levy Cynthia , Bowlus Christopher L. , Jones David E. , Johnson Jeff D. , McWherter Charles A. , Choi Yun-Jung 
Published: December 2023

Background and Aims:Pruritus is a debilitating symptom for many people living with primary biliary cholangitis (PBC). In studies with seladelpar, a selective peroxisome proliferator-activated receptor-delta agonist, patients with PBC experienced significant improvement in pruritus and reduction of serum bile acids. Interleukin-31 (IL-31) is a cytokine known to mediate pruritus, and blocking IL-31 signaling provides relief in pruritic skin diseases. This study examined the connection between seladelpar’s antipruritic effects and IL-31 and bile acid levels in patients with PBC.Approach and Results:IL-31 levels were quantified in serum samples from the ENHANCE study of patients with PBC receiving daily oral doses of placebo (n = 55), seladelpar 5 mg (n = 53) or 10 mg (n = 53) for 3 months, and for healthy volunteers (n = 55). IL-31 levels were compared with pruritus using a numerical rating scale (NRS, 0–10) and with bile acid levels. Baseline IL-31 levels closely correlated with pruritus NRS (r= 0.54,p< 0.0001), and total (r= 0.54,p< 0.0001) and conjugated bile acids (up to 0.64,p< 0.0001). Decreases in IL-31 were observed with seladelpar 5 mg (−30%,p= 0.0003) and 10 mg (−52%,p< 0.0001) versus placebo (+31%). Patients with clinically meaningful improvement in pruritus (NRS ≥ 2 decrease) demonstrated greater dose-dependent reductions in IL-31 compared to those without pruritus improvement (NRS < 2 decrease). Strong correlations were observed for the changes between levels of IL-31 and total bile acids (r= 0.63,p< 0.0001) in the seladelpar 10 mg group.Conclusions:Seladelpar decreased serum IL-31 and bile acids in patients with PBC. The reductions of IL-31 and bile acids correlated closely with each other and pruritus improvement, suggesting a mechanism to explain seladelpar’s antipruritic effects.
Circulating metabolic markers after surgery identify patients at risk for severe postoperative complications: a prospective cohort study in colorectal cancer
Authors: Montcusí Blanca , Madrid-Gambin Francisco , Pozo Óscar J , Marco Santiago , Marin Silvia , Mayol Xavier , Pascual Marta , Alonso Sandra , Salvans Silvia , Jiménez-Toscano Marta , Cascante Marta , Pera Miguel 
Published: December 2023

Background:
Early detection of postoperative complications after colorectal cancer (CRC) surgery is associated with improved outcomes. The aim was to investigate early metabolomics signatures capable to detect patients at risk for severe postoperative complications after CRC surgery.

Materials and methods:
Prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before and after surgery, and analyzed by mass spectrometry obtaining 188 metabolites and 21 ratios. Postoperative complications were registered with Clavien–Dindo Classification and Comprehensive Complication Index.

Results:
One hundred forty-six patients were included. Surgery substantially modified metabolome and metabolic changes after surgery were quantitatively associated with the severity of postoperative complications. The strongest positive relationship with both Clavien–Dindo and Comprehensive Complication Index (β=4.09 and 63.05, P<0.001) corresponded to kynurenine/tryptophan, against an inverse relationship with lysophosphatidylcholines (LPCs) and phosphatidylcholines (PCs). Patients with LPC18:2/PCa36:2 below the cut-off 0.084 µM/µM resulted in a sevenfold higher risk of major complications (OR=7.38, 95% CI: 2.82–21.25, P<0.001), while kynurenine/tryptophan above 0.067 µM/µM a ninefold (OR=9.35, 95% CI: 3.03–32.66, P<0.001). Hexadecanoylcarnitine below 0.093 µM displayed a 12-fold higher risk of anastomotic leakage-related complications (OR=11.99, 95% CI: 2.62–80.79, P=0.004).

Conclusion:
Surgery-induced phospholipids and amino acid dysregulation is associated with the severity of postoperative complications after CRC surgery, including anastomotic leakage-related outcomes. The authors provide quantitative insight on metabolic markers, measuring vulnerability to postoperative morbidity that might help guide early decision-making and improve surgical outcomes.
Characterization changes and research waste in randomized controlled trials of global bariatric surgery over the past 20 years: cross-sectional study
Authors: Huang Ze-ning , Qiu Wen-Wu , He Qi-Chen , Zhang Zhi-quan , Xu Binbin , Zheng Chang-yue , Zheng Chao-Hui , Xie Jian Wei , Wang Jia-Bin , Lin Jian-Xian , Chen Qi-yue , Cao Long-Long , Huang Chang-ming , Lu Jun , Li Ping 
Published: December 2023

Background:
The results of several large randomized controlled trials (RCTs) have changed the clinical practice of bariatric surgery. However, the characteristics of global RCTs of bariatric surgery have not been reported internationally and whether there was research waste in these RCTs is unknown.

Methods:
Search ClinicalTrials.gov for bariatric surgery RCTs registered between January 2000 and December 2022 with the keywords ‘Roux-en-Y gastric-bypass’ and ‘Sleeve Gastrectomy’. The above analysis was conducted in January 2023.

Results:
A total of 326 RCTs were included in this study. The number of RCTs registered for sleeve gastrectomy and gastric bypass surgery increased year by year globally. Europe has always accounted for the largest proportion, Asia has gradually increased, and North America has decreased. A total of 171 RCTs were included in the analysis of waste, of which 74 (43.8%) were published. Of the 74 published RCTs, 37 (37/74, 50.0%) were judged to be adequately reported and 36 (36/74, 48.6%) were judged to have avoidable design defects. In the end, 143 RCTs (143/171, 83.6%) had at least one research waste. Body weight change as the primary endpoint (OR: 0.266, 95% CI: 0.103–0.687, P=0.006) and enrolment greater than 100 (OR: 0.349, 95% CI: 0.146–0.832, P=0.018) were independent protective factors for research waste.

Conclusions:
This study for the first time describes the characteristic changes of the mainstream RCT of bariatric surgery globally in the last 20 years and identifies a high research waste burden and predictive factor in this area, which provides reference evidence for carrying out bariatric surgery RCTs more rationally.
Ophthalmology and oculoplastics for the rhinologist
Authors: Stefko S. Tonya , Terrarosa Anna K. 
Published: December 2023

Purpose of reviewAs the management of ophthalmic and sinus disease advances, it is important to stay abreast of all current management options. This involves knowledge of adjacent anatomy and disease processes, and collaboration between multiple specialties. The authors provide a review of relevant ophthalmic and oculoplastic topics for the rhinologist.Recent findingsThe scope and surgical skills of oculoplastic and rhinologist specialists have grown in conjunction with medical and technological advancements. Familiarity with the presentations of sinus disease in the orbit can decrease the time to disease recognition, and improve morbidity and mortality. Collaborative approaches provide improved access to areas of interest throughout the orbit and sinuses. Multiportal, transorbital, and endoscopic techniques can improve patient morbidity and mortality compared to conventional open approaches. Familiarity with all medical and surgical treatment options can help tailor treatments to patients’ needs.SummaryMultidisciplinary approaches to sinus and orbit disease and the incorporation of new surgical technologies can improve patient options and outcomes.
Management of aggressive variants of papillary thyroid cancer
Authors: Lee Ying Ki , Rovira Aleix , Carroll Paul V. , Simo Ricard 
Published: December 2023

Purpose of review
The aim of this study was to provide a timely and relevant review of the latest findings and explore appropriate management of aggressive variants of papillary thyroid cancer (AVPTC).

Recent findings
In general, AVPTCs tend to exhibit more invasive characteristics, a lack of responsiveness to radioiodine, increased occurrences of regional spreading, distant metastases and higher mortality rates. Meanwhile, each variant showcases unique clinical and molecular profiles.

Summary
Given the elevated risk of recurrence postsurgery, a more aggressive strategy may be necessary when suspected preoperatively, particularly for those presenting with invasive features. Decision on the extent of surgical treatment and adjuvant therapy is individualized and made by experienced clinicians and multidisciplinary teams based on the clinical presentation, presence of aggressive features and molecular profile. Future studies on development of personalized medicine and molecular target therapy may offer tailored treatment options.
Benign bony lesions of paranasal sinuses and skull base: from osteoma to fibrous dysplasia
Authors: Papargyriou Georgia Evangelia , Oostra Amanda , Georgalas Christos 
Published: December 2023

Purpose of review
Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if required, highly challenging.
This article reviews the current literature on their pathophysiology, diagnosis, natural course and treatment, with a focus on most recent findings.

Recent findings
A new classification has been suggested concerning endoscopic resectability. The ratio of lateral frontal to interorbital distance can accurately and reliably predict the endoscopic reach to lateral frontal sinus, while orbital transposition can assist us in reaching lateral frontal sinus when anatomy is unfavorable. New and combined endoscopic transnasal and transorbital approaches are now in the surgical armamentarium. Prophylactic optic nerve decompression in fibrous dysplasia is absolutely contraindicated as it leads to worse visual outcomes. Radiotherapy of such lesions is of no benefit and may lead to a higher risk of malignant transformation. The presence of Guanine Nucleotide binding protein Alpha Stimulating (GNAS) mutation in chromosome 20 is universally present in fibrous dysplasia and can differentiate them from ossifying fibromas.

Summary
Diagnosis and therapeutic management of benign craniofacial bone lesions remains challenging. If surgical treatment is contemplated, the morbidity of the intervention should always be weighed against the potential benefits. Evolution of extended endoscopic endonasal and transorbital surgery means that more lesions can be reached purely endoscopically with better oncological and cosmetic results.
Evidence-Based Practice Implementation
Authors: Kawar Lina Najib , Fangonil-Gagalang Evangeline , Failla Kim Reina , Aquino-Maneja Emma , Vaughn Stephanie , Mestler Loos Nancy 
Published: December 2023

OBJECTIVE
This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture.

BACKGROUND
Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation.

METHODS
Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method.

RESULTS
Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something).

CONCLUSIONS
Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.
Using Machine Learning (XGBoost) to Predict Outcomes following Infrainguinal Bypass for Peripheral Artery Disease
Authors: Li Ben , Eisenberg Naomi , Beaton Derek , Lee Douglas S. , Aljabri Badr , Verma Raj , Wijeysundera Duminda N. , Rotstein Ori D. , de Mestral Charles , Mamdani Muhammad , Roche-Nagle Graham , Al-Omran Mohammed 
Published: December 2023

Objective:
To develop machine learning (ML) algorithms that predict outcomes following infrainguinal bypass.

Summary Background Data:
Infrainguinal bypass for peripheral artery disease (PAD) carries significant surgical risks; however, outcome prediction tools remain limited.

Methods:
The Vascular Quality Initiative (VQI) database was used to identify patients who underwent infrainguinal bypass for PAD between 2003-2023. We identified 97 potential predictor variables from the index hospitalization (68 pre-operative [demographic/clinical], 13 intra-operative [procedural], and 16 post-operative [in-hospital course/complications]). The primary outcome was 1-year major adverse limb event (MALE; composite of surgical revision, thrombectomy/thrombolysis, or major amputation) or death. Our data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, we trained 6 ML models using pre-operative features. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). The top-performing algorithm was further trained using intra- and post-operative features. Model robustness was evaluated using calibration plots and Brier scores.

Results:
Overall, 59,784 patients underwent infrainguinal bypass and 15,942 (26.7%) developed 1-year MALE/death. The best pre-operative prediction model was XGBoost, achieving an AUROC (95% CI) of 0.94 (0.93-0.95). In comparison, logistic regression had an AUROC (95% CI) of 0.61 (0.59-0.63). Our XGBoost model maintained excellent performance at the intra- and post-operative stages, with AUROC’s (95% CI’s) of 0.94 (0.93-0.95) and 0.96 (0.95-0.97), respectively. Calibration plots showed good agreement between predicted and observed event probabilities with Brier scores of 0.08 (pre-operative), 0.07 (intra-operative), and 0.05 (post-operative).

Conclusions:
ML models can accurately predict outcomes following infrainguinal bypass, outperforming logistic regression.
Blepharospasm Secondary to Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson Disease: Clinical Characteristics and Management Outcomes
Authors: Ting Michelle A. , Manta Alexandra I. , Samia-Aly Emma , Lai Michelle , de Carvalho Emanuel R. , Buttery Philip , Ezra Daniel G. 
Published: December 2023

Background:
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for patients with motor symptoms of Parkinson disease but can be complicated by disabling blepharospasm and apraxia of eyelid opening (ALO). Currently, there is no clear consensus on optimal management, and addressing these issues is further hindered by systemic morbidity and resistance to treatments. We aim to describe the different phenotypes of these eyelid movement disorders, to report our management approach and patient responses to treatment.

Methods:
A retrospective case series of all patients with blepharospasm/ALO secondary to STN-DBS that were treated at a tertiary center between 2011 and 2020. Data collected included date of Parkinson diagnosis, date of DBS surgery, date of development of blepharospasm/ALO symptoms, STN-DBS stimulation settings, and treatment given. Patients' symptoms before and after treatment were measured using the blepharospasm disability index and Jankovic Rating Scale.

Results:
Five patients were identified with eyelid movement disorders secondary to STN-DBS. All patients had moderate-to-severe symptoms at presentation. Four patients received periocular botulinum toxin injections. Three patients underwent surgery in the form of frontalis suspension or direct brow lift with or without upper lid blepharoplasty. All reported an improvement in symptoms following treatment.

Conclusions:
A multimodality, patient-specific approach is required in the treatment of blepharospasm/ALO secondary to STN-DBS. Botulinum toxin injections can be effective, but patients may require surgery if toxin treatment alone becomes ineffective. Tailoring treatment to individual needs can result in a measurable improvement in symptoms.