bluuebunny/crossref_metadata_2025_split huggingface dataset:
Offloading of Diabetic Neuropathic Plantar Ulcers: Secondary Analysis of Step Activity and Ulcer Healing
Authors: Wendland Deborah M. , Kline Paul W. , Bohnert Kathryn L. , Biven Theresa M. , Sinacore David R. 
Published: March 2023

ABSTRACT

OBJECTIVE
Although it is well-known that offloading devices facilitate healing in people with diabetes and neuropathic plantar ulcers, little is known about how step activity affects healing. The purposes of this study were to compare: (1) healing outcomes (time to healing, percentage of ulcers healed); (2) healing rates by ulcer location; and (3) step activity (daily step count, daily peak mean cadence) among patients using either total contact casts (TCCs) or removable cast walker boots (RCWs).

METHODS
The study included 55 participants (TCC, 29; RCW, 26) with diabetes mellitus, peripheral neuropathy, and a Wagner grade 1 or 2 neuropathic plantar ulcer. Each participant wore an activity monitor for 14 consecutive days. Step activity and healing variables were assessed using independent t tests, Kruskal-Wallis, Kaplan-Meier, and Mantel-Cox log-rank tests.

RESULTS
Mean participant age was 55 (SD, 11) years. The percentage of ulcers healed was lower in the RCW group versus the TCC group (65% vs 93%). If healed, average healing rate was 77 (SD, 48) days in the TCC group and 138 (SD, 143) days in the RCW group. Survival distribution by ulcer location was different for RCW forefoot than other locations (132 ± 13 days vs 91 ± 15, 75 ± 11, and 102 ± 36 days for TCC forefoot, TCC-midfoot/hindfoot, and RCW-midfoot/hindfoot, respectively; χ
2 = 10.69, P = .014). Average step count was 2,597 in the RCW group versus 1,813 steps in the TCC group (P = .07). The daily peak mean cadence for 20-, 30-, or 60-minute periods was greater with RCW use.

CONCLUSIONS
Step activity in participants with RCWs was increased compared with those with TCCs. Because of their potential to be easily removable, RCWs may impair ulcer healing by allowing greater step activity.
Debridement: Technical Considerations and Treatment Options for the Interprofessional Team
Authors: Tran David L. , Huang Ren-Wen , Chiu Ernest S. , Rajhathy Erin M. , Gregory John H. , Ayello Elizabeth A. , Sibbald R. Gary 
Published: March 2023

ABSTRACT
Debridement is a critical component in the management of both acute and chronic wounds. Six reviewed methods of debridement exist, and specific techniques are more appropriate to match patient needs with available clinical resources. Accurate differentiation between healable, maintenance, and nonhealable wounds is paramount when determining whether a wound would benefit from debridement.
Clinical assessment includes review of the patient’s underlying medical conditions/ previous surgeries along with the history and progression of the wound. Awareness of the physiologic wound bed preparation components that contribute to the current wound status will direct treatment of the abnormal components. Optimal wound status includes complete healing or reduced abnormal wound-related symptoms or signs.
Debridement competency requires an awareness of the six types of debridement, their clinical utility, and appropriate patient selection. Providers need to assess patients’ wounds, triage them, and refer them as necessary to an interprofessional setting. For stalled but healable wounds, specialized testing may be necessary when managing patients who would benefit from more invasive or advanced forms of wound care. This article informs providers on the training and experience required for specific debridement techniques depending on the wound etiology.

GENERAL PURPOSE
To enhance the learner’s chronic wound debridement competence as an interprofessional team member.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will:
1. Differentiate healable, maintenance, and nonhealable wounds to create a holistic debridement treatment plan using the Wound Bed Preparation paradigm.
2. Evaluate active debridement options including the potential need for an interprofessional referral or specialized investigations.
3. Assess chronic wound debridement options.
4. Analyze case studies for appropriate clinical application of debridement modalities.
Characteristics of the Summating Potential Measured Across a Cochlear Implant Array as an Indicator of Cochlear Function
Authors: Panario Jared , Bester Christofer , O’Leary Stephen John 
Published: March 2023

Objectives:
The underlying state of cochlear and neural tissue function is known to affect postoperative speech perception following cochlear implantation. The ability to assess these tissues in patients can be performed using intracochlear electrocochleography (IC ECochG). One component of ECochG is the summating potential (SP) that appears to be generated by multiple cochlear tissues. Its qualities may be able to detect the presence of functional inner hair cells, but evidence for this is limited in human cochleae. This study aimed to examine the IC SP characteristics in cochlear implantation recipients, its relationship to preoperative speech perception and audiometric thresholds, and to other IC ECochG components.

Design:
This is a retrospective analysis of 113 patients’ IC ECochG recordings across the array in response to a 500 Hz tone burst stimulus. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the cochlear microphonic and added to one another to emphasize the SP, auditory nerve neurophonic, and compound action potential. Patients were grouped based on their maximum SP deflection being large and positive (+SP), large and negative (−SP), or minimal (0 SP) to further investigate these relationships.

Results:
Patients in the +SP group had better preoperative speech perception (mean consonant-vowel-consonant phoneme score 46%) compared to the −SP and 0 SP groups (consonant-vowel-consonant phoneme scores 34% and 36%, respectively, difference to +SP: p < 0.05). Audiometric thresholds were lowest for +SP (mean pure-tone average 50 dB HL), then −SP (65 dB HL), and highest for 0 SP patients (70 dB HL), but there was not a statistical significance between +SP and −SP groups (p > 0.1). There were also distinct differences between SP groups in the qualities of their other ECochG components. These included the +SP patients having larger cochlear microphonic maximum amplitude, more apical SP peak electrode locations, and a more spatially specific SP magnitude growth pattern across the array.

Conclusions:
Patients with large positive SP deflection in IC ECochG have preoperatively better speech perception and lower audiometric thresholds than those without. Patterns in other ECochG components suggest its positive deflection may be an indicator of cochlear function.
Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Wetmore Douglas S. , Dalal Sidhant , Shinn Daniel , Shahi Pratyush , Vaishnav Avani , Chandra Akhil , Melissaridou Dimitra , Beckman James , Albert Todd J. , Iyer Sravisht , Qureshi Sheeraz A. 
Published: March 2023

Study Design.
Matched cohort comparison.

Objective.
To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Summary of Background Data.
There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF.

Materials and Methods.
Patients who underwent 1-level MI-TLIF and received the ESP block (group E) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups.

Results.
Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption (P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 (P = 0.016), and lower first pain scores postsurgery (P < 0.001). Group E had lower intraoperative opioid requirements (P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 (P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively (P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1.

Conclusions.
In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF.

Level of Evidence.
Level 3.
Predictors of Subsidence and its Clinical Impact After Expandable Cage Insertion in Minimally Invasive Transforaminal Interbody Fusion
Authors: Subramanian Tejas , Merrill Robert K. , Shahi Pratyush , Pathania Shane , Araghi Kasra , Maayan Omri , Zhao Eric , Shinn Daniel , Kim Yeo Eun , Kamil Robert , Song Junho , Dalal Sidhant S. , Vaishnav Avani S. , Othman Yahya , Steinhaus Michael E. , Sheha Evan D. , Dowdell James E. , Iyer Sravisht , Qureshi Sheeraz A. 
Published: March 2023

Study Design.
Retrospective review of prospectively collected multisurgeon data.

Objective.
Examine the rate, clinical impact, and predictors of subsidence after expandable minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) cage.

Summary of Background Data.
Expandable cage technology has been adopted in MI-TLIF to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as the force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence.

Materials and Methods.
Patients who underwent 1 or 2-level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of >1 year were included. Preoperative and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by >25% compared with the immediate postoperative value. Patient-reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) time points. Fusion was assessed by 1-year postoperative computed tomography.

Results.
One hundred forty-eight patients were included (mean age, 61 yr, 86% 1-level, 14% 2-level). Twenty-two (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, had lower bone mineral density, and had higher body mass index and comorbidity burden. Operative time was significantly higher (P = 0.02) and implant width was lower (P < 0.01) for subsided patients. Visual analog scale-leg was significantly lower for subsided patients compared with nonsubsided patients at a >6 months time point. Long-term (>6 mo) patient-acceptable symptom state achievement rate was lower for subsided patients (53% vs. 77%), although statistically not significant (P = 0.065). No differences existed in complication, reoperation, or fusion rates.

Conclusions.
Of the patients, 14.9% experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most patient-reported outcome measures and complication, reoperation, or fusion rates, patients had lower visual analog scale-leg and patient-acceptable symptom state achievement rates at the >6-month time point.

Level of Evidence.
Level 4.
Herpesvirus Infection Masquerading as a Neoplasm in an HIV-Positive Patient: A Potential Diagnostic Pitfall
Authors: Levett Kaitlyn , Youngs Julie , Hoppenot Claire , Masand Ramya P. 
Published: March 2023

Abstract:
Herpesvirus infection classically presents as a clustered, vesicular rash over mild erythema. However, unusual presentations may mimic tumors and be a potential pitfall. We describe the case of a 55-year-old HIV positive woman with this unusual manifestation of a common disease which was initially diagnosed as a benign neoplasm. Review of pathology revealed histologic features characteristic of this form of herpesvirus eruption. Awareness of this rare clinical and microscopic presentation is important to guide appropriate use of immunostains, prevent misdiagnosis, and promptly institute of antiviral therapy.
Radiotherapy-Associated Cutaneous Mastocytosis in a Patient With Breast Carcinoma. Case Report and Review of the Literature
Authors: Murphy Michael , Valentini Rodolfo , Shaughnessy Emily 
Published: March 2023

Abstract:
Mast cell skin disease is rarely described after external beam radiation therapy in patients with breast carcinoma, with only 7 previous reports in the literature. Skin changes typically occur within (but are not limited to) the radiation field. We present a 64-year-old woman with postradiotherapy cutaneous mastocytosis on the left breast and adjacent chest wall. The clinical and laboratory findings in all reported patients, including the current case, are reviewed. No clear mechanism has been presented to explain disease pathogenesis; although, mast cell accumulation secondary to local mediators produced in response to radiation damage and/or koebnerization phenomenon have been proposed. Cutaneous/systemic mastocytosis is not widely recognized and may be underdiagnosed in the setting of postradiation for breast cancer. It is important for clinicians and pathologists to be aware of this diagnosis for patients presenting with rashes after radiotherapy.
Beyond “Chilling Effects”
Authors: Young Maria-Elena De Trinidad , Tafolla Sharon , Saadi Altaf , Sudhinaraset May , Chen Lei , Pourat Nadereh 
Published: March 2023

Objectives:
Immigration enforcement policies are associated with immigrants’ barriers to health care. Current evidence suggests that enforcement creates a “chilling effect” in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants’ direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants’ encounters with law and immigration enforcement and assessed associations with health care access.

Methods:
We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care.

Results:
Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10–1.50). There were no associations with the usual source of care.

Conclusion:
Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants’ enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants’ access to care.
Machine learning prediction algorithm for in-hospital mortality following body contouring
Authors: Peng Chi , Yang Fan , Jian Yu , Peng Liwei , Zhang Chenxu , Chen Chenxin , Lin Zhen , Li Yuejun , He Jia , Jin Zhichao 
Published: March 2023

Background:
Body contouring is a common procedure, but it is worth attention due to concerns for a variety of complications, and even potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning models.

Methods:
The National Inpatient Sample (NIS) database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors such as demographics, comorbidities, personal history, postoperative complications, operative features were included. The outcome was the in-hospital mortality. Models were compared on area under the curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis (DCA) curve.

Results:
Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) patients died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all machine learning algorithms, followed by Elixhauser Comorbidity Index (ECI), cardiac arrest (CA), and so forth. Naïve Bayes (NB) had a higher predictive performance (AUC 0.898, 95% CI 0.884 to 0.911) among these eight machine learning models. Similarly, in the DCA curve, the NB also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a trade-off between false-negatives and false-positives)—over the other seven models across a range of threshold probability values.

Conclusions:
The machine learning models, as indicated by our study, can be used to predict in-hospital deaths for patients at risk who underwent body contouring.
Comparison of multiple 3D scanners to capture foot, ankle, and lower leg morphology
Authors: Farhan Muhannad , Wang Joyce Zhanzi , Lillia Jonathon , Cheng Tegan L. , Burns Joshua 
Published: March 2023

Background:
3D scanning of the foot and ankle is gaining popularity as an alternative method to traditional plaster casting to fabricate ankle-foot orthoses (AFOs). However, comparisons between different types of 3D scanners are limited.

Objective(s):
The aim of this study was to evaluate the accuracy and speed of seven 3D scanners to capture foot, ankle, and lower leg morphology to fabricate AFOs.

Study Design:
Repeated-measures design.

Methods:
The lower leg region of 10 healthy participants (mean age 27.8 years, standard deviation [SD] 9.3) was assessed with 7 different 3D scanners: Artec Eva (Eva), Structure Sensor (SS I), Structure Sensor Mark II (SS II), Sense 3D Scanner (Sense), Vorum Spectra (Spectra), Trnio 3D Scanner App on iPhone 11 (Trnio 11), and Trnio 3D Scanner App on iPhone 12 (Trnio 12). The reliability of the measurement protocol was confirmed initially. The accuracy was calculated by comparing the digital scan with clinical measures. A percentage difference of #5% was considered acceptable. Bland and Altman plots were used to show the mean bias and limit of agreement (LoA) for each 3D scanner. Speed was the time needed for 1 complete scan.

Results:
The mean accuracy ranged from 6.4% (SD 10.0) to 230.8% (SD 8.4), with the SS I (21.1%, SD 6.8), SS II (21.7%, SD 7.5), and Eva (2.5%, SD 4.5) within an acceptable range. Similarly, Bland and Altman plots for Eva, SS I, and SS II showed the smallest mean bias and LoA 21.7 mm (LoA 25.8 to 9.3), 21.0 mm (LoA 210.3 to 8.3), and 0.7 mm (LoA 213 to 11.5), respectively. The mean speed of the 3D scanners ranged from 20.8 seconds (SD 8.1, SS I) to 329.6 seconds (SD 200.2, Spectra).

Conclusions:
Eva, SS I, and SS II appear to be the most accurate and fastest 3D scanners for capturing foot, ankle, and lower leg morphology, which could be used for AFO fabrication.
Respiratory syncytial virus infection in the modern era
Authors: Ludlow Martin 
Published: March 2023

Purpose of review
Respiratory syncytial virus (RSV) continues to be a major cause of severe lower respiratory tract infection in infants, young children, and older adults. In this review, changes in the epidemiology of RSV during the coronavirus disease 2019 (COVID-19) pandemic are highlighted together with the role which increased molecular surveillance efforts will have in future in assessing the efficacy of vaccines and therapeutics.

Recent findings
The introduction of nonpharmaceutical intervention (NPIs) strategies during the COVID-19 pandemic between 2020 and 2022 resulted in worldwide disruption to the epidemiology of RSV infections, especially with respect to the timing and peak case rate of annual epidemics. Increased use of whole genome sequencing along with efforts to better standardize the nomenclature of RSV strains and discrimination of RSV genotypes will support increased monitoring of relevant antigenic sites in the viral glycoproteins. Several RSV vaccine candidates based on subunit, viral vectors, nucleic acid, or live attenuated virus strategies have shown efficacy in Phase 2 or 3 clinical trials with vaccines using RSVpreF protein currently the closest to approval and use in high-risk populations. Finally, the recent approval and future use of the extended half-life human monoclonal antibody Nirsevimab will also help to alleviate the morbidity and mortality burden caused by annual epidemics of RSV infections.

Summary
The ongoing expansion and wider coordination of RSV molecular surveillance efforts via whole genome sequencing will be crucial for future monitoring of the efficacy of a new generation of vaccines and therapeutics.