bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial
Authors: Chen Han , Zhou Bing , Huang Qian , Li Cheng , Wu Yubin , Huang Zhenxiao , Li Yunxia , Qu Jing , Xiao Nianci , Wang Mingjie 
Published: July 2021

Objective: To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. Methods: This was a prospective, self-controlled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. Results: A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea ( P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment ( P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. Conclusion: Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.
Delay between clinical presentation and treatment of deep venous thrombosis in the lower limbs and regression of thrombosis
Authors: Musil Dalibor , Kováčik František 
Published: July 2021

Introduction The objective was to investigate the delay between the onset of DVT symptoms and start of anticoagulation in common practice, assess whether this has any impact on the recanalization of venous thrombosis over one year follow up. Methods A prospective observational study on 76 consecutive patients (39 men, 51.3%) with DVT diagnosed using compression ultrasound (CUS). Timing was classified as very early treatment ≤72 hours, early treatment ˂7 days and late treatment ≥7 days from onset of symptoms. Further development of the disease was monitored by CUS in scheduled visits 1, 3, 6 and 12 months after the start of treatment. Results Mean delay from symptom onset to the start of anticoagulation was 11.1 days (median 7 days, range 1-42 days) with significant difference (p˂0.05) between proximal (12.9 days, median 30 days) and distal DVT (6.5 days, median 2 days). In less than 25% of all patients, with both proximal and distal DVT, treatment was started very early (≤72 hours), 40 patients (52.6%) received late treatment ≥7 days. There was a positive correlation between delay, average time of complete recanalization (≤72 hours 4.2 months, ≥7 days 5.3 months, p˂0.05) and rate of incomplete recanalization (≤72 hours 7.3%, ≥7 days 30.9%, p˂0.01) in proximal DVT, not in distal DVT. Conclusions There was a delay of ≥7 days in treating in more than half of our patients. The mean interval between clinical onset and start of treatment was significantly shorter and a delay ≥7 days significantly less frequent in patients with distal DVT compared to patients with proximal DVT. A very significant positive correlation between delay in treatment and rate of incomplete recanalization of proximal and distal thrombosis indicates that delayed anticoagulation could be a signal risk factor for the incomplete recanalization and development of PTS.
Proximal Overresection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint: A Cadaver Study
Authors: Lazaro Lionel E. , Lim Daniel P. , Nelson Trevor J. , Eberlein Sam A. , Banffy Michael B. , Metzger Melodie F. 
Published: July 2021

Background: Contact between the acetabular labrum and articular cartilage of the femoral head creates a suction seal that helps maintain stability of the femoral head in the acetabulum. A femoral osteochodroplasty may occasionally extend proximally into the femoral head, diminishing the articular surface area available for sealing contact. Purpose: To determine whether proximal overresection decreases the rotational and distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Six hemipelvises in the following conditions were tested: intact, T-capsulotomy, osteochondroplasty to the physeal scar, and 5- and 10-mm proximal extension. The pelvis was secured to a metal plate, and the femur was potted and attached to a multiaxial hip jig. Specimens were axially distracted using a load from 0 to 150 N. For rotational stability testing, 5 N·m of internal and external torque was applied. Both tests were performed at different angles of flexion (0°, 15°, 30°, 60°, 90°). Displacement and rotation were recorded using a 3-dimensional motion tracking system. Results: The T-capsulotomy decreased the distractive stability of the hip joint. A femoral osteochondroplasty up to the physeal scar did not seem to affect the distractive stability. However, a proximal extension of the resection by 5 and 10 mm increased axial instability at every angle of flexion tested, with the greatest increase observed at larger angles of flexion ( P < .01). External rotation increased significantly after T-capsulotomy in smaller angles of flexion (0°, P = .01; 15°, P = .01; 30°, P = .03). Femoral osteochondroplasty did not create further external rotational instability, except when the resection was extended 10 mm proximally and the hip was in 90° of flexion ( P = .04). Conclusion: This cadaveric study demonstrated that proximal extension of osteochondroplasty into the femoral head compromises the distractive stability of the hip joint but does not affect hip rotational stability. Clinical Relevance: Clinically, this study highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint.
Older Adults’ Goals and Expectations When Using Long-Term Services and Supports
Authors: Travers Jasmine L. , Hirschman Karen B. , Naylor Mary D. 
Published: July 2021

Objective Despite recent research focused on aging well, little is known regarding the goals and expectations from long-term services and supports (LTSS) use among older adults. Methods To address this knowledge gap, interviewer-guided surveys with older adults newly receiving LTSS in home and community-based, assisted living, and nursing home settings in Philadelphia, New Jersey, and New York were conducted. Results Twelve subthemes regarding the goals and expectations of 464 older adults receiving LTSS and in the context of Aging Well emerged from our analysis: maintaining function, optimizing health and circumstances, maintaining the status quo, transitioning back to the previous state, achieving independence, preserving cognitive function and capacity for psychosocial and emotional health, achieving purpose, increasing quality of life, receiving social support, increasing engagement, relieving burden, and feeling a sense of security/safety. Discussion This in-depth analysis of qualitative data provides context for LTSS use among older adults.
Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series
Authors: Fiori Simona , Pannek Kerstin , Podda Irina , Cipriani Paola , Lorenzoni V. , Franchi Beatrice , Pasquariello Rosa , Guzzetta Andrea , Cioni Giovanni , Chilosi Anna 
Published: July 2021

We report a case series of children with childhood apraxia of speech, by describing behavioral and white matter microstructural changes following 2 different treatment approaches. Five children with childhood apraxia of speech were assigned to a motor speech treatment (PROMPT) and 5 to a language, nonspeech oral motor treatment. Speech assessment and brain MRI were performed pre- and post-treatment. The ventral (tongue/larynx) and dorsal (lips) corticobulbar tracts were reconstructed in each subject. Mean fractional anisotropy and mean diffusivity were extracted. The hand corticospinal tract was assessed as a control pathway. In both groups speech improvements paralleled changes in the left ventral corticobulbar tract fractional anisotropy. The PROMPT treated group also showed fractional anisotropy increase and mean diffusivity decrease in the left dorsal corticobulbar tract. No changes were detected in the hand tract. Our results may provide preliminary support to the possible neurobiologic effect of a multimodal speech motor treatment in childhood apraxia of speech.
Factors Influencing China’s Outward Foreign Direct Investment
Authors: Wu Hsiu-Ling , Chen Chien-Hsun , Chen Yi-Rou 
Published: July 2021

The main purpose of this study is to explore factors determining China’s outward FDI (OFDI), with particular emphasis on the unique characteristics of China’s economy during the period of institutional transformation. The empirical results obtained in the present study show that Chinese enterprises tend to invest in countries that have a mature economy. Exports have a significantly positive effect on China’s OFDI, with the relationship between OFDI and exports in China being a complementary one. The relationship between imports and OFDI for China is one of substitution, as Chinese enterprises have often relied upon the importation of key components as a means of acquiring the technology they need. Exchange rates, monopolistic advantage, foreign exchange reserves and the level of technology intensity, all have a significant impact on China’s OFDI, while the GDP growth rate and geographical distance have not had a significant impact. JEL Classification: F200, O160, P450
Relationship Between International Factoring and Cross-border Trade: A Granger Causality Approach
Authors: Marak Zericho R. , Pillai Deepa 
Published: July 2021

Trade finance is integral for international trade as it offers fluidity and safety to the movement of merchandise and services globally. After the financial crisis of 2008–2009, there has been an increase in the use of open accounts, which enhances the possibilities for availing factoring for international trade. International factoring has witnessed considerable growth in the last decade. This article examines the relationship between international factoring and cross-border trade using Granger causality. It also examines the causal relations of international factoring with disaggregated data of cross-border trade of imports and exports. We find a unidirectional causal flow from international trade to international factoring, and a unidirectional casual flow from exports to international factoring. JEL Classification: F10, F30
Evaluating and Managing the Painful Total Ankle Replacement
Authors: Henry Jensen K. , Rider Carson , Cody Elizabeth , Ellis Scott J. , Demetracopoulos Constantine 
Published: July 2021

The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.
Joint Preservation Surgery for Varus Ankle Arthritis with Large Talar Tilt
Authors: Park Chul Hyun , Kim Ji Beom , Kim Jaeyoung , Yi Young , Lee Woo-Chun 
Published: July 2021

Background: Varus ankle arthritis with large talar tilt (TT) is a challenging condition when considering joint preservation surgery. Three-dimensional deformity of the talus has been demonstrated with weightbearing computed tomography in varus ankle arthritis with large TT. The aim of this study was to investigate the clinical and radiographic results of posterior tibial tendon (PTT) transfer generally combined with bony realignment for varus ankle arthritis with large TT in nonparalytic ankle arthritis and to determine the indications for PTT transfer. Methods: This study includes 23 ankles with varus arthritis and TT larger than 7.5 degrees. Patients were categorized into improved (19 ankles) and unimproved (4 ankles) groups according to the postoperative clinical results at the last follow-up. Clinical and radiographic results were compared between the groups. A cut-off point for preoperative TT that indicated a borderline between improved and unimproved groups was determined to suggest the appropriate indication for joint preservation surgery. Results: In the improved group, TT, radiographic stage, Meary angle, and hindfoot alignment significantly improved at 6 months after surgery and were maintained at the last follow-up. In the unimproved group, the radiographic parameters mentioned above did not improve at 6 months after surgery, and TT decreased to 0.8 degrees as radiographic stage had progressed to end-stage arthritis at the last follow-up. In this small series, the cut-off point for predicting failure of surgery was 14.3 degrees of preoperative TT. Conclusion: PTT transfer often combined with bony realignment procedures may be a reasonable option for treating painful varus ankle arthritis with TT less than 14 degrees and hindfoot varus. Level of Evidence: Level IV, case series.
Analysis of periodic laminated fiber-reinforced composite beams in free vibration
Authors: Bishay Peter L , Rodriguez Julian 
Published: July 2021

The dynamic behavior of solid structures is an important aspect that must be considered in the design phase to ensure that the designed structure will have desired response under external excitation. Periodic structures offer various design possibilities that can tailor the dynamic behavior of the structure to match the desired response under a given applied excitation. The use of laminated fiber-reinforced composite materials in periodic structures further increases the design degrees of freedom by introducing new design parameters, such as the number of plies in each periodic patch and their fiber-orientation angles. In this article, the classical lamination theory is integrated with the forward approach of the wave finite element method to analyze periodic fiber-reinforced composite beams in flexural vibration. Since Euler–Bernoulli’s beam theory is used, the proposed approach is much simpler and computationally efficient than using laminated shell finite elements. The article shows the effects of the number of periodic cells, the segment length ratio, the number of plies in each periodic patch, and their fiber-orientation on the first stop band of the beam. The results reported can guide the design of such structures to attenuate vibration amplitudes at specific target frequency bands and avoid undesired dynamic responses. Results have been validated in the 0–2000 Hz frequency range by comparison with finite element laminated shell models.
Five-Year Outcomes After Hybrid Coronary Revascularization: A Single Center Experience
Authors: de Jong Roos , Jacob Kirolos , Jalali Alireza , Moharrem Yehia , Buijsrogge Marc , Gianoli Monica , Teefy Patrick , Kiaii Bob 
Published: July 2021

Objective Hybrid coronary revascularization (HCR) combines both surgical and percutaneous coronary revascularization procedures. It offers a minimally invasive strategy for multivessel coronary artery disease and combines the advantages of both. However, quantitative long-term patency and clinical outcomes remain understudied. The objective of this study was to assess clinical outcomes and graft and stent patency at 5-year follow-up. Methods From January 2004 to January 2015, 120 patients were enrolled in this study. They underwent robotically assisted minimally invasive coronary artery bypass grafting of left internal thoracic artery (LITA) to the left descending artery (LAD) and percutaneous coronary intervention of non-LAD vessels. Primary outcome was graft (LITA-LAD) patency determined at 5 years of follow-up, assessed by computed tomography angiography and rest and stress myocardial perfusion scintigraphy (MPS-MIBI). Secondary outcomes were stent patency and major adverse major cardiac and cerebrovascular events (MACCE). Also, freedom from recurrence of angina was assessed. Results At follow-up, 18 of 120 patients (15%) had died (in 5 patients the cause of death was cardiovascular). Among survivors, follow-up was achieved in 83 of 102 (81%). In 76 of 83 patients (92%) there was a patent LITA-LAD graft and in 75 of 83 (90%) a patent stent was demonstrated. MACCE occurred in 36 of 120 patients (30%). Freedom from recurrence of angina occurred in 92 of 120 patients (77%). Conclusions HCR is a safe and a promising procedure. It provides a minimally invasive approach and results in complete revascularization with good 5-year patency and clinical outcomes.
Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis
Authors: Ferraz-Amaro Iván , Rueda-Gotor Javier , Genre Fernanda , Corrales Alfonso , Blanco Ricardo , Portilla Virginia , González Mazón Iñigo , Llorca Javier , Expósito Rosa , Vicente Esther F. , Quevedo-Abeledo Juan Carlos , Rodríguez-Lozano Carlos , Ortega-Castro Rafaela , Ladehesa-Pineda María Lourdes , Fernández-Carballido Cristina , Martínez-Vidal M Paz , Castro-Corredor David , Anino-Fernández Joaquín , García Vivar María Luz , Galíndez-Agirregoikoa Eva , Peiteado Diana , Plasencia-Rodríguez Chamaida , Montes Perez Esther , Fernández Díaz Carlos , Castañeda Santos , González-Gay Miguel Ángel 
Published: July 2021

Background: Axial spondyloarthritis (axSpA) patients are known to have a higher prevalence of several comorbidities, including, among others, an increased risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The purpose of the present study was to determine whether the sum of traditional cardiovascular (CV) risk factors is related to disease characteristics, such as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was conducted. Patients were assessed for the presence of five traditional CV risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking status), and disease activity measurements. A multivariable regression analysis was performed to evaluate whether the number of classic CV risk factors was independently associated with specific features of the disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity Score–C reactive protein (ASDAS-CRP) activity score was significantly higher in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI) 0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI 0.3–0.7), p = 0.000] CV risk factors compared with those without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI 0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31), p = 0.000] CV risk factors had a higher odds ratio for the presence of high disease activity compared with the zero CV category. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity score was significantly associated with the number of CV risk factors, being higher in patients with more CV risk factors. These relationships showed a CV risk factor-dependent effect being beta coefficients and ORs higher for the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors increased, disease activity similarly increases in an independent manner.
Diversity and Conservation of Cave-Roosting Bats in Central Ghana
Authors: Nkrumah Evans Ewald , Baldwin Heather Joan , Badu Ebenezer Kofi , Anti Priscilla , Vallo Peter , Klose Stefan , Kalko Elisabeth Klara Viktoria , Oppong Samuel Kingsley , Tschapka Marco 
Published: July 2021

Background Ghana is one of the six bat diversity hotspots on the African continent, yet its caves have not been fully explored for the bats they host. Research Aims We aimed to assess the species composition and diversity of five caves in central Ghana and identified those needing immediate conservation attention. Methods Using mist-nets, we captured bats over 102 full nights between October 2010 and July 2012 from the Upper Guinean forest and Savannah regions in central Ghana. Results A total of 10,226 bats belonging to nine species were recorded. PERMANOVA suggested significant variation in species composition among the caves. A SIMPER analysis revealed Coleura afra and Hipposideros jonesi to be the main discriminating species between caves, with a dominance of Hipposideros cf. ruber in all caves. The Bat Cave Vulnerability Index (BCVI) revealed Mframabuom cave from the Upper Guinean forest region as a high priority cave hosting threatened species, yet highly disturbed. The remaining caves were identified as medium priority caves. Conclusion The results of the study suggest the need for further research and an immediate conservation strategy as essential for approaching national conservation goals.