bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Changes to the Modified K-Line Using Kinematic MRIs
Authors: Bajouri Zabiullah , Telang Sagar , Fresquez Zoe , Kim Michael , Gilbert Zachary , Pickering Trevor , Buser Zorica , Hah Raymond J. , Wang Jeffrey C. , Alluri Ram Kiran 
Published: February 2023

Study Design.
Retrospective cross-sectional review of a large database

Objective.
Little is known regarding extension K-lines for treatment of cervical myelopathy. Therefore, this study seeks to examine differences between K-lines drawn in neutral and extension.

Summary of Background Data.
The modified K-line is a radiological tool used in surgical planning of the cervical spine. As posterior cervical decompression and fusion often results in patients being fused in a more lordotic position than the preoperative neutral radiograph, a K-line measured in the extension position may offer better utility for these patients.

Materials and Methods.
Total of 97 patients were selected with T2-weighted, upright cervical magnetic resonance imaging taken in neutral and extension. For each patient, the K-line was drawn at the mid-sagittal position for both neutral and extension. The distance from the most posterior portion of each disk (between C2 and C7) to the K-line was measured in neutral and extension and the difference was calculated. Paired t test was used to assess significant differences.

Results.
Across all levels between C2 and C7 there was an increase in the distance between the dorsal aspect of the disk and K-line when comparing neutral and extension radiographs. The average change in difference (extension minus neutral) at each cervical spinal level was 0.9 mm (C2–C3), 2.5 mm (C3–C4), 2.6 mm (C4–C5), 2.0 mm (C5–C6), and 0.9 mm (C6–C7). A paired t test showed that the K-line increase from neutral to extension was statistically significant across all disk levels (P<0.001).

Conclusion.
When positioned in extension, patients experience a significant increase in distance from the dorsal aspect of a disk to the K-line compared to when positioned in neutral, especially between C3 and C6. This is clinically relevant for surgeons considering a posterior cervical decompression and fusion in patients with a negative modified K-line on preoperative magnetic resonance imaging, as these patients may have enough cervical cord drift back when fused in an extended position, maximizing likelihood of improving postoperative DSM functional outcomes.
The Influence of Covid-19 on Utilization of Epidural Procedures in Managing Chronic Spinal Pain in the Medicare Population
Authors: Manchikanti Laxmaiah , Pampati Vidyasagar , Knezevic Nebojsa Nick , Kaye Alan D. , Abdi Salahadin , Sanapati Mahendra R. , Abd-Elsayed Alaa , Kosanovic Radomir , Soin Amol , Beall Douglas P. , Shah Shalini , Hirsch Joshua A. 
Published: February 2023

Study Design.
A retrospective cohort study of utilization patterns and variables of epidural injections in the fee-for-service (FFS) Medicare population.

Objectives.
To update the utilization of epidural injections in managing chronic pain in the FFS Medicare population, from 2000 to 2020, and assess the impact of COVID-19.

Summary of Background Data.
The analysis of the utilization of interventional techniques also showed an annual decrease of 2.5% per 100,000 FFS Medicare enrollees from 2009 to 2018 contrasting to an annual increase of 7.3% from 2000 to 2009. The impact of the COVID-19 pandemic has not been assessed.

Methods.
This analysis was performed by utilizing master data from the Centers for Medicare and Medicaid Services (CMS), physician/supplier procedure summary from 2000 to 2020. The analysis was performed by the assessment of utilization patterns using guidance from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Results.
Epidural procedures declined at a rate of 19% per 100,000 Medicare enrollees in the FFS Medicare population in the United States from 2019 to 2020, with an annual decline of 3% from 2010 to 2019. From 2000 to 2010, there was an annual increase of 8.3%. This analysis showed a decline in all categories of epidural procedures from 2019 to 2020. The major impact of COVID-19 with closures taking effect from April 1, 2020, through December 31, 2020, will be steeper and rather dramatic, comparing to April 1 to December 31, 2019. However, monthly data from CMS is not available as of now. Overall declines from 2010 to 2019 showed a decrease for cervical and thoracic transforaminal injections with an annual decrease of 5.6%, followed by lumbar interlaminar and caudal epidural injections of 4.9%, followed by 1.8% for lumbar/sacral transforaminal epidurals, and 0.9% for cervical and thoracic interlaminar epidurals.

Conclusion.
Declining utilization of epidural injections in all categories was exacerbated to a decrease of 19% from 2019 to 2020 related, in part, to the COVID-19 pandemic. This followed declining patterns of epidural procedures of 3% overall annually from 2010 to 2019.

Level of Evidence:
4.
Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis
Authors: McHenry Ryan D. , Moultrie Christopher E. J. , Quasim Tara , Mackay Daniel F. , Pell Jill P. 
Published: February 2023

Objectives:
Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care.

Data Sources:
A systematic search of CINAHL, Ovid MEDLINE, and EMBASE was undertaken on September 13, 2022.

Study Selection:
Observational cohort studies of adults assessing the association between socioeconomic status and critical care outcomes including mortality, length of stay, and functional outcomes were included. Two independent reviewers assessed titles, abstracts, and full texts against eligibility and quality criteria.

Data Extraction:
Details of study methodology, population, exposure measures, and outcomes were extracted.

Data Synthesis:
Thirty-eight studies met eligibility criteria for systematic review. Twenty-three studies reporting mortality to less than or equal to 30 days following critical care admission, and eight reporting length of stay, were included in meta-analysis. Random-effects pooled analysis showed that lower socioeconomic status was associated with higher mortality at less than or equal to 30 days following critical care admission, with pooled odds ratio of 1.13 (95% CIs, 1.05–1.22). Meta-analysis of ICU length of stay demonstrated no significant difference between socioeconomic groups. Socioeconomic status may also be associated with functional status and discharge destination following ICU admission.

Conclusions:
Lower socioeconomic status was associated with higher mortality following admission to critical care.
Evaluation of an Academic Detailing Program to Improve Blood Pressure Measurement and Hypertension Treatment in Urban Community Health Centers
Authors: Holliday Michael , Burnett Alexandra , Leavitt Molly , Knapke Jackie , Hargraves Daniel , Pallerla Harini 
Published: February 2023

Introduction:
Hypertension is estimated at a prevalence of 30 to 50% in the United States. Only 54% of patients with hypertension have their condition adequately controlled. This study aimed to use academic detailing (AD) to improve practice team knowledge and confidence in blood pressure (BP) management, specifically in low-income, underresourced patient populations.

Methods:
AD was developed for five practices that care for high percentages of Medicaid-eligible patients. A needs assessment was administered to each site's practice champion to determine high-yield AD sessions for their team. Presession and postsession evaluations were completed by practice team members.

Results:
Fifty providers and eight staff member participants completed evaluations over nine sessions for two AD topics at four practice sites. Statistical significance was found for several items within sessions including accurately choosing cuff sizes and identifying barriers to home BP monitoring.

Discussion:
AD is a potentially financially efficient model to improve knowledge and confidence in hypertension care at the practice level. Tailoring session content to specific needs of a practice site, along with an identified practice champion, facilitated implementation of the program. This replicable model is one way to deliver evidence-based information to those who serve Medicaid-eligible patients.
An open-label evaluation of safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide for post-exposure prophylaxis following potential exposure to human immunodeficiency virus-1
Authors: Liu An , Xin Ruolei , Zhang Hongwei , Dai Lili , Wu Ruojun (Esther) , Wang Xi , Li Aixin , Hua Wei , Li Jianwei , Shao Ying , Gao Yue , Wang Zhangli , Ye Jiangzhu , bu dou re xi ti Gulimila A , Li Zaicun , Sun Lijun 
Published: January 2023

Abstract

Background:
Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese individuals.

Methods:
This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and 24.

Results:
Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1–99.0). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant's decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3) by self-reporting and 98.5% (SD: 3.5) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).

Conclusions:
A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.

Trial Registration:
ChiCTR.org.cn, ChiCTR2100048080
Adalimumab Biosimilar–Induced Autoimmunity-Related Sweet-Like Neutrophilic Dermatosis
Authors: Lobato-Berezo Alejandro , Pujol Ramon M. , Fernández-Figueras María Teresa 
Published: February 2023

Abstract:
Antitumor necrosis factor therapies have shown to produce a broad range of cutaneous eruptions. We report the case of a patient under adalimumab biosimilar treatment for a punctate inner choroidopathy who developed a cutaneous eruption on sun-exposed areas that showed a diffuse dermal neutrophilic infiltrate consistent with a Sweet-like neutrophilic dermatosis and some features of autoimmunity.
Challenging Case: Leveraging Community Partnerships to Address Barriers to Care for Students with Autism
Authors: Cerda Natalie , Brinster Meredith , Turner Caroline , Shahidullah Jeffrey D. , Augustyn Marilyn 
Published: January 2023

CASE:
Sam is an 11-year-old young boy with autism spectrum disorder (ASD), unspecified anxiety disorder, and attention-deficit/hyperactivity disorder, combined presentation. He was initially diagnosed with ASD at 6 years of age after evaluation by a developmental-behavioral (DB) pediatrician. He presents to the DB pediatrics clinic to reestablish care. He established care with psychiatry 5 months ago after his school referred him to a hospital-school-community telepartnership bridge program following statements of self-harm and numerous concerns with his behavior, including elopement.
Sam currently receives special education support under the classifications of “Emotional Disturbance” and “Speech Impairment.” His parents report significant challenges with having his medical diagnosis of autism recognized by the school, which has impeded him receiving educational support as a student with autism. This has resulted in Sam being penalized for challenging behaviors related to his neurodevelopmental disorder. He is not currently making meaningful progress in the school setting. Sam currently demonstrates avoidance, physical and verbal aggression, and difficulty adapting to change across settings. In addition to difficulties advocating for more individualized support at school, Sam has never received applied behavior analysis (ABA) therapy because of challenges obtaining insurance approval. There are no additional barriers to accessing care, such as language, geographic, or socioeconomic factors.
Sam's visit to reestablish care with DB pediatrics consisted of an individual clinician evaluation model. The Childhood Autism Rating Scale, Second Edition, (CARS-2) and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), were administered, and Sam continued to meet DSM-5 criteria for ASD following re-evaluation. A new referral for ABA therapy was submitted. Shortly afterward, his family received an insurance denial letter specifying that additional developmental testing was needed before ABA therapy would be approved. His clinician called the insurance company to appeal this decision but was unsuccessful. Sam was then seen by the DB pediatrics embedded psychologist, who completed additional testing, including assessment of cognitive functioning, administration of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and autism-specific rating scales. This process led to further delays in access to ABA services. Throughout this process, the parents reported feeling helpless and frustrated given the barriers faced in receiving appropriate services. What are your next steps to advocate for supports through the school and insurance company?
Controversial preservation of eye drops: the toxicity of benzalkonium chloride
Authors: Hedengran Anne , Kolko Miriam 
Published: January 2023

Summary
Eye drops are a major cornerstone in the treatment of ophthalmic diseases, and adherence is crucial. Most eye drops are preserved with the surfactant benzalkonium chloride (BAK). Great controversy revolves around the use of BAK, as BAK has continuously been proven to be cytotoxic. In cell cultures, BAK-preserved eye drops cause increased cell death, and in patients, preservation with BAK causes more side effects and ocular surface damage. Side effects can negatively affect adherence and, with this, disease control. This is namely a problem in glaucoma patients. Glaucoma is irreversible, and a lack of disease control may lead to incurable blindness. The purposes of treating ophthalmic diseases are to secure good visual acuity, ocular comfort, and good quality of life for the patients. When administering, BAK-preserved eye drops ocular damage may be inflicted and these purposes are put at risk. Preservative-free and alternatively preserved eye drops are available, why there is no need for the use of BAK.
Comparing Polyurethane and Acellular Dermal Matrix Implant Cover in Prepectoral Breast Reconstruction: Short-term Complications
Authors: Correia-Pinto Jorge M. , Poleri Filipa , Barbosa José P. , Casimiro Rui , Azevedo Marta S. , Andresen Carolina , Coelho Gustavo , Cunha Cristina S. , Costa Horácio 
Published: February 2023

Background:
Implant covering with an interface material is the standard in prepectoral breast reconstruction. Acellular dermal matrix (ADM) is frequently used, but it is expensive and associated with complications. Alternatively, we have been using integrated devices consisting of a silicone implant coated with polyurethane (PU) foam. We aimed to compare both techniques in terms of acute complications.

Methods:
The authors retrospectively reviewed patients undergoing prepectoral direct-to-implant reconstruction from June 2018 to January 2022. Two cohorts were defined based on the interface material used: ADM versus PU. Total drainage volume, time to drain removal, and acute complications (hematoma, seroma, infection, and explantation) were analyzed.

Results:
Forty-four breast reconstructions were performed in 35 patients (10 bilateral); implants were covered with ADM in 23 cases and with PU foam in 21. Median total drainage volume (500 versus 515 cc for ADM and PU, respectively) and time to drain removal (9 versus 8 days) were not affected by the interface material used, but seromas and infections occurred exclusively in the ADM cohort (seromas in four of 23 of cases, P = 0.109; infections in three of 23 cases, P = 0.234). Overall complications occurred more often in cases reconstructed with ADM, but the difference was nonsignificant (P = 0.245).

Conclusions:
The use of interface materials is generally considered a prerequisite for state-of-the-art prepectoral breast reconstruction for a variety of reasons, including the prevention of capsular contracture. In this study, PU coating tended to be associated with fewer short-term complications than ADM, including seroma and infection.
Varicella Manifestation after Mastopexy with Simultaneous Breast Augmentation
Authors: Melnikov Dmitry , Tomova Alina , Kovaleva Ksenia , Venediktov Maxim 
Published: February 2023

Summary:
We report on a rare case of primary varicella infection manifestation in the early postoperative period after mastopexy with simultaneous breast augmentation that caused dehiscence of surgical wound edges and spread of infection to a subcutaneous fat layer, leading to unaesthetic scarring. Whether such dehiscence in the background of varicella occurred coincidentally or was specifically triggered by the infection is unknown. The treatment is comprised of oral antiviral therapy, surgical wound debridement, and topical application of antiseptic solutions and ointments. We would like to raise awareness of the existence of such a rare case of chickenpox in an early postoperative period of a plastic surgery patient. Thereby, physicians can recognize it, test for it, and treat it promptly and appropriately. Also, we recommend taking a detailed history of infectious diseases.
Factor XI inhibitors: what should clinicians know
Authors: Pandey Arjun , Verma Raj , Eikelboom John , Verma Subodh 
Published: January 2023

Purpose of review
Factor XI (FXI) inhibitors were developed to address unmet needs and limitations of current anticoagulants and are currently being studied in several indications. In this paper, we review the rationale for the development of these agents and summarize what clinicians should know about drugs that target FXI.

Recent findings
Patients with FXI deficiency may have a lower risk of venous thromboembolism and cardiovascular events and have a variable but generally mild bleeding diathesis. FXI has been proposed as a target for anticoagulants due to the potential for reduction in thrombosis with a lower risk of bleeding than current anticoagulant agents. Several classes of drugs that target FXI are under development, of which three classes (small molecule inhibitors, antisense oligonucleotides and monoclonal antibodies) have been studied in Phase II trials. At least three large Phase III trial programs are planned or are underway, and will study the efficacy and safety of FXI inhibitors in tens of thousands of patients across a variety of indications including atrial fibrillation, stroke and cancer-associated venous thromboembolism.

Summary
FXI inhibitors were developed with the hope of attenuating thrombosis with reduced bleeding/impairment of haemostasis. These agents have shown promise in preliminary trials with a low rate of bleeding. Ongoing Phase III investigations will inform the utility of these agents in clinical practice.
Influenza vaccination in mitigating vascular events and risk
Authors: Mares Adriana C. , Mukherjee Debabrata 
Published: February 2023

Purpose of review
Influenza imparts a significant health burden on the United States and global population. Furthermore, influenza is associated with acute cardiovascular events, including heart failure exacerbations, acute coronary syndromes, strokes, and overall cardiovascular mortality. We review the role of seasonal influenza vaccination in mitigating cardiovascular risk.

Recent findings
A large study assessed the impact of influenza vaccine on cardiovascular outcomes and mortality using the US National Inpatient Sample (NIS) database. This study included 22 634 643 hospitalizations. Vaccination against influenza was associated with a reduction in myocardial infarctions (MI) [relative risk (RR) = 0.84, 95% CI 0.82–0.87, P < 0.001], transient ischemic attacks (RR = 0.93, 95% CI 0.9–0.96, P < 0.001), cardiac arrests (RR = 0.36, 95% CI 0.33–0.39, P < 0.001), strokes (RR = 0.94, 95% CI 0.91–0.97, P < 0.001), and overall mortality (RR = 0.38, 95% CI 0.36–0.4, P < 0.001).

Summary
Available data suggests that seasonal influenza vaccination is very effective in mitigating cardiovascular risk. Increasing the rates of influenza vaccination, especially among those with cardiovascular risk factors, is critical in preventing infection and attenuating influenza-related cardiovascular complications and adverse outcomes.
Advances in contemporary medical management to treat patients with heart failure
Authors: Velez Mauricio 
Published: January 2023

Purpose of Review
Neurohormonal blockade and device-based therapies for heart failure (HF) greatly reduce morbidity and mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated benefits in patients with HF across a broad range of phenotypes. In addition to SGLT2i, drugs targeting novel pathways have demonstrated benefit in heart failure with reduced ejection fraction (HFrEF). This review will provide an update on recent advances in the medical management of HF, highlighting the role of SGLT2i, vericiguat and omecamtiv mecarbil, along with new evidence on the benefit of rapid up-titration of guideline-directed medical therapy (GDMT) in patients with acute HF.

Recent Findings
Dapagliflozin and empagliflozin reduce the risk of HF hospitalization and cardiovascular (CV) death in HF patients regardless of left ventricular ejection fraction (LVEF) and diabetes status. Their true mechanism of action in HF is not yet defined. Vericiguat, a stimulator of guanylate cyclase, and omecamtiv mecarbil, a cardiac myotrope, have shown benefit in HFrEF. Rapid up-titration of GDMT in patients hospitalized with HF is safe and results in improved clinical outcomes.

Summary
SGLT2i have earned their place as the fourth pillar of HF medical therapy alongside sacubitril-valsartan, evidence-based beta-blockers and mineralocorticoid receptor antagonists. They should be considered for the treatment of all symptomatic patients across the entire range of HF phenotypes, including patients hospitalized with HF. Vericiguat benefits high risk patients with worsening HF clinical profile. Most patients hospitalized with HF can be up-titrated to high doses of GDMT within weeks and this approach reduces the likelihood of adverse HF outcomes.