bluuebunny/crossref_metadata_2025_split huggingface dataset:
750 Paddling into danger - Key lessons for a summertime
Authors: Schrire Timothy , Thakkar Mehul , Bednarz Bartlomiej 
Published: March 2022

Abstract

Introduction
Paddling pools are a source of entertainment for many children. In cooler climates, parents often attempt to heat up the water temperature by adding freshly boiled water into outdoor pools. Our Regional Burns Centre has seen many of these injuries and we wanted to investigate trends and prevalence.

Methods
Utilising the local Burn Injury Database, we searched for paddling pool related injuries which occurred between 2015-2020. We retrieved age, burn size and depth, need for surgical intervention and outcome, as well as circumstances surrounding the injury.

Results
We identified 26 injuries over six years, of which 11 were in 2020. The age of children ranged between 6 months and 13 years old (median 4 years 8 months). The majority, 22 (84%) of patients, had superficial partial thickness injuries. Only five patients (19%) had burns larger than 2% TBSA and only a single patient required general anaesthetic procedure to clean and dress the wounds. Two patients were admitted (length of stay 2- 5 days). Burns affected a range of locations with the majority being lower limbs (11) and upper limbs (8). Head and neck area was affected in 4 cases followed by flank (3), abdomen (2) and buttocks (2). Injuries occurred between April and August and the majority happened during the Friday – Sunday period 18 (69%). All burns occurred between 11:00 and 18:30, with average time being 14:40.

Conclusions
Paddling pools represent a common potential risk to children. With the recent of COVID-19 pandemic leading to closure of the schools, there has been a significant increase in paddling pool sales, resulting in an increase in these injuries and, without relevant education, they are expected to become more common.
754 The Effect of the COVID-19 Pandemic on Burn Care and Short-Term Patient Outcomes
Authors: Withers Jacquelyn , Gedallovich Jodi , Grossman Richard 
Published: March 2022

Abstract

Introduction
The COVID-19 pandemic has forced profound changes on many aspects of American healthcare delivery. Resource utilization and risk minimization have been the primary goals behind these shifts, and adaptations made to optimize public safety continue to affect patients. It is not known, however, how these changes have impacted burn patients. The aim of this study is to detect any effects the pandemic has had on this population by describing the incidence, nature, and short-term outcomes of patients treated by a single surgeon at a major burn center during the area’s shelter-in-place period.

Methods
A retrospective cohort study was performed using a database of one surgeon’s (RG) admissions and surgical procedures. All patients treated for acute burn injuries within the year following the announcement of COVID-associated shelter-in-place orders in the burn center’s area (March 2020-March 2021) were included. The control group consisted of the same surgeon’s patients treated in the prior year (March 2019-March 2020). All patients were included regardless of age. Patients treated for other conditions such as dermatologic issues or chronic burn sequelae were excluded. Delayed presentation was defined as an interval longer than 24 hours between injury and first medical encounter. Descriptive analyses were performed to compare the demographics, timing of presentation, treatment courses, and short-term outcomes between pre-pandemic and COVID period groups.

Results
408 patients were included overall, with 227 admitted pre-COVID and 181 during the pandemic. The only significant difference in demographics between groups was a higher incidence of homelessness in the COVID group (7 vs 13%, p &lt; 0.04). Delayed presentation was not significantly different between groups (15 vs 17%, p=0.75). We found no significant differences between groups in rates of cellulitis or sepsis at presentation (9 vs 10%, p=0.8; 5 vs 8%, p=0.32) or during admission (16 vs 18%, p=0.54; 5 vs 8%, p=0.32). The mean number of surgeries per patient was 2 in both groups. Rates of autografting (62 vs 56%, p=0.24), lengths of stay (16 vs 17 days, p=0.34), readmissions (2 vs 4%, p=0.11), and deaths (2 vs 2%, p=0.74) were also similar. There were several complicated cases of delayed care in the COVID group after burns were evaluated initially via telemedicine, including one patient who presented in septic shock, though this finding did not reach statistical significance.

Conclusions
Our results demonstrate that the pandemic did not have a significant impact on many key aspects of acute burn care in this cohort. Patients in the pandemic period did not delay treatment at a higher rate, and short-term outcomes were comparable overall between groups. Further studies will be useful in understanding the effect of the pandemic and telemedicine on burn care in a broader context.
794 Use of Cultured Epithelial Autografts After Biodegradable Temporizing Matrix in Massive Burns
Authors: Heard Jason , Wallace David L , Sen Soman , Palmieri Tina L , Greenhalgh David G , Skipton Romanowski Kathleen S 
Published: March 2022

Abstract

Introduction
As burn care advances, patients are surviving with larger burn injuries, that previously would have been fatal. However, the need for autologous skin coverage continues to be an unmet need for massive burn injuries. Several attempts have been made to address this with various dermal substitutes, temporary coverage, and skin substitutes. For 25 years, Cultured Epithelial Autografts (CEA) have been used to treat large burn injuries, but this was met with variable success and has a mandatory pre-requisite lab time before it is ready for use. In 2018, Biodegradable Temporizing Matrix (BTM) that can be placed immediately on excised burns was first studied in burn patients, which has led to its increased use in subsequent years. This case series seeks to examine our experience using CEA following the application and ingrafting of BTM on large burns.

Methods
A retrospective review was conducted from 2017-2020 of adult burn patients admitted to an ABA verified burn center who underwent placement of both BTM and CEA. Demographics, mechanism of injury, burn characteristics, surgeries, and outcome data were collected. Surgical technique was early excision, BTM placement, a BTM integration period, repeat superficial excision, fibrin/thrombin spray, split thickness skin grafting with usually 6:1 mesh autograft, and finally CEA application. CEA was managed per manufacturer protocols. Descriptive statistics and univariate analyses were performed with Microsoft Excel.

Results
Eight patients met inclusion criteria. The average age was 29.3±5.3 years, 2nd degree TBSA 22.5±22.6%, 3rd degree TBSA 55.8±21%, and total TBSA was 78.3±4.4%. Four patients died during their hospital course and four survived to discharge. For survivors, the age length of stay was 135±23.6 days and they underwent an average of 8.5±1.5 total excision and/or grafting procedures. All patients had severe complications including severe sepsis/septic shock (n=8), gastrointestinal bleeds (n=2), acute respiratory distress syndrome (n=3), acute kidney injury or renal failure (n=4), pulmonary embolism (n=1) and myocardial infarction (n=1). The average time to 95% wound closure was 5 (79-147) days for survivors.

Conclusions
There continues to be an unmet need for autologous skin coverage in massive burn injuries when there is insufficient donor skin. In this series, we describe eight patients with massive burn injuries who underwent initial BTM placement, followed by 6:1 meshed autograft and CEA application. Although four patients died during their treatment course, the four surviving patients had acceptable wound closure rates and length of stay for their burn size.
801 Topical hemostatic agents in burn surgery: a systematic review
Authors: Battistini Andrea , Vrouwe Sebastian Q 
Published: March 2022

Abstract

Introduction
Acute burn surgery (tangential excision and grafting) has long been associated with significant intra-operative bleeding over large surface areas, where in adults approximately 200-250 mL of blood loss would be expected per %TBSA excised and grafted using traditional methods. Several techniques were introduced to limit bleeding, including tourniquets, tumescent infiltration, and topical agents. To date, no study has comprehensively investigated the available data regarding topical hemostatic agents in burn surgery.

Methods
A systematic review was performed by two independent reviewers using PubMed, Scopus, and Web of Science databases from first available to September 10, 2021. Articles were included if they were published in English and described or evaluated topical hemostatic agents used in acute burn surgery (excision and/or grafting). Animal studies and review articles were excluded. Data was extracted on the topical agent(s) used, their dosage, mode of delivery, hemostasis outcomes (if measured), and complications (if reported).

Results
The search identified 1982 non-duplicate citations, of which 134 underwent full text review, and 49 met inclusion criteria. Papers were grouped whether they compared (n=11, 22%), described (n=21, 43%) or secondarily described (n=17, 35%) topical hemostatic agents. Several authors (n=22, 45%) described topical hemostatics as part of a protocol that included other methods of blood conservation (tourniquet, tumescent infiltration, etc). In total, 31 studies incorporated a vasoconstrictor agent (epinephrine, phenylephrine, vasopressin), and 30 studies incorporated a procoagulant agent (thrombin, fibrin). Four studies incorporated other agents (hydrogen peroxide, tranexamic acid and collagen). The most common vasoconstrictor used was epinephrine, with doses ranging from 1:1,000 to 1:1,000,000. The most common procoagulant used was thrombin, with doses ranging from 10 to 1000 IU/mL. Among the comparative studies, outcomes of blood loss were not reported in a consistent manner, therefore meta-analysis could not be performed. The majority of studies (94%) were level of evidence III to V.

Conclusions
A multitude of topical hemostatic agents have been reported in the burn literature, with a wide range of dosages and modes of deliveries, as well as protocolization with other blood conservation techniques to limit blood loss during surgery. Determining the optimal topical hemostatic agent is limited by low quality data and challenges with consistent reporting of intra-operative blood loss and other clinically meaningful outcomes.
812 Evaluation of Dermal and Epidermal Replacement Strategies for the Treatment of Full-thickness Wounds
Authors: Hickerson William L , Mangum Lauren , Bell Cameron C , Bush Katie A 
Published: March 2022

Abstract

Introduction
In full-thickness (FT) wounds, autologous skin cell suspension (ASCS) is used in combination with widely meshed split-thickness skin grafts (mSTSGs) to obtain definitive closure, reducing donor skin requirements compared to traditional autografting (AG) techniques. In the treatment of these wounds, dermal matrices (DMs) are also often utilized to address various challenges including need for temporization, mitigation of contour defects, covering avascular structures, and modulation of scar formation. Varying DMs exist and are composed of different biologic and synthetic materials designed to address these clinical needs. The purpose of this study was to compare outcomes obtained in FT wounds using 3 different DMs coupled with ASCS+mSTSG in immediate or delayed AG procedures.

Methods
A FT excisional porcine wound model was used. DMs evaluated included a single-layer dermal matrix composed of bovine dermal collagen and elastin (Col/E), a bilayer construct composed of a bovine collagen-glycosaminoglycan with a silicone epidermal layer (Col/GAG), and a synthetic bilayer polyurethane DM (Poly/U).
DMs were applied, managed, and grafted following manufacturer’s recommendations. AG included ASCS+mSTSG (1:80 expansion, 3:1 mesh). Wounds were evaluated for inflammation, infection, DM take, AG take, re-epithelialization, and contracture over 49 days post-excision. Additionally, biopsies were evaluated to further inform tissue generation and healing outcomes.

Results
Results related to healing outcomes are reported in the table below. Inflammation at wound margins was noted during acute phase of healing for all DMs and visual cues for infection were noted in 1 wound for Col/E, 3 wounds for Col/GAG causing partial loss of DM, and 1 wound for Poly/U. All signs of infection were resolved by day 14.

Conclusions
ASCS+mSTSG can be used successfully over DMs composed of various materials in both immediate and delayed AG procedures. No difference was observed on percent AG take between the DMs, however the data suggest that time to definitive closure is impacted based on utilized DM and AG strategy, with potential implications on contracture.
Sit-ups and emergency abdominal surgery: a rare case of intestinal volvulus and resultant chylous ascites incited by abdominal exercises
Authors: Gritsiuta Andrei I , Bracken Alexander , Lara-Gutierrez Jorge , Gilleland William N 
Published: March 2022

Abstract
Chylous ascites is a unique phenomenon defined in the literature by ascitic fluid with a triglyceride content &gt;200 mg/dl. This rather rare entity can be associated with a number of different pathologies related to abnormalities within the lymphatic system. This case report serves to demonstrate an intestinal volvulus and resultant chylous ascites found on exploratory laparotomy in an otherwise healthy individual who participated in routine, extreme abdominal exercises.
Omental lipoma: a rare cause of a giant intra-abdominal mass
Authors: Li Jia Xi Julian , Giddings Hugh Lewis , Owen Gareth 
Published: March 2022

Abstract
Primary tumors of the omentum, let alone omental lipomas, are rare causes of a large intra-abdominal mass. We report a case of an adult male presenting with an intra-abdominal mass, representative of a giant omental lipoma radiologically, confirmed on histopathology after complete resection at laparotomy. The case highlights the preoperative workup of a suspected omental lipoma, including the utility of various radiological modalities in differentiating from malignant pathologies, and anatomical characterization of the lesion for surgical planning.
The role of linearly polarized transverse MHD waves in heating the solar coronal plasma
Authors: Pandey V S , Kumar Ankit , Nayak M K 
Published: March 2022

ABSTRACT
We derive a general dispersion relation for linearly polarized transverse magnetohydrodynamic (MHD) waves in an inhomogeneous, viscous, and resistive coronal plasma. We assume density structuring along the direction of polarization of the wave. In the linear regime and for an incompressible and homogeneous plasma, where the criterion of ignorable coordinates is satisfied, our solution corresponds to the customary Alfvén wave, which is basically dissipated by shear viscosity or resistivity. However, the assumption of density stratification along the direction of polarization of waves breaks down the criterion of ignorable coordinates, due to which transversal wave perturbations become compressible and, consequently, compressive viscosity turns out to be an important process. We find that for a typical coronal plasma with a magnetic field of 5 to 22 G, transverse body waves with a period of less than 10 s can dissipate energy on a time scale comparable to the coronal radiative time in their antisymmetric mode. Thus, it is possible that linearly polarized transverse wave perturbations dissipated by ion compressive viscosity maintain a hot coronal temperature.
Navigating Human Immunodeficiency Virus and Primary Care Concerns Specific to the Transgender and Gender-Nonbinary Population
Authors: Lieber Mark , Hamill Matthew M , Pham Paul , Pine Elyse , Crank Jill , Shah Maunank 
Published: March 2022

Abstract
Human immunodeficiency virus (HIV) prevention and treatment remain critically important to outpatient care among transgender and gender-nonbinary individuals. Epidemiologically, trans men and trans women are significantly more likely to have HIV compared with all adults of reproductive age. Here, we provide an overview of unique primary care considerations affecting transgender and gender-nonbinary individuals, including screening and treatment of HIV and other sexually transmitted infections as well as cancer screening and fertility preservation options. We also seek to review current literature and clinical practice guidelines related to drug–drug interactions between antiretroviral therapy (ART) and gender-affirming hormonal therapy (GAHT). In short, integrase strand transfer inhibitor–based therapy is not expected to have significant drug interactions with most GAHT and is preferred in most transgender individuals, including those on GAHT. Clinicians should also remain aware of current GAHT regimens and consider tailoring ART and GAHT to reduce cardiovascular and other risk factors.
Population Attributable Fractions of Underlying Medical Conditions for Coronavirus Disease 2019 (COVID-19) Diagnosis and COVID-19 Hospitalizations, Ventilations, and Deaths Among Adults in the United States
Authors: Nguyen Jennifer L , Alfred Tamuno , Reimbaeva Maya , Malhotra Deepa , Khan Farid , Swerdlow David , Angulo Frederick J 
Published: March 2022

Abstract

Background
Several underlying medical conditions have been reported to be associated with an increased risk of coronavirus disease 2019 (COVID-19) and related hospitalization and death. Population attributable fractions (PAFs) describing the proportion of disease burden attributable to underlying medical conditions for COVID-19 diagnosis and outcomes have not been reported.

Methods
A retrospective population-based cohort study was conducted using Optum’s de-identified Clinformatics Data Mart database. Individuals were followed up from 20 January 2020 to 31 December 2020 for diagnosis and clinical progression, including hospitalization, intensive care unit admission, intubation and mechanical ventilation or extracorporeal membrane oxygenation, and death. Adjusted rate ratios and PAFs of underlying medical conditions for COVID-19 diagnosis and disease progression outcomes were estimated by age (18–49, 50–64, 65–74, or ≥75 years), sex, and race/ethnicity.

Results
Of 10 679 566 cohort members, 391 964 (3.7%) were diagnosed with COVID-19, of whom 87 526 (22.3%) were hospitalized. Of those hospitalized, 26 640 (30.4%) died. Overall, cardiovascular disease and diabetes had the highest PAFs for COVID-19 diagnosis and outcomes of increasing severity across age groups (up to 0.49 and 0.35, respectively). Among adults ≥75 years of age, neurologic disease had the second-highest PAFs (0.05‒0.27) after cardiovascular disease (0.26‒0.44). PAFs were generally higher in Black persons than in other race/ethnicity groups for the same conditions, particularly in the 2 younger age groups.

Conclusions
A substantial fraction of the COVID-19 disease burden in the United States is attributable to cardiovascular disease and diabetes, highlighting the continued importance of COVID-19 prevention ( eg, vaccination, mask wearing, social distancing) and disease management of patients with certain underlying medical conditions.
The Impact of Point-of-Care Polymerase Chain Reaction Testing on Prescribing Practices in Primary Care for Management of Strep A: A Retrospective Before–After Study
Authors: May Larissa , Sickler Joanna , Robbins Elissa M , Tang Shaowu , Chugh Kamal , Tran Nam 
Published: March 2022

Abstract

Background
Rapid antigen detection tests (RADTs) are the standard of care (SOC) for testing in patients with suspected group A Î²-hemolytic Streptococcus (Strep A) infection. Due to lower sensitivity, guidelines recommend confirmatory microbiological culture following negative RADT results. This process is time-consuming, and adherence is often poor, resulting in high rates of inappropriate antibiotic prescribing. We sought to evaluate the impact of switching from RADTs to point-of-care (POC) polymerase chain reaction (PCR) testing on use of antibiotics in primary care, when used as part of an antibiotic stewardship initiative.

Methods
In this retrospective before–after study, electronic medical records of any patients presenting with suspected acute pharyngitis (June 2018–May 2019) across 15 outpatient primary care clinics were evaluated. Strep A was detected using the cobas Strep A assay (cobas Liat system).

Results
Analysis of 10 081 eligible patient records showed that POC PCR testing resulted in a 44.1% reduction in antibiotic prescribing for patients with a negative POC PCR test result (10.1% PCR vs 18.0% RADT; P &lt; .0001). Rates of antibiotic prescription varied across clinical sites, ranging between 10.7% and 33.8% and 12.4% and 34.4% during the use of PCR tests and RADTs, respectively. POC PCR had no impact on prescription rates in patients with positive POC test results compared to RADTs (76.2% vs 76.5%, respectively). More than 99% of antibiotics were prescribed during the initial primary care encounter.

Conclusions
As part of a broader antibiotic stewardship initiative, implementation of POC PCR as SOC in outpatients with acute pharyngitis symptoms reduced the volume of inappropriate antibiotic prescriptions.
β-Cyanoalanine synthase protects mites against Arabidopsis defenses
Authors: Dixit Sameer , Widemann Emilie , Bensoussan Nicolas , Salehipourshirazi Golnaz , Bruinsma Kristie , Milojevic Maja , Shukla Akanchha , Romero Luis C , Zhurov Vladimir , Bernards Mark A , Chruszcz Maksymilian , Grbić Miodrag , Grbić Vojislava 
Published: March 2022

Abstract
Glucosinolates are antiherbivory chemical defense compounds in Arabidopsis (Arabidopsis thaliana). Specialist herbivores that feed on brassicaceous plants have evolved various mechanisms aimed at preventing the formation of toxic isothiocyanates. In contrast, generalist herbivores typically detoxify isothiocyanates through glutathione conjugation upon exposure. Here, we examined the response of an extreme generalist herbivore, the two-spotted spider mite Tetranychus urticae (Koch), to indole glucosinolates. Tetranychus urticae is a composite generalist whose individual populations have a restricted host range but have an ability to rapidly adapt to initially unfavorable plant hosts. Through comparative transcriptomic analysis of mite populations that have differential susceptibilities to Arabidopsis defenses, we identified β-cyanoalanine synthase of T. urticae (TuCAS), which encodes an enzyme with dual cysteine and β-cyanoalanine synthase activities. We combined Arabidopsis genetics, chemical complementation and mite reverse genetics to show that TuCAS is required for mite adaptation to Arabidopsis through its β-cyanoalanine synthase activity. Consistent with the β-cyanoalanine synthase role in detoxification of hydrogen cyanide (HCN), we discovered that upon mite herbivory, Arabidopsis plants release HCN. We further demonstrated that indole glucosinolates are sufficient for cyanide formation. Overall, our study uncovered Arabidopsis defenses that rely on indole glucosinolate-dependent cyanide for protection against mite herbivory. In response, Arabidopsis-adapted mites utilize the β-cyanoalanine synthase activity of TuCAS to counter cyanide toxicity, highlighting the mite’s ability to activate resistant traits that enable this extreme polyphagous herbivore to exploit cyanogenic host plants.