bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevertebral Soft Tissue Thickness of the Cervical Spine in Children: An Insensitive but Specific Aid in the Diagnosis of Occult Trauma
Authors: Karlin Lawrence I. , Jordan Eric M. , Miller Patricia E. , Shore Benjamin J. 
Published: July 2022

Background:
The purpose of this study was to investigate the sensitivity and specificity of current cervical prevertebral soft tissue swelling (PVST) values in a cohort of children with known cervical fractures or dislocations.

Methods:
Forty two children (average age 11.9, range 1.4 to 17.0 y) with documented cervical spine injury and 61 children (average age 11.9, range 0.5 to 17.9 y) with cervical pain but no injury were reviewed (January 2004 to December 2015). PVST was measured on lateral cervical radiographs at C2, C3, and C6. Patients were stratified by age (0 to 2 y, 3 to 6 y, 7 to 10 y, 11 to 15 y, and 16 y and above). The Wilcoxon rank sum test was used to compare PVST measurements at each spine level across injury and noninjury cohorts. Sensitivity and specificity were estimated to assess the ability of abnormal reference values to detect when a true injury was present. In addition, positive predictive value and negative predictive value were also estimated.

Results:
The majority of c-spine injuries (31/42; 76%) involved bony fracture and 57% (24/42) were treated with a collar or brace. Comparison of PVST measurement found no difference at C2 (P=0.07), C3 (P=0.07), or at C6 (P=0.99) across injury and non-injury cohorts. Sensitivity was poor at single-level measures for C2 (26%), C3 (31%), and C6 (24%), while specificity was relatively high (92%, 87%, and 79%, respectively). When an increased value at either C2 or C3 indicated injury, sensitivity increased to 36%, and when an increased measurement at just one of the 3 measured levels indicated injury, the sensitivity increased to 48%, while the specificity decreased to 72%. While retropharyngeal measures were more likely to detect injury than retrotracheal, C6 alone was increased in 5 of the 20 injury patients.

Conclusions:
PVST measurements exhibit poor sensitivity but good specificity as indicators for the diagnosis of occult cervical trauma in children. Negative values do not exclude injury; positive values suggest further evaluation.

Levels of Evidence:
Level III
Barriers to Discharge After Hip Reconstruction Surgery in Non-ambulatory Children With Neurological Complex Chronic Conditions
Authors: Flaugh Rachel A. , Shea Jodie , Difazio Rachel L. , Berry Jay G. , Miller Patricia E. , Lawler Kathleen , Matheney Travis H. , Snyder Brian D. , Shore Benjamin J. 
Published: July 2022

Background:
Hip reconstruction surgery in patients with neurological complex chronic conditions (CCC) is associated with prolonged hospitalization and extensive resource utilization. This population is vulnerable to cognitive, developmental, and medical comorbidities which can increase length of stay (LOS). The aims of this study were to characterize barriers to discharge for a cohort of children with neurological CCC undergoing hip reconstruction surgery and to identify patient risk factors for prolonged hospitalization and delayed discharge.

Methods:
Retrospective chart review of nonambulatory patients with neurological CCC undergoing hip reconstruction surgery between 2007-2016 was conducted. Hospitalization ≥1 day past medical clearance was characterized as delayed discharge. Barriers were defined as unresolved issues at the time of medical clearance and categorized as pertaining to the caregiver and patient education, durable medical equipment, postdischarge transportation/placement, and patient care needs.

Results:
The cohort of 116 patients was 53% male, 16% non–English speaking, and 49% Gross Motor Function Classification System (GMFCS) V with the mean age at surgery of 9.1±3.64 years. Median time from admission to medical clearance was 5 days with median LOS of 6 days. Approximately three-quarters of patients experienced delayed discharge (73%) with barriers identified for 74% of delays. Most prevalent barriers involved education (30%) and durable medical equipment (29%). Postdischarge transportation and placement accounted for 26% of barriers and 3.5 times longer delays (P<0.001). Factors associated with delayed discharge included increased medical comorbidities (P<0.05) and GMFCS V (P<0.001). Longer LOS and medical clearance times were found for female (P=0.005), older age (P<0.001), bilateral surgery (P=0.009), GMFCS V (P=0.003), and non–English-speaking patients (P<0.001).

Conclusions:
Patients with neurological CCC frequently encounter postoperative barriers contributing to increased LOS and delayed discharge. Patients that may be at higher risk for prolonged hospitalization and greater resource utilization include those who are female sex, adolescent, GMFCS V, non–English speaking, have additional comorbidities, and are undergoing bilateral surgery. Standardized preoperative assessment of educational needs, perioperative equipment requirements, and posthospital transportation may decrease the LOS, reduce caregiver and patient burden/distress, cost, and ultimately reduce variation in care delivery.

Level of Evidence:
Level III, Retrospective Case Series.
Squamous Cell Carcinoma of the Scalp Arising in a Site of Synthetic Hair Grafts
Authors: Maitani Kosuke , Kadowaki Miki , Yasuhara Yumiko , Yamaguchi Shunichi , Kubo Tateki 
Published: July 2022

Summary:
Synthetic hair implantation was developed in the 1970s and initially gained popularity until major cutaneous complications, such as facial swelling, severe dermatitis, recurrent cellulitis, and cicatricial alopecia, became an issue. In particular, the procedure has been suggested to have a possible causal relationship with squamous cell carcinoma (SCC). This article describes the third reported case in the English literature of SCC arising in a site of synthetic hair grafts. The patient was an 80-year-old man with a prominent verrucous tumor in the parietal region; he had undergone synthetic hair implantation for the past 28 years. The pathological diagnosis of SCC was made by dermal punch biopsy, and computed tomography images revealed cranial osteolytic changes, with possible direct dural tumor invasion. Extensive resection of the tumor and reconstruction were performed following downsizing radiotherapy. The protruding tumor was excised with the adjacent portion of the parietal bone. Several synthetic hair grafts were found stuck in the cranium. The defect area was reconstructed with a synthetic bone material and a free latissimus dorsi muscle flap with skin graft. The pathological examination revealed well-differentiated SCC surrounded by numerous synthetic hair grafts inducing inflammatory cell infiltration and severe cicatrizing fibrous changes. The postoperative course was uneventful, and no recurrence or metastasis was observed at 9 months postoperatively.
VALUABLE APPLICATION OF THE β-d-GLUCAN TESTING OF INTRAOCULAR FLUID FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS
Authors: Chen Li , Feng Jing , Hu Xiaofeng , Bao Han , Luan Fuxiao , Tao Yong 
Published: July 2022

Purpose:
To evaluate the value of the β-d-glucan (BDG) testing of intraocular fluid for the diagnosis of fungal endophthalmitis (FE).

Methods:
Twenty patients (22 eyes) with FE were diagnosed using both culture and nonculture methods. Intraocular fluid was collected for BDG testing, including 22 eyes of FE and 55 eyes of control group. Under different BDG cutoff points as the test-positives, the BDG sensitivity, specificity, positive predictive value, and negative predictive value for FE were analyzed.

Results:
The BDG testing value was 1,022.78 ± 1,362.40 pg/mL in the FE group, significantly higher than that of the control group (105.0 ± 180.80 pg/mL, P < 0.001). The area under the receiver operating characteristic (ROC) curve was 0.885 (95% confidence interval, 0.793–0.978; P < 0.001). With the prespecified BDG cutoff 107.83 pg/ml as the test-positive, sensitivity was 81.8%, specificity was 87.5%, and the Youden index was 0.693. When the BDG cutoff was depicted as 202.05 pg/mL, sensitivity reduced to 77.3%, specificity increased at 95.8%, and the Youden index reached the highest value of 0.731.

Conclusions:
β-d-glucan testing of intraocular fluid demonstrated good sensitivity and specificity regarding the diagnosis of FE, which can provide earlier diagnosis to achieve better outcomes.
Overall and repeated measures agreement between brachial-femoral and carotid-femoral measures of pulse wave velocity in young and healthy individuals
Authors: Poles Jillian , Burnet Kathryn , Kelsch Elizabeth , Heffernan Kevin S. , Meyer Michelle L. , Kowalsky Robert J. , Barone Gibbs Bethany , Stoner Lee 
Published: July 2022

Background
Carotid-femoral pulse-wave velocity (cfPWV) is the gold standard measure of arterial stiffness and independently predicts cardiovascular disease. However, obtaining cfPWV requires technical precision and can be difficult in some populations. Brachial-femoral PWV (bfPWV) is a simpler alternative, but there is limited research comparing the two measures. For physiological studies, it is important to know how well the measures agree at rest, and to what extent changes in the measures correspond after perturbation.

Objective
To assess the overall and repeated measures agreement between cfPWV and bfPWV.

Methods
cfPWV and bfPWV were measured in the supine and seated positions, both before and after a 3-h bout of prolonged sitting. The intraclass correlation coefficient (ICC) for overall agreement was calculated using the random variance components from linear mixed-model regression. Repeated measures agreement (change in cfPWV vs. change in bfPWV) was calculated using repeated measures correlation.

Results
Complete data from 18 subjects (22.6 ± 3.1 years old, 33% female) were included in the analysis. There was strong (ICC ≥ 0.70) overall agreement (ICC, 0.75; 95% CI, 0.60–0.85) and very strong (ICC ≥ 0.90) repeated measures agreement (ICC, 0.90; 95% CI, 0.84–0.94) between cfPWV and bfPWV.

Discussion
The current findings indicate strong overall agreement and very strong repeated measures agreement between bfPWV and cfPWV. bfPWV is a user-friendly alternative method that agrees with cfPWV-based assessments of central arterial stiffness.
Study on the mechanism of Gualou Xiebai Guizhi decoction (GLXBGZD) in the treatment of coronary heart disease based on network pharmacology
Authors: Teng Chao , Wang Yong , Pang Songhai , Wei Xiaotong , Liu Xiangzhen 
Published: July 2022

Background:
This study aims to analyze the mechanism of Gualou Xiebai Guizhi decoction (GLXBGZD) in treating coronary heart disease (CHD) utilizing network pharmacology.

Methods:
The GLXBGZD effective components were searched on the pharmacological database platform of the Traditional Chinese Medicine Systems Pharmacol, and its potential target was predicted. The Online Mendelian Inheritance obtained CHD disease target in Man and GeneCards database. The Venn map of the intersection target for GLXBGZD and CHD was constructed by using Venn online website. The “drug-component-target-disease” network map was constructed by Cytoscape 3.7.2 software. The DAVID online platform was used to analyze the function of Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) at the intersection of targets of drugs and diseases.

Results:
A total of 27 articles were searched for GLXBGZD, including 111 potential targets, 5521 disease targets, 100 drug and disease intersection targets. The core target network map shows that Interleukin (IL)-6, TNF, vascular endothelial growth factor (VEGFA), TP53, EGF, JUN, MAPK1, Catalase (CAT), and prostaglandin-endoperoxide synthase 2 (PTGS2) may be the key targets in CHD therapy. GO functional enrichment analysis revealed that the biological functions of GLXBGZD involved biological processes such as response to drugs, positive regulation of nitric oxide biosynthesis process, and response to hypoxia. KEGG pathway enrichment analysis showed that GLXBGZD might participate in CHD treatment through Hypoxia-inducible factor-1 (HIF-1), Tumor necrosis factor (TNF), PhosphoInositide-3 Kinase--Threonine protein kinase (PI3K-Akt), and the calcium signal pathway.

Conclusions:
This study reveals that the GLXBGZD mechanism in CHD treatment has the characteristics of multi-components, multi-targets, and multi-pathways, which provides a theoretical basis for its clinical application and subsequent experimental verification.
Association of sorting and assembly machinery component 50 homolog gene polymorphisms with nonalcoholic fatty liver disease susceptibility
Authors: Qiao Ming , Yang Jian-hua , Zhu Yi , Hu Jun-ping 
Published: July 2022

Background:
Sorting and assembly machinery component 50 homolog (SAMM50) gene single-nucleotide polymorphisms (SNPs) have been connected with the susceptibility of nonalcoholic fatty liver disease (NAFLD), but with inconsistent results across the current evidence. The present work was schemed to explore the association between SAMM50 gene SNPs and NAFLD vulnerability via meta-analysis.

Methods:
PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang were retrieved for eligible literature previous to June 10, 2021. The odds ratios (ORs) of the dichotomic variables and the standardized mean difference of quantitative variables with corresponding 95% confidence intervals (95% CIs) were computed to evaluate the strength of the associations. The quality of included studies was assessed using Newcastle-Ottawa Scale (NOS).

Results:
In total, 8 case-control studies encompassing 6297 NAFLD patients and 7306 disease-free controls in this meta-analysis. Ultimately, this analysis included 8, 6, and 5 studies for rs2143571, rs3761472, and rs738491 polymorphisms respectively. The pooled data revealed that the 3 polymorphisms had conspicuous associations with NAFLD susceptibility: rs2143571, A vs. G, OR=1.51, 95% CI, 1.37–1.66, P < .01; rs3761472, A vs. G, OR=1.50, 95% CI, 1.35–1.67, P < .01; rs738491, A vs. G, OR=1.51, 95% CI, 1.40–1.63, P < .01.

Conclusion:
This meta-analysis suggests that rs2143571, rs3761472, and rs738491 polymorphisms of the SAMM50 gene are appreciably associated with augmented risk of NAFLD vulnerability. It will provide the latest evidence to support the susceptibility of SAMM50 gene polymorphisms and NAFLD, and provide strategies for the prevention and treatment of NAFLD.
Spontaneous tumor lysis syndrome in a patient with accelerated phase chronic myeloid leukemia treated successfully with rasburicase
Authors: Al-Mashdali Abdulrahman F. , Yassin Mohamed A. 
Published: July 2022

Rationale:
Tumor lysis syndrome (TLS) is an oncological emergency that occurs due to diffuse tumor cell destruction with the massive release of intracellular electrolytes. Spontaneous tumor lysis syndrome (STLS) is the development of TLS before the commencement of chemotherapy. To the best of our knowledge, there are no reported cases of STLS in the chronic or accelerated phase of chronic myeloid leukemia (CML).

Patient concerns:
A 37-year-old woman of Arabic descent with a history of CML presented with a 3-day history of nausea and abdominal pain. She had not started any new treatment for CML within the last 3 months of presentation.

Diagnosis:
The patient was diagnosed with hyperuricemia, hyperphosphatemia, hypocalcemia, and acute kidney injury. A peripheral blood smear confirmed the accelerated CML phase. Our patient met the criteria for clinical TLS, specifically, STLS. She was also diagnosed with autoimmune hemolytic anemia.

Interventions:
The patient was started on intravenous normal saline (200 mL/h) and rasburicase (6 mg/d). In addition, hydroxyurea was used as a cytoreductive agent.

Outcomes:
The creatinine level returned to normal within 48 hours of rasburicase initiation.

Lessons:
Any patient with hematological malignancy should be monitored for TLS even before the initiation of chemotherapy. The exact mechanism of spontaneous TLS remains unknown, and further studies are needed to explain the pathophysiology of this condition. Rapid initiation of rasburicase, in addition to vigorous hydration, is effective in the treatment of acute kidney injury associated with TLS.
Wernicke encephalopathy after sleeve gastrectomy
Authors: Al-Mashdali Abdulrahman F. , Alkailani Yaman I. , Elmudathir Ahmed M. , Elhams Mohamed M. 
Published: July 2022

Rationale:
Wernicke encephalopathy (WE) is a recognized complication of bariatric surgery. WE is characterized by the classic triad of ataxia, ophthalmoplegia, and acute confusion due to thiamine deficiency. Bariatric surgery has complications in the form of vitamin deficiencies, and thiamine deficiency following bariatric surgery can present as WE. However, WE after sleeve gastrectomy is rarely observed in clinical practice.

Patient concerns:
A 24-year-old man presented to our hospital with a 3-week history of vomiting, diplopia, and unsteady gait. He also noticed problems in his memory and loss of concentration. He had undergone sleeve gastrectomy 3 months prior to presentation.

Diagnoses:
The patient was diagnosed with bilateral abducent nerve palsy, horizontal nystagmus, and ataxic gait. Based on the typical clinical manifestations and history of sleeve gastrectomy, the patient was diagnosed with WE. In addition, the magnetic resonance imaging of brain was consistent with WE.

Intervention:
The patient received a 7-day course of intravenous thiamine and other vitamin supplements.

Outcome:
Significant improvement in neurological manifestations after parenteral thiamine administration.

Lessons:
Clinicians should be aware that WE is a complication of bariatric surgery. Prompt administration of parenteral thiamine is effective in treating such conditions.
Experiences of U.S. Nurses Compared With Nonnurses in the First Year of COVID-19
Authors: Chen-Lim Mei Lin , McCabe Margaret A. , Xu Haolin , Thomas Laine E. , Forrest Christopher B. , Birnbaum Shira , Webb Laura E. , O’Brien Emily C. 
Published: July 2022

Background
Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs).

Objectives
Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic.

Methods
Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings.

Results
Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity.

Discussion
Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.
Reliability of Using a Smartphone Application to Objectify Skull Deformation
Authors: Meijer Sofie , Suir Imke , Maissan Francois , Nuysink Jacqueline 
Published: July 2022

Purpose:
To establish intrarater and interrater reliability of photographs made in a newly developed smartphone app to determine the severity of infantile skull deformation by taking a cranial photograph of an infant's head.

Methods:
Using the app, 1 pediatric physical therapist and 2 pediatric physical therapy master students photographed heads of 30 infants aged up to 12 months receiving treatment for asymmetric or delayed motor development. Modified Cranial Vault Asymmetry Index and Cranial Index determined the severity of skull deformation.

Results:
Intrarater reliability was excellent both for mCVAI and CI, with an ICC(3,1) = 0.97, and ICC(3,1) = 0.98, respectively. Interrater reliability with an ICC(2,1) = 0.97 for the mCVAI, and ICC(2,1) = 0.99 for the CI was excellent too.

Conclusion:
The reliability of the Skully Care App proved to be excellent when used by pediatric physical therapists.
Supplemental Digital Content 1. Video Abstract available at: http://links.lww.com/PPT/A399.
Advancing Leadership Training to Address Health Equity and Respond to Public Health Emergencies
Authors: Levis Maria , Ugarte Raisa , Arana Mayela , Ocasio Carolina , Viera Tariz , Ortiz Sofía , Murrman Marita 
Published: July 2022

Context:
In 2015, Impactivo developed the Advancing Leadership in Times of Crisis (ALTC) program for the Region 2 Public Health Training Center under a subaward from the Health Resources and Services Administration. Puerto Rico's (PR) government had defaulted on its debt, and public health officials needed tools to face the fiscal crisis. The ALTC has since been adapted for PR's public health emergencies, including the Zika epidemic, category 5 hurricanes, earthquakes, and the Covid-19 pandemic.

Program:
The program incorporates Ron Heifetz's work on Adaptive Leadership and Marshall Ganz's work on community organizing to address the Centers for Disease Control and Prevention's Essential Public Health Services (EPHS) and health equity. The ALTC is a contextualized and modularized training program that has been provided in different modalities in person and online.

Implementation:
The Spanish language program has been carried out with 4 cohorts (totaling 82 graduates). Participants were 80% women and 100% Hispanic, empowering underrepresented groups to achieve change.

Evaluation:
In the immediate postprogram survey, more than 90% strongly agree that their understanding of the subject matter improved, that they were able to identify actions that apply to their work, and that they were confident in their ability to apply it. Follow-up surveys after the COVID-19 pandemic found that 89% of respondents continue to work in public health, 25% were promoted, and 49% felt confident to train others. Participants also reported that ALTC helped them increase their public health tools (91%), expand their network (84%), and strengthen knowledge about the EPHS (90%).

Discussion:
Evidence supports that ALTC is a promising training program to increase leadership skills and EPHS competencies that can be adapted to address contextual health equity and public health emergencies. Future research should explore the expansion of ALTC to other contexts and its impact on population health and health equity.