bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Smartphone App to Reduce Burnout in the Emergency Department: A Pilot Randomized Controlled Trial
Authors: Monfries Nicholas , Sandhu Naminder , Millar Kelly 
Published: November 2022

Background: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED. Methods: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group. Results: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score −5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants. Conclusions/Application to Practice: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.
Intersurgeon Consistency of Ulnar Collateral Ligament Repair With Internal Brace: A Biomechanical Analysis
Authors: Kouk Shalen N. , Beason David P. , Rothermich Marcus A. , Dugas Jeffrey R. , Cain E. Lyle 
Published: November 2022

Background: Injury to the ulnar collateral ligament (UCL) of the medial elbow has been treated successfully with ligament repair augmented with internal brace. Previous work has shown that this procedure does not overconstrain the ulnohumeral joint; however, the procedures were conducted by a single surgeon, which controlled for anchor placement and graft tensioning. Purpose/Hypothesis: Our purpose was to evaluate the reproducibility of contact mechanics and joint torque after UCL repair with internal brace as performed by different surgeons compared with repair by a single surgeon. It was hypothesized that there would be no significant difference in elbow contact mechanics, valgus torque, or torsional stiffness between the 2 groups. Study Design: Controlled laboratory study. Methods: Nine pairs of fresh-frozen cadaveric elbows were tested biomechanically under 3 conditions: UCL-intact (UCL-I), UCL-deficient (UCL-D), and UCL-repaired with internal brace augmentation (UCLR-IB). For each pair, 1 elbow was repaired by a single surgeon, and the contralateral elbow was repaired by 1 of 9 other surgeons. Testing consisted of valgus torsion between 0° and 5° with the elbow positioned at 90° of flexion. Ulnohumeral contact mechanics and overall joint torque and stiffness were measured and compared between surgeon groups. Results: There were no statistically significant differences between the single-surgeon and multiple-surgeon groups regarding contact area ( P = .83), contact force ( P = .27), peak pressure ( P = .26), or peak force ( P = .30); however, contact pressure was significantly affected ( P = .02) by surgeon group. Compared with UCL-I, both UCL-D and UCLR-IB conditions had a significant overall effect on contact area ( P = .004) and contact force ( P = .05); however, contact pressure ( P = .56), peak pressure ( P = .27), and peak force ( P = .24) were not affected by injury condition. Measurements of elbow torque ( P = .28) and stiffness ( P = .98) were not significantly different between surgeon groups. Conclusion: UCL repair with internal brace provided consistent results among several surgeons when compared with a single surgeon. The procedure did not lead to joint overconstraint while also returning the ligament to near-intact levels of resisting valgus stress. Clinical Relevance: UCL repair with internal brace augmentation is a reproducible surgical technique that has good clinical outcomes in the literature.
A Cohort Study of Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study using the National Joint Registry and NHS Digital
Authors: Jennison Toby , Goldberg Andrew J. , Sharpe Ian T. 
Published: November 2022

Category: Ankle Arthritis Introduction/Purpose: Despite the increasing numbers of ankle replacements that are being performed there are still limited studies on the survival of ankle replacements and which factors influence survivorship comparisons between different implants. The primary aim of this study is to link NJR data with NHS digital data to determine the true failure rates of ankle replacements and to determine the risk factors for failure of total ankle replacements Methods: A data linkage study combined National Joint Registry Data and NHS Digital data. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device inserted during ankle replacement surgery. Life tables and Kaplan Meier survival charts demonstrated survivorship. Cox proportional hazards regression models with the Breslow method used for ties were fitted to compare failure rates. Results: 5,562 primary ankle replacement were recorded on the NJR between 1st April 2010 and 31st December 2018. The unadjusted 1-year survivorship of ankle replacements was 98.8% (95% CI 98.4%-99.0the 5-year survival in 2725 patients was 90.2% (95% CI 89.2%-91.1) and the 10-year survival in 199 patients was 86.2% (95% CI 84.6%-87.6%). In univariate cox regression models age, BMI, ASA, Charlson co-morbidity score, indication for surgery were significantly associated with an increased risk of failure. In multivariate cox regression models only age (HR 0.956, 95% CI 0.942-0.970), BMI (HR 1.032, 95% CI 1.006-1.059) and indication (HR 0.880, 95% CI 0.799-0.968) were associated with an increased risk of failure. Conclusion: Ankle replacements have been demonstrated to have higher failure rates in younger patients, those with an increased BMI, and those with osteoarthritis. These findings should be taken into account when deciding which patients should undergo an ankle replacement and in counselling them on the likely survivorship of their ankle replacement
Total Talus Replacement: A Systematic Review of the Literature
Authors: Jennison Toby , Dalgleish James S. , Davies Mark , Sharpe Ian T. , Goldberg Andrew J. 
Published: November 2022

Category: Ankle Arthritis Introduction/Purpose: Total talus replacements have been proposed as a method to treat talar AVN replacing the entire talus. The potential for total talar replacements has increased with the advent of patient specific implants utilising 3D printing based on CT scanning of the ipsilateral or contralateral talus. The primary aim of this systematic review is to analyse the current literature on total talus replacements. It specifically aims to look at the indications, complications, survival and functional outcomes. Methods: A systematic review was undertaken including all levels of evidence and following PRISMA guidelines. Basic percentages and a weighted pooled proportion for failures using the Freeman Tukey double arscine transformation were performed. Results: 9 papers with 151 patients were included. The mean age ranged from 27.6 to 72, with 5 papers having a mean age of less than 50. Mean follow-up ranged from 12.8 to 58 months. The most common indication was avascular necrosis in 103 patients.4 studies used 3D printing and 5 customised implants. 3 studies undertook a talus replacement with an ankle replacement. 4 studies used ceramic prostheses, 3 cobalt chromium 1 stainless steel and 1 titanium with ceramic surface. Post-operative complications ranged from 0 to 33%. 69.6% of 23 functional outcomes scores demonstrated significant improvement in functional scores with the others demonstrating a non-significant improvement.3 of 151 implants failed requiring further surgery with 2 revisions and 1 amputation. 6 of the 8 studies did not report any operations for failure. The cumulative incidence of failure was 0.1 % (95% CI 0.0- 4.9%). Conclusion: Total talus replacements are a potential alternative to tibiotalocalcaneal fusion for patients with avascular necrosis of the talus. Further studies are required to ensure good outcomes prior to an increase in use of this prosthesis.
Predictors of High-Dose Initial Opioid Prescriptions in Primary Osteoarthritis: A Single Institution Analysis
Authors: Johnson Charles , O'Leary Ryan J. , Hoch Caroline P. , Scott Daniel J. , Gross Christopher E. 
Published: November 2022

Category: Ankle Arthritis; Other Introduction/Purpose: High-dose opioid prescriptions in osteoarthritis (OA) increase the risk of overdose and chronic opioid dependence, which is associated with worse perioperative outcomes in total joint arthroplasty (TJA). The purpose of this study was to determine the (1) incidence and (2) identify independent risk factors for receiving high-dose initial opioid prescriptions in OA patients. Methods: A retrospective chart review was performed to evaluate initial outpatient opioid prescriptions for OA in opioid-naïve adult patients at a single academic institution between 2013 and 2020. Patients with prior surgery or opioid prescriptions were excluded. Patient demographic data, medical comorbidities, Charlson Comorbidity Index (CCI) scores, and prescription metadata were recorded. High-dose prescriptions were defined as daily oral morphine equivalents (OME/d) >=50. Univariate analysis and multivariate logistic regression were used to identify independent predictors for high-risk opioid prescriptions. Results: A total of 1,527 patients were identified with an initial opioid prescription for OA, with 21.5% of patients receiving high- dose prescriptions. The majority of high-dose prescriptions (>=50 OME/d) were given oxycodone (56.1%), while low-dose prescriptions (<50 OME/d) were more commonly prescribed hydrocodone-acetaminophen (34.2%) and tramadol (32.5%). Using multivariate logistic regression, patient factors that are independently associated with high-dose prescriptions include decreased age, decreased BMI, white race, and non-orthopaedic encounters. Comorbid factors that were independently predictive of high- dose prescriptions include hip OA, higher CCI scores, and depression. (Table 1) Conclusion: Independent predictors for high-dose initial opioid prescriptions in OA include younger age, decreased BMI, white race, non-orthopaedic encounters, hip OA, higher CCI scores, and depression.
Papillary Thyroid Cancer Metastases to the Parathyroid Gland
Authors: O’Sullivan Brian , Burton Tom , Ziad Fouzia , Meyer Rochow Goswin 
Published: November 2022

Introduction: Papillary Thyroid cancer (PTC) is the most common malignancy encountered by endocrine surgeons accounting for up to 85% to 90% of all thyroid malignancies. Parathyroid metastases appear to be an uncommon phenomenon however are likely to be underdiagnosed due to routine parathyroid gland preservation during thyroidectomy. Case: We present the case of 63-year-old lady with PTC metastases to the parathyroid gland. She underwent total thyroidectomy, central compartment lymph node dissection and selective left neck (levels IIA-IV) lymph node dissection. Final pathology confirmed a 45 mm low grade conventional type papillary carcinoma with microscopic extension into perithyroidal soft tissue focally and into the adjacent left parathyroid gland. Conclusion: Parathyroid gland thyroid cancer infiltration/metastasis is rarely reported and likely underdiagnosed. This is the first case of parathyroid gland metastasis reported from New Zealand or Australia to our knowledge. There is currently limited research available to guide whether parathyroid gland infiltration or metastasis is of clinical or prognostic significance and whether a more aggressive treatment strategy is warranted when present.
NRX-0492 degrades wild-type and C481 mutant BTK and demonstrates in vivo activity in CLL patient-derived xenografts
Authors: Zhang Deyi , Harris Hailey M. , Chen Jonathan , Judy Jen , James Gabriella , Kelly Aileen , McIntosh Joel , Tenn-McClellan Austin , Ambing Eileen , Tan Ying Siow , Lu Hao , Gajewski Stefan , Clifton Matthew C. , Yung Stephanie , Robbins Daniel W. , Pirooznia Mehdi , Skånland Sigrid S. , Gaglione Erika , Mhibik Maissa , Underbayev Chingiz , Ahn Inhye E. , Sun Clare , Herman Sarah E. M. , Noviski Mark , Wiestner Adrian 
Published: November 2022

Abstract
Bruton tyrosine kinase (BTK) is essential for B-cell receptor (BCR) signaling, a driver of chronic lymphocytic leukemia (CLL). Covalent inhibitors bind C481 in the active site of BTK and have become a preferred CLL therapy. Disease progression on covalent BTK inhibitors is commonly associated with C481 mutations. Here, we investigated a targeted protein degrader, NRX-0492, that links a noncovalent BTK-binding domain to cereblon, an adaptor protein of the E3 ubiquitin ligase complex. NRX-0492 selectively catalyzes ubiquitylation and proteasomal degradation of BTK. In primary CLL cells, NRX-0492 induced rapid and sustained degradation of both wild-type and C481 mutant BTK at half maximal degradation concentration (DC50) of ≤0.2 nM and DC90 of ≤0.5 nM, respectively. Sustained degrader activity was maintained for at least 24 hours after washout and was equally observed in high-risk (deletion 17p) and standard-risk (deletion 13q only) CLL subtypes. In in vitro testing against treatment-naïve CLL samples, NRX-0492 was as effective as ibrutinib at inhibiting BCR-mediated signaling, transcriptional programs, and chemokine secretion. In patient-derived xenografts, orally administered NRX-0492 induced BTK degradation and inhibited activation and proliferation of CLL cells in blood and spleen and remained efficacious against primary C481S mutant CLL cells collected from a patient progressing on ibrutinib. Oral bioavailability, &gt;90% degradation of BTK at subnanomolar concentrations, and sustained pharmacodynamic effects after drug clearance make this class of targeted protein degraders uniquely suitable for clinical translation, in particular as a strategy to overcome BTK inhibitor resistance. Clinical studies testing this approach have been initiated (NCT04830137, NCT05131022).
Integrated analyses reveal the response of peanut to phosphorus deficiency on phenotype, transcriptome and metabolome
Authors: Wu Qi , Yang Liyu , Liang Haiyan , Yin Liang , Chen Dianxu , Shen Pu 
Published: November 2022

AbstractBackgroundPhosphorus (P) is one of the most essential macronutrients for crops. The growth and yield of peanut (Arachis hypogaeaL.) are always limited by P deficiency. However, the transcriptional and metabolic regulatory mechanisms were less studied. In this study, valuable phenotype, transcriptome and metabolome data were analyzed to illustrate the regulatory mechanisms of peanut under P deficiency stress.ResultIn present study, two treatments of P level in deficiency with no P application (–P) and in sufficiency with 0.6 mM P application (+ P) were used to investigate the response of peanut on morphology, physiology, transcriptome, microRNAs (miRNAs), and metabolome characterizations. The growth and development of plants were significantly inhibited under –P treatment. A total of 6088 differentially expressed genes (DEGs) were identified including several transcription factor family genes, phosphate transporter genes, hormone metabolism related genes and antioxidant enzyme related genes that highly related to P deficiency stress. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses indicated that 117 genes were annotated in the phenylpropanoid biosynthesis pathway under P deficiency stress. A total of 6 miRNAs have been identified significantly differential expression between + P and –P group by high-throughput sequencing of miRNAs, including two up-regulated miRNAs (ahy-miR160-5p and ahy-miR3518) and four down-regulated miRNAs (ahy-miR408-5p, ahy-miR408-3p, ahy-miR398, and ahy-miR3515). Further, the predicted 22 target genes for 6 miRNAs andcis-elements in 2000 bp promoter region of miRNA genes were analyzed. A total of 439 differentially accumulated metabolites (DAMs) showed obviously differences in two experimental conditions.ConclusionsAccording to the result of transcripome and metabolome analyses, we can draw a conclusion that by increasing the content of lignin, amino acids, and levan combining with decreasing the content of LPC, cell reduced permeability, maintained stability, raised the antioxidant capacity, and increased the P uptake in struggling for survival under P deficiency stress.
Practice of oxygen use in anesthesiology – a survey of the European Society of Anaesthesiology and Intensive Care
Authors: Scharffenberg Martin , Weiss Thomas , Wittenstein Jakob , Krenn Katharina , Fleming Magdalena , Biro Peter , De Hert Stefan , Hendrickx Jan F. A. , Ionescu Daniela , de Abreu Marcelo Gama ,   for the European Society of Anaesthesiology and Intensive Care
Published: November 2022

Abstract
Background
Oxygen is one of the most commonly used drugs by anesthesiologists. The World Health Organization (WHO) gave recommendations regarding perioperative oxygen administration, but the practice of oxygen use in anesthesia, critical emergency, and intensive care medicine remains unclear.

Methods
We conducted an online survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC). The questionnaire consisted of 46 queries appraising the perioperative period, emergency medicine and in the intensive care, knowledge about current recommendations by the WHO, oxygen toxicity, and devices for supplemental oxygen therapy.

Results
Seven hundred ninety-eight ESAIC members (2.1% of all ESAIC members) completed the survey. Most respondents were board-certified and worked in hospitals with > 500 beds. The majority affirmed that they do not use specific protocols for oxygen administration. WHO recommendations are unknown to 42% of respondents, known but not followed by 14%, and known and followed by 24% of them. Respondents prefer inspiratory oxygen fraction (FiO2) ≥80% during induction and emergence from anesthesia, but intraoperatively < 60% for maintenance, and higher FiO2 in patients with diseased than non-diseased lungs. Postoperative oxygen therapy is prescribed more commonly according to peripheral oxygen saturation (SpO2), but shortage of devices still limits monitoring. When monitoring is used, SpO2 ≤ 95% is often targeted. In critical emergency medicine, oxygen is used frequently in patients aged ≥80 years, or presenting with respiratory distress, chronic obstructive pulmonary disease, myocardial infarction, and stroke. In the intensive care unit, oxygen is mostly targeted at 96%, especially in patients with pulmonary diseases.

Conclusions
The current practice of perioperative oxygen therapy among respondents does not follow WHO recommendations or current evidence, and access to postoperative monitoring devices impairs the individualization of oxygen therapy. Further research and additional teaching about use of oxygen are necessary.
Supraglottic jet oxygenation and ventilation decreased hypoxemia during gastrointestinal endoscopy under deep sedation at high altitudes: a randomized clinical trial
Authors: Jiang Bailin , Li Yi , Ciren Deji , Dawa Ouzhu , Feng Yi , Laba Ciren 
Published: November 2022

Abstract
Background
Hypobaric hypoxia is common at high altitudes. Whether this exacerbates hypoxia during procedural sedation and whether hypoxia can be alleviated by the use of supraglottic jet oxygenation and ventilation (SJOV) are unknown. This study aimed to compare the incidence of hypoxia during gastrointestinal endoscopy under deep sedation at high altitudes with oxygen supply techniques using either a nasal cannula or SJOV.

Methods
This study was conducted from April 2022 to July 2022 in a tertiary hospital located 3650 m above sea level. Adult patients scheduled for routine gastrointestinal endoscopy under sedation were enrolled and randomized 1:1 to receive SJOV or a nasal cannula during sedation. Moderate hypoxia was the primary outcome, defined as an SPO2 of 75–89% for < 60 s. The secondary outcomes were respiratory-, cardiovascular-, and SJOV-related complications. The influence of characteristics regarding acclimatization to high altitudes (Tibetan ethnic group and erythrocytosis) on the occurrence of hypoxia was analyzed.

Results
None of the patients were lost to follow-up. A total of 72 patients were included in the analysis (36 patients in each group). There were 20 (27.8%) patients who experienced moderate hypoxia events. Significantly fewer hypoxic events occurred in the SJOV group than in the nasal cannula group [3 (8.3%) vs. 17 (47.2%), absolute risk difference (95% CI): − 38.9 (− 57.5, − 20.2) %, risk ratio (RR, 95% CI): 0.18 (0.06, 0.55), P < 0.001]. Significantly fewer patients in the SJOV group experienced mild hypoxia (P < 0.001) and severe hypoxia (P = 0.002). No serious adverse events occurred in either of the groups. The Tibetan ethnic group (P = 0.086) and erythrocytosis (P = 0.287) were not associated with the occurrence of hypoxia events.

Conclusions
The incidence of hypoxia was lower with SJOV than with nasal cannula in patients undergoing gastrointestinal endoscopy under deep sedation at high altitudes. The Tibetan ethnic group and erythrocytosis did not influence the occurrence of hypoxia.

Trial registration
This study was registered at ClinicalTrials.gov (NCT05304923) before enrollment by Dr. Yi Feng on 31/03/2022.
Correlation of a guidewire maximum insertion length with tortuous radial artery and the success rate during transradial coronary angiography
Authors: Li Hongsong , Chen Xia , Sha Shuang , Xu Xiangdong , Chen Yingmin 
Published: November 2022

Abstract
Background
Percutaneous coronary intervention (PCI) is a safe and effective therapy for patients with obstructive coronary artery disease (CAD). We aimed to assess the correlation between the success rate of angiography and the maximum insertion length and resistance of a soft-tipped guidewire.

Methods
Five hundred twenty-one patients were treated by successful radial artery puncture. According to whether the guidewire resistance, the patients were divided to three groups. 17 patients were maximum insertion length of guidewire ≤ 30 cm when resistance was encountered (group 1). 17 patients were maximum insertion length of guidewire between 30 and 45 cm when resistance was encountered (group 2). 487 patients were no resistance encountered (group 3).

Results
The coronary angiography success rates of group 1, 2, and 3 were 52.94%, 47.05%, 98.97%, respectively. Typically, angiography can be completed in patients with Ω-shaped, S-shape or Z-shaped tortuosity.

Conclusions
The maximum insertion length of straight guidewire and resistance can be used to determine radial artery status. The radial artery tortuosity or spasm significantly affects the success rate of coronary angiography.