bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study on sustentaculum tali fragment constancy in intraarticular calcaneus fracture
Authors: Yan Hongfei , Na Ho Dong , Park Jeong Jin , Park Chul Hyun 
Published: July 2023

ABSTRACT

OBJECTIVES:
To establish reproducible measurements of the sustentaculum tali (ST) fragment regarding fracture classification and patient-related factors.

DESIGN:
Retrospective.

SETTING:
Trauma center, University Hospital.

PATIENTS:
A retrospective analysis of the 142 fractured calcanei of 122 patients (101 men and 21 women) treated at our institution between 2012 to 2020 was performed. As control, 62 unaffected calcanei were used.

INTERVENTION:
Radiographic images were evaluated twice within 2 weeks by two orthopedic surgeons and one postgraduate student. Angulation and diastasis were used to distinguish ST fragment constancy based on computed tomography. Using these parameters, the prevalence of inconstant ST fragments was assessed. We also analyzed factors related to ST fragment inconstancy. Patient factors included age, body mass index, smoking, and diabetes. Radiographic factors included the Sanders’ classification, location of the outermost fracture line of the posterior facet, presence of an intraarticular fracture of the ST, and ST fragment width.

MAIN OUTCOME MEASUREMENTS:
Angulation and diastasis were used to confirm the ST fragment constancy. Potential risks for inconstant ST fragment subsequently defined.

RESULTS:
According to the criteria, ST fragment inconstancy was observed in 34.5%. ST fragment width was significantly smaller in the inconstant group (p < 0.001). Severe comminution of the posterior facet (p < 0.05), intraarticular fracture of the ST (p < 0.001), and diabetes (p < 0.05) were significantly higher in the inconstant group. The cut-off value of the ST fragment width was 20.5 mm.

CONCLUSIONS:
In intraarticular calcaneus fractures, small ST fragment width, comminuted fracture, intraarticular fracture of the ST, and diabetes were associated with the inconstant group. The ST fragment was expected to be inconstant when the width was less than 20.5 mm.

LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Costs and Consequences of a Novel Emergency Department Sepsis Diagnostic Test: The IntelliSep Index
Authors: Hollenbeak Christopher S. , Henning Daniel J. , Geeting Glenn K. , Ledeboer Nathan A. , Faruqi Imran A. , Pierce Christi G. , Thomas Christopher B. , O’Neal Hollis R. 
Published: July 2023

OBJECTIVES:
Sepsis causes 270,000 deaths and costs $38 billion annually in the United States. Most cases of sepsis present in the emergency department (ED), where rapid diagnosis remains challenging. The IntelliSep Index (ISI) is a novel diagnostic test that analyzes characteristics of WBC structure and provides a reliable early signal for sepsis. This study performs a cost-consequence analysis of the ISI relative to procalcitonin for early sepsis diagnosis in the ED.

PERSPECTIVE:
U.S. healthcare system.

SETTING:
Community hospital ED.

METHODS:
A decision tree analysis was performed comparing ISI with procalcitonin. Model parameters included prevalence of sepsis, sensitivity and specificity of diagnostic tests (both ISI and procalcitonin), costs of hospitalization, and mortality rate stratified by diagnostic test result. Mortality and prevalence of sepsis were estimated from best available literature. Costs were estimated based on an analysis of a large, national discharge dataset, and adjusted to 2018 U.S. dollars. Outcomes included expected costs and survival.

RESULTS:
Assuming a confirmed sepsis prevalence of 16.9% (adjudicated to Sepsis-3), the ISI strategy had an expected cost per patient of $3,849 and expected survival rate of 95.08%, whereas the procalcitonin strategy had an expected cost of $4,656 per patient and an expected survival of 94.98%. ISI was both less costly and more effective than procalcitonin, primarily because of fewer false-negative results. These results were robust in sensitivity analyses.

CONCLUSIONS:
ISI was both less costly and more effective in preventing mortality than procalcitonin, primarily because of fewer false-negative results. The ISI may provide health systems with a higher-value diagnostic test in ED sepsis evaluation. Additional work is needed to validate these results in clinical practice.
Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole Severe Acute Respiratory Failure
Authors: Miller Jenna , Khan Hason , Mino-Kenudson Mari , Taylor Martin , Shih Angela , Goldman Jennifer 
Published: July 2023

OBJECTIVES:
Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs.

DESIGN:
A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children’s Mercy Hospital Genomic Center and Vanderbilt University Medical Center.

SETTING:
U.S. ICUs, 1996–2021.

PATIENTS:
Nineteen young patients (10–37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, (n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered.

CONCLUSIONS:
TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.
Long-term exposure to low-concentration PM2.5 and heart disease in older men in Perth, Australia: The Health in Men Study
Authors: Jones Joshua S. , Nedkoff Lee , Heyworth Jane S. , Almeida Osvaldo P. , Flicker Leon , Golledge Jonathan , Hankey Graeme J. , Lim Elizabeth H. , Nieuwenhuijsen Mark , Yeap Bu B. , Trevenen Michelle L. 
Published: July 2023

Background:
Exposure to particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) is associated with increased risk of heart disease, but less is known about the relationship at low concentrations. This study aimed to determine the dose-response relationship between long-term PM2.5 exposure and risk of incident ischemic heart disease (IHD), incident heart failure (HF), and incident atrial fibrillation (AF) in older men living in a region with relatively low ambient air pollution.

Methods:
PM2.5 exposure was estimated for 11,249 older adult males who resided in Perth, Western Australia and were recruited from 1996 to 1999. Participants were followed until 2018 for the HF and AF outcomes, and until 2017 for IHD. Cox-proportional hazards models, using age as the analysis time, and adjusting for demographic and lifestyle factors were used. PM2.5 was entered as a restricted cubic spline to model nonlinearity.

Results:
We observed a mean PM2.5 concentration of 4.95 μg/m3 (SD 1.68 μg/m3) in the first year of recruitment. After excluding participants with preexisting disease and adjusting for demographic and lifestyle factors, PM2.5 exposure was associated with a trend toward increased incidence of IHD, HF, and AF, but none were statistically significant. At a PM2.5 concentration of 7 μg/m3 the hazard ratio for incident IHD was 1.04 (95% confidence interval [CI] = 0.86, 1.25) compared with the reference category of 1 μg/m3.

Conclusions:
We did not observe a significant association between long-term exposure to low-concentration PM2.5 air pollution and IHD, HF, or AF.
Comparative safety of conjugated estrogens/bazedoxifene versus estrogen/progestin combination hormone therapy among women in the United States: a multidatabase cohort study
Authors: Hoffman Sarah R. , Governor Samuel , Daniels Kimberly , Seals Ryan M. , Ziyadeh Najat J. , Wang Florence T. , Dai Dingwei , Mcmahill-Walraven Cheryl N. , Shuminski Patty , Frajzyngier Vera , Zhou Xiaofeng , Shen Rongjun , Garg Renu K. , Fournakis Nicole , Lanes Stephan , Beachler Daniel C. 
Published: July 2023

Abstract

Objective
To assess the risk of select safety outcomes including endometrial cancer, endometrial hyperplasia, and breast cancer among women using conjugated estrogens/bazedoxifene (CE/BZA) as compared with estrogen/progestin combination hormone therapy (EP).

Methods
We conducted a new-user cohort study in five US healthcare claims databases representing more than 92 million women. We included CE/BZA or EP new users from May 1, 2014, to August 30, 2019. EP users were propensity score (PS) matched to users of CE/BZA. Incidence of endometrial cancer, endometrial hyperplasia, breast cancer, and eight additional cancer and cardiovascular outcomes were ascertained using claims-based algorithms. Rate ratios (RR) and differences pooled across databases were estimated using random-effects models.

Results
The study population included 10,596 CE/BZA and 33,818 PS-matched EP new users. Rates of endometrial cancer and endometrial hyperplasia were slightly higher among CE/BZA users (1.6 and 0.4 additional cases per 10,000 person-years), although precision was limited because of small numbers of cases (endometrial cancer: RR, 1.50 [95% confidence interval {CI}, 0.79-2.88]; endometrial hyperplasia: RR, 1.69 [95% CI, 0.51-5.61]). Breast cancer incidence was lower in CE/BZA users (9.1 fewer cases per 10,000 person-years; RR, 0.79; 95% CI, 0.58-1.05). Rates of other outcomes were slightly higher among CE/BZA users, but with confidence intervals compatible with a wider range of possible associations.

Conclusions
CE/BZA users might experience slightly higher rates of endometrial cancer and endometrial hyperplasia, and a lower rate of breast cancer, than EP users in the first years of use.
Prevalence and Predictors of Unmet Need for Upper-Limb Prostheses: An Observational Cohort Study
Authors: Resnik Linda J. , Borgia Matthew L. , Clark Melissa A. 
Published: July 2023

ABSTRACT

Introduction
No prior studies have examined the prevalence of unmet prosthesis need among prosthesis nonusers.

Objectives
The aim of this study was to describe the prevalence of unmet need for an upper-limb prosthesis and identify independent covariates associated with unmet need for a prosthesis.

Study Design
This study is a telephone survey of 742 persons with upper-limb amputation (ULA).

Methods
Differences between users and nonusers and between nonusers with and without an unmet need were compared statistically. Covariates associated with unmet need P ≤ 0.2 in bivariate analyses were included in a multivariate logistic regression model predicting unmet need.

Results
Odds of unmet need were higher for those who stopped using a prosthesis within the past year compared with 20 years or more ago (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.28–14.51) and those on disability (OR, 4.01; 95% CI, 0.95–16.85). Odds of unmet need were lower for those with higher upper-limb function scores (OR, 0.94; 95% CI, 0.96–1.00), who were unemployed versus employed/student (OR, 0.15; 95% CI, 0.02–0.98), and those who had abandoned a prior prosthesis because it was “too much fuss” (OR, 0.41; 95% CI, 0.18–0.92).

Conclusions
Unmet need was prevalent, impacting approximately 50% of persons with upper-limb amputation who were not using a device and 14% who reported never having used a prosthesis. Independent correlates of greater unmet included worse upper-limb function, prosthesis use within the prior year, and disability status. Correlates of lesser unmet need included being unemployed and having abandoned a prosthesis because it was perceived as an undue burden. Further studies are needed to understand barriers to prosthesis use among nonusers with an unmet need.

Clinical Relevance
Persons with ULA who do not use a prosthesis should be reevaluated regularly to identify unmet needs. Our findings suggest recent prosthesis users, those with poorer upper-limb function, and those who are employed or on disability are more likely to have unmet needs.
Consumer attitudes toward aging skin during the COVID-19 pandemic
Authors: Yang Lynna J. , Knoll Justin , Kundu Roopal V. 
Published: July 2023

Background:
The impact of the novel coronavirus disease (COVID-19) pandemic on consumer attitudes toward their skin has not been well characterized.

Objective:
This study investigated how consumers’ attitudes toward their skin changed during the COVID-19 pandemic.

Methods:
A cross-sectional survey was conducted using REDCap. A total of 1,434 participants were recruited and consented to participate online through ResearchMatch. The survey gathered demographic information and assessed participants’ attitudes toward their skin using a Likert scale. An ordered logistic regression analysis was performed.

Results:
Nearly one-third of participants felt unhappy with their skin. Forty four percent feel less happy about their skin compared with 5 years earlier. The top skin concerns were eye puffiness (86.5%), loose skin (85.1%), uneven tone (84.9%), uneven texture (83.5%), and dry skin (81.4%). Video conferencing (31%), wearing masks (23%), and increased stress (21%) during the COVID-19 pandemic affected how participants felt about their skin. Compared with men, women were 1.6 to 1.8 times (P < .01) more likely to “strongly agree” that all 3 pandemic-related factors—video conferencing, wearing masks, and increased stress—affected how they felt about their skin. Younger age groups were 1.5 to 2.8 times (P < .01) more likely to answer in the top category for all 3 pandemic-related factors compared with the oldest age group.

Limitations:
Recruitment of participants was limited to English-speaking adults aged 18 years or older who were registered on ResearchMatch, which underrepresents minority populations. Further studies should be conducted to elucidate how the pandemic affected perceptions of skin.

Conclusion:
Skin aging is a significant concern among adults of all ages. The COVID-19 pandemic has exacerbated skin concerns. Women and young adults are more likely to be affected by the COVID-19 pandemic in their attitudes toward their skin.
A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions
Authors: Bhadra Krish , Setser Randolph M. , Condra William , Bader Brittany Amento , David Stephanie 
Published: July 2023

Background:
Compared with the standard cryoprobe, the novel ultrathin 1.1 mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials.

Methods:
In this single-center, retrospective review, we examine 200 (N=200) consecutive patients referred for cone beam CT bronchoscopic biopsy of peripheral lung lesions. We utilized an extended multimodality approach, including transbronchial needle aspirate, brush, traditional forces biopsies, UTCP biopsies, and BAL. We analyzed tool in lesion, tool touch lesion, center strike rates, and diagnostic yield. We assessed for molecular adequacy and analyzed safety.

Results:
A total of 222 lesions were biopsied. We achieved a tool in lesion or tool touch lesion confirmation for all biopsy attempts (100%) and a center strike rate of 68%. AQuIRE diagnostic yield was 90%, with 60% malignant, 30% benign lung nodules, and 10% nondiagnostic. UTCP was diagnostic in 3.6 % of peripheral lung lesions biopsies when all other modalities were nondiagnostic; thus, raising our overall diagnostic yield from 86.4% to 90.1%. Our analysis demonstrates superior adequacy for molecular analysis for histologic samples (TBBX or UTCP) versus cytologic samples (FNA) (P<0.001). Three patients (1.5%) had a pneumothorax, and 1 patient (0.5%) had moderate bleeding.

Conclusion:
UTCP was diagnostic in 3.6% of peripheral lung lesions when all other modalities were nondiagnostic. In the setting of CBCT guidance, UTCP has a similar safety profile to standard biopsy tools. Future trials are warranted to assess UTCP and its impact on peripheral lung lesion biopsies.
An open label randomized controlled trial of atorvastatin versus aspirin in elite controllers and antiretroviral-treated people with HIV
Authors: Mystakelis Harry A. , Wilson Eleanor , Laidlaw Elizabeth , Poole April , Krishnan Sonya , Rupert Adam , Welker Jorden L. , Gorelick Robert J. , Lisco Andrea , Manion Maura , Baker Jason V. , Migueles Stephen A. , Sereti Irini 
Published: July 2023

Background:
Residual inflammation in people with HIV (PWH) despite suppression of HIV replication is associated with many comorbidities including cardiovascular disease. Targeting inflammation may decrease the risk of cardiovascular disease.

Methods:
An open label randomized study was conducted to evaluate the effect of nine months of 81 mg aspirin versus 40 mg atorvastatin in antiretroviral therapy (ART) treated PWH and elite controllers (EC), not on ART. Biomarkers associated with inflammation and virologic indices were measured and analyzed using non-parametric and linear mixed effect models.

Results:
53 participants were randomized and 44 were included in the final analysis. Median age was 54 years, 72% were male, 59% were Black. Median CD4 count was 595 cells/μL in the aspirin and 717 cells/μL in the atorvastatin arm. After 9 months of treatment, plasma soluble (s) CD14 was reduced in the aspirin group within both treated PWH and EC (P = 0.0229), yet only within treated PWH in the atorvastatin group (P = 0.0128). A 2.3% reduction from baseline in tissue factor levels was also observed in the aspirin arm, driven by the EC group. In the atorvastatin arm, there was a 4.3% reduction in IL-8 levels (P = 0.02) and a small decrease of activated CD4 T cells (P < 0.001). No statistically significant differences were observed in the plasma HIV viral load and cell-associated (CA) HIV DNA and RNA.

Conclusions:
Aspirin and atorvastatin could play a role in targeting HIV-associated inflammation. Elite controllers may warrant special consideration for anti-inflammatory strategies.
Extracutaneous Kaposi sarcoma risk remains higher in people with HIV in the post-ART era: a nation-wide population-based study
Authors: Dinh Sofia , Malmström Stina , Möller Isabela Killander , Yilmaz Aylin , Svedhem Veronica , Carlander Christina 
Published: July 2023

Objective:
To assess Kaposi sarcoma (KS) by HIV-status in Sweden 1983–2017, with particular focus on extracutaneous KS.

Design:
Population-based study linking the Total Population Registry, the Swedish HIV Registry InfCareHIV, and the Swedish Cancer Registry.

Methods:
We included all Swedish residents, born in or outside Sweden between 1940 and 2000 (n = 8 587 829), assessing the annual incidence of KS, adjusted hazard ratios (adjHR), and odds ratios (adjOR) in the pre- and post-combination antiretroviral therapy (ART) eras.

Results:
KS was found in 324 individuals of whom 202 (62%) were people living with HIV (PLHIV). While the incidence of KS decreased in PLHIV, it remained higher compared to HIV-negative at end of follow-up (28 vs. 0.09 per 100 000 person-years, p < 0.001). In the post ART era PLHIV still had an increased risk of both cutaneous (adjHR 616, 95% confidence interval [CI] 410–926) and extracutaneous KS (adjHR 2068, 95% CI 757–5654), compared to HIV-negative individuals, although there were no cases of extracutaneous disease among virally suppressed PLHIV. In the post-ART era, the relative risk for KS remained higher in men, particularly MSM, and viral suppression was associated with lower odds of KS (adjOR 0.05, 95% CI 0.03–0.09).

Conclusions:
KS remained increased in PLHIV in the post-ART era, with a particularly high risk for extracutaneous disease compared to HIV-negative individuals. Notably, there were no cases of extracutaneous disease among virally suppressed PLHIV, suggesting a less aggressive disease in this population. Further studies on KS in virally suppressed PLHIV are warranted.
Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation
Authors: Laothamatas Indira , Fang Eric , Lee Justine , Abbas Syed Muhammad Hashim , Ding Juan , Kagen Alexander , Zakashansky Konstantin , Taouli Bachir , Kamath Amita , King Michael J. 
Published: July 2023

Abstract
The purpose of this article is to provide a comprehensive review of the imaging findings along with histopathologic correlation of mature (benign) teratomas and malignant ovarian teratomas, which include both immature teratomas and malignant degeneration of mature teratomas. The radiologist's ability to provide an accurate diagnosis plays an essential role in guiding the interdisciplinary care of patients with malignant teratomas and improving their outcomes.
An Unreported Variation of Origin of Posterior Tibial Artery Encountered During Free Fibula Flap Harvest
Authors: Karmakar Shilpi , Singla Priyanka 
Published: July 2023

Abstract
Variations in the division of popliteal artery and origin of the 3 vascular systems are well documented. Here, we report a case in which the posterior tibial artery originated from the peroneal artery, in lower leg and then followed the normal course. The anomaly was detected intraoperatively precluding the harvest of free fibula flap. The procedure was abandoned and fibula was fixed using plates and screws and a free radial forearm flap was done over 2 mini-plates, which spanned the bone gap. A second bone flap procedure was to be planned in another sitting.
The anomalous origin of posterior tibial artery from the peroneal artery in lower leg did not fall into any of the categories described previously by Kim et al (Ann Surg 1989;210:776–81.). In the event such atypical anatomy is encountered, it must be delineated, and the surgical plan adjusted accordingly. Flexibility in surgical approach can prevent vascular catastrophe.