bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nail-preserving excision of glomus tumor in the second toe: Case report and literature review
Authors: Park Young Uk , Han Jongseong , Seo Young Wook 
Published: March 2024

Introduction:
This case report describes the diagnosis of a glomus tumor in the second toe of a 38-year-old female, followed by surgical treatment utilizing a transungual approach to preserve the nail. This study highlights the diagnostic challenges and surgical strategies to treat such tumors while preserving nail integrity.

Patient concerns:
Pain occurred once a week, but over time, it increased, and just before seeking medical attention, she experienced pain more than 5 times a day. The pain worsened when cold water touched her toe.

Diagnosis:
We observed a slight hump indicating nail plate deformity, and the patient exhibited severe pinpoint tenderness (positive Love test) in the affected area. Color duplex ultrasound was performed for further investigation, revealing a hypervascular hypoechoic nodule measuring 0.5 cm in size at the nail bed of the right second toe.

Intervention:
The surgery was performed under digital nerve block anesthesia using a modified transungual nail-preserving approach for the excision of the glomus tumor.

Outcomes:
The pain that was reported prior to the surgery has improved postoperatively, and the recovery has been uneventful without any other complication.

Conclusion:
This paper provides a comprehensive examination of a rare glomus tumor in the second toe, elucidating both diagnostic intricacies and treatment modalities. It emphasizes the dual necessity of achieving total tumor excision while also considering aesthetic outcomes. The insights presented herein are intended to serve as valuable guidance for clinicians confronted with similar clinical scenarios, underlining the delicate interplay between effective tumor management and the preservation of cosmetic integrity.
Investigating awareness of artificial intelligence in healthcare among medical students and professionals in Pakistan: a cross-sectional study
Authors: Umer Mohammad , Naveed Aiman , Maryam Qanita , Malik Arif Rasheed , Bashir Naghmana , Kandel Kamal 
Published: March 2024

Objective:
The purpose of this study is to find out the level of awareness and acceptance of artificial intelligence (AI) in Pakistan’s medical community so as to comment on its future in our healthcare system.

Methods:
A survey consisting of 15 close-ended questions was conducted. The questions inquired about awareness about AI and discovered the opinions of healthcare professionals regarding its benefits and expected problems. The data were analyzed using SPSS version 26, and descriptive statistics for percentage and frequency were computed. χ2 test was used to analyze the subgroups (Significant p value <0.05).

Results:
A total of 351 participants were included in this study. General familiarity with AI was low. Only 75 (21.3%) participants answered that they had good familiarity with AI, and only 56 (16%) of them had good familiarity with the role of AI in medicine. One hundred sixty-eight (47.9%) participants disagreed that AI would out-compete the physician in the important traits of professionalism. Only 71 (20.2%) participants believed AI to be diagnostically superior to the physician. Two hundred fourteen (61.0%) were worried about completely trusting AI in its decisions, and 204(58.1%) believed that AI systems lacking human traits would not be able to mirror the doctor-patient relationship. Two hundred sixty-one (74.4%) participants believed that AI would be useful in Administrative tasks. A majority, 162 (46.2%), do not believe that AI would replace them. Finally, a huge majority of participants [225 (64.1%)] demanded the integration of AI in Pakistan’s healthcare system.

Conclusion:
This study suggests that a majority of healthcare professionals in Pakistan do not believe that they are sufficiently aware of the role of AI in healthcare. This was corroborated by their answers to various questions regarding the capabilities of AI. This study indicates the need for a more comprehensive ascertainment of healthcare professionals’ perceptions regarding the role of Artificial Intelligence in medicine and bridging the gap between doctors and technology to further promote a patient-centred approach to medicine.
Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease
Authors: Monaghan Andrew S. , Hooyman Andrew , Dibble Leland E. , Mehta Shyamal H. , Peterson Daniel S. 
Published: March 2024

Background and Purpose:
Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task.

Methods:
Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps.

Results:
After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months.

Discussion and Conclusions:
These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
Silver carboxylate-TiO2/polydimethyl siloxane is a safe and effective antimicrobial with significant wound care potential
Authors: Allu Sai , Whitaker Colin , Stone Benjamin , Vishwanath Neel , Clippert Drew , Jouffroy Elia , Antoci Valentin , Born Christopher , Garcia Dioscaris R. 
Published: March 2024

Abstract

Introduction:
With the rise in antibiotic resistance, new methodologies are needed to combat musculoskeletal infections. Silver is an antimicrobial that can be synthesized in different forms, but its pharmacokinetics are difficult to control. This study details the antibacterial efficacy and cellular cytotoxicity of a formulation consisting of silver carboxylate (AgCar) released through a titanium dioxide/polydimethylsiloxane matrix with a predictable release profile on Pseudomonas aeruginosa, Acinetobacterium baumannii, and human-derived primary osteoblasts.

Methods:
Through an Institutional Animal Care and Use Committee and IRB-approved protocol, AgCar was applied to live Yucatan porcine skin and histologically analyzed for skin penetration. Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) was used to measure elution of AgCar. Dose–response curves were generated through optical density to assess potency. Finally, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to quantify the cellular cytotoxicity of the novel formulation. The results were subject to statistical analysis using analysis of variance and post hoc Tukey tests.

Results:
The silver carboxylate coating demonstrated deep penetration into the epithelium at the level of the deep pilosebaceous glands in animal models. GFAAS testing demonstrated the extended elution profile of silver carboxylate over 96 hours, while 100% silver with no titanium dioxide-polydimethylsiloxane matrix fully eluted within 48 hours. 10x silver carboxylate demonstrated superior antimicrobial activity to antibiotics and other silver formulations and showed minimal cytotoxicity compared with other silver formulations.

Discussion/Clinical Relevance:
Current antimicrobial therapies in wound care and surgical antisepsis, such as chlorhexidine gluconate, have pitfalls including poor skin penetration and short duration of efficacy. The broad antimicrobial activity, extended elution, and deep skin penetration of this AgCar formulation show great promise for surgical site infection and wound care treatment. Novel technology to fight the growing threat of microbial resistance should be at the forefront of orthopaedic surgical site infection prevention and treatment.
Social media use and vision impairment in adults between the ages of 18 and 35 years in India
Authors: Subramanian Ahalya , Kodavati Krishna Priya , Kanchustambam Jahnavi , Gothwal Vijaya K. 
Published: March 2024

SIGNIFICANCE
Social media is used by >4.48 billion people worldwide. Despite its popularity, vision-impaired individuals struggle to use social media given visual inaccessibility of content and lack of access to Internet/Wireless-Fidelity–enabled devices. Our study explores visually impaired adult's use of social media in comparison to a control group.

PURPOSE
This study aimed to report the demographic profile and patterns of social media use among adults with vision impairment (VI) aged 18 to 35 years and compare it with an age-matched normally sighted group in India. In addition, we explored barriers to use of social media among adults with VI.

METHODS
Vision-impaired and normally sighted adults (controls) aged 18 to 35 years at L V Prasad Eye Institute, Hyderabad, India, answered a questionnaire about social media use (e.g., platform used).

RESULTS
Four hundred twenty-two individuals (201 VI, 221 controls) participated. Normally sighted adults (98%) used social media more than the VI group (81%; p<0.001). Vision-impaired users were predominantly male (85%) and unemployed (57%; p<0.00001 for both). There was no significant difference in educational level between groups (p=0.17). Smartphones were the most popular device used (VI, 161 [99%]; control, 206 [95%]), with tablet PC/iPad being the least popular (VI, 5 [3%]; control, 12 [6%]). Adults with VI and controls commonly used WhatsApp as communication platforms, and Facebook and Twitter as networking platforms. Approximately one-third of individuals across both social media user groups reported barriers to use (VI, 48 [30%]; control, 74 [34%]; p<0.001). Vision-impaired individuals cited accessibility issues of having to rely on audio over vision to navigate social media, whereas controls reported having to share a phone.

CONCLUSIONS
The proportion of social media usage among VI adults is high (81%) and is substantially higher than the 33% reported in the general Indian population. Vision-impaired adults who used social media were male with moderate VI and were less likely to be employed compared with controls.
Cost Analysis of Short Messaging Service and Peer Navigator Interventions for Linking and Retaining Adults Recently Diagnosed With HIV in Care in South Africa
Authors: Shade Starley B. , Gutin Sarah A. , Agnew Emily , Grignon Jessica S. , Gilmore Hailey , Ratlhagana Mary-Jane , Sumitani Jeri , Steward Wayne T. , Lippman Sheri A. 
Published: March 2024

Introduction:
Large proportions of people living with HIV (PLHIV) in sub-Saharan Africa are not linked to or retained in HIV care. There is a critical need for cost-effective interventions to improve engagement and retention in care and inform optimal allocation of resources.

Methods:
We estimated costs associated with a short message service (SMS) plus peer navigation (SMS+PN) intervention; an SMS-only intervention; and standard of care (SOC), within the I-Care cluster-randomized trial to improve HIV care engagement for recently diagnosed PLHIV. We employed a uniform cost data-collection protocol to quantify resources used and associated costs for each intervention.

Results:
Compared with SOC, the SMS+PN intervention cost $1284 ($828–$2859) more per additional patient linked to care within 30 days and $1904 ($1158–$5343) more per additional patient retained in care at 12 months, while improving linkage by 24% (95% CI: 11 to 36) and retention by 16% (95% CI: 6 to 26). By contrast, the SMS-only intervention cost $198 ($93-dominated) more per additional patient linked to care and $697 ($171-dominated) more per additional patient retained in care but was not significantly associated with improvements in linkage (12%; 95% CI: −1 to 25) or retention (3%; 95% CI: −7 to 14) compared with SOC. The efficiency of the SMS+PN intervention could be improved by 46%, to $690 more per additional patient linked and $1023 more per additional patient retained in care, if implemented within the Department of Health using more efficient distribution of staff resources.

Discussion:
Findings suggest that scale-up of the SMS+PN intervention could benefit patients, improving care and health outcomes while being cost-effective.
Age Matters
Authors: Wehrle Chase J. , Maspero Marianna , Pinna Antonio D. , Dutkowski Philipp , Miller Charles , Hashimoto Koji , Clavien Pierre-Alain , Schlegel Andrea 
Published: March 2024

Objective:
To assess factors affecting the cumulative lifespan of a transplanted liver.

Background:
Liver aging is different from other solid organs. It is unknown how old a liver can actually get after liver transplantation.

Methods:
Deceased donor liver transplants from 1988 to 2021 were queried from the United States UNOS registry. Cumulative liver age was calculated as donor age + recipient graft survival.

Results:
In total, 184,515 livers were included. Most were donation after brain death donors (n = 175,343). The percentage of livers achieving >70, 80, 90, and 100 years cumulative age was 7.8% (n = 14,392), 1.9% (n = 3576), 0.3% (n = 528), and 0.01% (n = 21), respectively. The youngest donor age contributing to a cumulative liver age >90 years was 59 years, with posttransplant survival of 34 years. In pediatric recipients, 736 (4.4%) and 282 livers (1.7%) survived >50 and 60 years overall, respectively. Transplanted livers achieved cumulative age >90 years in 2.86 per 1000 and >100 years in 0.1 per 1000. The U.S. population at large has a cumulative “liver age” >90 years in 5.35 per 1000 persons, and >100 years in 0.2 per 1000. Livers aged >60 years at transplant experienced both improved cumulative survival (P < 0.0001) and interestingly improved survival after transplantation (P < 0.0001). Recipient warm ischemia time of >30 minutes was most predictive of reduced cumulative liver survival overall (n = 184,515, hazard ratio = 1.126, P < 0.001) and excluding patients with mortality in the first 6 months (n = 151,884, hazard ratio = 0.973, P < 0.001).

Conclusions:
In summary, transplanted livers frequently get as old as those in the average population despite ischemic-reperfusion-injury and immunosuppression. The presented results justify using older donor livers regardless of donation type, even in sicker recipients with limited options.
Cardiovascular outcomes and fracture risk after the discontinuation of preventative medications in older patients with complex health needs: a self-controlled case series analysis
Authors: Prieto-Alhambra Daniel , Dernie Francesco , Delmestri Antonella , Rathod-Mistry Trishna , Tan Eng Hooi , Jödicke Annika M. 
Published: March 2024

AbstractObjectiveTo assess the effect of stopping statins, antihypertensives, and bisphosphonates on the risk of cardiovascular events and fractures in older patients with complex health needs (CHN).MethodsPatients aged >65 years, registered in CPRD GOLD for ≥1 year before study start (01/01/2010) and with CHN (non-elective hospitalisation/s, frailty or polypharmacy) were selected.Self-controlled case series (SCCS) analyses were subsequently conducted among people who did not use the respective preventative treatment in the year before study start.Incidence rate ratios (IRR) were calculated for myocardial infarction (MI) and stroke [antihypertensives, statins] and fractures [bisphosphonates] comparing event rates for the respective outcomes during treatment vs. post-discontinuation periods.Results198,039 people were included to the CHN cohort. Among those, 6,245 individuals were included for the analysis of bisphosphonate discontinuation and fracture risk; 738 and 669 persons for the analysis of antihypertensive therapy discontinuation and MI/stroke risk; and 1,408 and 1,361 people for statin discontinuation and MI/stroke risk.Risk of MI was substantially increased following discontinuation of antihypertensives (IRR 2.6 [95%CI 1.56-4.33]) and statins (IRR 1.75 [1.16-2.62]). No significant association for treatment discontinuation and stroke risk was seen. Likewise, no increased fracture risk was seen after discontinuing bisphosphonates. However, discontinuation among people with >1 year history of bisphosphonate therapy pointed towards increased fracture risk.ConclusionsOur study showed risks associated with discontinuing preventative medications in people with CHN, likely explained by the continued efficacy of these medications. Further research focussing on the risk-benefit of these treatments for most vulnerable older adults is needed.Key pointsSelf-controlled case series showed substantially increased risk for myocardial infarction following discontinuation of antihypertensives and statins.Fracture risk was not increased during treatment with bisphosphonates vs. post-discontinuation, but in people with >1 year of treatment a trend towards increased risk was seen.Future research is required to study further conditions, medications, and sequalae in older patients with complex health needs.
Changes in lung function and dyspnea perception in Colombian Covid-19 patients after a 12-week pulmonary rehabilitation program
Authors: Páez-Mora Carlos D , Zona-Rubio Carolina , Angarita-Sierra Teddy , Rojas-Paredes Matilde E , Cano-Trejos Daniela 
Published: March 2024

BACKGROUNDAlthough moderate and severe COVID-19 patients have shown obstructive and restrictive disorders in pulmonary function after recovery from the disease, studies evaluating the effectiveness of rehabilitation programs that seek to improve lung function are scarce.AIMHerein, we evaluate changes in lung function and perceived dyspnea in Covid-19 patients after undergoing 12 weeks of a PR program.DESIGNRetrospective observational studySETTINGCesar, Colombia Neumocesar Pneumological Center.POPULATION100 outpatients with a history of Covid-19METHODSWe evaluated respiratory function using spirometry parameters, as well as the mMRC dyspnea scale for perceived dyspnea in 100 patients with a history of Covid-19. We used univariate and multivariate statistical approaches to assess changes in lung function and perceived dyspnea before and after a PR program to determine whether gender, age, height, weight, comorbidities, and oxygen delivery system affect the recovery of lung function and perceived dyspnea.RESULTSWe found that PR treatment has positive effects on respiratory pathologies caused by SARS-CoV-2 infection regardless of patient gender, indicating that rehabilitation provided benefits regardless of the physical characteristics of the patients. Both univariate and multivariate statistical analyses indicated that FVC, FEV1, FEF 25-75, and mMRC are robust diagnostic indicators of lung function recovery and perceived dyspnea. Both invasive and non-invasive positive pressure ventilatory support had deleterious effects on lung function prolongating patient recovery.CONCLUSIONSRehabilitation programs can benefit patients facing respiratory pathologies caused by SARS-CoV-2 infection. Additional research on the long-term effects of the sequelae of Covid-19 is needed. A large sample of patients is needed to clarify the effects of therapy on respiratory function.CLINICAL REHABILITATION IMPACTPR programs have positive effects on patients facing respiratory pathologies caused by SARS-CoV-2 infection.
Integrating Real-Time Location Systems with Electronic Medical Records: A Machine Learning Approach for In-Hospital Fall Risk Prediction
Authors: Kim Dong Won , Seo Jihoon , Kwon Sujin , Park Chan Min , Han Changho , Kim Yujeong , Yoon Dukyong , Kim Kyoung Min 
Published: March 2024

AbstractHospital falls are the most prevalent adverse event in healthcare, posing significant risks to patient health outcomes and institutional care quality. The effectiveness of several fall prediction models currently in use is limited by various clinical factors. This study explored the efficacy of merging real-time location system (RTLS) data with clinical information to enhance the accuracy of in-hospital fall predictions. The model performances were compared based on the clinical data, RTLS data, and a hybrid approach using various evaluation metrics. The RTLS and integrated clinical data were obtained from 22,201 patients between March 2020 and June 2022. From the initial cohort, 118 patients with falls and 443 patients without falls were included. Predictive models were developed using the XGBoost algorithm across three distinct frameworks: clinical model, RTLS model, and clinical + RTLS model. The model performance was evaluated using metrics, such as AUROC, AUPRC, accuracy, PPV, sensitivity, specificity, and F1 score. Shapley additive explanation values were used to enhance the model interpretability. The clinical model yielded an AUROC of 0.813 and AUPRC of 0.407. The RTLS model demonstrated superior fall prediction capabilities, with an AUROC of 0.842 and AUPRC of 0.480. The clinical + RTLS model excelled further, achieving an AUROC of 0.853 and AUPRC of 0.497. Feature importance analysis revealed that movement patterns of patients on the last day of their stay were significantly associated with falls, together with elevated RDW levels, sedative administration, age. This study underscored the advantages of combining RTLS data with clinical information to predict in-hospital falls more accurately. This innovative technology-driven approach may enhance early fall risk detection during hospitalization, potentially preventing falls, improving patient safety, and contributing to more efficient healthcare delivery.
Deoxynivalenol induced inflammation and increased the adherence of entero-invasiveEscherichia colito intestinal epithelial cells via modulation of mucin and pro-inflammatory cytokine production
Authors: Wan Murphy LY , Anna Vanessa Co , Turner Paul C , Nagendra Shah P , El-Nezami Hani 
Published: March 2024

AbstractDeoxynivalenol (DON) is a mycotoxin that commonly occurs in crops. It was hypothesized that DON could trigger intestinal inflammation and increase the susceptibility of intestinal epithelial cells (IECs) to pathogen infection. Accordingly, the aim of this study was to investigate the effects of DON on intestinal susceptibility to pathogen infection. Semiconfluent Caco-2 cells were exposed to DON followed by acute entero-invasiveEscherichia coli(EIEC) infection. The effects of DON and EIEC contamination on mucin, cytokines and related signal transduction pathways were examined as part of the local immune system. Caco-2 cells were able to generate a rapid immune response against DON with or without EIEC post-challenge. An increase in EIEC attachment to DON-exposed cells was observed, probably in part, mediated by modulation of secretory MUC5AC mucins and membrane bound MUC4 and MUC17 mucins. Cells were also able to express and produce important mediators of inflammation, such as cytokines as a result of activation of toll-like receptors signalling cascades, modulation of nuclear factor κ-light chain-enhancer of activated B cells (NK-κB) and/or mitogen-activated protein kinase (MAPK) pathways. These data indicate that DON may exert immunomodulatory effects on intestinal epithelial cells, which might thereby modify the susceptibility to bacterial infection.