bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas?
Authors: Huang Shao Hui , Hahn Ezra , Salunkhe Rohan , Barcelona Marc Vincent N. , O'Sullivan Brian 
Published: March 2023

Purpose of review
Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022).

Recent findings
Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice.

Summary
Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
Disease Experience of Patients With Differentiated Thyroid Cancer at Different Phases Based on Timing It Right Framework
Authors: Pei Jiaqin , Meng Jingyu , Xue Yajuan , Zhang Li 
Published: March 2023

Background
As the incidence of differentiated thyroid cancer (DTC) continues to rise globally, it is important to gain insight into the disease experience of cancer patients at different phases of the disease. However, surveys addressing the longitudinal disease experience and specific needs of this population are lacking.

Objective
The aim of this study was to explore the disease experience of people with DTC at key time points in their cancer trajectory so support can be rendered for “patient-centered” supportive care services.

Methods
On the basis of the Timing It Right framework, a semistructured in-depth interview was conducted with 14 patients with DTC at 5 key phases from initial diagnosis to 6 months postoperatively, and data were analyzed using the Colaizzi 7-step analysis.

Results
The themes of disease experience at different phases were as follows: (1) diagnostic phase: differences in acceptance; (2) perioperative phase: physical and mental distress; (3) discharge preparation phase: anxiety and helplessness, and gap of disease knowledge; (4) discharge adjustment phase: fear of recurrence and proactive health; and (5) discharge adaptation phase: multiple needs.

Conclusion
The experience, care needs, and nature of the needs of patients with DTC change dynamically with the different phases of the disease. Capturing the most appropriate time throughout the continuum of care to implement supportive care that patients need most will help to improve the continuity and precision of cancer care.

Implications for Practice
Healthcare providers should provide a continuum of dynamic care by scientifically and systematically assessing the actual supportive care needs of patients with DTC according to their different phases of disease.
Will ChatGPT Match to Your Program?
Authors: Zumsteg Jennifer M. , Junn Cherry 
Published: March 2023

Abstract
ChatGPT and other artificial intelligence (AI) word prediction large database models are now readily available to the public. Program directors should be aware of the general features of this technology and consider its effect in graduate medical education, including the preparation of materials such as personal statements. The authors provide a sample ChatGPT-generated personal statement and general considerations for program directors and other graduate medical education stakeholders. The authors advocate that programs and applicants will be best served by transparent expectations about how/if programs will accept application materials created using AI, starting with this application cycle. Graduate medical education will have many additional factors to consider for the innovative use and safeguards for the ethical application of AI in clinical care and educational processes. However, the exponential increase in the application of this technology requires an urgent review for appropriate management of program procedures, iteration of policies, and a meaningful national discussion.
Carbodiimide Derivatized Synovial Fluid for Tendon Graft Coating Improves Long-Term Functional Outcomes of Flexor Tendon Reconstruction
Authors: Reisdorf Ramona L. , Liu Haoyu , Bi Chun , Vrieze Alyssa M. , Moran Steven L. , Amadio Peter C. , Zhao Chunfeng 
Published: March 2023

Background:
Flexor digitorum profundus (FDP) tendon injury is common in hand trauma, and flexor tendon reconstruction is one of the most challenge procedures in hand surgery due to severe adhesion that exceed 25% and hinders hand function. Surface property of graft from extrasynovial tendons is inferior to the native intrasynovial FDP tendons, which has been reported as one of the major causations. Improve surface gliding ability of extrasynovial graft is needed. Thus, this study was to use carbodiimide derivatized synovial fluid and gelatin (cd-SF-gel) to modify the graft surface thus improving functional outcomes using a dog in-vivo model.

Methods:
40 flexor digitorum profundus tendons (FDP) from the second and fifth digits of 20 adult female underwent reconstruction with peroneus longus (PL) autograft after creation of tendon repair failure model for six weeks. Graft tendons were either coated with or without de-SF-gel (n=20). Animals were sacrificed 24 weeks following reconstruction and digits were collected post-sacrifice for biomechanical and histological analyses.

Results:
Adhesion score (cd-SF-Gel 3.15±1.53, control 5±1.26 (p<0.00017)), normalized work of flexion (cd-SF-gel 0.47 N-mm/degree±0.28, control 1.4 N-mm/degree±1.45 (p<0.014)), DIP motion (cd-SF-gel (DIP 17.63⁰±6.77⁰, control (DIP 7.07⁰±12.99⁰) (p<0.0015)) in treated graft all showed significant differences compared to non-treated graft. However, there was no significant difference in repair conjunction strength between two groups.

Conclusions:
Autograft tendon surface modification with cd-SF-Gel improves tendon gliding ability, reduces adhesion formation, and enhances digit function without interfering with graft-host healing.
“Use of Treatments After Recovering from Thumb Carpometacarpal Arthritis Surgery
Authors: Yousaf Imran S. , Sanghavi Kavya K. , Higgins James P. , Giladi Aviram M. , Means Kenneth R. 
Published: March 2023

Background:
What treatments patients continue to use more than 1 year after primary thumb carpometacarpal (CMC) arthritis surgery, and how such use relates to patient-reported outcomes, is largely unknown.

Methods:
We identified patients who had isolated primary trapeziectomy alone or with ligament reconstruction ± tendon interposition (LR±TI) and were 1 to 4 years post-operative. Participants completed a surgical site-focused electronic questionnaire about what treatments they still used. Patient-reported outcomes measures (PROMs) were the Quick Disability of the Arm, Shoulder, and Hand (qDASH) questionnaire and Visual Analog/Numerical Rating Scales (VA/NRS) for current pain, pain with activities, and typical worst pain.

Results:
One hundred twelve patients met inclusion and exclusion criteria and participated. At a median of 3 years after surgery, over 40% reported current use of at least one treatment for their thumb CMC surgical site, with 22% using more than one treatment. Of those who still used treatments, 48% used over-the-counter medications (OTC), 34% used home or office-based hand therapy, 29% used splinting, 25% used prescription medications, and 4% used corticosteroid injections. One hundred eight participants completed all PROMs. With bivariate analyses we found use of any treatment after recovering from surgery was associated with statistically and clinically significantly worse scores for all measures.

Conclusions:
Clinically relevant proportions of patients continue to use various treatments a median of 3 years following primary thumb CMC arthritis surgery. Continued use of any treatment is associated with significantly worse patient-reported outcomes for function and pain.

Level of Evidence:
IV
Prospective Cohort Study Comparing Ligament Reconstruction with Tendon Interposition and Suture-Only Suspension Arthroplasty for the Treatment of Basal Joint Arthritis
Authors: Suszynski Thomas M , Fowler John R , Munsch Maria , Bourne Debra A , Chow Ian , Balk Marshall L , Hagberg William C , Buterbaugh Glenn A , Sivak Wesley N , Imbriglia Joseph E 
Published: March 2023

Basal joint arthritis is a common form of osteoarthritis. There is no consensus procedure for maintenance of trapezial height following trapeziectomy. Suture-only suspension arthroplasty (SSA) is a simple method for stabilizing the thumb metacarpal following trapeziectomy.
This single-institution prospective cohort study compares trapeziectomy followed by either ligament reconstruction with tendon interposition (LRTI) or SSA for the treatment of basal joint arthritis. Patients underwent LRTI or SSA from 5/2018-12/2019. VAS pain scores, DASH functional scores, clinical thumb ROM, pinch and grip strength data, and patient-reported outcomes (PROs) were recorded and analyzed preoperatively, and at 6-weeks and 6-months postoperatively.
Total number of study participants was 45 (LRTI 26, SSA 19). Mean (± standard error, SE) age was 62.4 (±1.5) years, with 71% female, and 51% operated were on the dominant side. VAS scores improved for LRTI and SSA (p<0.0001) over 6-months, with no differences between groups at any timepoint (p>0.3). DASH scores improved for LRTI and SSA over 6-months (p<0.0001), with no differences between groups at any timepoint (p>0.3). Following SSA, opposition improved (p=0.02), but not as well for LRTI (p=0.16). Grip and pinch strength decreased following LRTI and SSA at 6-weeks but recovered similarly for both groups over 6-months. PROs were generally no different between groups at all timepoints.
LRTI and SSA are similar procedures following trapeziectomy relative to pain, function and strength recovery.
Primary Repair versus Reverse End-to-Side Coaptation by Anterior Interosseous Nerve Transfer in Proximal Ulnar Nerve Injuries
Authors: Gonzalez Gilberto A. , Polmear Michael , Carter Jordan T. , Castagno Christopher , Herrera Fernando 
Published: March 2023

Background:
Proximal ulnar nerve lacerations are challenging to treat due to the complex integration of sensory and motor function in the hand. The purpose of this study was to compare primary repair and primary repair plus anterior interosseous nerve (AIN) reverse end-to-side (RETS) coaptation in the setting of proximal ulnar nerve injuries.

Methods:
A prospective cohort study was performed of all patients at a single, academic, level 1 trauma center from 2014-2018 presenting with isolated complete ulnar nerve lacerations. Patients underwent either primary repair (PR) only or primary repair and AIN RETS (PR+RETS). Data collected included demographic information, quick Disabilities of the Arm, Shoulder, and Hand (qDASH), Medical Research Council (MRC) scores, grip and pinch strength, and Visual Analog Scale pain scores at 6 and 12 months post-operatively.

Results:
Sixty patients were included in the study: 28 in the PR group and 32 in the RETS+PR group. There was no difference in demographic variables or location of injury between the two groups. Average qDASH scores for the PR and PR+RETS groups were 65 ± 6 and 36 ± 4 at six months and 46 ± 4 and 24 ± 3 at 12 months postoperatively, respectively, and were significantly lower in the PR+RETS group at both points. Average grip and pinch strength were significantly greater for the PR+RETS group at 6 and 12 months.

Conclusions:
This study demonstrated primary repair of proximal ulnar nerve injuries plus AIN RETS coaptation yielded superior strength and improved upper extremity function when compared to primary repair alone.
Distal Ulnar Bifurcation Arthroplasty in the Treatment of Bayne and Klug Types 3 and 4 Radial Club Hands: Preliminary Outcomes
Authors: Jia Ya-chao , Zhao Hao-yu , Wu Tian-yi , Xu Jia , Kang Qing-lin 
Published: March 2023

Background:
The treatment of Bayne and Klug types 3 and 4 radial club hands remains challenging and controversial. In this study, the authors reported a new procedure called distal ulnar bifurcation arthroplasty and reviewed the preliminary results.

Methods:
Between 2015 and 2019, 11 patients with 15 affected forearms having type 3 or 4 radial club hands underwent distal ulnar bifurcation arthroplasty. The mean age was 55.5 months (range, 29 to 86 months). The surgical protocol consisted of (1) bifurcation of the distal ulnar to accommodate the wrist with stable support; (2) pollicization to treat hypoplastic or absent thumb; (3) in the case of significant bowed ulna, ulnar corrective osteotomy was performed. In all patients, clinical and radiologic parameters including hand-forearm angle, hand-forearm position, ulnar length, wrist stability and motion were recorded.

Results:
The mean duration of follow-up was 42.2 months (range, 24 to 60 months). The average correction of hand-forearm angle was 80.2 degrees. The overall range of active wrist motion was approximately 87.5 degrees. Ulna growth per year was 6.7 mm (range 5.2 to 9.2 mm). No major complications were recorded during follow up.

Conclusions:
The distal ulnar bifurcation arthroplasty offers a technically feasible alternative for the treatment of type 3 or 4 radial club hand, which enables satisfactory appearance, provides stable support to the wrist and maintains wrist function. Despite the promising preliminary results, longer follow-up is necessary to evaluate this procedure.
Quantifying the Impact of Genetics on Neurocognition in Non-Syndromic Sagittal Craniosynostosis
Authors: Junn Alexandra , Dinis Jacob , Long Aaron , Timberlake Andrew T. , Persing John A. , Alperovich Michael 
Published: March 2023

Background:
Previous work has identified an association between de novo and transmitted loss of function mutations in genes under high evolutionary constraint (high pLI) with neurodevelopmental delays in non-syndromic craniosynostosis (NSC). We sought to quantify the neurocognitive effect of these genetic lesions.

Methods:
In a prospective, double-blinded cohort study, demographic surveys and neurocognitive tests were administered to patients recruited from a national sample of children with sagittal NSC. Scores for academic achievement, full-scale intelligence quotient (FSIQ), and visuomotor skills were directly compared between patients with and without damaging mutations in high pLI genes using two-tailed t tests. Analysis of covariance was also used to compare test scores while controlling for surgery type, age at surgery, and sociodemographic risk.

Results:
56 patients completed neurocognitive testing, 18 of whom had a mutation in a highly constrained gene. There was no significant difference between groups in any sociodemographic factors. After controlling for patient factors, patients with high-risk mutations had poorer performance compared to patients without high-risk mutations in every testing category, with significant differences in FSIQ (102.9 ± 11.4 vs. 110.1 ± 11.3, P=0.033) and visuomotor integration (100.0 ± 11.9 vs. 105.2 ± 9.5, P=0.003). There were no significant differences in neurocognitive outcome when stratifying groups based on type of surgery or age at time of surgery.

Conclusions:
Even after controlling for exogenous factors, the presence of mutations in high-risk genes led to poorer neurocognitive outcomes. High risk genotypes may predispose individuals with NSC to deficits, particularly in full-scale IQ and visuomotor integration
Cartilage-Sparing Otoplasty – A New Approach
Authors: Benkler Michal , Weiss Nathaniel , Egozi Dana , Dolgunin Luda , Kouniavski Elizaveta 
Published: March 2023

Summary:
Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring/excision and suture-fixation techniques. However, disadvantages include either irreversible distortion of the anatomy, irregularities, or overcorrection; or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two-to-three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which could otherwise appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring and anatomical deformity can be avoided. This technique was used on 91 ears in 2020–2021, with only 1 ear (1.1%) requiring revision. Rates of complications or recurrence were low. Overall, it appears to be a rapid and safe method for treating the prominent ear deformity, with aesthetically pleasing results.
Molecular scalpels: the future of pediatric craniofacial surgery?
Authors: Timberlake Andrew T. 
Published: March 2023

Summary:
CRISPR-Cas genome editing tools are among the most substantial advances in the life sciences in modern history. Single dose gene therapies to correct pathogenic mutations have moved quickly from bench to bedside, with several therapeutics designed by CRISPR pioneers entering various stages of clinical investigation. Applications of these genetic technologies are poised to reshape the practice of both medicine and surgery. Many of the most morbid conditions treated by craniofacial surgeons are syndromic craniosynostoses caused by mutations in fibroblast growth factor receptor (FGFR) genes, including Apert, Pfeiffer, Crouzon, and Muenke syndromes. The fact that pathogenic mutations in these genes are recurrent in the majority of affected families presents a unique opportunity to develop “off the shelf” gene editing therapies to correct these mutations in affected children. The therapeutic potential of these interventions could reshape pediatric craniofacial surgery, potentially first eliminating the need for midface advancement procedures in affected children.
Novel treatment protocol for combined tear through ligament stretching and injection
Authors: Philippe Berros , Atlan Lilian , Hubschman Sasha , Converset Sophie , Enright Kaitlyn M. , Nikolis Andreas 
Published: March 2023

Introduction:
Complex anatomical changes have been the main challenges for optimal treatment results of tear trough deformities through hyaluronic acid (HA) injections. This study presents a novel technique consisting of a pre-injection tear trough ligament stretching (TTLS-I) leading to its release, and compared its efficacy, safety and patient satisfaction to tear trough deformity injection (TTDI).

Method:
This was 4-year retrospective single-center cohort study of 83 TTLS-I patients, with a follow-up period of one year. One hundred and thirty five TTDI patients served as a comparison group.
Outcome analyses included the analysis of possible risk factors for adverse outcome, as well as comparative statistics between the complication and satisfaction rates among the two groups.

Results:
TTLS-I patients received significantly less hyaluronic acid (HA) (0.3cc (0.2cc-0.3cc)) than TTDI patients (0.6cc (0.6cc-0.8cc), p<0.001). The injected HA amount was a significant predictive factor for complications (p<0.05).
Complication rates assessed during the follow-up visit for hematomas, edema, as well as the need for corrective hyaluronidase injection were low in both groups, with no significant differences among both groups. TTDI patients had significantly higher rates (5.1%) of lump surface irregularities during follow-up compared to 0% in the TTLS-I group (p<0.05).
After one year of follow-up, 98.8% of TTLS-I patients were satisfied whereas TTDI patients were satisfied in 95.6%, with no significant difference.

Conclusion:
TTLS-I is a novel, safe and effective treatment method, necessitating significantly less HA compared to TTDI. Moreover, it leads to very high satisfaction, as well as very low complication rates.
Brief Report: The Influence of the COVID-19 Pandemic on the Physical, Social, and Mental Health of Black and Latinx Young People With HIV in the United States
Authors: Sauceda John A. , Dubé Karine , Harris Orlando , Campbell Chadwick K. , Ndukwe Samuel , Saberi Parya 
Published: March 2023

Background:
Whereas national attention has been paid to the ongoing mental health crises among young people triggered by the COVID-19 pandemic, less is known about the social, physical and psychological impacts of COVID-19 on young people living with HIV, especially racial/ethnic minorities.

Setting:
Online survey of participants across the U.S.

Method:
A national cross-sectional survey of non-Latinx Black and Latinx young adults (18–29) living with HIV. Between April and August 2021, participants answered survey questions about several domains (eg, stress, anxiety, relationships, work, quality of life) that were worsened, improved, or unchanged during the pandemic. We ran a logistic regression estimating the self-reported impact of the pandemic on these domains between 2 age groups (ages 18–24 versus 25–29).

Results:
The sample size was 231 (186 non-Latinx Black, 45 Latinx) and mainly male (84.4%) and gay identified (62.2%). Nearly 20% of participants were 18–24 years old and 80% were ages 25–29. Participants who were 18–24 years old reported 2–3 times the odds for having worse sleep quality and mood and greater stress, anxiety, and weight gain compared with those 25–29 years old.

Conclusion:
Our data provide a nuanced picture of the negative impacts that COVID-19 had on non-Latinx Black and Latinx young adults living with HIV in the U.S. Given that these adults represent a priority population for HIV treatment outcomes, it is critical to better understand the ongoing toll that these dual pandemics have on their lives.