bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear
Authors: Chebib Emilien , Maudoux Audrey , Benoit Charlotte , Bernard Sophie , Van Den Abbeele Thierry , Teissier Natacha , Wiener Vacher Sylvette R. 
Published: June 2022

Objectives:
To investigate the impact of congenital cytomegalovirus infection on cochlear and vestibular function.

Design:
This retrospective study conducted between March 2014 and March 2020 included children with confirmed congenital cytomegalovirus infection who underwent a complete audio-vestibular evaluation. It included a bithermal caloric test, a video head impulse test and a cervical vestibular evoked myogenic potential associated with a complete hearing assessment.

Results:
The cohort of 130 children included in the study had a median age of 21 months (interquartile range: 12 to 37 months). Eighty-three children (64%) showed an inner ear impairment (both cochlear and vestibular). The vestibular part of the inner ear was significantly more frequently impaired than the cochlear part (ρ = 0.003). Sixty-two children (48%) showed confirmed hearing impairment. The severity of hearing loss was variable, with a high proportion of profound hearing loss (30/62, 48%), which was often bilateral (47/62, 76%). The vestibular assessment showed a canal function disorder in 67 children (88%) and an otolith function disorder in 63 children (83%; ρ = 0.36). The video head impulse test was significantly less altered (64%) compared with the bithermal caloric test (80%; ρ = 0.02) and the cervical vestibular evoked myogenic potential (83%; ρ = 0.009). Only seven out of 83 children (8%) showed hearing loss without vestibular dysfunction, of which only one had a normal hearing screening test at birth. For the children who passed the hearing screening test at birth and presented an inner ear impairment [n = 36, median age: 16 (11 to 34) months], vestibular disorders were later found in 35 children (97%) and 17 of them (47%) developed hearing loss secondarily. This underlines the importance of assessing both vestibular and auditory parts of the inner ear. When comparing the agreement of cochlear and vestibular impairment, the severity and the laterality of the impairment were low [Cohen’s kappa 0.31 (0.22 to 0.40) and 0.43 (0.32 to 0.55), respectively].

Conclusion:
In our study, we demonstrated that although both cochlear and vestibular parts of the inner ear can be impaired by congenital cytomegalovirus infection, the vestibular part seems more often impaired compared with the cochlear part. This underlines the importance of vestibular evaluation in the follow-up of cytomegalovirus-infected children associated with hearing assessment.
Technique and Early Outcomes for High-Energy Calcaneus Fractures Treated With Staged External Fixation to Combined Open Reduction Internal Fixation and Subtalar Arthrodesis
Authors: Neumaier Mackenzie , Kohring Jessica , Ciufo David , Ketz John P. 
Published: June 2022

Objective:
(1) To present an effective surgical technique for the treatment of open and high-energy calcaneal fractures with significant soft tissue injuries. (2) To present complications with this technique and to evaluate patient-reported outcomes of staged external fixation followed by delayed reconstruction with open reduction internal fixation (ORIF) and subtalar arthrodesis.

Design:
Retrospective case series.

Setting:
Level I trauma center.

Patients/Participants:
Twelve patients with 13 calcaneus fractures associated with open traumatic wounds (10 patients) or other severe soft tissue injury (ie, fracture blisters) between April 2013 and December 2019.

Intervention:
All patients were treated with staged ankle-spanning external fixation and delayed reconstruction with ORIF with subtalar arthrodesis.

Main Outcome Measures:
Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes are presented via the domains of physical function (PF), pain interference (PI), and depression (D) in addition to visual analog score. Complications with the injury and surgical procedure were reported as well.

Results:
Patients underwent initial stabilization on average 1.3 days (range, 0–12 days) from injury with stage II occurring on average 31.1 days (range, 18–42 days) from external fixation. Mean time to radiographic union was 5.6 months (range, 4–10 months). One-year mean PROMIS outcomes were as follows: PF final average of 37.4 with an average improvement of 12.2 (P < 0.01), PI final average of 62.2 with average improvement of 5.6 (P = 0.01), and D final average of 52.1 with average improvement of 6 (P = 0.12). Mean final visual analog score pain score was 3.6 with an average improvement of 2.25 (P = 0.01).

Conclusion:
Staged treatment with initial external fixation followed by ORIF and subtalar arthrodesis in the setting of highly comminuted calcaneus fractures with significant soft tissue compromise effectively addresses both bony and soft tissue concerns while providing for positive outcomes postoperatively with regards to pain and function. There were minimal complications noted for this complex injury.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Contribution of Chest X-Ray to Predict Extubation Failure in Mechanically Ventilated Patients Using Machine Learning-Based Algorithms
Authors: Fukuchi Kiyoyasu , Osawa Itsuki , Satake Shunya , Ito Honoka , Shibata Junichiro , Dohi Eisuke , Kasugai Daisuke , Miyamoto Yoshihisa , Ohbe Hiroyuki , Tamoto Mitsuhiro , Yamada Naoki , Yoshikawa Keisuke , Goto Tadahiro 
Published: June 2022

OBJECTIVES:
To evaluate the contribution of a preextubation chest X-ray (CXR) to identify the risk of extubation failure in mechanically ventilated patients.

DESIGN:
Retrospective cohort study.

SETTINGS:
ICUs in a tertiary center (the Medical Information Mart for Intensive Care IV database).

PATIENTS:
Patients greater than or equal to 18 years old who were mechanically ventilated and extubated after a spontaneous breathing trial.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Among 1,066 mechanically ventilated patients, 132 patients (12%) experienced extubation failure, defined as reintubation or death within 48 hours of extubation. To predict extubation failure, we developed the following models based on deep learning (EfficientNet) and machine learning (LightGBM) with the training data: 1) model using only the rapid-shallow breathing index (RSBI), 2) model using RSBI and CXR, 3) model using all candidate clinical predictors (i.e., patient demographics, vital signs, laboratory values, and ventilator settings) other than CXR, and 4) model using all candidate clinical predictors with CXR. We compared the predictive abilities between models with the test data to investigate the predictive contribution of CXR. The predictive ability of the model using CXR as well as RSBI was not significantly higher than that of the model using only RSBI (c-statistics, 0.56 vs 0.56; p = 0.95). The predictive ability of the model using clinical predictors with CXR was not significantly higher than that of the model using all clinical predictors other than CXR (c-statistics, 0.71 vs 0.70; p = 0.12). Based on SHapley Additive exPlanations values to interpret the model using all clinical predictors with CXR, CXR was less likely to contribute to the predictive ability than other predictors (e.g., duration of mechanical ventilation, inability to follow commands, and heart rate).

CONCLUSIONS:
Adding CXR to a set of other clinical predictors in our prediction model did not significantly improve the predictive ability of extubation failure in mechanically ventilated patients.
Thoracic Aortic Graft Salvage after Sternal Wound Infection with Antibiotic Beads and Flap Coverage
Authors: Cole Samuel H. , Wagner Ryan D. , Volk Angela S. , Nemec Michelle K. , Preventza Ourania A. , La Cruz Kim De , Coselli Joseph S. , Izaddoost Shayan A. 
Published: June 2022

Summary:
Infections involving thoracic aortic grafts are difficult to treat and have devastating consequences. The traditional approaches to surgical management include aggressive debridement with graft explantation and replacement. Despite treatment, the reported morbidity and mortality rates are high. The purpose of this study was to present our experience with an innovative approach to aortic graft salvage in the setting of sternal wound infection using antibiotic impregnated polymethylmethacrylate beads followed by definitive wound closure with flap coverage. A retrospective review identified patients with surgical wounds after aortic graft or cardiac valve placement over a 7-year period at a single institution. Patients were treated using an algorithm consisting of repeated surgical debridement and placement of antibiotic beads followed by flap coverage after suppression of the infection. A total of 20 patients were treated for surgical wounds, including 19 sternal and one thoracotomy wound. Culture positive surgical site infections were documented in 16 patients. One patient required a bead exchange before definitive closure. There were no in-hospital mortalities. All but two patients achieved successful infection suppression and wound closure with flap coverage. The use of antibiotic beads with serial debridement and flap closure may offer a valid option for aortic graft salvage in the setting of infected sternal wounds in the appropriate patient population. The proposed algorithm showed that patients may be successfully treated, and their infection suppressed without the need for graft removal. Mortality rates were lower from those previously reported in the literature.
Hemodynamics and Vascular Histology of Keloid Tissues and Anatomy of Nearby Blood Vessels
Authors: Eura Shigeyoshi , Nakao Junichi , Iimura Takeshi , Ichinose Shizuko , Kaku Chiemi , Dohi Teruyuki , Akaishi Satoshi , Tosa Mamiko , Ogawa Rei 
Published: June 2022

Background:
Keloids are red‚ invasive scars that are driven by chronic inflammation in the reticular dermis. The role of blood vessels in keloid behavior remains poorly understood. In the present study with 32 keloid patients, we examined the hemodynamics of keloid tissue, the anatomy of the blood vessels feeding and draining the keloids, and the vascular histology of keloids.

Methods:
Ten patients with large anterior chest keloids underwent near-infrared spectroscopy, which measured regional saturation of oxygen and total hemoglobin index in the keloid and surrounding skin. Another 10 patients with large chest keloids and three healthy volunteers underwent multidetector-low computed tomography. The extirpated chest keloids of 12 patients were subjected to histology with optical, CD31 immunohistochemical, and electron microscopy.

Results:
All keloids had a low regional saturation of oxygen and a high total hemoglobin index, which is indicative of blood congestion. Multidetector-low computed tomography revealed dilation of the arteries and veins that were respectively feeding and draining the keloid leading edge. Hematoxylin-eosin staining and CD31 immunohistochemisty revealed considerable neovascularization in the keloid leading edge but not in the center. Electron microscopy showed that the lumens of many vessels in the keloid center appeared to be occluded or narrowed.

Conclusions:
Keloids seem to be congested because of increased neovascularization and arterial inflow at the leading edge and blocked outflow due to vascular destruction in the center. The surrounding veins seem to expand in response to this congested state. Methods that improve the blood circulation in keloids may be effective therapies.
Examining the Evidence From Single-Case Experimental Designs to Treat Challenging Behaviors Following Moderate to Severe Traumatic Brain Injury
Authors: Beaulieu Cynthia L. , Persel Chris , Shannon Tracy , Whyte John , Hurlburt Daniel , Huffine Natasha , Bogner Jennifer 
Published: June 2022

Objective:
To evaluate evidence on the effectiveness of behavioral interventions using single-case experimental design (SCED) methodology and to identify behavioral interventions with sufficient evidence for possible inclusion in the development of guidelines for the management of challenging behaviors in adults following moderate to severe traumatic brain injury (TBI).

Methods:
As a subinvestigation of a larger systematic review process designed to identify evidence for guidelines development, the current review focused on studies using SCED methodology applied to persons with challenging behaviors following moderate to severe TBI. Articles were identified from a search of the published literature through January 2021, identifying studies in CINAHL, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE/Ovid, and PsycINFO. Articles meeting inclusion criteria were assessed for design rigor to allow for effect size determination. The identified cases were then critically appraised using the RoBiNT (Risk-of-Bias in N-of-1 Trails) Scale to determine strength of evidence for causal inference.

Results:
Thirty-four studies met inclusion criteria, with a total of 44 cases evaluated for effect of the treatment intervention on defined target behaviors. Seventeen cases had effect sizes rated as large, 22 cases as medium, 3 cases as small, and 3 as no effect. An observed trend was for large and medium effect sizes to be associated with lower RoBiNT Scale internal validity scores. Randomization, blinded provider and assessor, and assessment of treatment adherence were the internal validity items unlikely to meet criteria.

Conclusions:
SCED methodology was found to produce large and medium effect sizes for behavioral interventions targeting challenging behaviors following moderate to severe TBI. However, the strength of the evidence is limited because of weaknesses in study designs. Most of the studies failed to meet established internal validity criteria designed to reduce risk of bias in SCED studies as such rigor is difficult to establish or often not practical in clinical settings. Suggestions and recommendations are outlined for improving the quality of published cases using SCED methodology, which, in turn, will improve credibility of evidence and better inform the development of treatment guidelines for behavior regulation.
Lower Extremity Somatosensory Function Throughout Concussion Recovery: A Prospective Cohort Study
Authors: Lempke Landon B. , Hoch Matthew C. , Call Jarrod A. , Schmidt Julianne D. , Lynall Robert C. 
Published: June 2022

Objective:
Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being symptom-free) time points.

Setting:
Laboratory.

Participants:
Participants with a concussion and matched controls (n = 24; 58% male, age: 19.3 ± 1.1 years, mass: 70.3 ± 16.4 kg, height: 177.3 ± 12.7 cm).

Design:
Prospective cohort.

Main Measures:
Somatosensory assessments on the dominant limb at both time points included: (1) plantar touch sensation threshold via Semmes-Weinstein monofilaments, (2) plantar pressure pain threshold via algometry, and (3) knee absolute passive joint repositioning (PJR) error via Biodex across 3 arcs (105°-75°, 30°-60°, 90°-45° knee-flexion). We used mixed-model analyses of variance, post hoc Tukey honestly significant difference t tests with mean difference, 95% CI, and Hedges' g effect sizes to examine outcomes.

Results:
Touch sensation had a group effect with the concussion cohort needing 0.95 grams of force (gf) more relative to controls (95% CI: 0.03 to 1.87; P = .043). No touch sensation interaction was present, but medium and large effects were observed for greater gf needed among the concussed cohort at the acute (1.11 gf; 95% CI: 0.17 to 2.05; g = 0.96) and asymptomatic time points (0.79 gf; 95% CI: −0.15 to 1.73; g = 0.73). No plantar pressure pain threshold effects were observed (P ≥ .311), with negligible pressure difference magnitudes at the acute (0.26 pound force [lbf]/cm2; 95% CI: −1.54 to 2.06; g = 0.13) and medium magnitudes at the asymptomatic time points (0.99 lbf/cm2; 95% CI: −0.81 to 2.80; g = 0.42) for the concussed cohort needing more pressure to detect pain. The 30° to 60° PJR had a time effect, with asymptomatic time point having 3.12° better accuracy (95% CI: 1.23° to 5.02; P = .002). The concussed cohort had small-to-medium magnitude differences relative to controls at the acute time point for PJR during 105° to 75° (0.89°; g = 0.30) and 90° to 45° (0.62°; g = 0.17), but not 30° to 60° (−1.75°; g = −0.40).

Conclusions:
Individuals with a concussion exhibited large effects for diminished plantar touch sensation and small to medium effects for inhibited plantar pressure pain sensation compared with controls, which may indicate altered somatosensory function. Negligible PJR differences suggest knee joint position sense is not altered post-concussion. Pre- and postconcussion examination is warranted to understand causal somatosensory mechanisms.
Examining the Usability of Workload Monitoring in Firefighter Recruits
Authors: Giuliani-Dewig Hayden K. , Gerstner Gena R. , Mota Jacob A. , Ryan Eric D. 
Published: June 2022

Objective
Although workload monitoring is commonly used in athletic settings to mitigate injury risk, we are unaware of previous studies examining its feasibility among firefighters.

Methods
Nineteen firefighter recruits completed a short online workload survey at the end of each training day (Monday–Friday) for 26 weeks during the academy. A modified System Usability Scale was provided at midtesting (3 months into the academy) and posttesting (end of the academy).

Results
The recruits perceived the survey to be user-friendly throughout the academy (83.6 ± 13.6). However, questions 1 (survey frequency) and 6 (survey consistency) decreased and increased from midtesting to posttesting, respectively. Adherence was overall poor, decreasing from midtesting to posttesting.

Conclusions
Our findings suggest that workload monitoring is a user-friendly tool within tactical populations; however, future research should consider optimal survey frequency to enhance compliance.
Validation of the watch-type HUAWEI WATCH D oscillometric wrist blood pressure monitor in adult Chinese
Authors: Zhang Wei , Zhou Yi-Ni , Zhou Yi , Wang Ji-Guang 
Published: June 2022

Objective
The aim of this study was to evaluate the accuracy of the watch-type automated oscillometric wrist blood pressure (BP) monitor HUAWEI WATCH D in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard.

Method
Subjects were recruited to fulfill the age, sex, BP and cuff distributions of the AAMI/ESH/ISO Universal Standard in the general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for wrist circumference of 13–16 cm (medium) and 16–20 cm (large), respectively.

Results
One-hundred and nine subjects were recruited and 85 were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was −1.4 ± 6.47/−0.2 ± 5.85 mmHg (systolic/diastolic). For criterion 2, the SD of the average BP differences between the test device and reference BP per subject was 5.66/5.48 mmHg (systolic/diastolic).

Conclusion
The HUAWEI WATCH D watch-type wrist BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard in the general population and can be recommended for self-measurement.
Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Lăcătuşu Cristina-Mihaela , Rogozea Liliana M. , Cernea Simona 
Published: June 2022

Background:
Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons.

Study Question:
What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century?

Study Design:
To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States.

Data Sources:
The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine
.

Results:
Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient.

Conclusions:
The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.