bluuebunny/crossref_metadata_2025_split huggingface dataset:
A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel
Authors: Kumar Alexander , Soliman Nadia , Gan Zoe , Cullinan Paul , Vollert Jan , Rice Andrew S.C. , Kemp Harriet 
Published: December 2023

Abstract
Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and residual limb pain (RLP). The military population is distinct with respect to demographic, injury, and social characteristics compared with other amputation and trauma cohorts. We undertook a systematic review of studies of military personnel, with a history of combat injury, that reported a prevalence of any type of postamputation pain or chronic neuropathic pain, identified from Embase and MEDLINE databases.Using the inverse variance method with a random-effects model, we undertook a meta-analysis to determine an overall prevalence and performed exploratory analyses to identify the effect of the type of pain, conflict, and time since injury on prevalence. Pain definitions and types of pain measurement tools used in studies were recorded. Thirty-one studies (14,738 participants) were included. The pooled prevalence of PLP, RLP, and chronic neuropathic pain were 57% (95% CI: 46-68), 61% (95% CI: 50-71), and 26% (95% CI: 10-54), respectively. Between-study heterogeneity was high (I2: 94%-98%). Characterisation of duration, frequency, and impact of pain was limited. Factors reported by included studies as being associated with PLP included the presence of RLP and psychological comorbidity. The prevalence of postamputation pain and chronic neuropathic pain after combat trauma is high. We highlight inconsistency of case definitions and terminology for pain and the need for consensus in future research of traumatic injury.
Vaccination and Nutritional Outcomes of Hemodialysis Patients Infected With SARS-CoV-2
Authors: Villaverde-Núñez Alberto , Ramírez López María Teresa , Rodríguez Cristina Antón , Hammel Inés Constanze , Pérez Ramos Cristina , Álvarez Villarreal Miriam , Ruíz Fernández Sandra , Arriero López Beatriz , Hernández Cordobés Gema , Manzano Guerrero Nemesio , Baena Ruíz Laura , Guerra Llamas María Isabel 
Published: December 2023

Abstract

Background
Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination due to a decreased immune response. The nutritional status prior or during the infection could also impact on the clinical effectiveness of vaccination.

Objectives
We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status.

Methods
An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry and biochemical parameters. The association of the vaccine doses with clinical and nutritional related variables were also evaluated.

Results
The percentage of vaccinated patients was similar to non-vaccinated patients. Prior to infection, the majority of the patients were malnourished. They presented lower albumin, creatinine and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight and Body Mass Index. Albumin and creatinine also decreased significantly post-infection whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post-pre GNRI scores and basal albumin and C-reactive protein at 7 days. Additionally, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein prior to infection and the number of vaccine doses received.

Discussion
COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study vaccines have demonstrated a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during and after the infection.
(How) ChatGPT - Artificial Intelligence Thinks It Can Help/Harm Physiatry
Authors: Jačisko Jakub , Veselý Viktor , Chang Ke-Vin , Özçakar Levent 
Published: December 2023

Abstract
ChatGPT is a chatbot that is based on the generative pre-trained transformer (GPT) architecture as an artificial inteligence based large language model. Its widespread use in health care practice, research and education seems to be (increasingly) inevitable. Also considering the relevant limitations regarding privacy, ethics, bias, legal and validity, in this article, its use as a supplement (for sure not as a substitute for physicians) is discussed in light of the recent literature. Particularly, the “opinion“ of ChatGPT about how it can help/harm physiatry is exemplified.
Posttraumatic Amputations Epidemiology and Outcomes Within the National Trauma Data Bank
Authors: Hergert Brooke C. , Rana Amtul-noor , Velasquez Jose E. , Johnson Anthony E. , Ali Sadia , Wong Kristin A. , Teixeira Pedro G. 
Published: December 2023

Objective
Acute trauma care has significantly reduced mortality over the last two decades. The last study to examine the epidemiology of traumatic amputees predates these gains. The majority of those who sustain traumatic amputation are male; therefore, limited data exist on female amputees. This study aimed to (1) provide a current epidemiological analysis of traumatic amputees and (2) compare male and female amputees.

Design
All patients sustaining a major limb amputation in the National Trauma Data Bank from 2013 to 2017 were identified. First, descriptive analyses of patient demographics and injury characteristics were performed and compared with a previous 2000–2004 National Trauma Data Bank study. Second, female and male traumatic amputees were compared in this study.

Results
From 2013 to 2017, we identified 7016 patients who underwent major limb amputation. Compared with previous years, the current amputees were older and more severely injured. Mortality was 6.3% in the current years compared with 13.4% in the previous years (odds ratio, 0.44, 95% CI = 0.37–0.51, P < 0.001). After multivariable analysis, mortality remained significantly decreased, with no difference in hospital length of stay.

Conclusions
Contemporary National Trauma Data Bank analysis demonstrated that patients with traumatic amputations, regardless of sex, often survive until hospital discharge, despite more severe injuries.
A Tale of Bilateral Rapidly Progressive Osteoarthritis of the Hip—It Is Not Always the Steroid Injection
Authors: Cheng Jennifer , Barcavage Christine , Leupold Olivia , Tsai Jefferson , Wyss James 
Published: December 2023

Abstract
Rapidly progressive osteoarthritis of the hip is an unusual subset of hip osteoarthritis in which a >2 mm/yr rate of joint space narrowing occurs. Rapidly progressive osteoarthritis of the hip has been associated with intra-articular steroid injection, with the incidence of rapidly progressive osteoarthritis of the hip after intra-articular steroid injection ranging from 2.8% to 21%. The occurrence of rapidly progressive osteoarthritis of the hip unrelated to intra-articular steroid injection is rare, and not frequently reported. This report presents a unique case of rapidly progressive osteoarthritis of the hip in the bilateral hips of one patient. The first hip developed rapidly progressive osteoarthritis of the hip within 6 mos after an intra-articular steroid injection. Three years later, the second hip developed rapidly progressive osteoarthritis of the hip within 4 mos without any injection or use of systemic steroid medication. The etiology of rapidly progressive osteoarthritis of the hip in the absence of intra-articular steroid injection is unclear, and this case presents the opportunity to observe the development of rapidly progressive osteoarthritis of the hip due to different causes within the same individual.
Risk of Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Executive Function Impairment in Metopic Craniosynostosis
Authors: Almeida Mariana N. , Alper David P. , Long Aaron S. , Barrero Carlos , Williams Mica C. G. , Boroumand Sam , Glahn Joshua , Shah Jinesh , Swanson Jordan , Alperovich Michael 
Published: December 2023

Background:
Favorable behavioral interactions are critical for academic and interpersonal success. An association between metopic synostosis and behavioral impairments has not been fully elucidated. Behavioral dysfunction in school-age children with surgically corrected metopic synostosis was evaluated using targeted testing to detect the most common behavioral abnormalities in this population.

Methods:
Parents of children 6 to 18 years of age with metopic synostosis completed the Conners Rating Scales, 3rd edition (Short Form) (Conners-3; attention-deficit/hyperactivity disorder), Social Responsiveness Scale, 2nd edition (SRS-2; autism spectrum disorder), Behavior Rating Inventory of Executive Function, 2nd edition (executive functioning), and Child’s Behavioral Checklist (behavioral/emotional functioning). Children also completed neurocognitive testing. Multivariable regression was used to determine predictors of clinically significant behavioral impairments.

Results:
Sixty children were enrolled. Average age at surgery was 9.2 ± 7.9 months, with an average age at assessment of 10.3 ± 3.5 years. Nearly half of patients demonstrated symptoms associated with attention-deficit/hyperactivity disorder, demonstrated by reaching or exceeding borderline clinical levels for inattention and hyperactivity subscales of the Conners-3. Greater age at surgery was associated with worse executive function, measured by reaching or exceeding clinically significant levels of the executive function subscale of the Conners-3 (P = 0.04) and subscales of the Behavior Rating Inventory of Executive Function, 2nd edition (Behavioral Regulator Index [P = 0.05], Cognitive Regulatory Index [P = 0.03], and Global Executive Composite [P = 0.04]).

Conclusions:
Nearly half of patients with surgically corrected metopic synostosis reached borderline clinical scores for inattention and hyperactivity. Older age at surgery was associated with worse executive function. Prompt surgical correction of metopic synostosis may portend improved long-term emotional and behavioral function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Indications for Furlow Double-Opposing Z-Plasty in Patients with Velopharyngeal Insufficiency following 2-Flap Palatoplasty
Authors: Park Tae Hyun , Kang Hyun Su , Ryu Jeong Yeop , Lee Joon Seok , Yang Jung Dug , Chung Ho Yun , Choi Kang Young 
Published: December 2023

Background:
Various surgical methods have been developed for treating velopharyngeal insufficiency (VPI); however, the choice of surgical treatment is controversial. The pharyngeal flap, which is commonly used, has a high success rate but frequently leads to airway complications. Furlow double-opposing Z-plasty (DOZ) does not deform the velopharyngeal port; therefore, it is expected to show good speech outcomes while reducing airway complications if an appropriate indication is noted. This study aimed to identify indications for DOZ in cases of VPI after palatoplasty.

Methods:
Nonsyndromic patients who underwent palatoplasty were prospectively followed from 2008 to 2016, and those diagnosed with VPI were treated with DOZ. Preoperative facial computed tomography (CT) and postoperative nasometric assessment results were examined. Surgical indication was set based on a 30% threshold value for postoperative nasalance.

Results:
Comparing the preoperative CT measurements of both groups, high need ratio (NR), wide width of the nasopharynx (WNP), and long velopharyngeal depth (VPD) were contributing factors to VPI occurrence (P < 0.05). Analyzing preoperative CT and postoperative speech evaluation results, a linear relationship was observed between preoperative NR, WNP, and VPD and postoperative nasalance. In cases where NR was less than 0.81, WNP was less than 27.64 mm, and VPD was less than 20.34 mm, DOZ showed favorable outcomes (P < 0.05).

Conclusions:
Preoperative CT evaluation should be performed in patients with VPI. When WNP, VPD, and NR values are small, DOZ can achieve sufficient correction of VPI and reduce the risk of airway complications. In cases where the indication range is exceeded, the pharyngeal flap is considered.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
The Clinical Value of Apparent Diffusion Coefficient of Readout Segmentation of Long Variable Echo Trains and Correlation With Ki-67 Expression in Distal Rectal Cancer
Authors: Pan Yu-Ning , Gu Meng-Yin , Mao Quan-Liang , Wang Hui-Ying , Liang Yi-Chuan , Zhang Lin , Tang Guang-Yu 
Published: December 2023

Objective
The aim of the study is to explore the clinical value of the apparent diffusion coefficient (ADC) derived from the readout segmentation of long variable echo trains (RESOLVE) technique for identifying clinicopathologic features of distal rectal cancer and correlations between ADC and Ki-67 expression.

Methods
The data of 112 patients with a proven pathology of distal rectal cancer who underwent preoperative magnetic resonance imaging were retrospectively analyzed. The mean ADC value was measured using the “full-layer and center” method. Differences in ADC values and Ki-67 expression in different clinical stages, pathological types, and tumor differentiation were compared using analysis of variance. Correlations between ADC value and clinicopathologic features were assessed using Spearman correlation analysis.

Results
Interobserver agreement of confidence levels from 2 radiologists was excellent for ADC measurement (k =  0.85). Patients with a lower clinical stage, well-differentiated adenocarcinomas, and a higher possibility of mucinous adenocarcinoma exhibited a positive correlation with higher ADC values, but these factors were negatively correlated with Ki-67 expression (all P < 0.05). We found that ADC value was negatively correlated with Ki-67 expression (r = −0.62, P < 0.001).

Conclusions
The ADC value generated by RESOLVE sequences was significantly associated with clinicopathologic features and Ki-67 expression in patients with distal rectal cancer in this study. Thus, the ADC value could be considered a new noninvasive imaging biomarker that could be helpful in predicting the biological properties of distal rectal cancer.
EFFECTS OF HYPERBARIC OXYGEN THERAPY ON INTESTINAL ISCHEMIA-REPERFUSION AND ITS MECHANISM
Authors: Song Shurui , Li Ruojing , Wu Changliang , Dong Jing , Wang Peige 
Published: December 2023

ABSTRACT
Ischemia can cause reversible or irreversible cell or tissue damage, and reperfusion after ischemia not only has no therapeutic effect but also aggravates cell damage. Notably, gut tissue is highly susceptible to ischemia-reperfusion (IR) injury under many adverse health conditions. Intestinal IR (IIR) is an important pathophysiological process in critical clinical diseases. Therefore, it is necessary to identify better therapeutic methods for relieving intestinal ischemia and hypoxia. Hyperbaric oxygenation refers to the intermittent inhalation of 100% oxygen in an environment greater than 1 atm pressure, which can better increase the oxygen level in the tissue and change the inflammatory pathway. Currently, it can have a positive effect on hypoxia and ischemic diseases. Related studies have suggested that hyperbaric oxygen can significantly reduce ischemia-hypoxic injury to the brain, spinal cord, kidney, and myocardium. This article reviews the pathogenesis of IR and the current treatment measures, and further points out that hyperbaric oxygen has a better effect in IR. We found that not only improved hypoxia but also regulated IR induced injury in a certain way. From the perspective of clinical application, these changes and the application of hyperbaric oxygen therapy have important implications for treatment, especially IIR.
Hemoglobin A1c and Reoperation After Surgery for Stress Incontinence or Prolapse
Authors: Bachar Austin , Wang Xi , Herzog Kiersten , Sahil Suman , Cheng An-Lin , Ohene-Agyei Jada A. , Shepherd Jonathan P. , Sutkin Gary 
Published: December 2023

Importance
Few studies compare the link between hemogobin A1c (HbA1c) and urogynecologic surgical complications.

Objective
The objective of this study was to determine the association between HbA1c and reoperation in women undergoing surgery for stress urinary incontinence (SUI) or pelvic organ prolapse (POP).

Study Design
We performed 2 separate retrospective cohort analyses using Cerner's HealthFacts Database (750 hospitals; 519,000,000 patient encounters from January 1, 2010, to November 30, 2018). We included women undergoing surgery for (1) SUI or (2) apical POP by International Classification of Diseases coding who had HbA1c at the initial procedure. Each analysis compared those undergoing reoperation for complications or recurrence and those who did not. Multivariable logistic regression assessed the association between reoperation and HbA1c both as a continuous variable and comparing the commonly accepted cutoff ≥8.

Results
Of 30,180 SUI surgical procedures and 26,389 POP surgical procedures, 1,625 (5.4%) and 805 (3.1%) had HbA1c. Median (interquartile range) HbA1c in grams per deciliter was similar by reoperation status (SUI: 6.0 [5.6–6.8] vs 6.1 [5.6–6.9], P = 0.35; POP: 6.2 [5.6–6.6] vs 6.1 [5.7–6.8], P = 0.60). Reoperation was also similar using the HbA1c ≥8% cutoff (SUI: 6.9% vs 7.4%, P = 0.79; POP: 6.3% vs 5.4%, P = 0.77). On multivariate analysis, HbA1c value was not a significant predictor of reoperation either as a continuous (SUI: odds ratio [OR] = 0.966, 95% CI = 0.833–1.119; POP: OR = 1.040, 95% CI = 0.801–1.350) or dichotomous variable ≥8 (SUI: OR = 0.767, 95% CI = 0.407–1.446; POP: OR = 0.988, 95% CI = 0.331–2.951). Mean follow-up was 4.28–5.13 years.

Conclusion
Although other studies have shown a link between diabetes and complications, we were unable to show an association between HbA1c values and rates of reoperation.
Challenging fungal infections in cystic fibrosis: a case of mixed Aspergillus species infection and antifungal combination testing
Authors: Pontes Laís , Reichert-Lima Franqueline , Perini Leme Giordano Ana Luisa , Moretti Maria Luiza , Zaninelli Schreiber Angélica 
Published: December 2023

Aspergillus stands as the predominant fungal genus in the airways of cystic fibrosis (CF) patients, significantly contributing to their morbidity and mortality. Aspergillus fumigatus represents the primary causative species for infections, though the emergence of rare species within the Aspergillus section Fumigati has become noteworthy. Among these, Aspergillus lentulus is particularly significant due to its frequent misidentification and intrinsic resistance to azole antifungal agents. In the invasive aspergillosis and resistant infections, combination antifungal therapy has proven to be an effective approach. This report documents a case involving the death of a CF patient due to a pulmonary exacerbation linked to the colonization of multiple Aspergillus species, including A. lentulus, A. fumigatus, and A. terreus, and treated with Itraconazole (ITC) monotherapy. We delineated the procedures used to characterize the Aspergillus isolates in clinical settings and simulated in vitro the impact of the combination antifungal therapy on the isolates obtained from the patient. We evaluated three different combinations: Amphotericin B (AMB) + Voriconazole (VRC), AMB + Anidulafungin (AND), and VRC + AND. Notably, all strains isolated from the patient exhibited a significant decrease in their minimum inhibitory concentration (MIC) or minimum effective concentration (MEC) values when treated with all combinations. The VRC + AMB combination demonstrated the most synergistic effects. This case report emphasizes the importance of susceptibility testing and precise identification of Aspergillus species to enhance patient prognosis. It also underscores the potential benefits of combined antifungal treatment, which, in this case, could have led to a more favorable patient outcome.
Early Detection of Diabetic Neuropathy Based on Health Belief Model: A Scoping Review
Authors: Purwanti Okti Sri , Nursalam  , Pandin Moses Glorino Rumambo 
Published: December 2023

AbstractIntroductionUncontrolled blood sugar levels may result in complications, namely diabetic neuropathy. Diabetic neuropathy is a nerve disorder that causes symptoms of numbness, foot deformity, dry skin, and thickening of the feet. The severity of diabetic neuropathy carries the risk of developing diabetic ulcers and amputation. Early detection of diabetic neuropathy can prevent the risk of diabetic ulcers.MethodsThis research studied articles in 6 databases via Scopus, Ebsco, Pubmed, Sage journal, Science Direct, and Springer link with the keywords “screening Neuropathy” AND “Detection Neuropathy” AND “Scoring Neuropathy” AND “Diabetic” published in 2019-2023. This study identified articles based on the English language, variables, and population. This research used PRISMA Flow-Chart 2020 to record the article filtering process.ResultsThis research identified articles through PRISMA Flow-Chart 2020, obtaining 25 articles that discussed early detection of diabetic neuropathy.ConclusionEarly detection of diabetic neuropathy prevents the occurrence of diabetic neuropathy. The method for early detection of neuropathy is using a neuropathy questionnaire and physical examination. Neuropathy questionnaires are Michigan Neuropathy Screening Instrument (MNSI), Toronto Clinical Neuropathy Score (TCNS), and Diabetic Neuropathy Classification (BDC). Physical examination tools include biotesimeters, vibrations, neurotesimeters, tuning forks, monofilament threads, ultrasonography (USG) results, artificial intelligence (AI), and nomograms.
Perception of primary care services among the Afroperuvian population
Authors: Juárez Chávez Elisa , Urday Fernández Dayana , Konda Kelika A. , Villalobos Ruiz José , Cuba Fuentes María Sofía 
Published: December 2023

AbstractThe Peruvian public healthcare system has various shortcomings that impact the experiences and perceptions of quality among the general population and, particularly, among minority populations, including the Afro-Peruvian community. In this context, understanding the population’s experiences in healthcare services and their perceptions regarding the treatment received from healthcare providers is crucial for developing improvement recommendations. Through in-depth interviews, our study explored the usage experiences and perceptions regarding the treatment received from public primary healthcare providers among 19 Afro-Peruvian individuals in Lima. Our analysis revealed that, in general, there is mistreatment of healthcare providers. This is not only recognized as a deficiency of the providers (human resources) but also as a consequence of a system that does not promote the quality of care, including issues such as inadequate infrastructure, low salaries, and limited time for patient care. Additionally, expressions of discrimination based on differences, primarily socioeconomic, were identified. Our findings provide insights for enhancing healthcare services in terms of treatment, effective communication, and infrastructure at the primary healthcare level.