bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Epidural Steroid Injection Does Not Increase Infection Risk Following Posterior Cervical Surgery
Authors: Shelby Tara , Mills Emily S. , Kang Hyunwoo P. , Ton Andy , Hah Raymond J. , Alluri Ram K. 
Published: March 2023

Study Design.
Retrospective cohort study.

Objective.
The purpose of this study was to characterize the infection risk of preoperative epidural steroid injection (ESI) in patients undergoing posterior cervical surgery.

Summary of Background Data.
ESI is a helpful tool for alleviating pain and is often used as a diagnostic tool before cervical surgery. However, a recent small-scale study found that ESI before cervical fusion was associated with an increased risk of postoperative infection.

Materials and Methods.
Patients from 2010 to 2020 with cervical myelopathy, spondylosis, and radiculopathy who underwent posterior cervical procedure including laminectomy, laminoforaminotomy, fusion, or laminoplasty were queried from the PearlDiver database. Patients who underwent revision or fusion above C2 or who had a diagnosis of neoplasm, trauma, or preexisting infection were excluded. Patients were divided on whether they received an ESI within 30 days before the procedure and subsequently matched by age, sex, and preoperative comorbidities. The χ2 analysis was used to calculate the risk of postoperative infection within 90 days. Logistic regression controlling for age, sex, Elixhauser Comorbidity Index, and operated levels was conducted within the unmatched population to assess infection risk for injected patients across procedure subgroups.

Results.
Overall, 299,417 patients were identified with 3897 having received a preoperative ESI and 295,520 who did not. Matching resulted in 975 in the injected group and 1929 in the control group. There was no significant difference in postoperative infection rate in those who received an ESI within 30 days preoperatively and those who did not (3.28% vs. 3.78%, odds ratio=0.86, 95% CI: 0.57–1.32, P=0.494). Logistic regression accounting for age, sex, Elixhauser Comorbidity Index, and levels operated demonstrated that injection did not significantly increase infection risk in any of the procedure subgroups.

Conclusions.
The present study found no association between preoperative ESI within 30 days before surgery and postoperative infection in patients undergoing posterior cervical surgery.
Paraspinal Sarcopenia is Associated With Worse Patient-Reported Outcomes Following Laminoplasty for Degenerative Cervical Myelopathy
Authors: Pinter Zachariah W. , Reed Ryder , Townsley Sarah E. , Mikula Anthony L. , Lakomkin Nikita , Kazarian Erick , Michalopoulos Giorgos D. , Freedman Brett A. , Currier Bradford L. , Elder Benjamin D. , Bydon Mohamad , Fogelson Jeremy , Sebastian Arjun S. , Nassr Ahmad N. 
Published: March 2023

Study Design.
Retrospective cohort study.

Objective.
The present study is the first to assess the impact of paraspinal sarcopenia on patient-reported outcome measures (PROMs) following cervical laminoplasty.

Background.
While the impact of sarcopenia on PROMs following lumbar spine surgery is well-established, the impact of sarcopenia on PROMs following laminoplasty has not been investigated.

Methods.
We performed a retrospective review of patients undergoing laminoplasty from C4-6 at a single institution between 2010 and 2021. Two independent reviewers utilized axial cuts of T2-weighted magnetic resonance imaging sequences to assess fatty infiltration of the bilateral transversospinales muscle group at the C5-6 level and classify patients according to the Fuchs Modification of the Goutalier grading system. PROMs were then compared between subgroups.

Results.
We identified 114 patients for inclusion in this study, including 35 patients with mild sarcopenia, 49 patients with moderate sarcopenia, and 30 patients with severe sarcopenia. There were no differences in preoperative PROMs between subgroups. Mean postoperative neck disability index scores were lower in the mild and moderate sarcopenia subgroups (6.2 and 9.1, respectively) than in the severe sarcopenia subgroup (12.9, P=0.01). Patients with mild sarcopenia were nearly twice as likely to achieve minimal clinically important difference (88.6 vs. 53.5%; P<0.001) and six times as likely to achieve SCB (82.9 vs. 13.3%; P=0.006) compared with patients with severe sarcopenia. A higher percentage of patients with severe sarcopenia reported postoperative worsening of their neck disability index (13 patients, 43.3%; P=0.002) and Visual Analog Scale Arm scores (10 patients, 33.3%; P=0.03).

Conclusion.
Patients with severe paraspinal sarcopenia demonstrate less improvement in neck disability and pain postoperatively and are more likely to report worsening PROMs following laminoplasty.

Level of Evidence.
3
Below-the-knee Amputation with Targeted Muscle Reinnervation: Operative Technique and Technical Pearls
Authors: Chang Brian L. , Kleiber Grant M. 
Published: March 2023

Background:
Postamputation pain from symptomatic neuromas and/or phantom limb pain can have a significant detrimental impact on patients’ quality of life following a major lower extremity amputation. Various methods of physiologic nerve stabilization, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface, have been proposed as the best current techniques to prevent that pathologic neuropathic pain.

Methods:
This article details our institution’s technique that has been performed safely and effectively on over 100 patients. Our approach and rationale for each of the major nerves of the lower extremity are presented.

Results:
In contrast to other described techniques for TMR for below-the-knee amputations, this current protocol does not involve performing transfers on all five major nerves, as one must balance rates of symptomatic neuroma formation and nerve-specific phantom limb pain with needed operative time and surgical morbidity from removing proximal sensory function and denervation of the donor motor nerve branches. This technique also differs significantly from others by performing a transposition of the superficial peroneal nerve to place the neurorrhaphy away from the weight-bearing stump.

Conclusion:
This article details our institution’s approach to physiologic nerve stabilization via TMR at time of below-the-knee amputation.
Artificial PGA/Collagen-based Bilayer Conduit in Short Gap Interposition Setting Provides Comparable Regenerative Potential to Direct Suture
Authors: Li Yu , Takanari Keisuke , Nakamura Ryota , Kambe Miki , Ebisawa Katsumi , Oishi Mayumi , Kamei Yuzuru 
Published: March 2023

Background:
The aim of this study was to evaluate whether the Nerbridge, an artificial polyglycolic acid conduit with collagen matrix, is comparable to direct nerve suture in a rat sciatic nerve injury model in a short-gap interposition (SGI) setting.

Methods:
Sixty-six female Lewis rats were randomly divided into the sham group (n = 13); no reconstruction (no-recon) group (n = 13; rat model with 10 mm sciatic nerve defect); direct group (n = 20; rat sciatic nerve injury directly connected by 10-0 Nylon); and SGI group (n = 20; sciatic nerve injury repaired using 5-mm Nerbridge). Motor function and histological recovery were evaluated. The sciatic nerve and gastrocnemius muscle were harvested for quantification of the degree of nerve regeneration and muscle atrophy.

Results:
The SGI and direct groups achieved equal recovery in both functional and histological outcomes. At weeks 3 and 8 postsurgery, there was a significant improvement in the sciatic functional index of the SGI group when compared with that of the no-recon group (P < 0.05). Furthermore, the direct and SGI groups had less muscle atrophy at 4 and 8 weeks postsurgery compared with the no-recon group (P < 0.05). The axon density and diameter at the distal site in the SGI group were significantly higher than that in the no-recon group and comparable to that in the direct and sham groups.

Conclusion:
An artificial nerve conduit has equal potential as direct suture in motor nerve reconstruction when used in the SGI setting.
The association between soluble CD163, disease severity, and ursodiol treatment in patients with primary biliary cholangitis
Authors: Bossen Lars , Lau Tobias Stemann , Nielsen Mette Bak , Nielsen Marlene Christina , Andersen Astrid Højmark , Ott Peter , Becker Sabine , Glerup Henning , Svenningsen Lise , Eivindson Martin , Kornerup Linda , Kjeldsen Niels Bjørndal , Neumann Anders , Møller Holger Jon , Jepsen Peter , Grønbæk Henning 
Published: March 2023

Introduction:
The macrophage activation marker soluble (s)CD163 is associated with disease severity and prognosis in patients with primary biliary cholangitis (PBC). Ursodeoxycholic acid (UDCA) treatment attenuates fibrosis progression in PBC patients, but its effect on macrophage activation is unclear. We examined the effect of UDCA on macrophage activation, as determined by sCD163 levels.

Methods:
We included 2 cohorts of PBC patients; 1 cohort with prevalent PBC patients, and 1 cohort of incident PBC patients before start of UDCA treatment and with follow-up after 4 weeks and 6 months. We measured sCD163 and liver stiffness in both cohorts. Further, we measured sCD163 and TNF-α shedding in vitro in monocyte-derived macrophages after UDCA and lipopolysaccharide incubation.

Results:
We included 100 patients with prevalent PBC [93% women, median age 63 y (interquartile range: 51–70)] and 47 patients with incident PBC [77% women, median age 60 y (49–67)]. Prevalent PBC patients had a lower median sCD163 of 3.54 mg/L (2.77–4.72) than incident PBC patients with a median sCD163 of 4.33 mg/L (2.83–5.99) at inclusion. Patients with an incomplete response to UDCA and patients with cirrhosis had higher sCD163 than responders to UDCA and noncirrhosis patients. After 4 weeks and 6 months of UDCA treatment median sCD163 decreased by 4.6% and 9.0%, respectively. In in vitro experiments, UDCA attenuated shedding of TNF-α, but not sCD163, from monocyte-derived macrophages.

Conclusion:
In PBC patients, sCD163 levels correlated with liver disease severity and treatment response to UDCA. Further, after 6 months of UDCA treatment, we observed a decrease in sCD163, which may be related to the treatment.
Disparities in presentation and management of chronic hepatitis B among Hispanics in a diverse safety net system
Authors: Wang Allison E. , Terrault Norah A. , Fong Tse-Ling , Zhou Kali 
Published: March 2023

Background:
Chronic hepatitis B (HBV) prevalence is highest in foreign-born Asian and African individuals in the US, though Hispanics make up the largest proportion of the immigrant population. Differences in the diagnosis and management of chronic HBV in Hispanics might exist due to the lower awareness of risk. We aim to examine racial/ethnic disparities in the diagnosis, presentation, and immediate management of chronic HBV in a diverse safety net system enriched for Hispanics.

Methods:
In a large urban safety-net hospital system, we retrospectively identified patients with chronic HBV by serological data and categorized them into mutually exclusive self-identified racial/ethnic groups: Hispanics, Asians, Blacks, and Whites. We then examined differences in screening, disease phenotype and severity, follow-up testing, and referral by race/ethnicity.

Results:
Among 1063 patients, 302 (28%) were Hispanics, 569 (54%) Asians, 161 (15%) Blacks, and 31 (3%) Whites. More Hispanics (30%) were screened in the acute setting (defined as inpatient or emergency department encounters) than Asians (13%), Blacks (17%), or Whites (23%) (p<0.01). Hispanics also had lower rates of follow-up testing after HBV diagnosis than Asians including HBeAg status (43% vs. 60%, p<0.01) and HBV DNA levels (42% vs. 58%, p<0.01) and lower rates of linkage to specialty care (32% vs. 55%, p<0.01). Among those with available testing, however, the presence of immune-active chronic HBV was infrequent and similar across racial/ethnic groups. 25% of Hispanics had cirrhosis at initial presentation, proportionally higher than other groups (p<0.01).

Conclusion:
Our results underscore the importance of raising chronic HBV awareness and increasing both screening and linkage to care among Hispanic immigrants in addition to the existing risk groups, with the goal of mitigating downstream liver-related complications.
Implementing a Sedentary Behavior Change Smartphone App in Cardiac Rehabilitation
Authors: Patterson Kacie , Keegan Richard , Davey Rachel , Freene Nicole 
Published: March 2023

Background
Smartphone apps used in research offer a variety of capabilities to track and influence behavior; however, they often do not translate well into real-world use. Implementation strategies for using apps to reduce sedentary behavior in cardiac rehabilitation are currently unknown.

Objective
The aim of this study was to explore (1) barriers and enablers for use of a behavioral smartphone app (Vire and ToDo-CR program) for reducing sedentary behavior in cardiac rehabilitation participants and (2) implementation strategies for future smartphone apps aimed at reducing sedentary behavior in this population.

Methods
In-depth semistructured interviews were conducted with cardiac rehabilitation participants in the ToDo-CR randomized controlled trial. Participants had used the Vire app and a wearable activity tracker for 6 months. Interviews were audio recorded and transcribed. The researchers used thematic analysis and deductive mapping of themes to the Theoretical Domains Framework and the Capability, Opportunity, and Motivation-Behavior model. Sociodemographic and clinical variables were recorded.

Results
Fifteen participants aged 59 ± 14 years were interviewed. Most were male, tertiary educated, and employed, and had varying experiences with smartphone apps and wearable activity trackers. Five core themes explaining the user experiences of cardiac rehabilitation participants with the Vire app were identified: (1) being tech savvy can be both an enabler and a barrier, (2) app messaging needs to be clear—set expectations from the beginning, (3) get to know me—personalization is important, (4) curious to know more instant feedback, and (5) first impression is key. The themes and subthemes mapped to 12 of the 14 Theoretical Domains Framework domains. Improving engagement and implementation of future smartphone apps for sedentary behavior may be aided by building psychological capability, physical opportunity, and reflective motivation.

Conclusions
Shifting to in-the-moment behavioral nudges, setting clear expectations, assisting participants to monitor their sitting time, increasing the frequency of tailoring, and understanding more about the participant as well as their experiences and needs for reducing sedentary behavior in cardiac rehabilitation are important future directions.
Expression, clinicopathologic, and prognostic significance of MMP15 in operable pancreatic ductal adenocarcinoma
Authors: Liu Wen-Jing , Liu Jian-Zhou , Zhou Wei-Xun , Zhou Li , Guo Jun-Chao 
Published: March 2023

Objective:
Matrix metalloproteinase 15 (MMP15) has been previously reported to be involved in many cancers. However, its expression pattern in pancreatic ductal adenocarcinoma (PDAC) remains contradictory. In addition, its clinicopathologic and prognostic significance in this malignancy has not been elucidated.

Methods:
Expression of MMP15 was immunohistochemically detected in a tissue microarray of formalin-fixed paraffin-embedded samples from 95 patients of PDAC after surgery. Its expression pattern and relations with clinicopathologic factors and disease-specific survival (DSS) were then evaluated. Finally, its expression and prognostic value were measured in the on-line publically available database, GEPIA, using TCGA data.

Results:
In comparison of all samples and 75 paired ones, MMP15 expression in tumor tissues was all significantly higher than that in para-tumor ones (P = .037 and .016). Furthermore, tumoral MMP15 expression was associated with peri-neural invasion. Survival analysis showed that patients with high tumoral MMP15 expression had significantly poorer DSS than those with low MMP15 expression (P = .0059). In univariate and multivariate Cox regression tests, tumoral MMP15 expression was all significantly predictive for DSS. In the on-line publically available GEPIA database, MMP15 was also overexpressed in PDAC, but was not found to be prognostic.

Conclusion:
Our results indicated that MMP15 expression was elevated in operable PDAC and might have a prognostic impact.
Attachment Style and Self-Experience
Authors: de With Justine , de Haan Lieuwe , Schirmbeck Frederike 
Published: March 2023

Abstract
The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.
Surgical Management of Presacral Tumors: Report of 5 Cases With Video Vignette of Laparoscopic Removal
Authors: Körfer Daniel , Jentschura Dirk 
Published: March 2023

Background:
Cystic tumors in the presacral space represent a rare pathology. In case of symptoms, but particularly due to the danger of malignant degeneration, surgical removal is indicated. Due to the complex position in the pelvis with its proximity to important anatomic structures, the choice of the surgical approach is decisive.

Methods:
To present an overview of the recent knowledge of presacral tumors, a PubMed-based literature review was performed. Subsequently, we present 5 cases where different surgical strategies were evaluated including a video of a laparoscopic removal.

Results:
Presacral tumors can be of different histopathologic origins. Complete surgical excision is the treatment of choice, with open abdominal, open abdominoperineal, and posterior accesses available, as well as minimally invasive techniques.

Conclusion:
Laparoscopic resection of presacral tumors is a well-suitable option, but the decision must always be made individually.
Up and over: Consequences of raising the United States-Mexico border wall height
Authors: Marshall William A. , Bansal Vishal , Krzyzaniak Andrea , Haines Laura N. , Berndtson Allison E. , Ignacio Romeo , Keller Benjamin A. , Doucet Jay J. , Costantini Todd W. 
Published: March 2023

OBJECTIVES
San Diego County’s geographic location lends a unique demographic of migrant patients injured by falls at the United States-Mexico border. To prevent migrant crossings, a 2017 Executive Order allocated funds to increase the southern California border wall height from 10 ft to 30 ft, which was completed in December 2019. We hypothesized that the elevated border wall height is associated with increased major trauma, resource utilization, and health care costs.

METHODS
Retrospective trauma registry review of border wall falls was performed by the two Level I trauma centers that admit border fall patients from the southern California border from January 2016 to June 2022. Patients were assigned to either “pre-2020” or “post-2020” subgroups based upon timing of completion of the heightened border wall. Total number of admissions, operating room utilization, hospital charges, and hospital costs were compared.

RESULTS
Injuries from border wall falls grew 967% from 2016 to 2021 (39 vs. 377 admissions); this percentage is expected to be supplanted in 2022. When comparing the two subgroups, operating room utilization (175 vs. 734 total operations) and median hospital charges per patient ($95,229 vs. $168,795) have risen dramatically over the same time period. Hospital costs increased 636% in the post-2020 subgroup ($11,351,216 versus $72,172,123). The majority (97%) of these patients are uninsured at admission, with costs largely subsidized by federal government entities (57%) or through state Medicaid enrollment postadmission (31%).

CONCLUSION
The increased height of the United States-Mexico border wall has resulted in record numbers of injured migrant patients, placing novel financial and resource burdens on already stressed trauma systems. To address this public health crisis, legislators and health care providers must conduct collaborative, apolitical discussions regarding the border wall's efficacy as a means of deterrence and its impact on traumatic injury and disability.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Altered functional connectivity between the default mode network in diabetic retinopathy patients
Authors: Chen Wan Yun , Zhong Yu Lin , Jin Han , Huang Xin 
Published: March 2023

Objectives
Previous studies have demonstrated that diabetic retinopathy is associated with cognitive impairment. This study aimed to investigate the intrinsic functional connectivity pattern within the default mode network (DMN) and its associations with cognitive impairment in diabetic retinopathy patients using resting-state functional MRI (rs-fMRI).

Methods
A total of 34 diabetic retinopathy patients and 37 healthy controls were recruited for rs-fMRI scanning. Both groups were age, gender, and education level matched. The posterior cingulate cortex (PCC) was chosen as the region of interest for detecting functional connectivity changes.

Results
Compared with the healthy control group, diabetic retinopathy patients showed increased functional connectivity between PCC and left medial superior frontal gyrus and increased functional connectivity between PCC and right precuneus.

Conclusion
Our study highlights that diabetic retinopathy patients show enhanced functional connectivity within DMN, suggesting that a compensatory increase of neural activity might occur in DMN, which offers new insight into the potential neural mechanism of cognitive impairment in diabetic retinopathy patients.
Bayesian causal inference: a critical review
Authors: Li Fan , Ding Peng , Mealli Fabrizia 
Published: March 2023

This paper provides a critical review of the Bayesian perspective of causal inference based on the potential outcomes framework. We review the causal estimands, assignment mechanism, the general structure of Bayesian inference of causal effects and sensitivity analysis. We highlight issues that are unique to Bayesian causal inference, including the role of the propensity score, the definition of identifiability, the choice of priors in both low- and high-dimensional regimes. We point out the central role of covariate overlap and more generally the design stage in Bayesian causal inference. We extend the discussion to two complex assignment mechanisms: instrumental variable and time-varying treatments. We identify the strengths and weaknesses of the Bayesian approach to causal inference. Throughout, we illustrate the key concepts via examples.This article is part of the theme issue ‘Bayesian inference: challenges, perspectives, and prospects’.